Neglected congenital bilateral knee dislocation treated by quadricepsplasty with semitendinosus and sartorius transfer:A case report

BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.

Ancylostoma ceylanicum and other zoonotic canine hookworms:neglected public and animal health risks in the Asia-Pacific region

Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.

Unequal Distribution of Innovation Efforts for Neglected Tropical Diseases: The Role of Funding Evaluation Criteria

Background: International research and innovation efforts for neglected tropical diseases have increased in recent decades due to disparities in overall health research funding in relation to global burden of disease. However, within the field of neglected tropical diseases some seem far more neglected than others. In this research the aim is to investigate the distribution of resources and efforts, as well as the mechanisms that underpin funding allocation for neglected tropical diseases. Methodology: A systematic literature review was conducted to establish a comprehensive overview of known indicators for innovation efforts related to a wide range of neglected tropical diseases. Articles were selected based on a subjective evaluation of their relevance, the presence of original data, and the breadth of their scope. This was followed by thirteen in-depth open-ended interviews with representatives of private, public and philanthropic funding organizations, concerning evaluation criteria for funding research proposals. Results: The findings reveal a large difference in the extent to which the individual diseases are neglected with notable differences between absolute and relative efforts. Criteria used in the evaluation of research proposals relate to potential impact, the probability of success and strategic fit. Private organizations prioritize strategic fit and economic impact;philanthropic organizations prioritize short-term societal impact;and public generally prioritize the probability of success by accounting for follow-up funding and involvement of industry. Funding decisions of different types of organizations are highly interrelated. Conclusions: This study shows that the evaluation of funding proposals introduces and retains unequal funding distribution, reinforcing the relative neglect of diseases. Societal impact is the primary rationale for funding but application of it as a funding criterion is associated with significant challenges. Furthermore, current application of evaluation criteria leads to a primary focus on short-term impact. Through current practice, the relatively most neglected diseases will remain so, and a long-term strategy is needed to resolve this.

Evaluation of Some Treatment Options Inlate and Neglected Hip Fractures Using the Modified Harris Hip Score

Background: The choice of the appropriate operative intervention in patients with late and neglected hip fracture continuous to be a huge dilemma for orthopedic surgeons. Purpose: To evaluate the satisfaction or otherwise of some treatment options using the modified Harris-hip score (HHS) in resource poor setting. Materials and Methods: A retrospective cross-sectional study conducted at ATBUTH, Bauchi. Data of 60 patients over the age of 18 years with hip fractures (femoral neck, intertrochanteric and sub trochanteric fractures) who had operative intervention between 1st September 2019 and 31st August 2020 with cannulated screws, Proximal femur lock compression plate (PFLCP), cementlessor cemented bipolar hemiarthroplasty (BHA). Results: The mean age of studied patients was 65.7 ± 16.1 years, with age ranging from 19 - 101 years. M:F ratio was 1.2:1 across all age groups and 1:1.4 amongst those >60 years. 51 patients (85%) presented > 1 week after injury with 24 patients (40%) sustaining hip fractures from low energy trivial indoor fall and 28 patients (46.7%) mostly younger sustaining fractures from high energy motor vehicular accident (MVA). The prevalence rate for femoral neck, intertrochanteric and subtrochanteric fractures were 32 (53.3%), 17 (28.3%) and 11 (18.3%) respectively. From the data retrieved, 21patients (35.0%), 17 patients (28.3%), 20 patients (33.3%) and 2 patients (3.3%) had PFLCP, cemented BHA, cementless BHA and cannulated screw fixation respectively. Most (66.7%) of those who had PFLCP achieved satisfactory radiologic union and there was also 94.1% and 85% satisfactory outcome rate amongst the patients with cemented BHA and cementless BHA respectively. Irrespective of the operative intervention method at 1 year follow-up, there was a statistically significant improvement in post-operative HHS (P value 0.02), with 83.4% having good to excellent results. Conclusion: There is highrate of late and neglected hip fracture in our environment. Satisfactory outcome with statistically significant improvement in Post-operative HHS was achieved in patients treated for hip fractures.

Traumatic Neglected Antero-Medial Knee Dislocation: Case Report

Introduction: Neglected knee dislocation is an unusual injury, only a few cases have been reported in the literature. The circumstances of onset are generally an unnoticed knee dislocation in a polytrauma context or a delay in consultation after the initial trauma. Presentation of case: We report the case of a 48-year-old female patient who sustained a knee injury during a domestic accident. Initial treatment was traditional and was followed for 3 years. She then consulted hospital, where a neglected knee dislocation was identified and treated with femorotibial arthrodesis. Discussion and conclusion: The treatment options of neglected knee dislocation include open reduction and fixation, arthrodesis and total knee arthroplasty. That the choice depends on the old unreduced of dislocation.

Standardization of apple cancellation test for neglect patients in Korea:An observational study

BACKGROUND Neglect can be divided into two types using apple cancellation test(apple test):Egocentric neglect(EN)and allocentric neglect(AN).However,in South Korea,apple test results and decision criteria are still largely dependent on tests by foreign countries.AIM To establish a new South Korea standard and improve the accuracy of neglect assessment,the apple experiment was standardized in this study.METHODS This study was conducted on 223 healthy subjects for a total of 7 mo from August 2021 to February 2022.Standardization was carried out using the original apple test developed by Bickerton in 2011.In scoring for the apple test,total omission error refers to the number of missed targets(full apple)in the entire test sheet(left,middle,and right area).The score for EN is the difference between the correct number of right area and the correct number of left area(excluding the middle area).For AN,the score is difference between the number of left opening apples and number of right opening apples(including the middle area).Linear regression analysis was used for standardization using the general characteristics of subjects and the results of the apple test.RESULTS The cut-off score,which is the standard value indicating the pathological condition by combining the results of all subjects,is as follows:Total omission error(5),error for EN(2),and error for AN(2).Also,differences in cut-off score according to age were found.CONCLUSION This study will be helpful in facilitating a more accurate differential diagnosis of neglect.

Neglected and Relapsed Clubfoot in Adults, the Functional Outcome of Acute Surgical Correction

Background: Neglected clubfoot in this series is defined as untreated equino-cavo-adducto-varus in older children or adults. Relapsed clubfoot is the residual deformity that remains after single or multiple surgical interventions. Severely neglected clubfoot rarely exists today in developed countries, except in some emigrants from low- and middle-income countries. Acute surgical management with corrective mid-foot osteotomy and elongation of the Achilles tendon has an excellent functional outcome. Objective: To assess the functional outcome of acute correction of neglected Talipes-quinoa-varus deformity in adults. Methods: This is a cross-sectional, hospital–based multi-centric study. Forty patients were included in this study. Midfoot osteotomy and elongation of the Achilles tendon were performed on all patients. Data was collected using a questionnaire and the functional outcome has been assessed using the American Orthopedic Foot and Ankle Society Score (AOFAS). This score was measured before surgery and one year after surgery. Results: the mean age was 19.9 ± 4.7 years. Males were 25 (62.5%) and females were 15 (37.5%). The mean preoperative AOFAS score was 37.7 ± 7.1 (poor). This score improved to 80.7 ± 13.7 (good to excellent), two years after surgery. However, this indicates a significant change in the functional outcome after the operation (p value Conclusion: acute correction of neglected and relapsed TEV with elongation of the Achilles tendon and single midfoot osteotomy has excellent functional outcome as assessed by AOFAS Score. The satisfaction with this procedure is impressive. The younger age population showed better outcomes with this procedure.

Snakebite: A neglected tropical disease that can stymie progress toward the Sustainable Development Goals

The adoption of Sustainable Development Goals(SDGs)under Agenda 2030 is one of the most ambitious ventures by the United Nations for the betterment of humanity.The SDGs are a comprehensive and holistic approach to making the lives of humans,not only the current human population but even future generations,worth living and celebrating.SDGs aim to end poverty,hunger,and inequities,provide everyone with clean water,energy,and an environment,and make the planet more peaceful,just,and habitable[1].

Challenges of Total Arthroplasty for Neglected Fracture-Dislocations of the Hip

This study examined neglected hip fracture-dislocations in developing countries, focusing on five cases in Dakar. The research adopted a prospective method, assessing epidemiological, clinical, radiological, and therapeutic aspects, utilizing the Postel Merle d’Aubigné scoring system for functional assessment. Results demonstrated that total joint replacement surgery, predominantly following traffic accidents, significantly improved mobility and reduced limb length disparity, with most patients achieving independent walking post-operation. The study concludes that early diagnosis and total hip arthroplasty are critical for optimal outcomes.

国内外医药期刊载文及被引用情况对比及分析——以《Asian Pacific Journal of Tropical Medicine》与《PLoS Neglected Tropical Diseases》为例

《Asian Pacific Journal of Tropical Medicine》是中国唯一一本被美国科学引文索引(SCI)数据库收录的全英文版热带医药期刊。文章通过Web of Science数据库对《Asian Pacific Journal of Tropical Medicine》2008-2012年载文及被引用情况进行了统计,并与国际热带医药杂志《PLoS Neglected Tropical Diseases》进行比较。结果显示,《Asian Pacific Journal of Tropical Medicine》与《PLoS Neglected Tropical Diseases》在IF值、载文量、被引总频次、每项平均引用次数、h指数等各方面都存在显著差距,杂志需不断加强组稿,完善审稿评议流程,缩短出版周期,建立出版后信息反馈制度,以提高杂志的学术质量和国际影响力。

Assessment tools for differential diagnosis of neglect: Focusing on egocentric neglect and allocentric neglect

BACKGROUND There are very few studies on the differential diagnosis between egocentric neglect(EN)and allocentric neglect(AN).AIM To investigate the overall trend of the previously developed assessment tools by conducting a descriptive review of the studies on assessment tools that can perform a differential diagnosis of EN and AN.METHODS The data were collected by using databases such as Google Scholar,PubMed,and ScienceDirect.The most commonly used search terms were“neglect”,“stroke”,“egocentric neglect”,and“allocentric neglect”.RESULTS A total of seven studies that met the inclusion criteria were selected and analyzed.We were able to confirm the research process,test method,and differential diagnosis criteria of the seven presented assessment tools from four studies on paper-based tests and three studies on computerized tests.The majority of the tests were carried out via the cancellation method using stimuli such as everyday objects or numbers.EN distinguished the left from right based on the test paper,while AN distinguished the left from right based on stimuli.In order to perform differential diagnosis,the difference in the number of left and right responses or non-responses was used based on the EN and AN criteria.CONCLUSION It was confirmed that all the seven assessment tools can effectively perform differential diagnosis of EN and AN.This study may provide important data that can be used in clinical practice for differential diagnosis and future intervention planning for neglect patients.

Demographic,socioeconomic and environmental changes affecting circulation of neglected tropical diseases in Egypt

Egypt has been plagued by many neglected tropical diseases since Pharaonic time.These diseases are Schistosomiasis.soil transmitted helminthiasis,lymphatic filariasis.leishmaniasis and fascioliasis beside the epidermal parasitic skin diseases.Indeed,theses disease still persist as public health problem in the country by the influence of demographic,socioeconomic and environmental obstacles.This study seeks for understanding the contribution of each factor in each obstacle in neglected tropical diseases perpetuation which in turn could help the governorate in planning integrated control strategies.It was found that poverty,unregulated urbanization and inadequate sanitation are important socioeconomic factors that have great effect on the transmission dynamics of the disease.The environmental factors which affect the epidemiology of these diseases in the counln are scarcity of water,construction of dams,land reclamation for agriculture beside the climate factors.Unfortunately.the panic increase in the population growth rale minimizes the efforts done by the governorate to elevate the public health services.These conditions also affect the transmission of epidermal parasitic skin diseases including scabies,head lice and hookworm—related cutaneous larva migrans.The control programs and the recommendations to combat the diseases were discussed.The present study showed that the ecological factors affecting each neglected tropical disease in Egypt are somewhat similar which makes it worthy to develop an integrated control approaches aiming at improving the leading factors of neglected tropical diseases circulation in the country.

Distinct neuronal excitability alterations of medial prefrontal cortex in early-life neglect model of rats

Object:Early-life neglect has irreversible emotional effects on the central nervous system.In this work,we aimed to elucidate distinct functional neural changes in me-dial prefrontal cortex(mPFC)of model rats.Methods:Maternal separation with early weaning was used as a rat model of early-life neglect.The excitation of glutamatergic and GABAergic neurons in rat mPFC was recorded and analyzed by whole-cell patch clamp.Results:Glutamatergic and GABAergic neurons of mPFC were distinguished by typi-cal electrophysiological properties.The excitation of mPFC glutamatergic neurons was significantly increased in male groups,while the excitation of mPFC GABAergic neurons was significant in both female and male groups,but mainly in terms of rest membrane potential and amplitude,respectively.Conclusions:Glutamatergic and GABAergic neurons in medial prefrontal cortex showed different excitability changes in a rat model of early-life neglect,which can contribute to distinct mechanisms for emotional and cognitive manifestations.

The emerging but neglected hepatic capillariasis in China

To the editor,Hepatic capillariasis is a serious parasitic zoonosis caused by the tissue-dwelling nematode Capillaria hepatica(C.hepatica).Humans are an accidental host;human infection is acquired by ingesting food or water contaminated with infective eggs.Hepatic capillariasis may cause clinical signs and symptoms of varying intensity from mild to severe,with a possible fatal outcome.The typical manifestations are persistent fever,hepatomegaly,and eosinophilia[1].

Child maltreatment, abuse and neglect in a Nigerian adolescent boy, the common but unheard menace: A case report form Southwest, Nigeria

Child abuse is a global problem. It includes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that result in actual or potential harm to the child’s health, development or dignity. Child abuse and neglect are common in Nigeria, yet poorly reported. We herein report a case of child abuse and neglect in a 14-year-old boy, complicated by severe malnutrition, human immunodeficiency virus infection and gross under achievement of educational goal. The social and economic factors that play major roles are highlighted with the aim of sensitizing health care professionals, child advocacy groups, policy makers and other stakeholders on the impact of child abuse. We also hope that this would remind all concerned organisations and individuals of child protection which is integrated in the child right act 2003 adopted by Nigeria.

Endosteal Fibular Strut Graft with Proximal Humeral Locking Plate in Delayed and Neglected Fractures of the Proximal Humerus

Purpose: The purpose of this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct are used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. Patients & Methods: Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study, conducted between March 2015 and December 2019. Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed up for a mean time of 16.3 months (range: 13 to 40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. Results: Union at the fracture site was achieved in all patients at a mean of 8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n = 11, this difference was found to be statistically significant (p < 0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p < 0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. Conclusions: An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.

A Multi-Agent Expert System for Prevention of Child Abuse and Neglect

When a child abuse situation arises, the responsible agencies and entities in charge of response should be capable of providing a fast and personalized solution for the good of the child. This need leads the authors to consider the formation of dynamic virtual organizations tailored to each particular abuse case. In the authors＇ approach the partner selection of these collaborative networks is done through a software tool that combines two technologies from the field of artificial intelligence, specifically multi-agent systems and expert systems. In addition, these partners come from the breeding environment constituted by all the agencies or individuals, either in a region or locality, which have the potential of response.

Choice of providers for treating a neglected tropical disease:an empirical analysis of kala azar in Nepal

Objective:To examine the choice of healthcare providers for treating kala azar(KA) in Nepal. Methods:Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts.The survey collected information from more than 25 percent of total KA cases in the country.For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider,a multinomial logit model was defined with five alternative options with self care as the reference category.Results:The empirical model found that price of medical care services,income of households,knowledge of patients on KA and KA treatment,borrowing money,age of patient,perceived quality of provider types,etc.determine the likelihood of seeking care from the alternative options considered in the analysis.All variables have expected signs and are con.vstent with earlier studies.The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes,even for a severe disease like KA.Using the empirical models, we have analyzed two policy instruments:demand side financing and interventions to improve the knowledge index about KA.Conclusions:Due to high price elasticity of KA care and high spillover effects of KA on the society,policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.

Potential of herbal constituents as new natural leads against helminthiasis: A neglected tropical disease

The WHO reports that billions of people and animals in tropical and subtropical regions are affected by helminthiasis as neglected tropical disease. It is predominant in underdeveloped areas;nevertheless, the increase in the number of travelers and migrants has made this infection more common. The current mass drug treatment produces severe side effects and many strains of helminths are resistant to them. None of the chemotherapeutic drugs meets the ideal requirements of anthelmintics, such as broad spectrum of activity, single dose cure, free from side effect and cost-effectiveness. Today, many researchers are screening the traditional herbal system in search of the anthelmintic herbal constituents which overcome all the problems of synthetic drugs. Several researchers proclaim anthelmintic activity of herbal medicines by using different experimental models. The present review demonstrates natural product drug discovery, outlining potential of herbal constituents from natural sources as natural leads against helminthiasis.

Ponseti method treatment of neglected idiopathic clubfoot:Preliminary results of a multi-center study in Nigeria

AIM To evaluate the effectiveness of the Ponseti method for initial correction of neglected clubfoot cases in multiple centers throughout Nigeria.METHODS Patient charts were reviewed through the International Clubfoot Registry for 12 different Ponseti clubfoot treatment centers and 328 clubfeet(225 patients) met inclusion criteria. All patients were treated by the method described by Ponseti including manipulation and casting with percutaneous Achilles tenotomy as needed.RESULTS A painless plantigrade foot was obtained in 255 feet(78%) without the need for extensive soft tissue release and/or bony procedures.CONCLUSION We conclude that the Ponseti method is a safe, effective and low-cost treatment for initial correction of neglected idiopathic clubfoot presenting after walking age. Longterm follow-up will be required to assess outcomes.