Search results for: late complications

Authors: Bradley Fevrier

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Background: Type 2 diabetes mellitus, a non-communicable metabolic disorder, is a fast-growing problem for health, as it presents numerous complications and death worldwide. St. Lucia, much like most other emerging nation in the Caribbean, struggles with the management of type 2 diabetes mellitus (T2DM) among its populace. Good knowledge, attitude, and practices [KAP] of T2DM are essential in the prevention and management of this disease.Lifestyle adaptation, including increased knowledge, positive attitude, and efficient practice towards lifestyle modifications, can avert the advancement of difficulties associated with diabetes. Methods: An institutional-based cross-sectional study was conducted during the period June 15, 2022, to July15 2022. Data were collected by using the self-administered questionnaire designed to collect the required information from participants, and the data wasanalyzed using the statistical package for social science (SPSS) version 26. Knowledge, attitude, and practice of lifestyle modification among participants were determined using descriptive statistics. Results: A total of 402 participants completed the study, fully yielding an 84% response rate. Overall, the assessed levels of KAP relating to the life-threatening complications of T2DM were moderate. Results further indicated that women outnumbered men 68.4% to 31.6%, respectively. Significant positive correlation (r= 0.244, p<0.001) and (r=.203, p<0.001) were found between the knowledge level as well as the attitude level of study respondents. Conclusion: The overall study findings regarding the level of knowledge and attitude concerning lifestyle modifications among study participants were interpreted as generally high. However, the practice of healthy lifestyle modification habits was poor. The current findings suggest a need for structured educational campaigns prioritizing the importance of lifestyle modifications (weight loss, smoking cessation, physical exercise) to the general population.

Keywords: Diabetes, knowledge, lifestyle, survey

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Authors: Vanessa Bennemann, Gabriela Laste, Márcia Inês Goettert

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The gestational period is a phase in which the pregnant woman undergoes constant physiological and hormonal changes, which are part of the woman’s biological cycle, the development of the fetus, childbirth, and lactation. These are factors of response to the immunological adaptation of the human reproductive process that is directly related to the pregnancy’s well-being and development. Although most pregnancies occur without complications, about 15% of pregnant women will develop potentially fatal complications, implying maternal and fetal risk. Therefore, requiring specialized care for high-risk pregnant women (HRPW) with obstetric interventions for the survival of the mother and/or fetus. Among the risk factors that characterize HRPW are the women's age, gestational diabetes mellitus (GDM), autoimmune diseases, infectious diseases such as syphilis and HIV, hypertension (SAH), preeclampsia, eclampsia, HELLP syndrome, uterine contraction abnormalities, and premature placental detachment (PPD), thyroid disorders, among others. Thus, pregnancy has an impact on the thyroid gland causing changes in the functioning of the mother's thyroid gland, altering the thyroid hormone (TH) profiles and production as pregnancy progresses. Considering, throughout the gestational period, the interpretation of the results of the tests to evaluate the thyroid functioning depends on the stage in which the pregnancy is. Thyroid disorders are directly related to adverse obstetric outcomes and in child development. Therefore, the adequate release of TH is important for a pregnancy without complications and optimal fetal growth and development. Objective: Investigate the physiological effects caused by thyroid disorders in the gestational period. Methods: A search for articles indexed in PubMed, Scielo, and MDPI databases, was performed using the term “AND”, with the descriptors: Pregnancy, Thyroid. With several combinations that included: Melatonin, Thyroidopathy, Inflammatory processes, Cytokines, Anti-inflammatory, Antioxidant, High-risk pregnancy. Subsequently, the screening was performed through the analysis of titles and/or abstracts. The criteria were: including clinical studies in general, randomized or not, in the period of 10 years prior to the research, in the English literature; excluded: experimental studies, case reports, research in the development phase. Results: In the preliminary results, a total of studies (n=183) were found, (n=57) excluded, such as studies of cancer, diabetes, obesity, and skin diseases. Conclusion: To date, it has been identified that thyroid diseases can impair the fetus’s brain development. Further research is suggested on this matter to identify new substances that may have a potential therapeutic effect to aid the gestational period with thyroid diseases.

Keywords: pregnancy, thyroid, melatonin, high-risk pregnancy

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Authors: Perdana Rakhmana Putra, Hansen Wijaya, Sri Budiyani, Muhamad Natsir, Alexis badai Samudra

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The Palembang Sub-Basin (PSB) located in southern part of South Sumatera basin (SSB) consist of half-graben complex trending N-S to NW-SE. These geometries are believe as an impact of strike-slip regime developed in Eocene-Oligocene. Generally, most of the wells in this area produced hydrocarbon from late stage of syn-rift sequences called Lower Talang Akar (LTAF) and post-rift sequences called Batu Raja Formation (BRF) and drilled to proved hydrocarbon on structural trap; three-way dip anticline, four-way dip anticline, dissected anticline, and stratigraphy trap; carbonate build-up and stratigraphic pinch out. Only a few wells reached the deeper syn-rift sequences called Lahat Formation (LAF) and Lemat Formation (LEF). The new interpretation of subsurface data was done by the tectonostratigraphy concept and focusing on syn-rift sequence. Base on seismic characteristic on basin centre, it divided into four sequences: pre-rift sequence, rift initiation, maximum rift and late rift. These sequences believed as a new exploration target on PSB mature basin. This paper will demonstrate the paleo depositional setting during Paleogene and exploration play concept of syn-rift sequence in PSB. The main play for this area consists of stratigraphic and structure play, where the stratigraphic play is Eocene-Oligocene sediment consist of LAF sandstone, LEF-Benakat formation, and LAF with pinch-out geometry. The pinch-out, lenses geometry and on-lap features can be seen on the seismic reflector and formed at the time of the syn-rift sequence. The structural play is dominated by a 3 Way Dip play related to reverse fault trap.

Keywords: syn-rift, tectono-stratigraphy, exploration play, basin center play, south sumatera basin

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Authors: Sandrieli Afornali, Adriano Keijiro Maeda, Renato Fedatto Beraldo, Carlos Alberto Mattozo, Ricardo Nascimento Brito

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BACKGROUND: The most used variety in hydrocephalus treatment is the ventriculoperitoneal shunt (VPS). However, it may fails in 20 to 70% of cases. It makes necessary to have alternative cavities for the implantation of the distal catheter. Ventriculo-atrial shunting (VAS) is described as the second option. To our knowledge, there are 121 reported cases of VGB shunt in children until 2020 and a highly variable success rate, from 25 to 100%, with an average of 63% of patients presenting good long-term results. Our goal is to evaluate the epidemiological profile of patients submitted to ventriculo-gallbladder (VGB) shunt and, through a review of literature, to compare our results with others series. METHODS: a retrospective cross-sectional observational study of a case series of nine patients. The medical records of all patients were reviewed, who underwent VGB shunt at the Hospital Pequeno Príncipe from Curitiba, Paraná, Brazil, from January 2014 to October 2022. The inclusion criteria were: patients under 17 years of age with hydrocephalus of any etiology, currently using or prior to VGB shunt. RESULTS: There were 6 (66,7%) male and 3 (33,3%) female. The average age of 73.6 months or 6.1 years at the time of surgery. They were submitted on average 5.1 VPS reviews previous to VGB shunt. Five (55,5%) had complications of VGB shunt: infection (11.1%), atony (11.1%), hypodrainage due to kinking the distal catheter in the solution (11.1%) and ventriculoenteric fistula (22.2%); all these patients were cured at surgical reapproach, and in 2 of them the VGB shunt was reimplanted. Two patients died (22.2%), and five (55,5%) patients maintained the use of VGB shunt in the follow-up period; and in 4 (44.4%) there was never need for review. CONCLUSION: VGB shunt tends to be underestimated because it is still unconventional and little publicized in literature. Our article shows a lower risk of death and similar risk of complications when compared to others altenatives shunts. We emphasize VGB shunt as a safe procedure to be the second option when VPS fails or has contraindications.

Keywords: hydrocephalus, ventricular-gallbladder shunt, VGB shunt, VPS, ventriculoperitoneal shunt, ventriculoatrial shunt

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Authors: Monika Michałowska, Anna Alichniewicz

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Detrimental outcomes of advanced maternal age on the chances of fertilization, pregnancy as well as mother and fetus health have been recognized for several decades. It seemed interesting to investigate whether there is a comparable awareness of the detrimental influence on the reproductive outcomes of late fatherhood, given that it has been already ten years since an intense and growing interest concerning later-age fatherhood commenced in medical research. To address that issue a two-step research was done. First, we performed a review of the subject literature to answer the following questions: 1) What age is defined as advanced?; 2) Is the same age defined as advanced in both genders?; 3) What terminology concerning age issues is used?; 4) Is the same age terminology used regarding both genders? The second part of our studies was devoted to the views of medical students. This part of our research comprised both quantitative and qualitative studies. Opinions of medical students in one of the Polish medical universities on several issues connected with assisted reproduction technology (ART) were gathered: 1) students’ attitude to in vitro fertilization (IVF) for women over 40 and for postmenopausal women; 2) students’ attitude to late fatherhood; 3) students’ reasoning given against acceptability of IVF procedure for all of these group of patients involved in an IVF procedure. Our analyses revealed that: First, there is no universal definition of the term ‘advanced age’; secondly, there is a general tendency to adopt different age limits depending on whether they refer to maternal or paternal age, but no justification is provided by the researchers explaining why they set different age limits for women and men; thirdly, the image of postponed fatherhood stands in stark contrast to postponed motherhood - while postponed fatherhood is frequently portrayed as a reasonable and conscious decision enabling a stable family environment for a child, the reasonableness of postponed motherhood is often questioned; finally, the bias regarding maternal versus paternal age is deeply embedded in medical students’ attitude to IVF for women over 40 and for postmenopausal women.

Keywords: gender stereotypes, reproductive medicine, maternal age, paternal age

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Authors: Mutwakil Nafi, Abed Elaziz El Amein, Muna El Dawi, Khalafala Salih, Osma Elbahi, Abed Elhalim Abou

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Recently a large deposit of oolitic iron ore of Late Carboniferous-Permotriassic-Lower Jurassic age was discovered in Wadi Halfa and Argein areas, North Sudan. It seems that the iron ore mineralization exists in the west and east bank of the River Nile of the study area that are found on the Egyptian-Sudanese border. The Carboniferous-Lower Jurassic age strata were covered by 67 sections and each section has been examined and carefully described. The iron-ore in Wadi Halfa occurs as oolitic ironstone and contained two horizons: (A) horizon and (B) horizon. Only horizon (A) was observed in southern Argein area. The texture of the ore is variable depending on the volume of the component. In thin sections the average of the ooids were ranged between 90% - 80%. The matrix varies between 10%-20% by volume and detritus quartz in other component my reach up to 30% by volume in sandy massive ore. Ooids size ranges from 0.2mm-1.00 mm on average in very coarse ooids may attend up to 1 mm in size. The matrix around the ooids is dominated by iron hydroxide, carbonate, fine and amorphous silica. The probable ore reserve estimate of 1.234 billion at a head grade of 41.29% Fe for the Wadi Halfa Oolitic Ironstone Formation. The iron ore shows higher content of phosphorus ranges from 6.15% to 0.16%, with mean 1.45%. The new technology Hatch–Ironstone Chloride Segregation (HICS) can be used to produce commercial-quality of iron and reduce phosphorus and silica to acceptable levels for steel industry. The development of infra structures and presence huge quantity of iron ore would make exploitation of the iron ore economic.

Keywords: HICS, Late Carboniferous age, oolitic iron ore, phosphorus

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Authors: Himanshu Rohela

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BACKGROUND: Ewing sarcoma can arise in either bone or soft tissue. Extraskeletal Ewing sarcoma (EES) is an uncommon primary tumor of the soft tissues, accounting for 20 30% of all reported cases of ES. AIM: Was to investigate demographic distribution, survival analysis and factors affecting the survival and recurrence in patients of EES. METHODS: Retrospective study of 19 biopsy-proven EES was performed. Overall survival (OS) using log-rank test and factors affecting OS and local recurrence (LR) were evaluated for the entire cohort. RESULTS: Patients with EES had a mean age of 19.5 and it was more commonly seen in males (63%). Axial location (58%) and solitary presentation (84%) were more common. The average size was 11 cm, 3 of 19 were metastatic at presentation, with the lung beings the most common site for metastasis. 17 received NACT, 16 with VAC-IE regimen and 1 underwent a second line with GEM/DOCE regimen. Unplanned surgery was done in 2 of 19. 3 patients received definitive RT and 13 underwent surgical-wide local excision. 2 of 13 showed good response to NACT. 10 patients required readmission out of which 6 patients had chemotherapy-related complications, 2 had surgical site complications and one patient developed secondary AML post-completion of treatment. A total of 4 patients had a recurrence. One had local recurrence alone, one had distant recurrence alone and 2 patients had a distant and local recurrence both. Tumor size >10 cm, axial location, and previous unplanned surgery was associated with higher LR rate. The mean overall survival was 32 months (2.66 years), with higher rates seen in non-metastatic and non-recurrent settings. CONCLUSIONS: Early and accurate diagnosis is the key to the management of EES, with promising results seen via NACT and RO resection regimens. But further studies with larger study groups are needed to standardize the treatment protocol and evaluate its efficacy.

Keywords: Ewings, sarcoma, extraskeletal, chemotherapy

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Authors: Ali D. El-mehdawi, Ibrahim E. Elkanouni

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Thick pre-Upper Cretaceous sandstones, sandstones intercalated with red/black shale or quarzitic sandstones, traditionally known to range in age from Cambrian to Early Cretaceous, mostly overlie the subsurface basement rocks of the Sirt Basin of Libya. These sediments known as Nubian, Sarir, Amal or Cambro-Ordovician sandstones. They are usually barren of any age datable palynomorphs and microfossils and represent the main hydrocarbon reservoirs in the basin. As a part of an ongoing regional project concerned with revision and updating of the stratigraphic nomenclature of the Sirt Basin and adjacent areas, sixteen core and ditch cutting samples from four wells penetrating the known Cambro-Ordovician sediments in the central and eastern parts of the basin were examined palynologicaly to investigate its age and the depositional paleoenvironment. The samples proved to be barren or yielded rare palynomorph assemblage, which dominated by dark grey to black small and large-sized sphaeromorph acritarchs assemblage of leiosphaerid types. The dominated species are Kildinosphaera chagrinata, K. cf. chagrinata, Kildinella ripheica, Kilinella timanica, Leiosphaeridia asperata and Leiosphaeridia spp. These leiosphaerides assemblage are comparable to those have been reported from the Late Precambrian, late Riphean age in Cyrenaica Platform, NE Libya, and would indicated shallow marine depositional environment. The age assignment suggests that this interval most probably equates to Mourizide, Bir Bayai and Wadi alHayt formations known in the Murzuq, Kufrah and Cyrenaica areas, respectively. This study proves the presence of Precambrian sediments in Jaghbub high and Amal Platform in the eastern part of Sirt Basin and probably in Maradah Trough and Aj Jahamah/Zoltun Platform northwestern part of the Sirt Basin.

Keywords: palynology, leiosphaerides, precambrian, sirt basin, libya

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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Authors: Murat Emre, Zeynep Tufekcioglu

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Objective: We describe a patient with late onset phenylketonuria which presented with rapidly progressive dementia and parkinsonism that were reversible after management. Background: Phenylketonuria is an autosomal recessive disorder due to mutations in the phenylalanine hydroxlase gene. It normally presents in childhood, in rare cases, however, it may have its onset in adulthood and may mimic other neurological disorders. Case description: A previously normal functioning, 59 year old man was admitted for blurred vision, cognitive impairment and gait difficulty which emerged over the past eight months. In neurological examination he had brisk reflexes, slow gait and left-dominant parkinsonism. Mini-mental state examination score was 25/30, neuropsychological testing revealed a dysexecutive syndrome with constructional apraxia and simultanagnosia. In cranial MRI there were bilateral diffuse hyper-intense lesions in parietal and occipital white matter with no significant atrophy. Electroencephalography showed diffuse slowing with predominance of teta waves. In cerebrospinal fluid examination protein level was slightly elevated (61mg/dL), oligoclonal bands were negative. Electromyography was normal. Routine laboratory examinations for rapidly progressive dementia and parkinsonism were also normal. Serum amino acid levels were determined to explore metabolic leukodystrophies and phenylalanine level was found to be highly elevated (1075 µmol/L) with normal tyrosine (61,20 µmol/L). His cognitive impairment and parkinsonian symptoms improved following three months of phenylalanine restricted diet. Conclusions: Late onset phenylketonuria is a rare, potentially reversible cause of rapidly progressive parkinsonism with dementia. It should be considered in the differential diagnosis of patients with suspicious features.

Keywords: dementia, neurology, Phenylketonuria, rapidly progressive parkinsonism

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Authors: C. Hall, J. Ramos, V. Ramasamy

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Hydrocarbon-based fuel vehicles are a major contributor to air pollution due to harmful emissions produced, leading to a demand for cleaner fuel types. A leader in this pursuit is hydrogen, with its application in vehicles producing zero harmful emissions and the only by-product being water. To compete with the performance of conventional vehicles, hydrogen gas must be stored on-board of vehicles in cylinders at high pressures (35–70 MPa) and have a short refueling duration (approximately 3 mins). However, the fast-filling of hydrogen cylinders causes a significant rise in temperature due to the combination of the negative Joule-Thompson effect and the compression of the gas. This can lead to structural failure and therefore, a maximum allowable internal temperature of 85°C has been imposed by the International Standards Organization. The technological solution to tackle the issue of rapid temperature rise during the refueling process is to decrease the temperature of the gas entering the cylinder. Pre-cooling of the gas uses a heat exchanger and requires energy for its operation. Thus, it is imperative to determine the least amount of energy input that is required to lower the gas temperature for cost savings. A validated universal thermodynamic model is used to identify an energy-efficient pre-cooling strategy. The model requires negligible computational time and is applied to previously validated experimental cases to optimize pre-cooling requirements. The pre-cooling characteristics include the location within the refueling timeline and its duration. A constant pressure-ramp rate is imposed to eliminate the effects of rapid changes in mass flow rate. A pre-cooled gas temperature of -40°C is applied, which is the lowest allowable temperature. The heat exchanger is assumed to be ideal with no energy losses. The refueling of the cylinders is modeled with the pre-cooling split in ten percent time intervals. Furthermore, varying burst durations are applied in both the early and late stages of the refueling procedure. The model shows that pre-cooling in the later stages of the refuelling process is more energy-efficient than early pre-cooling. In addition, the efficiency of pre-cooling towards the end of the refueling process is independent of the pressure profile at the inlet. This leads to the hypothesis that pre-cooled gas should be applied as late as possible in the refueling timeline and at very low temperatures. The model had shown a 31% reduction in energy demand whilst achieving the same final gas temperature for a refueling scenario when pre-cooling was applied towards the end of the process. The identification of the most energy-efficient refueling approaches whilst adhering to the safety guidelines is imperative to reducing the operating cost of hydrogen refueling stations. Heat exchangers are energy-intensive and thus, reducing the energy requirement would lead to cost reduction. This investigation shows that pre-cooling should be applied as late as possible and for short durations.

Keywords: cylinder, hydrogen, pre-cooling, refueling, thermodynamic model

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Authors: Danute Jablonskyte-Rasce, Laura Masilionyte

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The field experiments of different farming systems were conducted at Joniškėlis Experimental Station of the Lithuanian Research Centre for Agriculture and Forestry in 2006–2016. The soil of the experimental site was Endocalcari-Endohypogleyic Cambisol (CMg-n-w-can). The research was designed to identify the effects of dry matter and nitrogen accumulated in the above-ground biomass of various catch crops grown after winter wheat on soil mineral nitrogen variation during the autumn and spring period in the presence of intensive leaching complex. Research was done in the soil differing in humus status in the organic and sustainable cropping systems by growing various plant mixtures as catch crops: narrow-leafed lupine (Lupinus angustifolius L.) and oil radish (Raphanus sativus var. Oleifera L.), white mustard (Sinapis alba L.) and buckwheat (Fagopyrum exculentum Moench.) and white mustard as a sole crop. All crop and soil management practices have shown optimal efficiency in late autumn – stubble breaking, catch crops and straw used during the post-harvest period of the main crops, reduced Nmin migration into deeper (40–80 cm) soil layer. The greatest Nmin reduction in the 0–40 cm soil layer during the period from late autumn to early spring was identified in the sustainable cropping system having applied N30 for the promotion of straw mineralization and with no catch crops cultivation. The sustainable cropping system, having applied N30 for straw mineralization and growing white mustard in combination with buckwheat as catch crops, Nmin difference in the spring compared with its status in the autumn in the soil low and moderate in humus was lower by 70.1% and 34.2%, respectively.

Keywords: soil nitrogen, catch crops, ecological and sustainable farming systems, Cambisol

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Authors: V. N. Chebotkevich, E. E. Schetinkina, V. V. Burylev, E. I. Kaytandzhan, N. P. Stizhak

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Objective: Blood stream infections (BSI) are severe, life-threatening illness for immuno compromised patients with hematological malignancies. We report the trend in blood-stream infections in this group of patients in the period 1991-2013. Methods: A total of 4742 blood samples investigated. All blood cultures were incubated in a continuous monitoring system for 7 days before discarding negative. On signaled positive, organism was identified by conventional methods. The Real-time polymerase chain reaction (PCR) was used for the indication of human herpes virus 6 (HHV-6), Cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Results: Between 1991 and 2001 the incidence of Gram-positive bacteria (Staphylococcus epidermidis, Staphylococcus aureus) being the most common germs isolated (70,9%) were as Gram-negative rods (Escherichia coli, Klebsiella spp., Pseudomonas spp.) – 29,1%. In next decade 2002-2012 the number of Gram-negative bacteria was increased up to 40.2%. It is shown that the incidence of bacteremia was significantly more frequent at the background of detectable Cytomegalovirus and Epstein-Barr virus-specific DNA in blood. Over recent years, an increased frequency of micro mycetes was registered in blood of the patients with hematological malignancies (Candida spp. was predominant). Conclusion: Accurate and timely detection of BSI is important in determining appropriate treatment of infectious complications in patients with hematological malignancies. The isolation of Staphylococcus epidermidis from blood cultures remains a clinical dilemma for physicians and microbiologists. But in many cases this agent is of the clinical significance in immunocompromised patients with hematological malignancies. The role of CMV and EBV in development of bacteremia was demonstrated.

Keywords: infectious complications, blood stream infections, bacteremia, hemoblastosis

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Authors: Naim Izet Kajtazi

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Context: Although rare, glomus tumor (i.e., nonchromaffin chemodectomas and paragan¬gliomas) is the most common middle ear tumor, with female predominance. Pre-operative embolization is often required to devascularize the hypervascular tumor for better surgical outcomes. Process: A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor, compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Outcome: Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist. Relevance: This case highlights the complex nature of these tumors, which often bring challenges to the patients as well as treatment teams. The multi-disciplinary team approach is necessary to tailor the management plan for individual tumors. Although embolization is a safe procedure, careful attention and thoughtful anatomic knowledge regarding dangerous anastomosis are essential to avoid devastating complications. Complications occur due to encountered vessel anomalies and new anastomoses formed during the gluing and changes in hemodynamics.

Keywords: stroke, embolization, MRI brain, cerebral angiogram

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Authors: Khaled M. Ali, Ayman A. Mostafa, Soliman M. Soliman

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Objectives: To describe the most common clinical and endoscopic findings associated with complicated corneal ulcers in cats, and to determine the short-term outcomes after surgical treatment of these cats. Animals Eighteen client-owned cats of different breeds (52 females and 28 males), ranging in age from 3 months to 6 years, with corneal ulcers. Procedures: Cats were clinically evaluated to initially determine the concurrent corneal abnormalities. Endoscopic examination was performed to determine the anterior and posterior segments abnormalities. Superficial and deep stromal ulcers were treated using conjunctival flap. Corneal sequestrum was treated by partial keratectomy and conjunctival flap. Anterior synechia was treated via peripheral iridectomy and separation of the adhesion between the iris and the inner cornea. Symblepharon was treated by removal of the adhered conjunctival membrane from the cornea. Incurable endophthalmitis was treated surgically by extirpation. Short-term outcomes after surgical managements of selected corneal abnormalities were then assessed clinically and endoscopically. Results: Deep stromal ulcer with descemetocele, endophthalmitis, symblepharon, corneal sequestration and anterior synechia with secondary glaucoma and corneal scarring were the most common complications of corneal ulcer. FHV-1 was a common etiologic factor of corneal ulceration. Persistent corneal scars of varying shape and size developed in cats with deep stromal ulcer, anterior synechia, and corneal sequestration. Conclusions: Domestic shorthaired and Persian cats were the most predisposed breeds to FHV-1 infection and subsequent corneal ulceration. Immediate management of patients with corneal ulcer would prevent serious complications. No age or sex predisposition to complicated corneal ulceration in cats.

Keywords: cats, complicated corneal ulceration, clinical, endoscopic diagnosis, FHV-1

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Authors: Rajkumar Ghosh

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Out-of-sequence thrusts (OOST) are reported at different geographic locations with various local names along Siwalik Himalaya (SH), Lesser Himalaya (LH), Higher Himalaya (HH) from Bhutan, India, Nepal, and Pakistan Himalayan range. Most of OOSTs have been identified within the upper LH, and the lower HH based on geochronological age jump across. These thrusts activated from Late Miocene to recent. The Chaura Thrust (CT) was deciphered from age jump of Apatite Fission Track (AFT) and considered as blind thrust base on variable exhumation rates in Chaura region, Satluj river valley, Himachal Pradesh. CT is located north of Jhakri Thrust (JhT) and is also differently identified as Sarahan thrust (ST). Structural documentation from the rocks near the OOST in Chaura was not so far done. Detail structural study of the Jeori Group of rocks was carried out in this study to understand the manifestation of the Chaura thrust and associated structures in meso- to micro-scale. Box fold, scar fold, kink fold, crenulation cleavages, and boudins are developed in the Chaura region. These structures usually do not indicate shear sense. When studied under an optical microscope, the Chaura samples reveal that the mica fish are usually lenticular with aspect ratio (R) varying from 6–11 and inclination angle (α) from 15–40°. According to ‘R’ and ‘α’, elongated sigmoid shaped mica fish and parallelogram shaped mica fish were also documented. Asymmetric mica fish demonstrate top-to-S/SW ductile shear, which is similar as that of Chaura thrust. Grain boundary migration (GBM) structures in quartzo-feldspathic grains from Jeori Group of rocks indicate deformation temperature ranging from 400 to 650°C. This can indicate that the OOST at Chaura, i.e., the Chaura Thrust, underwent thrusting in the ductile regime.

Keywords: out-of-sequence thrust, chaura thrust, sarahan thrust, jakhri thrust, higher himalaya, s/c- fabric

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Authors: Prabir Patel, Eugene Ming Han Lim

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Introduction: Current literature shows that postoperative pulmonary complications following abdominal surgery may be reduced by using lower than conventional tidal volumes intraoperatively together with moderate levels of positive end expiratory pressure (PEEP). The recent studies demonstrated significant reduction demonstrated significant reduction in major complications in elective abdominal surgery through the use of lower tidal volumes (6-8 ml/kg predicted body weight), PEEP of 5 cmH20 and recruitment manoeuvres compared to higher ‘conventional’ volumes (10-12 mls/kg PBW) without lung recruitment. Our objective was to retrospectively audit current practice for patients undergoing major abdominal surgery in Sir Charles Gairdner Hospital. Methods: Patients over 18 undergoing elective general surgery lasting more than 3 hours and intubated during the duration of procedure were included in this audit. Data was collected over a 6 month period. Patients who had hepatic surgery, procedures necessitating one-lung ventilation, transplant surgery, documented history of pulmonary or intracranial hypertension were excluded. Results: 58 suitable patients were identified and notes were available for 54 patients. Key findings: Average peak airway pressure was 21cmH20 (+4), average peak airway pressure was less than 30 cmH20 in all patients, and less than 25 cmH20 in 80% of the cases. PEEP was used in 81% of the cases. Where PEEP was used, 75% used PEEP more than or equal to 5 cmH20. Average tidal volume per actual body weight was 7.1 ml/kg (+1.6). Average tidal volume per predicted body weight (PBW) was 8.8 ml/kg (+1.5). Average tidal volume was less than 10 ml/kg PBW in 90% of cases; 6-8 ml/kg PBW in 40% of the cases. There was no recorded use of recruitment manoeuvres in any cases. Conclusions: In the vast majority of patients undergoing prolonged abdominal surgery, a lung protective strategy using moderate levels of PEEP, peak airway pressures of less than 30 cmH20 and tidal volumes of less than 10 cmH20/kg PBW was utilised. A recent randomised control trial demonstrated benefit from utilising even lower volumes (6-8 mls/kg) based on findings in critical care patients, but this was compared to volumes of 10-12 ml/kg. Volumes of 6-8 ml/kg PBW were utilised in 40% of cases in this audit. Although theoretically beneficial, clinical benefit of lower volumes than what is currently practiced in this institution remains to be seen. The incidence of pulmonary complications was much lower than in the other cited studies and a larger data set would be required to investigate any benefit from lower tidal volume ventilation. The volumes used are comparable to results from published local and international data but PEEP utilisation was higher in this audit. Strategies that may potentially be implemented to ensure and maintain best practice include pre-operative recording of predicted body weight, adjustment of default ventilator settings and education/updates of current evidence.

Keywords: anaesthesia, intraoperative ventilation, PEEP, tidal volume

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Authors: Ndarusanze Berchmans

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This research work focused on the analysis of the observations of tuberculous meningitis in HIV-positive patients who were treated by the Prince Regent Charles Hospital in Bujumbura. A number of 246 seropositive patients were examined by the laboratory of Prince Regent Charles in the period between 2010 and 2015. We did a retrospective study; we used data from the registers of the laboratories mentioned above; the objective was to approach the epidemiological, biological, clinical, and therapeutic characteristics of tuberculosis meningitis infection: 124 women (50.40% of AIDS patients) and 122 men (49.59% of AIDS patients) were subject to the diagnosis by identification of cerebrospinal fluid (CSF). The average age of the patients was 30 years for this period. The population at risk has an average age of between 34 and 42 years for the years between 2010-2015. From 2010 to 2012, cases of opportunistic diseases (e.g., tuberculous meningitis and Cryptococcus neoformans meningitis), often found in immunocompromised, were observed at a high rate; in this period, there was a disturbance of the rhythm providing antiretroviral drugs to people with AIDS. The rate of the two meningitis (tuberculous meningitis and Cryptococcus neoformans meningitis) remained above 10% to gradually decrease until 2015, with the gradual return of antiretrovirals. This period records an overall average of 25 cases of tuberculous meningitis, or a percentage of 10.16%. For the year 2015, there were 4 cases of tuberculous meningitis out of a total of 35 seropositive examined (11.42%). This year's percentage shows that the number of tuberculous meningitis cases has fallen from the rate in previous years. This is the result of the care given by associations against HIV/AIDS to HIV-positive people. This decrease in cases of tuberculous meningitis is due to the acquisition of antiretrovirals by all HIV-positive people treated by hospitals. For the moment, these hospitals are taking care of many AIDS patients by providing them permanently with antiretrovirals; Besides that, there are many patients who are supported by associations whose activities are directed against HIV/AIDS.

Keywords: Cryptococcus neoformans meningitis, tuberculosis meningitis, neurological complications, epidemiology of meningitis

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Authors: Soma Kanta Baral

Abstract:

Background: Since 1981, when the first AIDS case was reported, worldwide, more than 34 million people have been infected with HIV. Almost 95 percent of the people infected with HIV live in developing countries. As HBV & HIV share similar routes of transmission by sexual intercourse or drug use by parenteral injection, co-infection is common. Because of the limited access to healthcare & HIV treatment in developing countries, HIV-infected individuals are present late for care. Enumeration of CD4+ T cell count at the time of diagnosis has been useful to initiate the therapy in HIV infected individuals. The baseline CD4+ T cell count shows high immunological variability among patients. Methods: This prospective study was done in the serology section of the Department of Microbiology over a period of one year from august 2012 to July 2013. A total of 13037 individuals subjected for HIV test were included in the study comprising of 4982 males & 8055 females. Blood sample was collected by vein puncture aseptically with standard operational procedure in clean & dry test-tube. All blood samples were screened for HIV as described by WHO algorithm by Immuno-chromatography rapid kits. Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. After informed consent, HIV positive individuals were screened for HBsAg by Immuno-chromatography rapid kits (Hepacard). Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. EDTA blood samples were collected from the HIV sero-positive individuals for baseline CD4+ T count. Then, CD4+ T cells count was determined by using FACS Calibur Flow Cytometer (BD). Results: Among 13037 individuals screened for HIV, 104 (0.8%) were found to be infected comprising of 69(66.34%) males & 35 (33.65%) females. The study showed that the high infection was noted in housewives (28.7%), active age group (30.76%), rural area (56.7%) & in heterosexual route (80.9%) of transmission. Out of total HIV infected individuals, distribution of HBV co-infection was found to be 6(5.7%). All co- infected individuals were married, male, above the age of 25 years & heterosexual route of transmission. Baseline CD4+ T cell count of HIV infected patient was found higher (mean CD4+ T cell count; 283cells/cu.mm) than HBV co-infected patients (mean CD4+ T cell count; 91 cells/cu.mm). Majority (77.2%) of HIV infected & all co-infected individuals were presented in our center late (CD4+ T cell count;< 350/cu. mm) for diagnosis and care. Majority of co- infected 4 (80%) were late presented with advanced AIDS stage (CD4+ count; <200/cu.mm). Conclusions: The study showed a high percentage of HIV sero-positive & co- infected individuals. Baseline CD4+ T cell count of majority of HIV infected individuals was found to be low. Hence, more sustained and vigorous awareness campaigns & counseling still need to be done in order to promote early diagnosis and management.

Keywords: HIV/AIDS, HBsAg, co-infection, CD4+

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Authors: Arman Kishan, Mark Haft, Steve Li, Duc Nguyen, Dawn Laporte

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Objective: Patients with Type 2 diabetes (T2DM) often face higher postoperative complication rates. Limited data exist on outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study aims to compare complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM. Methods: This was a retrospective cohort study using the TriNetX database of 56741 patients with T2DM undergoing ECTR (N= 14,949) or OCTR (N= 41,792). Demographic data, medical comorbidities, and complication rates were analyzed. We used multivariable analysis to identify differences in postoperative complication rates between the two treatment methods in patients with T2DM. Results: Patients with T2DM undergoing ECTR had a significantly lower incidence of 90-day wound infection (p < 0.001), 90-day wound dehiscence (p < 0.001), and nerve injury (p < 0.001) when compared to patients who underwent OCTR. After matching, there was a significantly higher number of T2DM patients undergoing ECTR who had peripheral vascular disease (p = 0.045) and hypertension (p = 0.020) when compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders (p = 0.002) and chronic blood loss anemia (p = 0.025). Conclusion: ECTR presents a superior choice for T2DM patients undergoing CTR, yielding significantly lower rates of wound infection, wound dehiscence, and nerve injury within 90 days post-surgery—reducing the risk by 31%, 48%, and 59%, respectively. These findings support the adoption of ECTR as the preferred method in this patient population, potentially leading to improved postoperative outcomes.

Keywords: endoscopic treatment of carpal tunnel syndrome, open treatment of carpal tunnel syndrome, carpal tunnel syndrome, postoperative complications in patients with diabetes mellitus

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Authors: Zahra Fotovatnia, Jeffery A. Jones, Alexandra Gottardo

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Speech communication often occurs in environments where noise conceals part of a message. Listeners should compensate for the lack of auditory information by picking up distinct acoustic cues and using semantic and sentential context to recreate the speaker’s intended message. This situation seems to be more challenging in a nonnative than native language. On the other hand, early bilinguals are expected to show an advantage over the late bilingual and monolingual speakers of a language due to their better executive functioning components. In this study, English monolingual speakers were compared with early and late nonnative speakers of English to understand speech in noise processing (SIN) and the underlying neurobiological features of this phenomenon. Auditory mismatch negativities (MMNs) were recorded using a double-oddball paradigm in response to a minimal pair that differed in their middle vowel (beat/bit) at Wilfrid Laurier University in Ontario, Canada. The results did not show any significant structural and electroneural differences across groups. However, vocabulary knowledge correlated positively with performance on tests that measured SIN processing in participants who learned English after age 6. Moreover, their performance on the test negatively correlated with the integral area amplitudes in the left superior temporal gyrus (STG). In addition, the STG was engaged before the inferior frontal gyrus (IFG) in noise-free and low-noise test conditions in all groups. We infer that the pre-attentive processing of words engages temporal lobes earlier than the fronto-central areas and that vocabulary knowledge helps the nonnative perception of degraded speech.

Keywords: degraded speech perception, event-related brain potentials, mismatch negativities, brain regions

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Authors: Nathalie Bolding, Marta Montero, Joaquim Cevallos, Juan F. Martin-Lazaro

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Background: Inhaled epoprostenol (iEPO) have been shown to improve PaO2:FiO2 (PF) in combination with bronchodilators (BD). However, there is not an available device to deliver these two therapies concomitantly. We describe a new method to provide this therapy successfully. Objective: To evaluate the response to continuous nebulization of iEPO and intermittent nebulization of Salbutamol/Ipratropium bromide in adults with severe respiratory failure through a double mesh nebulisation in tandem. Methods: This observational study included two mechanical ventilated adults under hourly ventilatory, gasometrical and clinical measurements during 48h. Both had severe respiratory failure treated with continuous iEPO (50 – 200 micrograms/h) and BD (Salbutamol 2.5 mg and Ipratropium bromide 500 mcg every 6 hours) through double mesh nebulisation (Aerogen solo®) placed in tandem in the dry side of the humidificator. The primary endpoints were the variables associated with a positive response to this tandem nebulised therapy (PaFiO2 index, ROX index). Secondary endpoints were laboratory (ABG) clinical and ventilatory variables. Statistical analysis (SPSS v29) included linear regression and ANOVA. Results: The patients included (n=2) survived, both extubated, one after ECMO therapy. Severe acute respiratory failure had a positive response rate to continuous iEPO and intermittent BD: PaFiO2 increased (7.40 to 30.91; P75: 27%) as well as ROX index (2.91 to 11.43; P75: 33%). There was a linear correlation of improvement between iEPO with PaFiO2 (ANOVA, r=0.393, p<0.002) and ROX (r=0.419, p<0.001). iEPO+BD therapy did not show any complications. Conclusion: Continuous and intermittent mesh tandem nebulisation can be effectively delivered with this method with a positive effect in ventilatory parameters without observed complications. Randomised studies will be able to provide reassurance in this new therapy.

Keywords: tandem, mesh, nebulisers, pulmonary, vasoldilators, bronchodilators, respiratory, failure

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Authors: Syahrir Andi Mangga, Ipranta

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The geological, paleomagnetic, geochemical and geophysical Investigation in The Sumatra Region has yielded some new data, has stimulated a reassessment of stratigraphy, structure, tectonic evolution and which can show a Sumatra geodynamic model. Sumatra island has in the margin of southwest part of the Eurasia plate in the Sundaland cratonic block and occurred as the amalgamation of allochtonous microplates, continental fragments, Island arc and accrctionary by foreland complex which assembled prior to Tertiary. The allochtonous rocks (terranes), can be divided into 4 (four) Terranes with Paleozoic to Mesosoic in age, had different origin, lithology and are separated by a Suture as main fault with trending NW-SE. The terranes are: the Tigapuluh-Bohorok (East Sumatra block / Sibumasu block), Permo-Carboniferous in age and is characterized by the rock types formed in glacio-marine and was intruded by Late Triassic to Early Jurrasic granitics, occupied in the Eastern part of Sumatra, the paleomagnetic data shown 41° South. Tanjung Karang - Gunung Kasih Terrane, is composed of higher metamorphic rocks and supposed to be pre-Carboniferous in age, covered by Mesozoic sedimentary rocks and were intruded by granitic-dioritic rocks, occupied in the Southern part of Sumatra, the paleomagnetic data shown 19° North. The Kuantan-Duabelas Mountain (West Sumatra block) is occupied by metamorphic, sedimentary and volcanic rocks of Paleozoic - Mesozoic (Carboniferous - Triassic) in age, contains a Cathaysion fauna and flora and are intruded by the Mesozoic granitoid rocks. The terrane occurred in the western part of Sumatra. Meanwhile, the Gumai-Garba (Waloya Terrane) which is occupied by the tectonite/melange, metasediment, carbonate and volcanic rocks of Mesozoic (Jurassic - Cretaceous) in age, are intruted by the Late Cretaceous granitoid rocks, the paleomagnetic data shown 30° - 31° South.

Keywords: tectonostratigraphy, amalgamation, allochtonous, terranes, sumatra

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Authors: Naufal Ahmed, Michael Lwin

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Background: MPFL reconstructions are ideally performed with au-tografts like gracilis semitendinosus tendon, which may be associated with donor site morbidity and complications. In this case series, we have tried to use fiber tape, which avoids the above complications and also keeps the graft virgin. This kind of synthetic graft has been used successfully in rotator cuffs and ACJ reconstructions with good results. Materials and methods: It was a retrospective data analysis of 45 patients who underwent this procedure from 2014-2020 under a single consultant in a DGH . These patiens have been followed up at 6 weeks, 6 months, 1 year, and 1 ½ years with clinical assessment and KOOS scores. We compared the results with the NJR and also with the Belgium report and was found to be satisfactory and comparable with them. Surgical technique : We used Arthrex fiber tape for the reconstruction of MPFL . Initially, two parallel holes drilled over sup aspect of the patella with help of an image intensifier, and then fiber wire passed through them from the medial to the lateral side and back to the medial side. The fiber wire was attached to the schottle point on the femoral side, giving a good extra articular internal brac-ing to the MPFL. All patients were scoped before the procedure, and the final tightening over the femoral side was done directly under vision to see the position of the patella. Results: We had 45 MPFL reconstructions along with 4 additional procedures 1 ACLR, 2 ACL REPAIR, 1 TTT advancement ( revision MPFL ). There were 14 males and 31 females, and their average age was 25 (13-55 ). We did not have any donor site morbidity, no infection, no fractures, no recurrent dislocations, no reoperations yet. Conclusion: Fiber tape is a feasible and appropriate option for MPFL reconstruction. We haven’t seen any re -operation in our 5 year follow up. This technique avoids the use of autograft, which can be used in the future if needed for revision surgeries. We don’t lose anything by following this simple novel technique.

Keywords: arthroscopy, fibertape, MPFL reconstruction, recurrent patella dislocation

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Authors: Saimir Cenameri, Arjana Tereziu, Kastriot Dallaku

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Introduction: Intra-uterine death is a common problem in obstetrical practice, and can lead to complications if left to resolve spontaneously. The cervix is unprepared, making inducing of labor difficult. Misoprostol is a synthetic prostaglandin E1 analogue, inexpensive, and is presented valid thanks to its ability to bring about changes in the cervix that lead to the induction of uterine contractions. Misoprostol is quickly absorbed when taken orally, resulting in high initial peak serum concentrations compared with the vaginal route. The vaginal misoprostol peak serum concentration is not as high and demonstrates a more gradual serum concentration decline. This is associated with many benefits for the patient; fast induction of labor; smaller doses; and fewer side effects (dose-depended). Mostly it has been used the regime of 50 μg/4 hour, with a high percentage of success and limited side effects. Objective: Evaluation of the efficiency of the use of oral and vaginal misoprostol in inducing labor, and comparing it with its use not by a previously defined protocol. Methods: Participants in this study included patients at U.H.O.G. 'Koco Gliozheni', Tirana from April 2004-July 2006, presenting with an indication for inducing labor in the third trimester for pregnancy termination. A total of 37 patients were randomly admitted for birth inducing activity, according to protocol (26), oral or vaginal protocol (10 vs. 16), and a control group (11), not subject to the protocol, was created. Oral or vaginal misoprostol was administered at a dose of 50 μg/4 h, while the fourth group participants were treated individually by the members of the medical staff. The main result of interest was the time between induction of labor to birth. Kruskal-Wallis test was used to compare the average age, parity, women weight, gestational age, Bishop's score, the size of the uterus and weight of the fetus between the four groups in the study. The Fisher exact test was used to compare day-stay and causes in the four groups. Mann-Whitney test was used to compare the time of the expulsion and the number of doses between oral and vaginal group. For all statistical tests used, the value of P ≤ 0.05 was considered statistically significant. Results: The four groups were comparable with regard to woman age and weight, parity, abortion indication, Bishop's score, fetal weight and the gestational age. There was significant difference in the percentage of deliveries within 24 hours. The average time from induction to birth per route (vaginal, oral, according to protocol and not according to the protocol) was respectively; 10.43h; 21.10h; 15.77h, 21.57h. There was no difference in maternal complications in groups. Conclusions: Use of vaginal misoprostol for inducing labor in the third trimester for termination of pregnancy appears to be more effective than the oral route, and even more to uses not according to the protocols approved before, where complications are greater and unjustified.

Keywords: inducing labor, misoprostol, pregnancy termination, third trimester

Procedia PDF Downloads 185

Authors: Amin Masoumiganjgah, Luke Salmon, Julianne Burnton, Fahimeh Bagheri, Gavin Lenton, S. L. Ezekial Tan

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Introduction: The incidence of proximal biceps tenodesis and acute distal biceps repair is increasing, and rehabilitation protocols following both are variable. Golf is a popular sport within Australia, and the Gold Coast has become a Mecca for golfers, with more courses per capita than anywhere else in the world. Currently, there are no clear guidelines regarding return to golf play following biceps procedures. The aim of this study was to determine biceps brachii activation during the golf swing through electromyographic analysis, and subsequently, aid in rehabilitation guidelines and return to golf following tenodesis and repair. Methods: Subjects were amateur golfers with no previous upper limb surgery. Surface electromyography (EMG) and high-speed video recording were used to analyse activation of the left and right biceps brachii and the anterior deltoid during the golf swing. Each participant’s maximum voluntary contraction (MVC) was recorded, and they were then required to hit a golf ball aiming for specific distances of 2, 50, 100 and 150 metres at a driving range. Noraxon myoResearch and Matlab were used for data analysis. Mean % MVC was calculated for leading and trailing arms during the full swing and its’ 4 phases: back-swing, acceleration, early follow-through and late follow-through. Results: 12 golfers (2 female and 10 male), participated in the study. Median age was 27 (25 – 38), with all being right handed. Over all distances, the mean activation of the short and long head of biceps brachii was < 10% through the full swing. When breaking down the 50, 100 and 150m swing into phases, mean MVC activation was lowest in backswing (5.1%), followed by acceleration (9.7%), early follow-through (9.2%), and late follow-through (21.4%). There was more variation and slightly higher activation in the right biceps (trailing arm) in backswing, acceleration, and early follow-through; with higher activation in the leading arm in late follow-through (25.4% leading, 17.3% trailing). 2m putts resulted in low MVC values (3.1% ) with little variation across swing phases. There was considerable individual variation in results – one tense subject averaged 11.0% biceps MVC through the 2m putting stroke and others recorded peak mean MVC biceps activations of 68.9% at 50m, 101.3% at 100m, and 111.3% at 150m. Discussion: Previous studies have investigated the role of rotator cuff, spine, and hip muscles during the golf swing however, to our knowledge, this is the first study that investigates the activation of biceps brachii. Many rehabilitation programs following a biceps tenodesis or repair allow active range against gravity and restrict strengthening exercises until 6 weeks, and this does not appear to be associated with any adverse outcome. Previous studies demonstrate a range of < 10% MVC is similar to the unloaded biceps brachii during walking(1), active elbow flexion with the hand positioned either in pronation or supination will produce MVC < 20% throughout range(2) and elbow flexion with a 4kg dumbbell can produce mean MVC’s of around 40%(3). Our study demonstrates that increasing activation is associated with the leading arm, increasing shot distance and the late follow-through phase. Although the cohort mean MVC of the biceps brachii is <10% through the full swing, variability is high and biceps activation reach peak mean MVC’s of over 100% in different swing phases for some individuals. Given these EMG values, caution is advised when advising patients post biceps procedures to return to long distance golf shots, particularly when the leading arm is involved. Even though it would appear that putting would be as safe as having an unloaded hand out of a sling following biceps procedures, the variability of activation patterns across different golfers would lead us to caution against accelerated golf rehabilitation in those who may be particularly tense golfers. The 50m short iron shot was too long to consider as a chip shot and more work can be done in this area to determine the safety of chipping.

Keywords: electromyographic analysis, biceps brachii rupture, golf swing, tendon surgery

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Authors: Hamida Memon, Muhammad Sanan

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A 34-year-old male with no prior health issues presented with a wound in his left leg exhibiting active pus discharge, intense inflammation, pain radiating from the buttocks to the knee, foot drop, and skin darkening. Four years prior, he sustained an untreated dislocation of the hip joint and acetabulum from a road traffic accident. Initial nerve conduction studies (NCS) and electromyography (EMG) revealed severe axonotomesis of the left sciatic nerve and reduced compound muscle action potential in the left common peroneal nerve. Despite normal venous flow, edema and cellulitis were noted. Follow-up NCS/EMG in 2022 showed improvement, but in 2023, the patient experienced recurrent infection and underwent surgical intervention with tissue culture. Postoperative care included antibiotics and pain management. NCS/EMG in 2024 indicated decreased nerve amplitudes and conduction velocities, consistent with moderate axonotmesis and ongoing recovery, alongside incidental right S1 radiculopathy. General lab tests and abdominal imaging were normal. The patient was treated with Pregabalin and Neurobion for neuropathic pain and nerve support and is currently under observation by a tertiary sector hospital for treatment. This case underscores the critical importance of prompt treatment for hip dislocations to prevent long-term complications such as neuropathy and avascular necrosis. Delays in treatment significantly increase the risk of severe outcomes, highlighting the need for timely intervention. Overall, the case illustrates the challenges of managing complex nerve injuries and the importance of comprehensive care for optimal recovery.

Keywords: sciatic nerve neuropathy, hip dislocation, acetabular fracture, radiculopathy

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Authors: Ali Kassem, Yhea Kishik, Ali Hassan, Mohamed Abdelwahab

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Introduction: Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A recent aspect of coronary artery disease in this condition is its silent nature. The aim of the work: Detection of the prevalence of silent myocardial ischemia (SMI) in Upper Egypt type 2 diabetic males and to select male diabetic population who should be screened for SMI. Patients and methods: 100 type 2 diabetic male patients with a negative history of angina or anginal equivalent symptoms and 30 healthy control were included. Full medical history and thorough clinical examination were done for all participants. Fasting and post prandial blood glucose level, lipid profile, (HbA1c), microalbuminuria, and C-reactive protein were done for all participants Resting ECG, trans-thoracic echocardiography, treadmill exercise ECG, myocardial perfusion imaging were done for all participants and patients positive for one or more NITs were subjected for coronary angiography. Results Twenty nine patients (29%) were positive for one or more NITs in the patients group compared to only one case (3.3%) in the controls. After coronary angiography, 20 patients were positive for significant coronary artery stenosis in the patients group, while it was refused to be done by the patient in the controls. There were statistical significant difference between the two groups regarding, hypertension, dyslipidemia and obesity, family history of DM and IHD with higher levels of microalbuminuria, C-reactive protein, total lipids in patient group versus controls According to coronary angiography, patients were subdivided into two subgroups, 20 positive for SMI (positive for coronary angiography) and 80 negative for SMI (negative for coronary angiography). No statistical difference regarding family history of DM and type of diabetic therapy was found between the two subgroups. Yet, smoking, hypertension, obesity, dyslipidemia and family history of IHD were significantly higher in diabetics positive versus those negative for SMI. 90% of patients in subgroup positive for SMI had two or more cardiac risk factors while only two patients had one cardiac risk factor (10%). Uncontrolled DM was detected more in patients positive for SMI. Diabetic complications were more prevalent in patients positive for SMI versus those negative for SMI. Most of the patients positive for SMI have DM more than 5 years duration. Resting ECG and resting Echo detected only 6 and 11 cases, respectively, of the 20 positive cases in group positive for SMI compared to treadmill exercise ECG and myocardial perfusion imaging that detected 16 and 18 cases respectively, Conclusion: Type 2 diabetic male patients should be screened for detection of SMI when aged above 50 years old, diabetes duration is more than 5 years, presence of two or more cardiac risk factors and/or patients suffering from one or more of the chronic diabetic complications. CRP, is an important parameter for selection of type 2 diabetic male patients who should be screened for SMI. Non invasive cardiac tests are reliable for screening of SMI in these patients in our locality.

Keywords: C-reactive protein, Silent myocardial ischemia, Stress tests, type 2 DM

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Authors: Said Ghalem

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Honey is primarily composed of sugars: glucose and fructose. Depending honey, it's either fructose or glucose predominates. More the fructose concentration and the less the glycemic index (GI) is high. Thus, changes in the insulin response shows a decrease of the amount of insulin secreted at an increased fructose honey. Honey is also a compound that can reduce the lipid in the blood. Several studies on animals, but which remain to be checked in humans, have shown that the honey can have interesting effects when combined with other molecules: associated with Metformin (a medicine taken by diabetics), it shows the benefits and effects of diabetes preserves the tissue; associated ginger, it increases the antioxidant activity and thus avoids neurologic complications, neuropathic. Molecular modeling techniques are widely used in chemistry, biology, and the pharmaceutical industry. Most of the currently existing drugs target enzymes. Inhibition of DPP-4 is an important approach in the treatment of type 2 diabetes. We have chosen for the inhibition of DPP-4 the following molecules: Linagliptin (BI1356), Sitagliptin (Januvia), Vildagliptin, Saxagliptin, Alogliptin, and Metformin (Glucophage), that are involved in the disease management of type 2 diabetes and added to honey. For this, we used software Molecular Operating Environment. A Wistar rat study was initiated in our laboratory with a well-studied protocol; after sacrifice, according to international standards and respect for the animal This theoretical approach predicts the mode of interaction of a ligand with its target. The honey can have interesting effects when combined with other molecules, it shows the benefits and effects of honey preserves the tissue, it increases the antioxidant activity, and thus avoids neurologic complications, neuropathic or macrovascular. The organs, especially the kidneys of Wistar, shows that the parameters to renal function let us conclude that damages caused by diabetes are slightly perceptible than those observed without the addition of a high concentration of fructose honey.

Keywords: honey, molecular modeling, DPP4 enzyme, metformin

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Authors: Bekalu Melis Alehegn, Dagnenet Sultan Alemu

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The insufficiency of water is the most severe restraint for the expansion of agriculture in arid and semi-arid areas. An important strategy for increasing water productivity and improving water productivity deficit irrigation at different growth stages is important to advance the yield and Water Productivity of barley in water scarce areas. A field experiment was conducted at the Koga irrigation scheme in Ethiopia to examine barley yield response to different irrigation regimes and validate the aqua crop model. The experimental setup comprised six randomized treatments (T) with three replications for one irrigation season because of financial limitations. The irrigation regimes were selected 100%, 75%, and 50% application levels in different growth stages of gross irrigation requirements using trial and error in order to select the optimal water application level. The treatments were: no stress at all (T1), 25% stressed during all crop stages (T2), 50% stressed at all stages (T3), 50% stressed at the development stage (T4), 50% stressed at mid-stage (T5) and 50% stress at initial and late season (T6). The agronomic parameters, including canopy cover, biomass, and grain yield, were collected to compare the ground-based crop yield and the aqua crop model. The results showed that the initial and late stages and stress 25% through the whole season were the right time for practice deficit irrigation without significant yield reduction. The highest (2.62kg/m³) and the lowest (2.03 kg/m³) water productivity were found under T3 and T4, respectively. The stress of 50% at the mid-growth stage and stress 50% of the full irrigation water requirement at all growth stages significantly (α=5%) affected the canopy expansion, biomass and yield production. The aqua Crop model performed well in simulating the yield of barley for most of the treatments (R2 = 0.84 and RMSE = 0.7 t ha–¹).

Keywords: aqua crop, barley, deficit irrigation, irrigation regimes, water productivity

Procedia PDF Downloads 26