Purpose: This study aimed to correlate the severity of carpal tunnel syndrome (CTS) in terms of the clinical picture with electrophysiological studies to determine whether the severity could be predicted through one measure based on correlations with another.Methods: This cross-sectional correlational study enrolled 96 patients (139 hands) whose nerve conduction studies (NCS) confirmed the diagnosis of CTS, and to whom the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to determine the subjective and clinical CTS severity. The severity of both measures was correlated. Results: The patients’ mean age was 49.84±12.23 years. Most (67.7%) were female. The NCS severity grades were as follows: mild, 46%; moderate, 32.4; severe, 9.4%; and very severe, 12.2%. The sensory and motor NCS parameters were significantly correlated with the BCTQ severity. The patients’ overall mean scores for symptom severity had substantive predictive accuracy for the patients’ CTS severity measured with the NCS. Similarly, most of the functional severity score items had significant predictive accuracy for the patients’ NCS-based carpal tunnel severity score.Conclusion: The clinical severity of CTS was strongly correlated with the severity based on nerve conduction. This correlation was more notable for symptom severity scores than for functional status scores. Night pain and numbness demonstrated the strongest associations of all BCTQ items with the NCS. Although clinical severity (based on the BCTQ) predicts the nerve conduction severity, we still recommend performing NCS for patients with a clinical diagnosis of CTS as a confirmatory objective measure and for medico-legal reasons.
Background. Hereditary tyrosinemia type 1 (HT1) is a recessively inherited inborn error of metabolism affecting the final step of tyrosine catabolism. The accumulation of tyrosine toxic metabolites leads to progressive hepatic, renal, and neurological manifestations. Treatment of HT1 consists of tyrosine-restricted diets and nitisinone. The untreated disease progresses into life-threatening liver failure with an increased risk of hepatocellular carcinoma. Methods. From April 2010 to March 2021, eighteen patients were diagnosed with HT1 in the metabolic department at Queen Rania Al Abdullah Hospital for Children in Jordan. Patients were reviewed retrospectively regarding their clinical features, laboratory data, and sociodemographic history. Results. The mean age of nine boys and nine girls was 6.03 years ( SD ± 3.85 ). The mean age for symptom onset was 5.61 months ( SD ± 6.02 ). However, the diagnosis was belated from the onset by 10.50 months (±10.42). Nitisinone treatment was delayed from diagnosis around 12.28 months ( SD ± 25.36 ). Most of the patients (66.7%) had acute onset of the disease. Two children (11.1%) died due to hepatic complications. Positive family history was identified in 61.1% of patients, and a similar percentage were born to parents with consanguineous marriage. The most common presentation was abdominal pain, vomiting, and fever. Hepatomegaly and abdominal distention were the most common findings. Six patients’ (42.9%) first presentation was rickets. Conclusion. HT1 diagnosis is usually delayed because it is not part of newborn screening and nonfamiliarity with the clinical features of the disease. Therefore, nationwide newborn screening should be expanded to include HT1.
Objectives: The objectives of this study were to evaluate the accuracy of the diagnosis based on the phone forwarded pelvic radiographs for developmental dysplasia of the hip (DDH) and whether to accept decisions based on phone images. Methods: Two hundred and eight pelvic radiographs (416 hips) performed for DDH screening were evaluated by three orthopedic surgeons on picture archiving and communication system (PACS) and re-evaluated by the same surgeons after receiving them blindly on their phones through the WhatsApp application. Phone pictures were evaluated on both portrait and landscape viewing interfaces. Results: Nine ossification centers (2.9%) were detected on PACS but were not noticed when evaluated on the phone due to the lower phone image quality. All dislocated and dysplastic hips were correctly diagnosed by the phone. The phone overestimated the acetabular index by about two degrees, which explains why 4.8% and 7.5% of normal hips on PACS viewers were labeled dysplastic once evaluated on phone portrait and landscape viewers, respectively. However, landscape phone viewing and smaller phone screens were associated with a higher overestimation of the acetabular index. Conclusion: The phone is a valuable and safe tool for diagnosing DDH from pelvic radiographs. However, a precaution should be taken in borderline cases as the phone overestimated hip angles resulting in a misdiagnosis of normal hips as dysplastic. However, we do not recommend or encourage this practice because clinical evaluation is essential in any clinical decision-making.
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