World Academy of Science, Engineering and Technology

Authors: Benhamouda Amira Chaimae

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Osteonecrosis of the jaw (ONJ) is a rare but serious complication associated with the use of bone-modifying agents, such as Denosumab, commonly prescribed to treat osteoporosis and other bone-related conditions. This case report presents a detailed account of a patient who developed ONJ following treatment with Denosumab. The patient’s clinical presentation, diagnostic process, and management are discussed, highlighting the challenges of diagnosing and treating ONJ in individuals undergoing Denosumab therapy. The report examines the potential pathophysiological mechanisms linking Denosumab treatment to ONJ, including its effects on bone remodeling and the immune response.

Keywords: denosumab, bone loss, osteonecrosis, rankl

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Authors: Benhamouda Amira Chaimae

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Obesity is a significant health concern that not only affects overall well-being but also increases the risk of developing periodontal disease, a serious gum condition that can lead to tooth loss and other complications. Individuals with obesity are more prone to chronic inflammation, which can exacerbate periodontal issues, making them more vulnerable to its onset and progression. Additionally, managing the health complications associated with obesity, including periodontal disease, leads to increased health care costs for these patients. This underscores the importance of addressing obesity as part of a comprehensive approach to improving both oral and systemic health outcomes.

Keywords: obesity, periodontal, health, tooth

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Authors: Ankita Sharma, Satish Kumar Meena, Neha Kawatra Madan

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Background and Aims: Pediatric septic shock, a life-threatening condition, is associated with significant morbidity and mortality. Dysregulation of thyroid function, presenting as Non-Thyroidal Illness Syndrome (NTIS), is a common observation in critically ill patients and may impact clinical outcomes. This study investigates the thyroid hormone profile in pediatric septic shock and its correlation with disease outcomes. Methods: A cross-sectional study was conducted in the Pediatric Department of VMMC and Safdarjung Hospital, New Delhi. Ninety-one children, aged 1 month to 12 years, diagnosed with septic shock were included. Thyroid function tests (Total T3, Total T4, Free T3, Free T4, and TSH) were measured upon admission. Outcomes were categorized as favorable (shock reversal within 24 hours, ICU stay <7 days) or unfavorable (prolonged shock, ICU stay >7 days, multiorgan dysfunction syndrome [MODS], or death). Statistical analysis included logistic regression and receiver operating characteristic (ROC) curve evaluation. Results: Thyroid hormone abnormalities were prevalent, with low Total T3 (84.6%), low Total T4 (70.3%), and low Free T3 (76.9%) being the most common findings. Significant associations were observed between low levels of Total T3, Total T4, Free T3, and Free T4 with unfavorable outcomes (p<0.001 for all). ROC analysis identified Free T3 as the strongest predictor of unfavorable outcomes, with an AUROC of 0.842. Conclusions: Thyroid hormone levels, particularly Free T3, are critical prognostic markers in pediatric septic shock. Timely monitoring of thyroid function could aid in risk stratification and therapeutic decision-making. Future research should focus on the potential benefits of thyroid hormone replacement therapy in this population.

Keywords: pediatric septic shock, thyroid function, non-thyroidal illness syndrome, prognostic markers, free T3

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Authors: Ould Ali R.L, Bensadok S, Mrabet S, Ahmed Fouatih N

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According to the terminology of Angle, the functional mandibular prognathism belongs to the class III malocclusion. Considered as a functional anomaly with considerable aesthetic prejudice, it needs to be detected and treated early to prevent it from becoming skeletal anomaly. With this in mind, early treatment enables a correct anterior guide to be restored quickly, and above all to rehabilitate craniofacial growth. Material and methodology Patient G.H, aged 11 years, who was treated in the Department of Dentofacial Orthopaedics at Oran University Hospital. He presented with functional mandibular prognathism and a sever crowding, which put the upper canines at risk of impaction. Results The orthodontic treatment of this case was divided into two distinct phases, the first of which aimed to correct the functionnal mandibular prognathism and thus re-establish a correct anterior articulation, using a Biourge appliance. The second phase aimed to create the needed space for the eruption of the upper canines, thus eliminating the risk of impaction thanks to multi-attachment fixed therapy. Conclusion Through this clinical case, we have once again been able to demonstrate the value of early caring for young patients. Although these are simple methods, the key is to know how to introduce them in the right way and at the right time. It would therefore seem useful to democratise this type of practice as part of the day-to-day management carried out in the dental practice. We'll finish by quoting Jean Rotrou, the French poet, who said ‘When you can prevent, it's weakness to wait’.

Keywords: functional mandibular prognathism, early treatment, impaction, orthodontics

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Authors: Jeremy Woods & Fanqing Chen

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Rapid genome testing can provide results in at best hours to days, though there are certain clinical decisions that could be guided by genetic test results that need results in hours to minutes. As such, methods of genetic Point of Care Testing (POCT) are required if genetic data is to guide management in illnesses in a wide variety of critical and emergent medical situations such as neonatal sepsis, chemotherapy administration in endometrial cancer, and glucose-6-phosphate dehydrogenase deficiency (G6PD)-associated neonatal hyperbilirubinemia. As such, we developed a POCT “lab-on-chip” technology capable of identifying up to 144 alleles in under an hour. This test required no specialized training to utilize and is suitable to deployment in clinics and hospitals for use by non-laboratory personnel such as nurses. We developed a multiplexed qPCR-based sample-to-answer system with melting curve analysis capable of detecting up to 144 alleles utilizing the Kelliop RapidSeq126 PCR platform combined with a single-use microfluidic cartridge. The RapidSeq126 is the size of a standard desktop printer and the microfluidic cartridges are smaller than a deck of playing cards. Thus the system was deployable in the outpatient setting for clinical trials of MT-RNR1 genotyping. The sample (buccal swab from volunteers or plasmids in media) used for DNA extraction was placed in the cartridge sample inlet prior to inserting the cartridge into the RapidSeq126. The microfluidic cartridge was composed of heat resistant polymer with a sample inlet, 100um conduits, liquid and solid reagents, valves, extraction chamber, lyophilization chamber, 12 PCR reaction chambers, and a waste chamber. No human effort was required for processing the sample and performing the assay other than placing the sample in the cartridge and placing the cartridge in the RapidSeq126. The RapidSeq126 has demonstrated ex vivo detection in plasmids and in vivo detection from human volunteer samples of up to 144 alleles per microfluidic cartridge used and did not require specialized laboratory training to operate. Efficacy was proven for several applications, such as multiple microsatellite instability (MSI) sites (SULF/RYR3/MRE11/ACVR2A/DIDO1/SEC31A/BTBD7), endometrial cancer POLE exonuclease domain (EMD) mutation status, and G6PD variants such as those commonly associated with hemolysis (c.202G>A, c.376A>G, c.680G>A>T, c.968T>C, 404A>C, c.871G>A). The RapidSeq126 system was also able to identify the three MT-RNR1 variants associated with aminoglycoside-induced sensorineural hearing loss (m.1555A>G, m.1095T>C, m.1494C>T). Results were provided in under an hour in a sample-to-answer fashion requiring no processing other than inserting the cartridge with the sample into the RapidSeq126. Results were provided in a digital, HL7-compliant format suitable for interfacing with Electronic Healthcare Record (EHR). The RapidSeq126 system provides a solution for emergency and critical medical situations requiring results in a matter of minutes to hours. The HL7-compliant data format of results enables the RapidSeq126 to interface directly with EHRs to generate best practice advisories and further reduce errors and time to diagnosis by providing digital results.

Keywords: genetic testing, pharmacogenomics, point of care testing, rapid genetic testing

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Authors: Taha Enes Kon, Vanshika Reddy

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This project focuses on developing a gamified mobile application to aid in stroke rehabilitation by enhancing motor skills through interactive activities. The primary goal was to design a companion app for a passive haptic rehab glove, incorporating Google MediaPipe for gesture tracking and vibrotactile feedback. The app simulates farming activities, offering a fun and engaging experience while addressing the monotony of traditional rehabilitation methods. The prototype focuses on a single minigame, Flower Picking, which uses gesture recognition to interact with virtual elements, encouraging users to perform exercises that improve hand dexterity. The development process involved creating accessible and user-centered designs using Figma, integrating gesture recognition algorithms, and implementing unity-based game mechanics. Real-time feedback and progressive difficulty levels ensured a personalized experience, motivating users to adhere to rehabilitation routines. The prototype achieved a gesture detection precision of 90%, effectively recognizing predefined gestures such as the Fist and OK symbols. Quantitative analysis highlighted a 40% increase in average session duration compared to traditional exercises, while qualitative feedback praised the app’s immersive design and ease of use. Despite its success, challenges included rigidity in gesture recognition, requiring precise hand orientations, and limited gesture support. Future improvements include expanding gesture adaptability and incorporating additional minigames to target a broader range of exercises. The project demonstrates the potential of gamification in stroke rehabilitation, offering a scalable and accessible solution that complements clinical treatments, making recovery engaging and effective for users.

Keywords: stroke rehabilitation, haptic feedback, gamification, MediaPipe, motor control

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Authors: Muneera Mohammed Al-Dossary, Fatimah Mohammed Al-Dossary, Mashael Al-Shahrani, Amal Al-Tammemi

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Johns Hopkins Aramco Healthcare (JAHA), a joint venture between Saudi Aramco and Johns Hopkins Medicine, delivers comprehensive healthcare services to a diverse patient population. Despite achieving high patient satisfaction rates and surpassing several operational targets, JAHA faces challenges such as appointment delays and resource inefficiencies. These issues highlight the need for an advanced, integrated approach to operational management. This paper proposes a Business Intelligence (BI) framework to address these challenges, leveraging tools such as Epic electronic health records and Tableau dashboards. The framework focuses on data integration, real-time monitoring, and predictive analytics to streamline operations and enhance decision-making. Key outcomes include reduced wait times (e.g., a 23% reduction in specialty clinic wait times) and improved operating room efficiency (from 95.83% to 98% completion rates). These advancements align with JAHA’s strategic objectives of optimizing resource utilization and delivering superior patient care. The findings underscore the transformative potential of BI in healthcare, enabling a shift from reactive to proactive operations management. The success of this implementation lays the foundation for future innovations, including machine learning models for more precise demand forecasting and resource allocation.

Keywords: business intelligence, operational efficiency, healthcare management, predictive analytics, patient care improvement, data integration, real-time monitoring, resource optimization, Johns Hopkins Aramco Healthcare, electronic health records, Tableau dashboards, predictive modeling, efficiency metrics, resource utilization, patient satisfaction

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Authors: Apameh Moslem Gheshlaghi

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This research explores advancements in dental implantology with a focus on improving osseointegration and long-term patient outcomes. It highlights cutting-edge materials, surface modifications, and minimally invasive surgical techniques. The study also evaluates the role of digital dentistry and 3D printing in revolutionizing implant design and placement. Findings demonstrate significant improvements in patient satisfaction, procedural efficiency, and overall success rates, paving the way for more predictable and sustainable practices in modern dentistry.

Keywords: dental implants, osseointegration, digital dentistry, 3D printing

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Authors: Cotran Mabeya

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This focuses on an artificially intelligent telemedicine application that aims to enrich the access to health care services, especially for those who live in remote and underserved areas. This app is highly packed with very advanced AI technologies—symptom checkers and virtual consultations—as well as health data integration for very efficient and user-friendly remote health support with main features: AI-based diagnostics, real-time health monitoring through wearables, and an intuitive interface. The Telemedicine Application tries too hard to address some of the healthcare problems, such as limited access in remote areas, high costs, lengthy wait times for certain services, as well as difficulty in getting second opinions. By making it friendlier for consultation remotely, the application removes geographic and financial barriers to accessing affordable and timely medical care. In addition, by having centralized patient records and communication between healthcare providers, it allows continuity of care by making it easier to transition to treatment. It has been confirmed that this multi-design approach incorporated both quantitative and qualitative designs to evaluate the socio-economic impacts of artificial intelligence and telemedicine on patients in Nairobi County. Adults made up the target population, while informers and respondents were categorized into patients, healthcare providers, and specialists in law, IT, and AI. Stratified and simple random sampling techniques were used to ensure diversely inclusive representation to enhance accuracy and triangulation in the data collected. Moreover, the study provides several recommendations, which include regular updating accuracy of AI symptom checkers, improving data security through encryption and multi-factor authentication, as well as real-time health data integration from bodily wearables for personal healthcare

Keywords: artificial intelligence, virtual consultations, user-friendly, remote areas

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Authors: Mahmoud Eladl, Bahaaeldeen Hesham, Saryia Adra, Ahmad Addasi, Mohammad Al Tahawi, Musa’Ab Omair, Nafe Alhariri, Mohamed Eladl, Hiba J. Barqawi

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Introduction: Prostate cancer is the second most common cancer in men globally and the fifth greatest cause of cancer-related mortality. In the United Arab Emirates (UAE), prostate cancer has been on the rise due to population aging. However, knowledge deficits and screening barriers do exist because of cultural, social, and psychological factors. The objective of this study is to assess the knowledge, practices, and attitudes of prostate cancer and its screening among men aged 40 years and above in the UAE. Methodology: A cross-sectional study was conducted between September 5 and October 31, 2024, using a self-administered online questionnaire distributed through social media platforms. Data collected from the questionnaire were analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Results: A total of 471 responses were analyzed. The median age of participants was 51 ± 12. Most of the respondents were non-healthcare workers with at least a bachelor's degree. Most of the participants were moderately aware of prostate cancer risk factors and symptoms. However, there was a severe lack of awareness of genetic predisposition and racial risk factors. While 80.3% of participants were aware of the role of prostate-specific antigen tests in prostate screening, 62.8% recognized the role of a digital rectal examination. The most important barriers to screening were lack of perceived risk, time constraints, and fear of diagnosis. Conclusion: Significant knowledge gaps and barriers to prostate screening exist. Health education initiatives targeting cultural stigma with the use of culturally appropriate and accurate information through credible online platforms are necessary.

Keywords: male health awareness, prostate cancer, PSA, screening, UAE

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Authors: Ramy Mohamed, Moushira E. Zaki, Hala T. El-Bassyouni, Walaa Yousef, Safinaz El Toukhy, Samira Ismail

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Obesity is a worldwide epidemic problem. This study investigates the role of obesity on body image, frequency of anxiety, depression disorders and DNA damage in a sample of Egyptian women. The study included 172 women, 84 were obese, and 88 were age-matched non-obese women. Obese women showed a significantly higher frequency of abnormal body image (77.4%) as compared with the non-obese (42%) (P < 0.0001). Moreover, they had significantly higher frequencies of severe anxiety (26.2%) and depression (41.7%) than non-obese women (2.3 and 18.2%, respectively) (P < 0.001). Leukocyte DNA damage was evaluated by comet assay and revealed high DNA damage in obese women. Obesity is a potential risk factor for abnormal body image, anxiety, depression, and DNA damage among Egyptian women. Identifying the psychological problems in obese women is essential to improve quality of life and promote management and prevention.

Keywords: anxiety, body image, depression, DNA damage, obesity

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Authors: Suparna Bharadwaj, Sriganesh Kamath, Gopalakrishna K. N., Subhas Konar

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Introduction: Post-operative cognitive dysfunction (POCD) is a spectrum of clinical syndrome presenting as emergence delirium (ED) and/or post-operative delirium (POD). ED is a transient state (minutes to hours) of marked agitation after the discontinuation of general anesthesia, which does not respond to consoling measures. On the other hand, POD without identifiable etiology is not temporally related to emergence from anesthesia. These patients often emerge smoothly and may be lucid in the post-anesthesia care unit (PACU), but may develop fluctuating mental status, most commonly between postoperative days one and three. General anesthesia (GA) has been identified as a risk factor for POCD. Cranial surgeries involve brain handling in addition to exposure to GA. We hypothesize that the incidence of postoperative delirium after cranial surgery is twice that of spinal surgery. The primary objective of this study was to evaluate the incidence of emergence delirium and postoperative delirium in patients undergoing cranial and spinal neurosurgeries. The secondary objective was to identify the perioperative risk factors of ED and POD. Methods: This was a prospective cohort observation study conducted from March 2020 to September 2023 conducted at a tertiary neurocentre. After obtaining institutional ethics committee approval, adult patients undergoing cranial or spinal surgery with a Glasgow coma scale of 15 were included in the study. Patients undergoing cranial surgery are considered exposed to risk factors, while patients undergoing spinal surgery are considered unexposed. All study subjects received standard general anesthesia. About twenty perioperative parameters were identified as risk factors for POCD. ED was assessed using the Riker sedation agitation scale, and POD was assessed using the confusion assessment method. A sample size of 2000 patients was planned with 1000 each cranial and spinal cases. However, around 700 spinal patients could be recruited for this study. Results: In this study, about two thousand patients were screened for inclusion. However, 1185 cranial cases and 742 spinal cases were considered for final analysis. Both the groups were similar in terms of demographics. Incidence of ED was 25.8% after cranial surgery vs 10.24% after spinal surgery (relative risk 2.5). The incidence of POD after cranial surgery is 20.25% vs 2.15% after cranial surgery (relative risk 9.3). All the proposed risk factors were assessed using binomial logistic regression. Conclusion: Cranial cases expose patients to a nine times higher risk for the development of postoperative delirium. The presence of ED predisposes to POD representing a spectrum.

Keywords: post operative cognitive dysfunction, Neurosurgical patients cohort study, cohort study, emergence delirium

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Authors: Alaa Ashraf Khaleel Abdallah

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Background: The global landscape has witnessed an alarming rise in armed conflicts, further devastating populations through enforced displacement, compromised infrastructure, and strained healthcare systems. In Sudan, the situation is particularly dire, with conflict exacerbating shortages in medical supplies and personnel, pushing the already fragile healthcare system into crisis, especially affecting surgical care. Initially, war impacts were significant in conflict zones like Khartoum, but since mid-April 2023, the entire country has descended into chaos. Weak monitoring and health information systems hinder accurate assessment of surgical care in conflict zones, leading to inadequate resource allocation, suboptimal care, and missed opportunities for global learning. This study investigates the impact of the Sudanese conflict on postoperative complications, exploring prevalence, types, outcomes, and psychological effects in conflict and safe areas. Methods: Conducted across 10 Sudanese states—5 in conflict zones such as Khartoum and West Darfur, and 5 in safer regions like River Nile and Kassala—this study analyzed data from 1,457 patients who underwent surgery post-April 2023. Data were collected using a pretested, mixed-mode questionnaire that incorporated elements from validated frameworks and tailored questions specific to the study's context. Hospital records and surgical logs were also used, with data analyzed via SPSS. Results: The overall prevalence of postoperative complications was 35.89%, with a higher rate in conflict zones (57.5%) compared to safe areas (26.4%). Surgical site infections predominated in conflict zones (24.7%) and higher than its prevalence in safe areas, and while fever was prevalent in safer regions even though much less compared to conflict areas, bleeding from surgical site was very frequent in conflict areas. Most patients recovered within two months at a rate higher in safe areas, but most of them required further medical or surgical management within the first month, but psychological impacts were more pronounced in conflict zones with 22.22% reported anxiety among injuries patients, and 20.6% experienced depression, 13.5% and 16.9% respectively, in those had surgeries for other medical conditions, compared to 0.22%anxiety rates and 8.1%for depression in safer regions. Risk factors included age, travel to conflict zones, access to care, delays, and comorbidities. Conclusion: Strengthening healthcare systems and ensuring accessible surgical care are critical in both conflict and safe areas. Specific attention must be given to addressing patient suffering and demographic shifts caused by armed conflict. Further research is needed to refine the predictive model for postoperative complications in conflict zones.

Keywords: postoperative complications, conflict zones, risk factors, surgical outcomes, Sudan

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Authors: Rofaida Ashour

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This study discusses the implementation of quality improvement initiatives aimed at reducing contamination rates in cultured karyotyping samples. The primary objective was to enhance patient outcomes through systematic audits and targeted staff engagement. Recognizing the critical impact of sample integrity on diagnostic accuracy, a thorough analysis was conducted to identify the root causes of contamination. The project involved two audit cycles, which facilitated a comprehensive assessment of adherence to local protocols. Key issues identified included lapses in the use of personal protective equipment (PPE) and inadequate awareness of proper sample handling procedures among staff. To address these challenges, a multi-faceted approach was adopted. Firstly, a presentation was delivered to the laboratory team emphasizing the significance of strict adherence to PPE guidelines during the collection and handling of samples. This session aimed to raise awareness and foster a culture of safety within the unit. Additionally, informative posters illustrating the correct procedures were strategically placed around the laboratory to serve as ongoing visual reminders for staff. Recognizing the heightened risk associated with patients exhibiting fever or signs of infection, special measures were introduced to manage their sample collection. These proactive strategies were designed to minimize the likelihood of introducing contaminated samples into the culture process. The results of the audits demonstrated a significant reduction in contamination rates, underscoring the effectiveness of the interventions. This experience reinforced the importance of continuous quality improvement in healthcare settings, particularly in ensuring the delivery of high-quality, safe, and efficient services. Conducting regular audits not only provided valuable insights into operational practices but also highlighted the critical role of active team engagement and a data-driven approach in decision-making. Effective communication and collaboration among team members emerged as essential components for the success of quality improvement initiatives.

Keywords: quality improvement, contamination rates, karyotyping samples, healthcare protocols, staff engagement

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Authors: Aaron Samuels, Ahmad Badeghiesh, Haitham Baghlaf, Michael H. Dahan

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Importance: Cervical cancer is the fourth most common cancer among women globally and a significant cause of cancer-related deaths. Understanding the impact of cervical cancer diagnosed during pregnancy on maternal, delivery, and neonatal outcomes is crucial for improving clinical management and outcomes for affected women and their children. Objective: The goal is to determine the effects of cervical cancer diagnosed during pregnancy on maternal, delivery, and neonatal outcomes using a population-based American database. Design: This study is a retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. The study period spans between 2004-2014, and the analysis was conducted in 2023. Setting: The study used the HCUP-NIS database, which includes data from hospital stays across the United States, covering 48 states and the District of Columbia. Participants: The study included all women who delivered a child or had a maternal death from 2004-2014, with pregnancies at 24 weeks or above. The population was comprised of 9,096,788 pregnant women, including 222 diagnosed with cervical cancer prior to delivery. Exposures: The exposure was a diagnosis of cervical cancer during pregnancy, identified using International Classification of Diseases 9th Revision codes 180.0, 180.1, 180.8, and 180.9. Main Outcomes and Measures: Primary outcomes included maternal, delivery, and neonatal complications including preterm delivery, cesarean section, hysterectomy, blood transfusion, deep venous thrombosis, pulmonary embolism, congenital anomalies, intrauterine fetal demise, and small-for-gestational-age neonates. Logistic regression analyses were conducted to evaluate the association between cervical cancer diagnosis and these outcomes, adjusting for potential confounding factors. Results: Women with cervical cancer were older (25.2% ≥35 years vs. 14.7%, p=0.001, respectively); more likely to have Medicare insurance (1.4% vs. 0.6%, p=0.005, respectively); use illicit drugs (4.1% vs. 1.4%, p=0.001, respectively); smoke tobacco during pregnancy (14.9% vs. 4.9%, p=0.001, respectively); and have chronic hypertension (3.6% vs. 1.8%, p=0.046, respectively). These women also had higher rates of preterm delivery (OR = 4.73, 95% CI (3.53-6.36), p=0.001); cesarean section (OR = 5.40, 95% CI (4.00-7.30), p=0.001); hysterectomy (OR = 390.23, 95% CI (286.43-531.65), p=0.001); blood transfusions (OR = 19.23, 95% CI (13.57-27.25), p=0.001); deep venous thrombosis (OR = 9.42, 95% CI (1.32-67.20), p=0.025); and pulmonary embolism (OR = 20.22, 95% CI (2.83-144.48), p=0.003). Neonatal outcomes, including congenital anomalies, intrauterine fetal demise, and small-for-gestational-age neonates, were comparable between groups. Conclusions and Relevance: Cervical cancer during pregnancy is associated with significant maternal and delivery risks; however, neonatal outcomes are largely unaffected. These findings highlight the need for a multidisciplinary approach to managing pregnant cervical cancer patients involving oncological, obstetrical, and neonatal care specialists.

Keywords: cervical cancer, maternal outcomes, neonatal outcomes, delivery outcomes

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Authors: Daphney Nozizwe Conco, Jonathan Levin, Boitumelo Komane, Sharon Fonn

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Background: South Africa is globally renowned for its reproductive rights framework. Despite the progressive abortion legislation, evidence points to limited access to safe abortion due to stigma, provider opposition, and lack of trained providers. Consequently, women resort to informal abortion providers and later present with incomplete abortion (ICA) at public hospitals. 20 years after the passing of the Choice for Termination of Pregnancy Act (CTOPA), we hypothesized that the incidence of ICA and abortion-related morbidity would change, influenced by access to safe abortion care and the availability of medication abortion. The aim was to generate data that could be compared with the results of similar studies conducted in 1994 and 2000. Objectives: The research objectives were to determine the number of women who presented with ICA to public hospitals, to describe their characteristics, to categorize medical complications according to severity, and to describe treatment provided to them at South African public hospitals. Methods: This is a cross-sectional retrospective medical record review study. A stratified random sample of public hospitals was selected. Data was extracted from the medical records of women who presented with incomplete abortions to sampled public hospitals in 2018. Data was captured directly into a REDCap database. To estimate the national prevalence of incomplete abortions, we used population estimates for 2018 comprising 17,199,227 women aged 12-49 years and 1,200,436 live births. Results: We found 913 medical records of women who presented with ICA to the 52 sampled hospitals. The women’s mean age of 27 years, and most had a previous pregnancy. These results were similar in the three studies (2018, 2000, and 1994). A greater proportion of women admitted with a gestation between 0-12 weeks seem to be on the increase, 60.5% in 1994, 67.1% in 2000, and 73.9% in 2024. We found an ICA incidence of 362 (269-455) per 100 000 women aged 12­49 years, which was the same as the 2000 incidence of 362 (282­441) but lower than the incidence of 375 (299­451) in 1994. Signs of infection decreased over time: 79.5% in 1994, 90.1% in 2000, and 92.5% in 2018 had no signs of infection. Similarly, 95.6% in 1994, 97.1% in 2000 and 99.1% in 2018 recorded no organ failure. Conclusion: A trend of lower infection rates was observed, suggesting that women are getting safer abortions, possibly from informal providers. However, the lack of change in ICA incidence indicates that the implementation of CTOPA has failed. It is safe to conclude that the legislation has made no significant impact on women’s health and rights. The implications of such failure are profound, as South Africa has not effectively implemented the act, which has important consequences for women’s health and rights.

Keywords: incomplete abortion, abortion-related morbidity, safe-abortion, South Africa public health, sexual and reproductive health rights, women’s health

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Authors: Sadaf Shaikh, Aishwariya Kapoor, Mustabshira Tahir, Zille Huma

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In accordance with national criteria, the purpose of this audit is to assess how quickly Doppler ultrasound can diagnose suspected deep vein thrombosis (DVT). In particular, it emphasizes the 4- and 24-hour ultrasound imaging targets that are advised by medical guidelines. In order to avoid consequences like pulmonary embolism or post-thrombotic syndrome, which might result from postponed treatment, it is imperative that DVT be diagnosed promptly. Data on patients who presented with suspected DVT during a certain time period were extracted from electronic health records as part of the retrospective analysis. The study's main goal is to evaluate the hospital's compliance with the deadlines for Doppler ultrasounds performed after a clinical suspicion of DVT.

Keywords: DVT, NICE compliance, Doppler ultrasound, d-dimer testing, vascular ultrasound, service delivery standards

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Authors: Jenny Carpenter, Josh Chan, Persephone MacKinlay, Madeline Chiang, Devlyn Sun, Hiba Syed, Jana Lau, Mariam Arshad, Joy Xu

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Introduction: Psoriasis is a chronic inflammatory skin condition that affects 1 million Canadians and over 8 million Americans. It is associated with psychosocial challenges exacerbated by the presence of visible lesions, which can lead to feelings of embarrassment and social discomfort. Children often experience bullying and lower self-esteem, while adults face workplace discrimination, impaired productivity, and higher rates of comorbid mental health conditions. Understanding these impacts across age groups is vital for tailored interventions. Objective: The main objective is to compare the longitudinal psychological impact of psoriasis between adults and children in Canada and the United States. Methods: This systematic review was conducted following PRISMA guidelines and a PROSPERO-registered protocol. Studies were identified from PubMed, Scopus, ProQuest, PsycINFO, Dermatology Online Journal, JMIR Dermatology, and Embase. The included studies were published between 2014 and 2024, measured standardized psychological outcomes, and had a longitudinal design with at least a one-year follow-up period. Methodological quality was assessed using the GRADE tool. Results: Fifteen studies encompassing 67,964 participants (mean age 49.1 years, 53.3% female) were included. Adults with moderate-to-severe psoriasis demonstrated significant impairments in Dermatology Life Quality Index (DLQI) scores, with a mean baseline score of 9.0 to 10.2 for severe cases, reflecting moderate-to-severe quality of life (QoL) impairments. Treatment with biologic therapies significantly improved outcomes, with DLQI scores decreasing by an average of 7 points (from 9.6 to 2.6; p < 0.001). Key areas of improvement included social functioning, reduced physical symptoms, and increased work productivity. In severe cases, DLQI scores were 7.95 points higher compared to mild cases (p < 0.05), indicating a disproportionate burden of disease severity. Anxiety and depression were common in adults, affecting 16-23% and 18-22%, respectively. These conditions were linked to visible lesions, social stigma, and comorbidities such as hypertension and metabolic syndrome. Children with psoriasis also exhibited similar impairments in QoL, as assessed by the Children’s Life Quality Index (CLDQI). Visible lesions negatively affected school participation and peer interactions, with bullying and stigma consistently reported as major contributors to social isolation and emotional distress. Although biological therapies improved CDLQI scores, children faced persistent challenges in psychological well-being, including lower self-esteem and stigma, which often persisted in adolescence. Disease severity was quantified using the Psoriasis Area and Severity Index (PASI). Among adults, severe cases had a mean baseline PASI score of 13.9, improving by 87.1% (to 1.8, p < 0001) following biologic therapy. Canadian cohorts showed greater PASI improvements, with biologic-naive adults achieving a 95.1% reduction (from 16.3 to 0.7, p < 0.0001). Canadian patients also had higher biologic continuation rates (89.9%). Conclusion: Psoriasis significantly impacts quality of life and psychological well-being across age groups, with notable differences in outcomes between adults and children. Regional differences further highlighted greater work-related impairments in U.S. adults and more pronounced psychological challenges in Canadian children, where bullying and stigma delayed recovery. These findings emphasize the need for age- and region-specific strategies to address both the physical and psychosocial dimensions of psoriasis and support long-term well-being.

Keywords: psoriasis, psychological impact, mental health, quality of life, self-esteem, autoimmune, chronic skin condition

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Authors: Olifan Degebas Olkeba

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Background: Males participate in family planning by utilizing the method, having discussions, approving decisions, and supporting their partners and other family members. One of the reasons Ethiopia has a low rate of FP use is the poor participation of men in family planning. So, the finding of the study could help married men and other stakeholders to alleviate the problems related to low involvement. Objective: To assess males’ involvement in family planning use and associated factors among married men in the pastoralist community of Yabelo district, Borena, Oromia, Ethiopia, 2024. Methods: Cross sectional study design supplemented by qualitative and multistage sampling method for quantitative one and purposive sampling method for qualitative was done. The interviewer administered questionnaires from 531 samples for quantitative and from 14 key informants for qualitative were taken. Quantitative data were entered using Epi Info version 7.2.2.6 and analyzed using SPSS version 24. Bivariate associations between dependent and independent variables were examined. Multi variable logistic regression analysis was done to identify factors significantly associated with male involvement. Qualitative data was analyzed using open code 4.03. The study was conducted from January 1-February 29, 2024. Results: A total of 531 respondents participated. The mean age of the study participant was 28 ±2.1 (SD). The prevalence of male involvement in FP use among married males in Yabelo district was 9.6 (AOR= 9.6, 95% CI: 7.14-12.15). Age above 40 years (AOR=0.18, 95% CI: 0.05-0.6 p=0.009), educational status unable read and write (AOR=9.4, 95% CI:3.5-25.4 p=0.001), read and write only (AOR=7.1, 95% CI:2.4-21.4 p=0.001), knowledge on side effects of FP (AOR=2.35, 95% CI: 1.09-5.06 p=0.029) were factors associated with male involvement in FP use. A total of 14 key informants participated in the interview of qualitative part and culturally perceived FP issues, lack of awareness and desire of more children were among the reasons for low involvement in FP use. Conclusion: The finding of the study showed that the magnitude of male involvement in family planning use was low. Age (>40), educational status (read and write only) and fear of side effects were factors associated with low husband involvement in FP use. Therefore, family planning programs need to target men at all levels of the service.

Keywords: family planning, male involvement, married men, Yabelo district

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Authors: Mazdak Ganjalikhani, Mohamad Namgar, Alireza Peyman

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Introduction: The present study was carried out to measure the levels of inflammatory markers Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in tear of keratoconus patients and investigate their relationship with the severity of keratoconus. Materials and Methods: This study was performed on 81 patients with keratoconus (cases) and 85 healthy individuals (controls) who were selected through the convenience sampling method from patients visiting the Feiz Ophthalmology Hospital affiliated with the Isfahan University of Medical Sciences. Tear levels of IL-6 and TNF-α were measured after collecting the patient's tears from the lower eyelid through the Schirmer I method using a filter paper (Schirmer tear test strip) without anesthesia. Findings: The mean levels of IL-6 and TNF-α were 26.77±8.16 and 34.58±9.82 in the control group and 103.22±51.94, and 183.76±54.61 in the case group, respectively, indicating a significant difference between two groups (p<0.05). In addition, there was a significant relationship between the severity of the keratoconus and the mean levels of TNF-α and IL-6 in the case group (p<0.05). Conclusion: According to the results, the mean levels of IL-6 and TNF-α were higher in keratoconus cases than in the controls, and the disease severity was significantly associated with the levels of inflammatory markers IL-6 and TNF-α.

Keywords: keratoonus, cataract, tumor necrotic factor, interleukin 6

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Authors: Devita Wardani, Pratiwi Gusti Wahyu, Andreas Infianto, Raden Dicky Wirawan Listiandoko, Descahirul, Yunnica

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Flexible fiberoptic bronchoscopy (FFB) is the essential method for both the diagnosis and staging of central lung cancer. Concerning central lesions, the sensitivity of endobronchial forceps biopsy of a visible endobronchial lesion is 74%. The aim is to determine the distribution of lung cancer types of patients diagnosed with and who underwent bronchoscopy at General Ahmad Yani Metro Hospital. Methods: This study is a cross-sectional descriptive study. Data are obtained from histopathological results of lung malignancy through bronchoscopy either from forceps biopsy, washing and brushing. Results: Lung cancer is more found in men (72.2%) than women (27.8%). The average age for men ranges 57 years old for Non-Small Cell and 56 years old for Small Cell case. Most histopathology found in non-small cell lung cancer (87.7%), with adenocarcinoma as the most common type (68.4%), followed by squamous cell carcinoma (29.1%). Findings for adenocarcinoma showed that men had an incidence of 64.8% and women had an incidence of 35.2%. Like NSCLC, men can have up to 90% of cases of SCLC compared to 10% in women. In addition to non-small cell and small cell types, other types, such as large cells and renal carcinoma metastases, were obtained. Conclusions: Adenocarcinoma lung cancer is the most widely obtained type with predominantly male patients.

Keywords: bronchoscopy, forceps biopsy, washing, brushing

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Authors: Yong H Sheng, Beatriz Garcillán, Eden Whitlock, Yukli Freedman, SiLing Yang, M Arifur Rahman, Nicholas Weber, Fabienne Mackay

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Chronic lymphocytic leukemia (CLL) is closely associated with immune dysfunction, yet the mechanisms underlying this immune deficiency remain poorly understood. Transmembrane Activator and CAML Interactor (TACI), a receptor known for its role in IL-10 regulation and autoimmunity, to the best of our knowledge has not been investigated in the context of anti-tumor immunity or its impact on CLL progression. This study addresses the gap by exploring the role of TACI in regulating CLL cells within the tumor microenvironment and its broader effects on disease progression and immune competence. We utilized the Eµ-TCL1 mouse model to generate CLL mice deficient in TACI and examined the consequences of TACI loss in adoptive transfer models over a five-week period. Comprehensive transcriptomic analysis, including RNA sequencing and microarray, was employed to determine TACI’s influence on the CLL gene expression profile. Additionally, we studied TACI’s direct role in CLL cell migration and immune modulation using patient-derived CLL cells in culture and Patient-Derived Xenograph (PDX) models. Our findings demonstrate that TACI signaling plays a pivotal role in promoting CLL progression and immune suppression. Loss of TACI signaling significantly inhibited CLL development and enhanced immune functionality. When TACI+/+ or TACI-/- TCL1 CLL cells were transferred into wild-type recipient mice, those receiving TACI-deficient cells showed reduced disease progression and lower incidence of CLL. Mice with TACI-/- CLL cells exhibited normalized serum levels of pro-inflammatory cytokines IL-6 and IL-10, restored proportions of T-cell subsets, and improved immune compartment function compared to counterparts with TACI+/+ CLL cells. Mechanistically, TACI-deficient CLL cells expressed significantly lower levels of IL-10, TNF, and inhibitory receptors such as PD-L1 and PD-L2. These cells also display restored circulating immunoglobulin levels and responses to T cell-dependent antigens, highlighting a recovery of immune competence. Further mechanistic studies revealed that TACI signaling drives CLL cell migration and homing to the spleen, where these cells actively establish an immunosuppressive microenvironment that supports immune evasion and tumor growth. Patient-derived CLL cells and PDX models confirmed TACI’s direct role in enhancing CLL cell migration and fostering immune suppression, emphasizing its critical function in the tumor microenvironment. By disrupting TACI signaling, we observed a reduction in CLL-associated immune suppression and tumor progression, offering a promising therapeutic avenue. This study establishes, for the first time, that targeting TACI disrupts key mechanisms underlying CLL progression while preserving vital immune functions. Unlike existing treatments that often impair immunity and lead to infection-related complications, TACI inhibition offers the dual benefit of controlling disease and maintaining immune homeostasis. These findings provide a strong rationale for developing therapeutic strategies that inhibit TACI as a means to improve outcomes in CLL patients. Beyond its implications for CLL, this research underscores the broader importance of TACI in regulating immune-tumor interactions, paving the way for future studies into its role in other malignancies.

Keywords: chronic lymphocytic leukemia, TACI, IL-10, immune suppression

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Authors: Dewaram Abhiman Nagdeve

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The present paper examined the urban-rural differentials and the factors influencing net change in reproductive and child health input, its utilization, and its output during the National Family Health Survey conducted during 1992-93 and 2019-21 in India. The analysis of NFHS data has been done and variables have been grouped into health input regarding antenatal care, postnatal care, and child care, utilization regarding reproductive and child health care, and reproductive and child health outcomes. An analysis was done using bivariate analysis and the chi-square test. The study reveals that there was an increase in health input, utilization, and output during the intra-survey period. Urban-rural disparities in Reproductive and Child Health (RCH) indicators persist, highlighting the need for focused intervention by the Indian government. Key steps should include enhancing RCH programs through robust information and education campaigns and deploying dedicated health personnel to remote and inaccessible rural areas. These initiatives are crucial to reducing both maternal and child mortality rates and ensuring equitable healthcare access nationwide.

Keywords: urban, rural, differentials, reproductive and child health, India

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Authors: Pechpailin Kortnoi, Tanitnun Paprad

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Background: Myasthenia gravis (MG) is an autoimmune disorder characterized by impaired neuromuscular transmission due to antibodies against nicotinic receptors, leading to muscle weakness, ptosis, and respiratory issues. The incidence of MG has risen globally, emphasizing the need for effective diagnostics. Objective: This study evaluates the validity of a combined bedside test (the ice pack test and fatigability test) for diagnosing juvenile myasthenia gravis (JMG) in pediatric patients with ptosis. Methods: This cross-sectional study, conducted from January 2012 to May 2024 at King Chulalongkorn Memorial Hospital, Thailand, included pediatric patients (1 month to 18 years) with ptosis undergoing ice pack and fatigability tests. Data included demographics, clinical findings, and test results. Diagnostic efficacy was assessed using sensitivity, specificity, accuracy, PPV, NPV, Fagan Nomogram, Kappa Statistics, and McNemar’s Chi-Square. Results: Of 43 identified patients, 32 were included, with 47% male and a mean age of 7 years. The combined bedside test had high sensitivity (92.8%) and accuracy (87.5%) but moderate specificity (50%). It significantly outperformed the ice pack test (P = 0.0005), which showed low sensitivity (42.8%) and accuracy (43.8%). The fatigability test had 82% sensitivity and 92% PPV. Confirmatory tests (AChR-Ab, MuSK-Ab, neostigmine, repetitive nerve stimulation) supported most diagnoses. Conclusions: The combined bedside test, with high sensitivity (92.8%) and accuracy (87.5%), is an effective screening tool for juvenile myasthenia gravis, outperforming the ice pack test. Integrating it into clinical practice may improve diagnosis and enable timely treatment. The fatigability test (82% sensitivity) is also useful as an adjunct screening tool.

Keywords: myasthenia gravis, the fatigability test, the ice pack test, the combined bedside test

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Authors: Fedor Semenov

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One of the most widespread facial bones’ malformations – the congenital palatoschisis – significant impact on drainage and ventilation of the middle ear through the incorrect work of soft palate muscles, which results in recurrent middle ear inflammation and subsequently leads to the hearing dysfunction. The purpose of this research is to evaluate the auditory tube function and hearing condition before the operative treatment (uranoplasty) and after 3 and 12 months. 42 patients aged from 6 months to 17 years who had soft and hard palate cleft and B and C type tympanogram were included in that study. The examination includes otoscopy, pure tone audiometry (for patients older than 8 years – 11 patients), tympanometry. According to the otoscopy results all the patients were divided into two groups: those who had a retracted eardrum and those who had a normal one. The results of pure tone audiometry showed that there were six patients with an air-bone gap of more than 10 dB and the five with normal audiograms. According to the results of this research, uranoplasty demonstrated strongly positive effects on the auditory tube function: normalization of eardrum view upon otoscopy was observed in 64% of children with a retracted eardrum three month after surgery and 85 % twelve months. The quantity of patients with A-type of tympanogram improved in 25 children out of 41 in 3 month and in 35 out of 41 in twelve months after operation. While before the operative treatment, six patients older than 8 years had had an air-bone gap of more than 10 dB; only two of them still had it in 12 months, and the others’ audiograms were normal. To sum it up, the uranoplasty showed a significant contribution in the restoration of auditory tube functioning. Some patients had signs of auditory dysfunction even after the operative treatment. That group of children needs further treatment by an otorhinolaryngologist.

Keywords: auditory tube dysfunction, palatoschisis, uranoplasy, otitis

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Authors: Hoorieh Darvishi, Rezaei

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Introduction: This study investigates the efficacy of computer-based interventions for children with Autism Spectrum Disorder , specifically targeting communication deficits and repetitive behaviors. The research evaluates novel software applications designed to enhance narrative capabilities and sensory integration through structured, progressive intervention protocols Method: The study evaluated two intervention software programs designed for children with autism, focusing on narrative speech and sensory integration. Twelve children aged 5-11 participated in the two-month intervention, attending three 45-minute weekly sessions, with pre- and post-tests measuring speech, communication, and behavioral outcomes. The narrative speech software incorporated 14 stories using the Cohen model. It progressively reduced software assistance as children improved their storytelling abilities, ultimately enabling independent narration. The process involved story comprehension questions and guided story completion exercises. The sensory integration software featured approximately 100 exercises progressing from basic classification to complex cognitive tasks. The program included attention exercises, auditory memory training (advancing from single to four-syllable words), problem-solving, decision-making, reasoning, working memory, and emotion recognition activities. Each module was accompanied by frequency and pitch-adjusted music that child enjoys it to enhance learning through multiple sensory channels (visual, auditory, and tactile). Conclusion: The results indicated that the use of these software programs significantly improved communication and narrative speech scores in children, while also reducing scores related to repetitive behaviors. Findings: These findings highlight the positive impact of computer-based interventions on enhancing communication skills and reducing repetitive behaviors in children with autism.

Keywords: autism, narrative speech, persian, SI, repetitive behaviors, communication

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Authors: Shirui Huang, Wei Chen, Chuanshu Huang

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Basal muscle-invasive bladder cancer (BMIBC) is considered one of the subtypes of BC with the highest metastatic rate and the poorest prognosis. Therefore, elucidating the mechanisms underlying BMIBC metastasis and identifying novel precision therapeutic targets are current research hotspots and challenges to cancer researchers. Through a series of in vitro and in vivo functional experiments, we have identified the crucial role of KRT14 in the high invasiveness and adverse prognosis of BMIBC. We found that the K294 site within the IGF2BP1-KH2 domain is responsible for reading the conserved genetic information carried by D226/E227 in the KRT14 nuclear export signal (NES). Activation of the KRT14-IGF2BP1 signaling axis is essential for IGF2BP1-mediated stabilization of SNAI1 mRNA through FTO modification. Additionally, IGF2BP1 forms a positive feedback loop by stabilizing its own mRNA, thereby accelerating the invasion and metastasis of BMIBC. Collectively, our study identifies the KRT14/IGF2BP1/FTO/Snail signaling axis as an essential regulatory mechanism associated with poor prognosis in BMIBC, providing a theoretical basis for KRT14 and its downstream regulated molecules as therapeutic targets for BMIBC and the development of corresponding targeted therapies.

Keywords: BMIBC, KRT4, IFGF2BP1, DNA methylation

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Authors: Aliakbar Hafezi, Jalal Taherian, Jamshid Abedi, Mahsa Elahi

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Background: Bones are commonly affected by renal cell carcinoma (RCC) (primarily or secondary), and this condition causes bone fragility. The aim of this study was to evaluate the diagnostic value of noninvasive methods for the diagnosis of ROD in RCC patients on hemodialysis (HD) in northern Iran. Methods: In this cross-sectional study, 50 RCC patients with ESRD referred to dialysis units in northern Iran during 2021-2024 were randomly selected and investigated. The biochemical and radiographic evaluation of ROD and its subtypes was performed, and then all patients underwent bone biopsy and histopathological study, and finally, the diagnostic value of the noninvasive methods was assessed. Results: The mean age of patients was 58.9 ± 11.7 years, and 27 cases (54.0%) were female. 38 (76.0%) of RCC patients with ESRD had ROD, and 12 patients (24.0%) had no evidence of bone disorders. The sensitivity, specificity, positive and predictive values and accuracy of the noninvasive methods for the diagnosis of ROD were 92%, 82%, 95%, 75% and 90%, respectively. Conclusion: This study showed that the frequency of ROD in RCC patients with ESRD in northern Iran was high and the biochemical and radiographic markers have a high diagnostic value for ROD as well as histopathological assessment.

Keywords: renal cell carcinoma, renal osteodystrophy, hemodialysis, non-metastatic

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Authors: Aliakbar Hafezi, Jalal Taherian, Mahsa Elahi, Jamshid Abedi

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Background: Patients with breast cancer with different molecular subtypes may have different pathological responses to neoadjuvant chemotherapy (NAC). The aim of this study was to evaluate the pathological response to NAC in patients with locally advanced breast cancer based on molecular subtypes. Method: In this retrospective cohort study, 210 female patients with breast cancer candidate for NAC referred to the radiation oncology departments in southern Iran between August 2019 and September 2024 were evaluated in terms of pathologic complete response (pCR) based on immunohistochemical molecular markers (estrogen and progesterone receptors, Her-2/neu and Ki-67), overall survival (OS) and disease-free survival (DFS). Results: The mean age of the patients was 38.22 ± 10.34 years, and 68 patients (32.4%) had a positive family history of breast cancer. The pCR rate was 17.6% (37 patients), which in the subtypes of luminal A, luminal B, Her-2/neu positive and triple negative was 7.7%, 16.9%, 26.5% and 21.05%, respectively. Patients with pCR had significantly better OS (78.4% vs. 49.1%, P = 0.014) and DFS (83.8% vs. 51.4%, P = 0.020) than patients with partial/no pathological response. Conclusion: It seems that the molecular subtype plays a decisive role in the clinical outcome and the pathological response to NAC in patients with locally advanced breast cancer.

Keywords: locally advanced breast cancer, neoadjuvant chemotherapy, pathologic complete response, clinical outcomes

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Authors: S. D. Zalepugin, A. E. Murzich, D. G. Satskevich, A. B. Palivanov

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Introduction. The incidence of spinal injuries in patients under 18 years of age has increased significantly in recent years, which represents a significant economic, social and medical problem. The most common method of surgical stabilization of spinal fractures in pediatric patients is transpedicular posterior spinal fusion, which is widely used by spinal neurosurgeons in adult patients. Purpose of the study: This study evaluates the results of treatment of thoracolumbar spine lesions in children using the transpedicular screw fixation method. Materials and methods. From 2019 to 2024, 35 children with injuries to the thoracic and lumbar spine underwent surgical treatment using the transpedicular screw fixation method. Among the injured, girls prevailed (21 cases, 60%). The age of the victims ranged from 9 to 17 years. The main causes of damage were: catatrauma (19 cases), road accident (5 cases), sports injury (6 cases), and other reasons - 5 cases. In 5 cases, suicidal attempts occurred. Co-injury was observed in most cases (20 patients, or 57%), which is natural for high-energy injury. Vertebral-spinal injury with neurological disorders was observed in 13 patients, the disorders ranged from mild inferior (4 children) to moderate/severe paraparesis (5 patients) and inferior paraplegia (4 children). 6 children had pelvic organ dysfunction in the form of urinary and fecal retention or incontinence. All thirty-five patients, within a period of 1 to 57 days after the injury, underwent several surgical interventions from the posterior surgical access using a screw fixation method (posterior decompression + spinal fusion). In 12 cases, it was necessary to perform the second stage of surgical treatment - anterior decompression of the spinal cord or its roots. Verticalization of patients was carried out within 1 to 5 days after surgery. Results. In all patients, the nearest, up to 1 year, results were evaluated. In children operated in 2019-2021, the results were studied in terms of 3 to 5 years. The procedures used, clinical results and the quality of the fixative installation were assessed. All patients managed to achieve positive results. The use of internal fixation made it possible to carry out early verticalization of children, eliminate pain syndrome and achieve a regression of neurological disorders in most patients (especially in cases when the operation was performed early after injury - from 1 to 3 days). Within the first month, the ability to self-care was fully restored. Bone fusion was observed within 6-12 months after surgery. There were no complications after surgery. The analysis of postoperative radiographs, CT and MRI images revealed the correct standing of the screws in all cases. Conclusion. The posterior spinal fusion using the new method of screw fixation in pediatric patients allows to achieve durable stabilization of damage, begins early rehabilitation of patients and reduces the duration of hospital treatment by 2-3 times. Thus, we recommend the use of a transpedicular fixator in children as a reliable, technically feasible method for restoring spinal stability with a low risk of intra- and postoperative complications.

Keywords: pediatric patients, spinal injuries, transpedicular stabilization, operative treatment

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