AbSTR Ac TThis study aimed to translate and adapt the Intermittent and Constant Osteoarthritis Pain questionnaire into the Arabic language and evaluate the validity and reliability of this scale for participants with knee or hip osteoarthritis. This questionnaire was translated based on the Manufacturers Alliance for Productivity and Innovation protocol. The test-retest reliability was calculated using the Intraclass Correlation Coefficient. Then, Cronbach's alpha was used to assess the internal consistency of Intermittent and Constant Osteoarthritis Pain questionnaire. After that, the criterion validity was evaluated against the Knee injury and Osteoarthritis Outcome Score. A total of 90 participants were included in this study, of which 29 participants were re-evaluated for reliability testing. The Intraclass Correlation Coefficient of the Knee Intermittent and Constant Osteoarthritis Pain questionnaire were 0.841, 0.923 and 0.911 for the total, constant, and intermittent knee pain, respectively. Cronbach's alpha was 0.88, 0.93 and 0.94 for the total score, the intermittent knee pain and the constant knee pain, respectively. Eventually, criterion validity was r = 0.24(P < 0.05). Intermittent and Constant Osteoarthritis Pain in Arabic is a valid and reliable instrument to be used in Arabic-speaking patients with knee/hip osteoarthritis.

BACKGROUND: Diabetic retinopathy (DR) is considered the fifth leading cause of visual impairment worldwide and is associated with a huge social and economic burden.OBJECTIVE: Describe the practicality of non-mydriatic funduscopic screening photography for the detection of DR among patients with type 1 and type 2 diabetes.DESIGN: Cross-sectional hospital-based study.SETTING: Diabetes center, Riyadh.PATIENTS AND METHODS: Between July and December 2017, patients with diabetes and aged ≥18 years were selected by systematic random sampling from the University Diabetes Center. Fundoscopic eye examination was performed using the TRC-NW8 non-mydriatic camera, which performs ocular coherence tomography (OCT) to detect macular edema. Using telemedicine, pictures were graded by a retinal-specialized ophthalmologist using the international clinical DR disease severity scale. Patients were classified according to the type and severity of DR.MAIN OUTCOME MEASURES: Detection and classification of DR.SAMPLE SIZE: 978 Saudi patients with diabetes.RESULTS: Of 426 (43.5%) patients with DR, 370 had nonproliferative DR and 55 had proliferative DR. Nineteen (1.9%) had macular edema. The most important risk factors for DR were longer diabetes duration and poor glycemic control. Both older age and insulin use contributed to the higher prevalence of DR and macular edema. DR was more common among type 1 patients at 55.4% compared with 49% among type 2 patients. In addition, more females had macular edema (57.1% versus 42.9% among males). Nine patients with macular edema (47.3%) had hypertension while 154 of 426 patients with DR (36.2%) had hypertension.CONCLUSION: Non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes.LIMITATIONS: Conducted in a single center.CONFLICT OF INTEREST: None.

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Background Charcot's arthropathy (CA) is a destructive rare complication of diabetes, and its diagnosis remains challenging for foot specialists and surgeons. We aimed to assess the clinical presentation and characteristics of CA and the frequencies of its various types. Methods This cross-sectional study was conducted from January 1, 2007, to December 31, 2016, and included 149 adults with diabetes diagnosed as having CA. Cases of CA were classified based on the Brodsky anatomical classification into five types according to location and involved joints. Results The mean ± SD age of the studied cohort was 56.7 ± 11 years, with a mean ± SD diabetes duration of 21.2 ± 7.0 years. The CA cohort had poorly controlled diabetes and a high rate of neuropathy and retinopathy. The most frequent type of CA was type 4, with multiple regions involved at a rate of 56.4%, followed by type 1, with midfoot involvement at 34.5%. A total of 47.7% of the patients had bilateral CA. Complications affected 220 limbs, of which 67.7% had foot ulceration. With respect to foot deformity, hammertoe affected all of the patients; hallux valgus, 59.5%; and flatfoot, 21.8%. Conclusions There is a high rate of bilateral CA, mainly type 4, which could be attributed to cultural habits in Saudi Arabia, including footwear. This finding warrants increasing awareness of the importance of maintaining proper footwear to avoid such complications. Implementation of preventive measures for CA is urgently needed.

Background Proximal junctional kyphosis (PJK) is a common complication of long spinal fusion. The prevalence of PJK ranges between 6 and 41% and frequently requires reoperation. One of the potential causes is thought to be posterior muscle dissection within the fused range at the time of posterior fusion. Various measurement protocols have been tested to evaluate extensor muscle strength, endurance and power in adults. However, it is not universally accessible and is rarely used clinically due to the high cost, requirement for considerable user expertise, demands on the functional capacities of the patient and protracted testing time. Currently, the Biering–Sørensen test is the most widely used isometric test for assessing extensor muscle endurance. But, it was deemed unsuitable and difficult for older patients with chronic low back pain undergoing spine surgery. In this study, we designed a simple method that allows us to perform lumbar spine extensor strength tests in a comfortable seated position. This study aimed to assess the within-day and between-day reliability of this novel test for evaluating back extensor strength in healthy individuals. Methods In this study, we examined 79 healthy subjects (33 males and 46 females), who were 25–63 years of age. The subjects were placed in a seated position on the novel chair and secured tightly with a lap belt. In each session, the subjects were asked to extend their backs against the force transducer at maximum capacity, maintaining the extension for 5 seconds. The maximal force delivered over that period was recorded. The subjects had a practice trial followed by three forceful extensions with pausing intervals of 30 seconds. Measurements were obtained by one of three trained raters, and the average force of all three trials was recorded. A follow-up session was carried out within 14 days. Intra-class correlation coefficients (ICCs) were used to assess within-day and between-day reliability. Results The mean force in the initial session was 314.6±118.3 N, and it was 318.6±123.6 N in the follow-up session. The ICCs for within-day reliability and between-day reliability were 0.89 [95%CI: 0.83–0.92] and 0.88 [95% CI: 0.81–0.93], respectively. There was a strong correlation between the average measures of the initial and follow-up sessions (r = 0.80; p < 0.001; R2 = 0.62). Conclusion The use of the static dynamometer chair is a reliable, non-invasive, cost-effective test that facilitates the assessment of the strength of lumbar spine extensors in healthy adults.

Background: Posterior lumbar fusions are a common and successful procedure, yet surgical site infection (SSI) is still prevalent and causes significant morbidity. Obesity is a well-established risk factor for SSI. Still, the accuracy of the body mass index (BMI) caused some to suggest other metrics that are more representative of the thickness of the soft-tissue envelope in the surgical site.Methods: A retrospective review of all cases that developed SSI following posterior lumbar fusion over the past 5 years was done. An age and gender-matched control group was formed from the lumbar fusion cases that did not develop SSI. Demographic and clinical data were collected, and morphometric measurements of the soft-tissue envelope were performed at the level of L4 for all cases on standing x-ray imaging and magnetic resonance imaging (MRI).Results: A total of 366 patients underwent posterior lumbar fusion, 26 of whom developed SSI. BMI and skin to spinous process measurements on x-ray imaging-not MRI-were found to be significantly associated with SSI. Regression analysis further confirmed the strength of the association.Conclusion: While BMI and MRI measurements are useful, wound depth measurements on x-ray imaging can be predictive of SSI in lumbar fusion cases.Clinical Relevace: Wound depth measurements are predictive of lumbar wound infection. The information within this study can help surgeons better predict and manage infections of posterior lumbar wounds.