METHODS: A total of 500 end-stage osteoarthritic knees subjected to TKA were radiologically analyzed. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were calculated from long limb radiographs before the aHKA and JLO were derived and a CPAK phenotype was assigned. Demographic data were harvested and analyzed for possible correlations.
RESULTS: There were 160 males (32%) and 340 females (68%), with a mean age of 66.42 years (range, 47-88). The mean MPTA was 85.8° (± 3.0)°, and the mean LDFA was 87.6° (± 2.4)°. The average aHKA was a varus of 1.8° (± 4.2)°, and the average JLO was 173.4° (± 3.45)°. The most common CPAK phenotype was Type 1 (43.4%). The Intraclass Correlation Coefficient demonstrated excellent reliability (> 0.9). No correlation existed between CPAK phenotypes and age, height, weight, or body mass index (BMI), but CPAK phenotype was significantly correlated with gender.
CONCLUSION: An urban Malaysian population with osteoarthritic knees was found to be constitutionally varus, with the most common phenotype being varus aHKA with an apex-distal JLO. Constitutional alignment is not influenced by factors such as age, height, weight, or BMI.
LEVEL OF EVIDENCE: Retrospective Observational Study-III.
METHODS: This review followed PRISMA guidelines. Literature searches were conducted in PubMed, ScienceDirect, Google Scholar, and Taylor & Francis, focusing on studies published from 2019 to 2024. Keywords included "Adolescent," "Rural," "Reproductive Health," "Awareness," and "Barriers." Studies were screened based on eligibility criteria, and data were extracted and analyzed to identify key barriers at the individual, interpersonal, social/community, and health services levels.
RESULTS: Out of 669 records, 20 studies met the inclusion criteria. Identified barriers at the individual level included lack of knowledge, myths, misconceptions, and feelings of shame and fear. Interpersonal barriers were related to poor communication between parents and adolescents and misinformation from peers. Social and community barriers encompassed rigid social norms, stigma, and discrimination. Health services barriers included limited access and negative experiences with reproductive health services.
DISCUSSION: Rural adolescents face complex barriers to reproductive health awareness driven by factors at the individual, interpersonal, social, and health services levels. Comprehensive interventions, such as educational campaigns, training for healthcare providers, and improved access via mobile or online platforms, are essential to enhance reproductive health awareness and outcomes.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/, PROSPERO (CRD42024554439).
METHODS: CSF samples were collected from 2 neurosurgical centers in Kuala Lumpur, Malaysia, between January 2022 and October 2023. Conventional markers and CLGR were quantified using standard laboratory methods, with BGA utilized for measurement when feasible. Samples were categorized into confirmed CBI-positive (CBI+) and CBI-negative (CBI-) groups. Marker performance was compared, and receiver operating characteristic analysis conducted. Pearson correlation assessed the agreement between BGA and laboratory measurements.
RESULTS: Among the 130 CSF samples, 11 were CBI+. Both cerebrospinal fluid lactate (cLac) and CLGR were significantly elevated in the CBI + group (P < 0.001). The area under the curve for cLac and CLGR was 0.990 and 0.994, respectively. Using a cutoff of 6.0 mmol/L, cLac demonstrated sensitivity of 100%, specificity of 93.3%, positive predictive value of 57.9%, negative predictive value of 100%, and diagnostic accuracy of 93.9%. CLGR ≥20.0 showed even higher accuracy: 100.0% sensitivity, 98.6% specificity, 84.6% positive predictive value, 100% negative predictive value, and overall accuracy of 98.5%. Both markers maintained excellent performance in blood-stained CSF. BGA measurements correlated well with laboratory results (r = 0.980 and 0.999, respectively, P < 0.001).
CONCLUSIONS: CLac levels ≥6.0 mmol/L and CLGR ≥20.0 accurately identified CBI in neurosurgical patients, with CLGR exhibiting superior efficacy. The potential for instant BGA measurement suggests promise for point-of-care testing.
MATERIAL AND METHODS: A randomized controlled trial was conducted from June 2021 to January 2022. 210 nulliparas at term for labor induction were randomized: 105 each to first vaginal examination at 8 or 4 h after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to expedite labor. Primary outcomes were the amniotomy-to-delivery interval (non-inferiority hypothesis) and maternal satisfaction with their allocated labor care (superiority hypothesis) within 24 h after delivery. Analyses performed using t-test, Mann-Whitney U test, and Chi-squared test as appropriate.
RESULTS: The amniotomy-to-delivery interval was mean ± standard deviation 8.7 ± 3.4 vs 8.4 ± 3.7, mean difference 0.4 (97.5% CI: -0.7 to 1.5) hours, p = 0.442 within the pre-specified 2-hour non-inferiority margin, and maternal satisfaction score with allocated labor care was median [interquartile range] 8[7.5-10] vs 8[7.0-10], p = 0.248 for 8 vs 4 h arms, respectively. The amniotomy to first vaginal examination intervals was 5.9 ± 2.3 vs 3.6 ± 1.0 h, p
METHODS: The study involved: (i) collecting Codex Committee on Food Labelling (CCFL) documents (2016-2023); (ii) identification, categorization, and enumeration of actors involved in the development of the Guidelines; and (iii) guided by a constructivist framework, analysis of how actors framed and contested key provisions of the Guidelines.
RESULTS: Country representation was skewed towards high-income (47.9%). Member state delegations were dominated by non-health ministries (59.8%) and industry actors (16.1%). Industry actors comprised the large majority of observers (84.2%) and civil society actors representing public health interests the least (12.2%). Commercial actors used frames supporting positive FOPNL messages (eg, low in salt) opposing negative ones (eg, "high-in" sugar warnings) and called for product exemptions (eg, sports foods and baby foods). Public health actors used frames supporting simplified FOPNL to reduce consumer confusion, that hold up public health goals, and prevent inappropriate marketing.
CONCLUSION: Participation in the Guidelines development process suggests stronger preferences for trade facilitation and commerce over public health. Ambitions to reform the international food regulatory system may require an examination of who participates and how to address this asymmetrical representation of interests. These results suggest the need to greatly strengthen public health representation at Codex.