STUDY DESIGN: Retrospective observational study.

OBJECTIVE: The study aims to evaluate the effects of early transfer of individuals with traumatic spinal cord injuries to a specialist

spinal injury centre, focusing on the duration of hospital and intensive care stays, as well as the incidence of medical complications.

SETTING: Regional Spinal Injuries Centre, UK.

PATIENTS AND METHODS: All patients with traumatic SCI admitted over a 4-year period to our Regional Spinal Injury Centre were

included in this study. A total of 104 patients were divided into 2 groups: those referred within 48 h (34 patients) and those referred

later after the injury but within 2 months of injury (70 patients). There were no differences in the number of patients with

tetraplegia or paraplegia or in the average age or sex between the two groups. there is no significant difference in the incidence of

associated injuries between the 2 groups.

RESULTS: Patients who were transferred early stayed less in the ICU than did those who were transferred late (9 and 25 days,

respectively; p < 0.05). The percentage of patients requiring ICU stay was also significantly lower (from 41–9%; p < 0.001); 24% of

patients in the early group had medical complications, while 45% of patients in the delayed group had these complications

(p < 0.05).The average length of hospital stay ( ± SD), including rehabilitation, in the early admission group was 121 (86.9) days,

while that in the delayed admission group was 188 (84.9) days (p < 0.0001).

CONCLUSION: Earlier admission of traumatic SCI patients to a spinal injury centre is associated with shorter acute care period,

shorter total hospital stay and reduced preventable complications.

Aim: The aim of the study was to assess the success and possible complications of closed reduction (CR) treatment of developmental

hip dysplasia (DHD) in late‑diagnosed children and explores its relation to the acetabular index (AI) measurement prior to treatment.

Patients and Methods: Twenty‑three consecutive patients with dislocated hips, 16 unilateral and 7 bilateral (30 hips), were retrospectively

included in the study. They were admitted to the specialist pediatric orthopedic unit of the University Hospital (Tripoli Medical Center) in

Tripoli, Libya. There were 21 females and 2 males with an average age at diagnosis of 17 months (range from 14 to 31 months). Their average

follow‑up period was 3 years (2–5 years), and none of them received treatment prior to diagnosis. All patients received prior inpatient skin

traction for at least 2 weeks followed by CR with soft tissue release (adductor tenotomy), hip spica applied and maintained for an average

of 3 months. Patients who had a failure of reduction or resubluxation at follow‑up went for open reduction and a reconstruction procedure.

Results: CR was successful in 27 hips (90%), failed in 3 (10%) other, the average age of the successful reduction group was 20.5 months, while

that of the open reduction group, it was 23 months (Р = 0.25). The average AI of the CR group was 39.0°, while that of the open reduction

group, it was 42.7° (Р = 0.15); 6.7% of patients with an AI of <40° had a failure of CR, while 16.7% of an AI of >40° had a failure of CR

of the hip (Р = 0.46). No complications of treatment were recorded at follow‑up. Conclusion: Staged CR of DHD in older children in the

hands of experienced specialists is still a valid means of their treatment, especially in developing countries with limited resources. There is a

relatively higher failure rate of CR, the older the child is and the higher the AI.

The incidence of spinal cord injuries is the lowest of all major trauma, with devastating impact on the individual affected. The immediate

treatment, though it remains mainly supportive, in many situations will determine the outcome and the cost of health care. Standards of care

are unfortunately still lacking, this is mainly due to the existing controversies and lack of effective treatment of the injured cord. The author

discusses here some of the controversial points based on literature review and personal observation.

Abbreviations: MP: Methyl Prednisolone; NASCIS: National Acute spinal Cord Injuries Study; SDI: Spinal Decompression in Acute

Objective: The aim of the study was to look at the long-term effects of conservative management of

odontoid peg fractures.

Methods: We reviewed 48 consecutive patients with type II (32) and 16 type III, odontoid peg fractures.

The clinical & radiological outcomes were assessed over an average period of follow up of 8 years. Union

rate was determined and we discussed several factors that may affect it. Patients were treated

conservatively with an average period of bed rest of 4 weeks followed by bracing for an average of 9

weeks.

Results: Bony unionwas established in 25 of 32 (78%) type II fractures. Of 7 cases of no bony union 4 were

stable probably with fibrous union. 3 remained unstable. In 13 of 16(83%) type III fractures bony union

was established. 2 of the 3 with no bony union were considered stable.

Conclusion: Osseous non-union was higher in patients with displacement of >5mm, but there is no

correlation between union and age, gender or angulation of the fracture in both types.

Introduction: The World Health Organization (WHO) Health Systems Framework (HSF) with its 6 building blocks is a widely accepted tool for accurate evaluation of health

systems. However, its role in the developing world has not been widely assessed yet. Methods: Six Questionnaires with 5-point Likert-scale were designed and distributed to all the attendees of Libya Health 500 (LH500) Conference, and collected just before the group discussion of Libyan health system’s session. Results: There were high levels of agreement of the respondents to the questionnaires items about the 6 building blocks. The application of evidence based medicine and equal provision of health service to all, received the highest levels of agreement. Most of the attendees agreed that health services should be paid by the health insurance system, as it has many advantages, including the peace of mind for the public. The fairness and efficiency of the workforce and the establishment of regulatory mechanisms to address the needs of the health workforce had a high level of agreement. Moreover, a functioning health technology requires an effective supply and distribution system of technology elements. The participants agreed that health information technology is important to improve healthcare services and to prevent financial and administrative corruptions. Conclusion: It is feasible to adapt the WHO-HSF to identify the needs and ways to enhance health systems in the developing world.

The Libyan healthcare providers were fully aware and committed to the need for the applicability of the WHOHSF to the National Health Service in Libya.

The extra demand imposed upon the Libyan health services during and after the Libyan revolution in 2011 led the ailing health systems to collapse. To start the planning process to re-engineer the health sector, the Libyan Ministry of Health in collaboration with the World Health Organisation (WHO) and other international experts in the field sponsored the National Health Systems Conference in Tripoli, Libya,

between the 26th and the 30th of August 2012. The aim of this conference was to study how health systems function at the international arena and to facilitate a consultative process between 500 Libyan health experts

in order to identify the problems within the Libyan health system and potential solutions. The scientific programme adopted the WHO health care system framework and used its proposesix system building blocks: i) Health Governance; ii) Health Care Finance; iii) Health Service Delivery; iv) Human Resources for Health; v) Pharmaceuticals and Health Technology; and vi) Health Information System. The experts used a structured approach starting with clarifying the concepts, evaluating the current status of that health system block in Libya, thereby identifying the strengths, weaknesses, and major deficiencies. This article summarises the 500 health expert recommendations that seized the opportunity to map a modern health systems to take the Libyan health sector into the 21st century.