Secular Trends of Hip Fractures in Lebanon, 2006 to 2017: Implications for Clinical Practice and Public Health Policy in the Middle East Region

Country-specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age- and sex-specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = −0.611, p = 0.022) but not in men (τb = −0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research.     

Impact of Extent of Antral Resection on Surgical Outcomes of Sleeve Gastrectomy for Morbid Obesity (A Prospective Randomized Study)

Background

Laparoscopic sleeve gastrectomy (LSG) is a surgical technique that treats morbid obesity.

Methods

Consecutive patients with morbid obesity treated by LSG at our department were evaluated. Patients enrolled in the study were randomized into group I (LSG begins the division 2 cm from the pylorus) and group II (LSG begins the division 6 cm from the pylorus). The primary outcome measure was the percent of excess weight loss (% EWL); secondary outcomes included postoperative morbidity and mortality and improvement of comorbidity.

Results

One hundred five patients (79 (75.2 %) were females) were randomized into two groups of (GI) 52 patients and (GII) 53 patients. In group I, the mean % EWL was 51.8?±?13.9, 63.8?±?16.1 and 71.8?±?12; however, in group II, the mean % EWL was 38.3?±?10.9, 51.9?±?13.6 and 61?±?11.1 at 6, 12, and 24 months, respectively (P?=?0.0001, 0.0001, 0.003). There was weight regain after 2 years in five patients in group II and only one patient in group I (P?=?0.09). There was no significant difference between both group as regards gastric leakage, vomiting or GER. There was significant improvement in comorbidity after LSG in both groups, but no significant difference between them. Hospital mortality occurred in group II in one case as a result of gastric leakage.

Conclusions

LSG is a safe and effective procedure with good short-term outcome. Increasing the size of the resected antrum is associated with better weight loss without increasing the rate of complications significantly.     

Performance improvement of keV Neutrons-based PGNAA setups

The performance of keV neutrons based Prompt Gamma Ray Neutron Activation Analysis (PGNAA) setups have been observed to improve by enclosing its neutron source inside the moderator. The keV neutrons were produced via ⁷Li(p,n) reaction and ³H(p,n) reactions. For the two PGNAA setups, the maximum intensity of the prompt γ-ray yield was observed for a 5 cm long moderator with the neutron source positioned at a distance of 0.5 cm from the moderator-end facing the sample. Due to enclosing the source inside the moderator, the prompt γ-ray yield from the ⁷Li(p,n) reaction and ³H(p,n) reaction based PGNAA setups have increased by a factor of three as compared to that achieved from these setups with the source outside the moderator. This study provides a theoretical basis for the measurement of performance of ⁷Li(p,n) reaction and the ³H(p,n) reaction based PGNAA setups.     

Prevalence and patterns of shoulder injuries in Major League Baseball

ABSTRACT

Background: This study aims to explore the epidemiological patterns of shoulder injuries in professional baseball.

Methods: The transaction lists of the ‘Major League Baseball’ website were screened for injuries from 2011 to 2016, inclusive. Only players that were placed on the ‘Disabled List’ were included in the study. Our database included the player’s position, injury location, injury cause, and time spent on the Disabled List.

Results: A total of 3090 injuries were recorded; 511 (17%) were shoulder injuries, making it the most vulnerable anatomic location in baseball (N = 511). Of the 511 shoulder injuries, 132 (25.8%) were due to inflammation, making it the most common cited cause of shoulder injury. Most shoulder injuries occurred in April with 125 (24%) injuries, while June and May came in second and third with 89 (17%) and 81 (16%) injuries, respectively. The pitcher was the player most prone to injury, as it constituted 78% of the injuries. The average time spent off by a shoulder injury was 69 days, which implicated substantial economic losses for the injured athlete’s club.

Conclusion: Shoulder injuries are prevalent in professional baseball. The overhead pitching motion puts the shoulder at risk and accounts for the high incidence of its injuries.     

Schmorl’s nodes distribution in the human spine and its possible etiology

Although Schmorl’s nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann–Todd Osteological Collection) for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into 13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region. The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae and the intervertebral disc along the spine during spinal movements (especially torsional movements).     

AHI1 gene mutations cause specific forms of Joubert syndrome-related disorders

OBJECTIVE: Joubert syndrome (JS) is a recessively inherited developmental brain disorder with several identified causative chromosomal loci. It is characterized by hypoplasia of the cerebellar vermis and a particular midbrain-hindbrain "molar tooth" sign, a finding shared by a group of Joubert syndrome-related disorders (JSRDs), with wide phenotypic variability. The frequency of mutations in the first positionally cloned gene, AHI1, is unknown. METHODS: We searched for mutations in the AHI1 gene among a cohort of 137 families with JSRD and radiographically proven molar tooth sign. RESULTS: We identified 15 deleterious mutations in 10 families with pure JS or JS plus retinal and/or additional central nervous system abnormalities. Mutations among families with JSRD including kidney or liver involvement were not detected. Transheterozygous mutations were identified in the majority of those without history of consanguinity. Most mutations were truncating or splicing errors, with only one missense mutation in the highly conserved WD40 repeat domain that led to disease of similar severity. INTERPRETATION: AHI1 mutations are a frequent cause of disease in patients with specific forms of JSRD.     

Brain development during adolescence: A mixed‐longitudinal investigation of cortical thickness,surface area,and volume

What we know about cortical development during adolescence largely stems from analyses of cross‐sectional or cohort‐sequential samples, with few studies investigating brain development using a longitudinal design. Further, cortical volume is a product of two evolutionarily and genetically distinct features of the cortex ‐ thickness and surface area, and few studies have investigated development of these three characteristics within the same sample. The current study examined maturation of cortical thickness, surface area and volume during adolescence, as well as sex differences in development, using a mixed longitudinal design. 192 MRI scans were obtained from 90 healthy (i.e., free from lifetime psychopathology) adolescents (11‐20 years) at three time points (with different MRI scanners used at time 1 compared to 2 and 3). Developmental trajectories were estimated using linear mixed models. Non‐linear increases were present across most of the cortex for surface area. In comparison, thickness and volume were both characterised by a combination of non‐linear decreasing and increasing trajectories. While sex differences in volume and surface area were observed across time, no differences in thickness were identified. Furthermore, few regions exhibited sex differences in the cortical development. Our findings clearly illustrate that volume is a product of surface area and thickness, with each exhibiting differential patterns of development during adolescence, particularly in regions known to contribute to the development of social‐cognition and behavioral regulation. These findings suggest that thickness and surface area may be driven by different underlying mechanisms, with each measure potentially providing independent information about brain development. Hum Brain Mapp 37:2027–2038, 2016. © 2016 Wiley Periodicals, Inc.     

Comprehensive sequencing of the LRRK2 gene in patients with familial Parkinson's disease from North Africa

The LRRK2 gene is a key player in Parkinson's disease (PD), however prevalence and pathogenicity of LRRK2 variants remain to be investigated in ethnically diverse populations. Herein, we performed comprehensive sequencing of the LRRK2 gene in 92 Tunisian probands with familial PD. We then performed an association study using all identified variants in a series of 167 Lrrk2 p.G2019S‐negative patients with sporadic PD and 365 Lrrk2 p.G2019S‐negative healthy control subjects, all from the same Arab‐Berber ethnicity. We identified one novel coding substitution (p.M2408I) and 24 known coding changes. Only the Lrrk2 p.G2019S mutation segregated with disease within families and was found in 39% of familial probands. None of the variants displayed significant association with risk for sporadic PD, however a trend was observed for Lrrk2 p.Y2189C. The present study underscores the importance of the LRRK2 gene in the Tunisian PD population. © 2010 Movement Disorder Society     

Protective immunity after hepatitis B vaccination

Background and study aimsThe purpose of this study was to evaluate the long term maintenance of antibody levels in adult healthcare workers and in children (with or without diabetes) after a three-dose regimen of HB vaccine and the ability to boost antibody levels with re-immunization.Patients and methodsThis study was conducted on 131 individuals including: an Adult group (67) comprising 52 HB vaccinated adult health care workers and 15 unvaccinated adult heath care workers as a control group; and a Children group (64) of 44 non-diabetic and 20 diabetic children. Following proper history and clinical examination, all serum specimens were tested for HBsAg, anti-HBs, anti-HBc and HCV antibodies.ResultsThe longer the time lapse since the last dose of HB vaccine in both adult health care workers and non-diabetic children, the lower the seroprotection rate (lower mean Anti-HBs levels) (P = 0.006, 0.004 respectively). Significantly increased Anti-HBs levels were found after booster dose vaccination of either children or adult health care workers (all P < 0.001 for both) and 97.22% of serongative children; 100% of the seronegative adults turned seropositive.ConclusionHB vaccine could be highly protective against HBV infection as evidenced by the absence of hepatitis B infection in the vaccinated groups. The longer the time lapse after vaccination, the lower is the seroprotection rate and the lower the mean Anti-HBs, but with persistence of an effective immunological memory in vaccinees. HB vaccine boosting could be advised for high risk subjects including adult health care workers and diabetic children at five year intervals.