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Osteoporosis represents the second most common cause of endocrinopathy in patients with beta thalassemia major (BTM). Some drugs proved effective to reduce vertebral and non-vertebral fracture risk. Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor kappa B ligand (RANKL), a member of the tumor necrosis factor receptor superfamily essential for osteoclastogenesis. The efficacy and safety of denosumab in BTM-induced osteoporosis has not been tested. To evaluate the efficacy and safety of anti-RANKL on the biochemical and radiological parameters of bone mineralization in patients with BTM-induced osteoporosis. The study population was selected using the random sampling method from the patient's database of our thalassemia clinic. Transfusion-dependent BTM patients above 18 years with no history of treatment with bisphosphonates were randomly selected. Bone mineral density (BMD) of the lumbar spine (LS) and right femoral neck (FN) were measured by dual energy X-ray absorption (DEXA) scan using a calibrated method. Independent factors likely to be associated with low bone mass were determined and included in the analysis to ascertain possible associations. We studied 30 patients with BTM-induced osteoporosis as per World Health Organization criteria (T Score of less than - 1.0 being defined as osteopenic and a T Score of less than - 2.5 being referred as osteoporotic). 19 males and 11 females aged between 18 and 32 years, with full pubertal development (Tanner's stage 5) at the time of the study. Their mean serum ferritin concentration was 3557 ng ± 1488 ng/ml. Every patient underwent DEXA scan as a baseline and after 12 months of denosumab therapy. Biochemical evaluation including serum concentrations of creatinine, Na, K, calcium, phosphorus, parathormone, bone specific alkaline phosphatase and type 1 collagen carboxy telopetide (ICCT) using enzyme-linked immunosorbent assay (Nordic Bioscience Diagnostics A/S) was done at baseline, after a month and then every 3 months for 12 months after starting denosumab. 60 mg of denosumab was administered subcutaneously twice yearly for a year. The mean BMD T Scores at baseline were -2.7 at the LS and -2.1 at the FN. Denosumab therapy for a year was associated with a significant increase in BMD of 9.2% (95% confidence interval [CI], 8.2-10.1) at the LS and 6.0% (95% CI, 5.2-6.7) at the FN. Denosumab treatment decreased serum ICCT levels by 56% at 1 month and normalized them in all patients at 1 year. Significant correlations were found between BMD T Score before and 1 year after denosumab in LS (r = 0.752, P < 0.001) and FN (r = 0.758 P < 0.001), respectively. The most common side effects were pain in the back and extremities (12%) and nausea (10%). Asymptomatic hypocalcaemia occurred in two patients. Denosumab therapy for a year significantly increased BMD density at LS and FN of patients with BTM and was associated with a rapid and sustained reduction in ICCT levels. Further studies are required to confirm long-term effects of this therapy.

Bilateral elbow dislocation is a rare injury. We report a rare case of a simultaneous bilateral traumatic elbow dislocation in a 28-year-old previously healthy Kenyan female. Initial clinical assessment and plain radiographs showed the possibility of an associated fracture at the right capitulum. CT scan demonstrated bilateral fractures at the capitulum simultaneously. This case was managed conservatively through a closed reduction under procedural sedation as a joint effort of orthopedics and the emergency department. Three days later, the left above elbow backslap was removed and the patient was discharged on analgesics and referred to the outpatient clinic for regular follow-up and physiotherapy. At seven weeks, the patient reported improvement of pain bilaterally and mild stiffness at the right elbow that is continuing to improve with physiotherapy.

Background Inadequate medical record documentation poses significant risks to patient safety and care continuity. This study aimed to analyze a quality improvement project that involved the implementation of a standardized inpatient admission sheet in the Department of Pediatrics at Atbara Teaching Hospital, Sudan. The project sought to address critical gaps in documentation completeness and accuracy. Methods We assessed a one-year quality improvement project (July 2024-July 2025) involving three audit cycles with two intervening interventions comprising staff training, standardized documentation protocols, checklist prompts, and enhanced supervision. Completeness rates for 25 admission parameters were evaluated across 153 pediatric admission records (Cycle 1: n=53; Cycle 2: n=50; Cycle 3: n=50). Statistical analysis was performed using chi-square (χ²) or Fisher's exact tests with significance set at p<0.05. Results At baseline (Cycle 1), documentation deficiencies were profound, with 0% completion of data on gender, triage, family/past medical/social histories, and most physical examinations. Anthropometric measurements (e.g., height and mid-upper-arm circumference (MUAC) were documented in under 5%. Following the first intervention (Cycle 2), significant improvements occurred in gender documentation (0% to 34.0%; χ²=19.8, p<0.001), past medical history (0% to 68.0%; χ²=56.2, p<0.001), and cardiovascular examinations (7.5% to 68.0%; χ²=45.2, p<0.001). MUAC documentation increased to 20.0%. After the second intervention (Cycle 3), core demographic parameters, including name, age, gender, weight, and date, reached near-complete documentation (84.0% to 96.0%), and address and triage improved significantly. However, detailed clinical histories and system examinations regressed to 0% completion. Vital signs, allergy, and discharge status documentation remained absent across all cycles. Conclusions Implementation of standardized documentation tools combined with targeted training substantially enhanced key demographic and presenting complaint documentation in pediatric admissions. Nonetheless, sustaining comprehensive clinical history and physical examination recording remains challenging, necessitating ongoing reinforcement, simplification of documentation workflows, and potential integration of electronic solutions to ensure durable quality improvements.