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Objectives The objectives of this study were: (1) to compare the incidence of effective orifice area (EOA) after either the trans-catheter and surgical aortic valve replacement (SAVR); and (2) to assess the impact of EOA on life style modifications and mortality recorded after either surgical or trans-catheter aortic valve replacement. Trans-catheter aortic valve replacement (TAVR) has emerged as a valid alternative to SAVR in selected patients. It appears important to implement preventive strategies to avoid prosthesis failure without increasing operative risk. Methods A case series of 148 consecutive patients from January 2023 to January 2025 with severe aortic valve stenosis. The patients were randomized into two groups as trans-catheter aortic valve replacement (TAVR as group A) and surgical aortic valve replacement (SAVR as group B). The Echocardiography was done pre- and postoperatively, plus scales of life activities in the follow-up period (6 months and one year). Results In this study, a total of 148 patients were studied to determine the outcomes of patients who underwent either trans-catheter or surgical aortic valve replacement in terms of demographic, operative, and postoperative variables. There were significant improvement in Echo findings after 6 months and one year. In the other side, there were no significant differences comparing both groups according to quality of life parameters. Conclusions In patients with severe aortic stenosis and high surgical risk, EOA is good indicator for the success of SAVR than TAVR. TAVR may be preferable to SAVR in patients with better life style modifications.

Study DesignNon-inferiority randomized controlled study.ObjectivesPedicle screws are the standard for thoracic and lumbar spine fixation. Various guidance techniques exist for optimal screw placement, among which three-dimensional (3D) navigation is regarded as one of the most accurate. The marker screw (MS) technique has been proposed as a method for defining entry points and trajectories. This study compares the accuracy of pedicle screw placement using the MS technique vs that of 3D-navigation.MethodsThe study was conducted in a tertiary center, where patients undergoing thoracic and lumbar spine pedicle instrumentation were assessed. Patients with deformities, tumors, and infections were excluded. Informed consent was obtained. Candidates were assigned to a guidance method by randomly withdrawing a sealed envelope. A computed tomography scan was obtained postoperatively, and the accuracy of pedicle screw placement was assessed and compared between the two groups. The Gertzbein and Robbins system was used to assess pedicle breach.ResultsForty-six patients (23 MS and 23 navigation) received a total of 266 pedicle screws (146 MS and 120 navigation). Baseline demographics and surgical parameters were comparable between groups. Overall accuracy was 94.5% in the MS group vs 99.1% in the navigation group ( .04). However, MS accuracy was not inferior to navigation and within the non-inferiority margin. No neurologic or vascular complications were attributed to screw misplacement.ConclusionsThe MS technique achieved high placement accuracy with no breach-related complications. Given its safety profile, lower cost, and broader availability, the MS guidance technique represents a viable alternative.

Congenital talipes equinovarus (CTEV), continues to rank among the most common congenital musculoskeletal deformities. The management of CTEV, particularly when it is part of a syndromic presentation or associated with conditions such as myelomeningocele (MMC), presents a significant challenge due to the deformity's tendency to be stiffer and more complex. Most children with CTEV may require surgical intervention. The current case report highlights the functional outcome of minimally invasive percutaneous surgical correction in a late-presenting, rigid, and severe foot deformity in an MMC patient, aiming to have accepted residual deformity that gave better function with less surgical complication. A case involving an eight-year-old girl having a deformity in her left foot secondary to low lumbar level MMC was referred for management. The Pirani score total was 6, signifying a severe deformity according to received initial assessments. Upon review of treatment alternatives, minimally invasive percutaneous surgical correction was performed consisting of percutaneous plantar fascia release followed by Achilles tendon lengthening and flexor digitorum tenotomy. We followed up with the patient for one year for wound healing and functional outcomes. An early weight bearing in cast was achieved 1 week with walker frame. Removal of cast and application of custom walker orthosis for walking on the 6th week post-operation. Following up to one year, she is a walker, and residual deformity of the foot did not affect her mobilization. As of the one-year follow-up, she is self-ambulatory, thanks to her custom walking orthosis. Residual deformity did not affect her functional outcome. We recommend further follow-up, and future surgery may be necessary if her deformity worsens. The functional outcome, the social and economic status of the family, and the psychological impact on the patient significantly influence the selection of the most suitable method.

Background Upper gastrointestinal endoscopy often causes discomfort and anxiety, requiring effective sedation to ensure patient comfort and procedural safety. This study compared the efficacy and safety of Midazolam and Fentanyl versus Dexmedetomidine and Fentanyl sedation during upper endoscopy, it was conducted as a preliminary investigation to guide the design of a future definitive trial. Methods A prospective pilot study was conducted at An-Najah National University Hospital, Palestine, from October 2021 to January 2022. Sixty-eight ASA I and II outpatients aged 18–60 years were assigned to receive either Dexmedetomidine (0.3 mcg/kg) or Midazolam (0.05 mg/kg), both with Fentanyl (1 mcg/kg). Sedation depth was assessed using the Ramsay Sedation Scale (RSS) and recovery by the Post-Anesthesia Recovery Score (PARS). All procedures were performed by the same endoscopist; sedation was administered by an independent anesthesiologist. Results Dexmedetomidine led to significantly higher patient and endoscopist satisfaction, shorter recovery time (9.5 ± 1.1 vs. 22.4 ± 7.7 min, p  < 0.05), and reduced anxiety and discomfort. Adverse effects were fewer but not significantly different. Vital signs remained stable in both groups. Conclusion Dexmedetomidine and Fentanyl offers a more effective and better-tolerated sedation option than Midazolam and Fentanyl for upper endoscopy, with higher satisfaction and faster recovery.

Total traumatic extrusion of the talus is a rare and disabling ankle injury. Treatment may include talar reimplantation or talar body removal, but an optimal treatment protocol has not yet been established. Several case reports showed that disruption of the vascular supply and contamination could lead to major complications, such as infection and avascular necrosis, with the high risk of these complications being associated with both the traumatic ankle injury itself and subsequent talar reimplantation. No report to date has described the revascularization of a completely extruded talus, as shown by serial MRI, a less invasive surgical strategy consisting of immediate reimplantation, early administration of antibiotics, and a short period of cast immobilization followed by early motion exercises. The present study describes complete revascularization and good clinical outcomes in a 30-year-old man who underwent talus reimplantation after isolated total talar extrusion.

The healthcare system of Saudi Arabia is going through some major shifts 2030 due and to its the exemplary implementation efforts of towards Vision enhancing the quality, innovation and paper accessibility aims of at the discussing healthcare how system. training This programs can be brought sector in to harmony bridge with the the existing current gaps, development incorporate in technologies the and health foster care collaborative practices. Through focusing on the development of the workforce, Saudi Arabia will be able to develop a competent and resilient healthcare workforce that is capable of delivering person centered healthcare as well as address the nations’ healthcare concerns.