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Medical education is being reshaped by two major technological disruptions: the rapid expansion of online learning since the COVID-19 pandemic and the equally rapid adoption of artificial intelligence (AI) in teaching, assessment, and clinical training. These developments are often treated as distinct phases of change. In reality, they are part of the same broader challenge: educational institutions have repeatedly adopted new technologies faster than they have developed the pedagogic, ethical, and regulatory frameworks needed to use them well. 1-3

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Dysfunctions and pain in the shoulder are a prevalent musculoskeletal condition and a key area for clinical research. This paper investigates the etiology, epidemiology, and risk factors associated with shoulder pathologies based on a data set from the Sydney Shoulder Research Institute (SSRI) that spans a cohort between the years 2015 and 2024. A cohort was retrospectively designed to analyze the demography of patients, their injury mechanisms, symptom durations, and the symptoms of joints that are associated with it. The findings pointed out that the male gender was more likely to encounter traumatic injuries when compared to the females, who reported degenerative conditions of the shoulder such as rotator cuff tendinitis. The age and symptom duration of the patients pointed to a significant correlation to chronic shoulder disorders, where above 42% experienced the symptoms for more than a year. Injury causes vary from trauma due to sports to degenerated conditions. The study pinpoints the role that hand dominance plays and the impact of contralateral shoulder and knee pathologies. Results highlighted the need for early diagnosis and

implementing of ideal management measures to handle the long-term healthcare impacts.

One of the most common problems seen in the office of a primary care physician is low back pain. Backache can have a variety of causes. The aim of this study is to assess the various etiological, occupational, and risk factors for low back pain, as well as its correlation with the patient's age, sex, and lifestyle. Materials and methods: This study collected patients from private clinics and hospitals in Libya between September and November 2024, admitted them, and treated them in the orthopedic department. Many people suffer from low back discomfort, which can be challenging to diagnose. In conclusion, orthopedists must acknowledge the diagnostic uncertainty that often accompanies this illness. The occurrence of incapacitating back pain can be significantly reduced by identifying the etiological and risk factors, the type of occupation, the origin of the pain, implementing preventive measures, and assisting patients in their recovery.

ABSTRACT Background. Hydrocephalus is a prevalent condition in children, affecting both developed and developing countries. Neurosurgical interventions such as ventriculoperitoneal shunts are common, but are associated with a high risk of complications, including infections, which can lead to additional issues and costs. This study aims to review the incidence of infection in pediatric patients before and after ventriculoperitoneal shunt placement, in order to address this issue. Methods. A standard process of analyzing scientific questions using the Population, Intervention, Control, and Outcome (PICO) method was used to develop a protocol for searching research articles in online databases such as PubMed, Cochrane, POPLINE, and Sciencedirect. The articles selected for inclusion in this study met the following criteria: 1) described interventional ventriculoperitoneal shunt placement in pediatrics, 2) focused on cases of ventriculoperitoneal shunt complications with a focus on infection, 3) were published within the last 10 years, and 4) were published in English-language journals with peer review standards. Results. Sixteen articles were identified for review. Seven of these articles mentioned surgical or mechanical interventions as a means of preventing infections, while six articles discussed medical treatment for infection prevention. Three articles described the microorganisms found in cerebrospinal fluid. Conclusion. Future studies should focus on the issues related to ventriculoperitoneal shunt complications and interventions related to immunological, neuroendocrine, and biophysical factors to prevent infections, as well as surgical management and medication administration. Keywords: infection, pediatrics, ventriculoperitoneal, shunt, cerebrospinal fluid

Ankle fracture-dislocations are complex injuries that pose significant challenges due to their association with severe functional impairments. Representing 9% of all fractures, these injuries predominantly affect young individuals experiencing high-energy trauma and elderly patients with conditions such as diabetes and osteoporosis. Younger patients are at risk of post-traumatic osteoarthritis and functional limitations, whereas older individuals often face complications such as wound infections, fixation failure, and, in severe cases, amputation. Classification systems provide a framework for categorizing fractures based on the mechanism of injury, guiding treatment decisions. Precise anatomical reduction of the talus within the ankle mortise and fibular length restoration are critical for maintaining joint congruity and preventing long-term complications.

Management strategies vary by fracture type. Posterior malleolus fractures typically benefit from surgical fixation, improving stability and reducing syndesmosis fixation requirements, while stable fractures are often managed conservatively. This review highlights the need for individualized treatment approaches to optimize recovery and minimize complications. Continued research is essential to refine fixation techniques and enhance the prognosis for patients with these challenging injuries.

Total Hip Replacement Outcomes in Alkhadra Hospital: A Retrospective Descriptive Epidemiological Study. We reviewed the outcomes of 77 total hip replacements done in Alkhadra Hospital from 1/9/1993 to 1/9/1997 using different types of prostheses and techniques. The mean age of the patients was 55 years, and the mean follow-up was four years. The most common complications were cup loosening (8%), hip dislocation (4%), and femoral neck fracture (3%). The mean hospital stay was 29 days. Our results suggest that total hip replacement is a safe and effective procedure for patients with hip arthritis in our setting. The aim of the study was to evaluate the clinical and radiological results, the complications, and the revision rates of the THR. Conclusions: The study shows that primary total hip replacement can be performed successfully in Libyan hospitals despite challenges. The complication rate and results were low, but careful patient selection, surgical technique, and follow-up are important to reduce complications and improve outcomes. Recommendation: Surgeons need proper training and resources for primary THR. A DVT prophylaxis protocol should be developed based on local risks. Further research is needed to investigate complications, risk factors, outcomes, and patient satisfaction in Libyan patients who undergo THR.

ABSTRACT Background. This case report highlights the importance of accurate diagnosis and treatment for intramedullary spinal cord hemangioma, which is a rare condition that can present with common symptoms of various spinal cord pathologies. The report recommends decompression laminectomy as the appropriate intervention for this condition. This report adds to the existing clinical literature on intramedullary spinal cord hemangioma and can assist clinicians in the diagnosis and treatment of similar cases. Case report. The patient is a 30-year-old female who complained of left leg heaviness, cramps, numbness, and urinary incontinence. MRI revealed a suspected intradural intramedullary lesion, as high as VTh5, suspected to be ependymoma or astrocytoma. The patient underwent decompressive laminectomy on thoracalis vertebra 5-7 and spinal cord mass with hemorrhage and calcification components was observed on post-operative Spinal CT Angiography. The mass was found to have a feeder artery from spinal branches of the left right a. intercostalis at T5 level and spinal branches of the left a. intercostalis at T6 level. Thoracolumbar spondylosis was also observed. Conclusion. The clinical impact of vertebral hemangioma lies in its potential to cause neurological deficits due to spinal cord or nerve root compression. Early diagnosis and treatment through imaging modalities such as MRI and surgical intervention, such as laminectomy, can alleviate symptoms and prevent disability or mortality. However, careful consideration of the patient’s clinical history, imaging findings, and neurological status is necessary for accurate diagnosis and appropriate management. Keywords: hemangioma, spinal cord capillary, intramedullary, laminectomy decompression, case reportcognitive deficits

Teachers have also begun to take note of the new technology and investigate how it affects student performance and conduct. High smartphone penetration has sparked an increase in the usage of apps by groups of teachers and their students to help the learning process by granting direct access to many online resources. In addition, engagement and satisfaction with online learning are important factors in encouraging effective educational processes Aim: In this study, we try to access students’ acceptance of free apps and social media that can be used to launch a respectable kind of distance learning for students and teachers during a pandemic or crisis. Methodology: we took 68 students registered, divided into 4 groups and the course planned to teach orthopedic surgery. The electronic questionnaire was distributed to students using the SurveyMonkey application to assess their acceptance of distance learning As a result, the students showed acceptance of the course as well as the time, material, and clarity of the course. In addition, they found the supportive materials such as videos that were delivered during the course were very useful. Conclusion: Programs for education that are less expensive than customary education programs. This technology made schooling possible. Technology is cost-effective, which is significant in nations with inadequate infrastructure.