Search results for: left ventricular dysfunction

Authors: Ghada Esheba, Bayan Hafiz, Ashwaq Al-Qarni, Abdulelah AlMalki, Esraa Kaheel

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Hydatid disease is caused by genus Echinococcus, it is transmitted to human through sheep and cattle. People who lived in an endemic area should be suspected to have the disease. Pulmonary hydatid disease can be presented by respiratory manifestations as in our case. We report a case of child, 13 years old, who was presented by shortness of breath and non-productive cough 2 months ago. The patient had an attack of hemoptysis 3 months ago but there is no history of fever, other constitutional symptoms or any medical illness. The patient has had a close contact with a horse. On examination, the patient was oriented and vitally stable. Both side of chest were moving equally with decrease air entry on the left side of the chest. Cervical lymph node enlargement was also detected. The case was provisionally diagnosed as tuberculosis. The x-ray was normal, while CT scan showed two cysts in the left side. The patient was treated surgically with resection of both cysts without lobectomy. Broncho-alveolar lavage was done and together with plural effusion and both cysts were sent for histopathology. The patient received the following medication: albendazole 200MG/BID/Orally for 30 days and Cefuroxime 250MG/Q12H/Orally for 10 days.

Keywords: Echinococcus granulosus, hydatid disease, pediatrics, pulmonary hydatid cyst

Procedia PDF Downloads 255

Authors: Kunal Garg, Louise Theusen Hermansan, Kanoktip Puttaraska, Oliver Hendricks, Heidi Pirttinen, Leona Gilbert

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The Germ Theory (one infectious determinant is equal to one disease) has unarguably evolved our capability to diagnose and treat infectious diseases over the years. Nevertheless, the advent of technology, climate change, and volatile human behavior has brought about drastic changes in our environment, leading us to question the relevance of the Germ Theory in our day, i.e. will vector-borne disease (VBD) sufferers produce multiple immune responses when tested for multiple microbes? Vector diseased patients producing multiple immune responses to different microbes would evidently suggest human polymicrobial infections (HPI). Ongoing diagnostic tools are exceedingly unequipped with the current research findings that would aid in diagnosing patients for polymicrobial infections. This shortcoming has caused misdiagnosis at very high rates, consequently diminishing the patient’s quality of life due to inadequate treatment. Equipped with the state-of-art scientific knowledge, PolyScan intends to address the pitfalls in current VBD diagnostics. PolyScan is a multiplex and multifunctional enzyme linked Immunosorbent assay (ELISA) platform that can test for numerous VBD microbes and allow simultaneous screening for multiple types of antibodies. To validate PolyScan, Lyme Borreliosis (LB) and spondyloarthritis (SpA) patient groups (n = 54 each) were tested for Borrelia burgdorferi, Borrelia burgdorferi Round Body (RB), Borrelia afzelii, Borrelia garinii, and Ehrlichia chaffeensis against IgM and IgG antibodies. LB serum samples were obtained from Germany and SpA serum samples were obtained from Denmark under relevant ethical approvals. The SpA group represented chronic LB stage because reactive arthritis (SpA subtype) in the form of Lyme arthritis links to LB. It was hypothesized that patients from both the groups will produce multiple immune responses that as a consequence would evidently suggest HPI. It was also hypothesized that the multiple immune response proportion in SpA patient group would be significantly larger when compared to the LB patient group across both antibodies. It was observed that 26% LB patients and 57% SpA patients produced multiple immune responses in contrast to 33% LB patients and 30% SpA patients that produced solitary immune responses when tested against IgM. Similarly, 52% LB patients and an astounding 73% SpA patients produced multiple immune responses in contrast to 30% LB patients and 8% SpA patients that produced solitary immune responses when tested against IgG. Interestingly, IgM immune dysfunction in both the patient groups was also recorded. Atypically, 6% of the unresponsive 18% LB with IgG antibody was recorded producing multiple immune responses with the IgM antibody. Similarly, 12% of the unresponsive 19% SpA with IgG antibody was recorded producing multiple immune responses with the IgM antibody. Thus, results not only supported hypothesis but also suggested that IgM may atypically prevail longer than IgG. The PolyScan concept will aid clinicians to detect patients for early, persistent, late, polymicrobial, & immune dysfunction conditions linked to different VBD. PolyScan provides a paradigm shift for the VBD diagnostic industry to follow that will drastically shorten patient’s time to receive adequate treatment.

Keywords: diagnostics, immune dysfunction, polymicrobial, TICK-TAG

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Authors: Michelangelo Liban, Debbie Liquete

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A case of a 93-year-old Filipina who experienced a sudden onset of left-sided hemichorea hemiballismus after falling from a standing height due to dizziness and then sought consult at the Emergency Room. She was not known to have diabetes mellitus nor experienced any symptoms of diabetes aside from its rare neurological manifestation of hemichorea-hemiballismus prior to this consult. On further workup, her baseline laboratory tests at the Emergency Room Department showed a CBG of 340mg/dL, an HbA1c of 15%, no ketones were detected in her urine but a hyperdensity with a Hounsfeld unit of 38 on CT, and hyperintensity on T1 weighted MRI on her right striatum with an incidental finding of a subdural hematoma measured as a 0.7cm hyperdensity on her right temporoparietal area with no midline shift. She was then treated with Clonazepam 2mg ¼ tab twice a day before bedtime and insulin 70/30 16 units in the morning and eight units in the evening, which provided good glycemic control maintained at 140-180 mg/dL, complete cessation of the left-sided hemichorea hemiballismus was also observed. The subdural hematoma was deemed non-surgical, and she refused admission into our institution; hence observation on an outpatient basis was done. This is a case of a rare neurological manifestation of diabetes mellitus but with good treatment response to anti-chorea medications combined with diabetes medications.

Keywords: hemichorea, hemiballismus, striatopathy, diabetes

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Authors: Argyris B. Karapetsas, Rozi M. Laskaraki, Aikaterini A. Karapetsa, Maria Bampou, Valentini N. Vamvaka

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The main aim of the current protocol is the contribution of neuropsychology in both assessment and rehabilitation settings for children with dyslexia. Objectives: The purpose of this study was to evaluate the significant role of neuropsychological assessment including both Psychometric and electrophysiological tests as well as to investigate the effectiveness of an Auditory Training program, designed via Music designed for children with Developmental Dyslexia (DD). Materials: In our study, participated 45 third-, and fourth-grade students with DD and a matched control group (n=45). Method: At the first phase of the protocol, children underwent a clinical assessment, including both electrophysiological, i.e. Event Related Potentials (ERPs) esp. P300 waveform, and psychometric tests, being conducted in Laboratory of Neuropsychology, at University of Thessaly, in Volos, Greece. Assessment’s results confirmed statistically significant lower performance for children with DD for all tests, compared to the typical readers of the control group. After evaluation, a subgroup of children with DD participated in a Rehabilitation Program including digitized musical auditory training activities. Results: The electrophysiological recordings after the intervention revealed shorter, almost similar, P300 latency values for children with DD to those of the control group, indicating the beneficial effects of the Intervention, thus enabling children develop reading skills and become successful readers. Discussion: Similar research data confirm the crucial role of neuropsychology in both diagnosis and treatment of common disorders, observed in children. Indeed, as for DD, there is growing evidence that brain activity dysfunction does occur, as it is confirmed by neuropsychological assessment and also musical auditory training may have remedial effects. Conclusions: The outcomes of the current study suggest that due to the neurobiological origin of DD, neuropsychology may give the means in both neuropsychological assessment and rehabilitation, enabling professionals to cope with cerebral dysfunction and recovery more efficiently.

Keywords: diagnosis, dyslexia, ERPs, Music, neuropsychology, rehabilitation

Procedia PDF Downloads 114

Authors: Salma A. El-Marasy, Rehab F. Abdel-Rahman, Reham M. Abd-Elsalam

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The burden of stroke is intensely increasing worldwide. Brain injury following transient or permanent focal cerebral ischemia develops ischemic stroke as a consequence of a complex series of pathophysiological events. The aim of this study is to evaluate the possible neuroprotective effect of a dipeptidyl peptidase-4 inhibitor, vildagliptin, independent on its insulinotropic properties in non-diabetic rats subjected to cerebral ischemia. Anaesthetized Wistar rats were subjected to either left middle cerebral artery occlusion (MCAO) or sham operation followed by reperfusion after 30 min of MCAO. The other three groups were orally administered vildagliptin at 3 dose levels (2.5, 5, 10 mg/kg) for 3 successive weeks before subjected to left focal cerebral ischemia/reperfusion and till the end of the study. Neurological deficit scores and motor activity were assessed 24h following reperfusion. 48h following reperfusion, rats were euthanized and their left brain hemispheres were harvested and used in the biochemical, histopathological, and immunohistochemical investigations. Vildagliptin pretreatment improved neurological score deficit, locomotor activity and motor coordination in MCAO rats. Moreover, vildagliptin reduced malondialdehyde (MDA), elevated reduced glutathione (GSH), phosphotylinosital 3 kinase (PI3K), phosphorylated of protein kinase B (p-AKT), and mechanistic target of rapamycin (mTOR) brain contents in addition to reducing protein expression of caspase-3. Also, vildagliptin showed a dose-dependent attenuation in neuronal cell loss and histopathological alterations in MCAO rats. This study proves that vildagliptin exerted the neuroprotective effect in a dose-dependent manner as shown in amelioration of neuronal cell loss and histopathological damage in MCAO rats, which may be mediated by attenuating neuronal and motor deficits, it’s anti-oxidant property, activation of PI3K/AKT/mTOR pathway and its anti-apoptotic effect.

Keywords: caspase-3, cerebral ischemia, dipeptidyl peptidase-4 inhibitor, oxidative stress, PI3K/AKT/mTOR pathway, rats, vildagliptin

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Authors: Munirah Ismail, Joon Hock Yeo

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Paediatric patients who require ventricular outflow tract reconstruction usually need valve construction to prevent valvular regurgitation. They would face problems like lack of suitable, affordable conduits and the need to undergo several operations in their lifetime due to the short lifespan of existing valves. Their natural growth and development are also of concern, even if they manage to receive suitable conduits. Current prosthesis including homografts, bioprosthetic valves, mechanical valves, and bovine jugular veins either do not have the long-term durability or the ability to adapt to the growth of such patients. We have developed a new design of bi-leaflet valve. This new technique accommodates patients’ annular size growth while maintaining valvular patency. A mock circulatory system was set up to assess the hemodynamic performance of the bi-leaflet pulmonary valve. It was found that the percentage regurgitation was acceptable and thus, validates this novel concept.

Keywords: bi-leaflet pulmonary valve, pulmonary heart valve, tetralogy of fallot, mock circulatory system

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Authors: Ozge Tahran, Sevgi Sevi Yesilyaprak

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Objective: The aim of the study was to investigate the effect of the Wilk’s modified two different stretching exercises on posterior shoulder tightness, pain, and dysfunction in patients with subacromial impingement syndrome (SIS). Method: This study was carried out on 67 patients who have more than 15° difference in shoulder internal rotation range of motion between two sides and had been diagnosed as SIS. Before treatment, all patients were randomly assigned into three groups. Standard physiotherapy programme was applied to the Group 3 (n=23), standard physiotherapy program with Wilk’s modified cross-body stretching exercises were applied to Group 1 (n=22), and standard physiotherapy program with Wilk’s modified sleeper stretching exercises were applied to Group 2 (n= 23). All the patients received 20 sessions of physiotherapy during 4 weeks, 5 days in a week by a physiotherapist. The patients continued their exercises at home at the weekends. Pain severity, shoulder rotation range of motion, posterior shoulder tightness, upper extremity functionality with Constant and Murley Score (CMS) and disability level with The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) were evaluated before and after physiotherapy programme. Results: Before treatment, demographic and anthropometric characteristics were similar in groups and there was no statistical difference (p > 0.05). It was determined that pain severity decreased, shoulder rotation range of motion, posterior shoulder tightness, upper extremity functionality, and disability were improved after physiotherapy in both groups (p < 0.05). Group 1 and 2 had better results in terms of reduction of pain severity during activity, increase in shoulder rotation range of motion, posterior shoulder mobility and upper extremity functionality and improvement in upper extremity disability, compared to Group 3 (p < 0.05). Conclusion: Modified posterior shoulder stretching exercises in addition to standard physiotherapy programme is more effective for reduction of pain during activity, to improve shoulder rotation range of motion, posterior shoulder mobility, and upper extremity functionality in patients with SIS compared to standard physiotherapy programme alone.

Keywords: modified posterior shoulder stretching exercises, posterior shoulder tightness, shoulder complex, subacromial impingement syndrome

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Authors: Diwei Lin, Amanda Tan, Rajinder Singh-Rai

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We present the first reported case of a concomitant Leydig cell tumor (LCT) and paratesticular leiomyoma in an adult male with a known history of bilateral cryptorchidism. An 80-year-old male presented with a 2-month history of a left testicular lump associated with mild discomfort and a gradual increase in size on a background of bilateral cryptorchidism requiring multiple orchidopexy procedures as a child. Ultrasound confirmed a lesion suspicious for malignancy and he proceeded to a left radical orchidectomy. Histopathological assessment of the left testis revealed a concomitant testicular LCT with malignant features and paratesticular leiomyoma. Leydig cell tumors (LCTs) are the most common pure testicular sex cord-stromal tumors, accounting for up to 3% of all testicular tumors. They can occur at almost any age, but are noted to have a bi-modal distribution, with a peak incidence at 6 to 10 and at 20 to 50 years of age. LCT’s are often hormonally active and can lead to feminizing or virilizing syndromes. LCT’s are usually regarded as benign but can rarely exhibit malignant traits. Paratesticular tumours are uncommon and their reported prevalence varies between 3% and 16%. They occur in a complex anatomical area which includes the contents of the spermatic cord, testicular tunics, epididymis and vestigial remnants. Up to 90% of paratesticular tumours are believed to originate from the spermatic cord, though it is often difficult to definitively ascertain the exact site of origin. Although any type of soft-tissue neoplasm can be found in the paratesticular region, the most common benign tumors reported are lipomas of the spermatic cord, adenomatoid tumours of the epididymis and leiomyomas of the testis. Genetic studies have identified potential mutations that could potentially cause LCTs, but there are no known associations between concomitant LCTs and paratesticular tumors. The presence of cryptorchidism in adults with both LCTs and paratesticular neoplasms individually has been previously reported and it appears intuitive that cryptorchidism is likely to be associated with the concomitant presentation in this case report. This report represents the first documented case in the literature of a unilateral concomitant LCT and paratesticular leiomyoma on a background of bilateral cryptorchidism.

Keywords: testicular cancer, leydig cell tumour, leiomyoma, paratesticular neoplasms

Procedia PDF Downloads 344

Authors: Yan Lu, Song Hong, Janakiraman Udaiyappan, Aarti Nagayach, Quoc-Viet A. Duong, Masao Morita, Shun Saito, Yuichi Kobayashi, Yuhai, Zhao, Hongying Peng, Nicholas B. Pham, Walter J Lukiw, Christopher A. Vuong, Nicolas G. Bazan

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Aims: Neurodegeneration and behavior dysfunction occurs in patients with Alzheimer's Disease (AD), and as the disease progresses many patients develop cognitive impairment. 5XFAD mouse model of AD is widely used to study AD pathogenesis and treatment. This study aimed to investigate the effect of maresin like 1 (MaR-L1) treatment in AD pathology using 5XFAD mice. Methods: We tested 12-month-old male 5XFAD mice and wild type control mice treated with MaR-L1 in a battery of behavioral tasks. We performed open field test, beam walking test, clasping test, inverted grid test, acetone test, marble burring test, elevated plus maze test, cross maze test and novel object recognition test. We also studied neuronal loss, amyloid β burden, and inflammation in the brains of 5XFAD mice using immunohistology and Western blotting. Results: MaR-L1 treatment to the 5XFAD mice showed improved cognitive function of 5XFAD mice. MaR-L1 showed decreased anxiety behavior in open field test and marble burring test, increased muscular strength in the beam walking test, clasping test and inverted grid test. Cognitive function was improved in MaR-L1 treated 5XFAD mice in the novel object recognition test. MaR-L1 prevented neuronal loss and aberrant inflammation. Conclusion: Our finding suggests that behavioral abnormalities were normalized by the administration of MaR-L1 and the neuroprotective role of MaR-L1 in the AD. It also indicates that MaR-L1 treatment is able to prevent and or ameliorate neuronal loss and aberrant inflammation. Further experiments to validate the results are warranted using other AD models in the future.

Keywords: Alzheimer's disease, motor and cognitive behavior, 5XFAD mice, Maresin Like 1, microglial cell, astrocyte, neurodegeneration, inflammation, resolution of inflammation

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Authors: Iassen Vanev

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The two objectives of the research are to enlighten the significant role of Venice as an agent of “transporting” the features of the Italian Renaissance in Cyprus, as well as to assess the countercheck that the Cypriots might have exercised in opposition to the Venetian influence and to what extent they left they own mark on the Serenissima and influenced the Venetian Renaissance. This will be achieved in the backdrop of Venice’s interaction and dichotomy with the Ottoman Empire during the Venetian rule over the island (1474-1571). The research is carried out within the interdisciplinary domains of architecture, visual arts, and literature. Such studies have already been carried out extensively for other ex-Byzantine centers and consecutively Venetian possessions, like, for example Crete. Cyprus, however, has largely been left on the periphery of scholarly interest, and the author will strive to fill this gap as much as possible. The nature of much of the Venetian Renaissance Architecture on Cyprus was dictated by the Ottoman threat to the island. On the other hand, the vast majority of the Cypriot Renaissance literary production was done in Italy, a little before and after the Ottoman conquest of Cyprus in 1571. This conquest was an enormous crisis for both Venetians and Cypriots, and it led to migrations, mutual Venetian-Cypriot interaction in arts and literature, the formation of cultural landscapes, the shaping of Cypriot identity/ies, dialect and diasporas in Italy, etc., which makes the current research very important.

Keywords: architecture, arts, Cyprus, gender, identity, linguistics, Ottoman Empire, Venice

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Authors: Sara Segura, Diego Nuñez, Miryam Villamil

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In this work, we studied the microscale interaction of foreign substances with blood inside an artificial transparent artery system that represents medium and small muscular arteries. This artery system had channels ranging from 75 μm to 930 μm and was fabricated using glass and transparent polymer blends like Phenylbis(2,4,6-trimethylbenzoyl) phosphine oxide, Poly(ethylene glycol) and PDMS in order to be monitored in real time. The setup was performed using a computer controlled precision micropump and a high resolution optical microscope capable of tracking fluids at fast capture. Observation and analysis were performed using a real time software that reconstructs the fluid dynamics determining the flux velocity, injection dependency, turbulence and rheology. All experiments were carried out with fully computer controlled equipment. Interactions between substances like water, serum (0.9% sodium chloride and electrolyte with a ratio of 4 ppm) and blood cells were studied at microscale as high as 400nm of resolution and the analysis was performed using a frame-by-frame observation and HD-video capture. These observations lead us to understand the fluid and mixing behavior of the interest substance in the blood stream and to shed a light on the use of implantable devices for drug delivery at arteries with different Endothelial dysfunction. Several substances were tested using the artificial artery system. Initially, Milli-Q water was used as a control substance for the study of the basic fluid dynamics of the artificial artery system. However, serum and other low viscous substances were pumped into the system with the presence of other liquids to study the mixing profiles and behaviors. Finally, mammal blood was used for the final test while serum was injected. Different flow conditions, pumping rates, and time rates were evaluated for the determination of the optimal mixing conditions. Our results suggested the use of a very fine controlled microinjection for better mixing profiles with and approximately rate of 135.000 μm3/s for the administration of drugs inside arteries.

Keywords: artificial artery, drug delivery, microfluidics dynamics, arteriosclerosis

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Authors: Christian Liebchen

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Both from an environmental perspective and with respect to road traffic flow quality, planning so-called green waves along major road axes is a well-established target for traffic engineers. For one-way road axes (e.g. the Avenues in Manhattan), this is a trivial downstream task. For bidirectional arterials, the well-known necessary condition for establishing a green wave in both directions is that the driving times between two subsequent crossings must be an integer multiple of half of the cycle time of the signal programs at the nodes. In this paper, we propose an integer linear optimization model to establish fixed-time green waves in both directions that are as long and as wide as possible, even in the situation where the driving time condition is not fulfilled. In particular, we are considering an arterial along whose nodes separate left-turn signal groups are realized. In our computational results, we show that scheduling left-turn phases before or after the straight phases can reduce waiting times along the arterial. Moreover, we show that there is always a solution with green waves in both directions that are as long and as wide as possible, where absolute priority is put on just one direction. Compared to optimizing both directions together, establishing an ideal green wave into one direction can only provide suboptimal quality when considering prioritized parts of a green band (e.g., first few seconds).

Keywords: traffic light coordination, synchronization, phase sequencing, green waves, integer programming

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Authors: Benjamas Penboon, Zachary Zimmer, Aree Jampaklay

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Cambodia is a country where labor migration has been consistently high. Coupled with advancing labor opportunities in urban areas, a function partly of globalization, this is resulting in massive migration out of rural areas. This is particularly true in Cambodia where there are high migration and a very large proportion of adult children living some distant from their parents. This paper explores characteristics associated with migrant providing support to parents in rural Cambodia. With reference to perspectives of family altruism and solidarity, this analysis particularly focusses on how a series of variables representing family integration and residential location associates with intergenerational monetary and instrumental support from migrants. The study hypothesizes that migrants are more likely to provide support when parents are in need, and there are no alternative means of support. Data come from The Rural Household Survey (N=3,713), part of the 2011 Cambodian Rural Urban Migration Project (CRUMP). Multilevel multinomial models indicate international migrants are likely to give money, while internal migrants are likely to provide both money and instrumental support, especially when migrants have no sibling and their parent in poor health status. In addition, employed migrants are two times providing monetary compared to those unemployed. Findings elucidate the decision to which and why support occurs more often when no other source of support exists and also depends on the ability to provide of migrants themselves.

Keywords: migration, left-behind parent, intergenerational relations, support, rural, Cambodia

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Authors: Prachi Abhishek Dave, Abhishek Dave

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Purpose: The purpose of this study is to elucidate the role of intravitreal injection Aflibercept in managing complex cases of Wet Age Related Macular Degeneration (ARMD) and the gratifying visual recovery experienced with a minimally invasive procedure. Methods: A 73-year-old gentleman presented with a drop in vision in the left eye for 25 days. On examination, his best corrected visual acuity (BCVA) in the Right eye (OD) was 6/60, and finger counting close to face in the Left eye (OS). On multimodal imaging, he was diagnosed to have a scarred Wet ARMD in OD and an active Wet ARMD with a large subretinal bleed secondary to Wet ARMD in OS. Treatment management options included monotherapy with an Injection Aflibercept or an intravitreal gas injection with tPA followed by Injection Aflibercept. Considering his one-eyed status, the patient decided to go for Aflibercept monotherapy. Results: After 3 monthly injections of injection Aflibercept, the subretinal bleed reduced, the subretinal fluid resolved, and his vision in OS improved to 6/9. He is on a regular follow-up and has not needed any further injections in OS and he maintains 6/9 vision. Conclusions: Conventional treatment guidelines for a large subretinal bleed dictate the use of gas followed by intravitreal Injection Aflibercept. However, gas has its own limitations of causing a rise in intraocular pressure and a transient loss of vision, which is particularly troublesome in one-eyed patients. Injection Aflibercept offers a much safer, less invasive, and elegant treatment option for such patients with equally good or even better visual outcomes.

Keywords: wet ARMD, subretinal bleed, intravitreal injections, aflibercept, EYELEA, intravitreal gas

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Authors: Christopher Leung, Tony Kim, Rebecca Lendzion, Scott Mackenzie

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Retroperitoneal abscesses are a rare but serious condition with often delayed diagnosis, non-specific symptoms, multiple causes and high morbidity/mortality. With the advent of more readily available cross-sectional imaging, retroperitoneal abscesses are treated earlier and better outcomes are achieved. Occasionally, a retroperitoneal abscess is present as a huge retroperitoneal abscess, as evident in this 53-year-old male. With a background of chronic renal disease and left partial nephrectomy, this gentleman presented with a one-month history of left flank pain without any other symptoms, including fevers or abdominal pain. CT abdomen and pelvis demonstrated a huge retroperitoneal abscess spanning from the diaphragm, abutting the spleen, down to the iliopsoas muscle and abutting the iliac vessels at the pelvic brim. This large retroperitoneal abscess required open drainage as well as drainage by interventional radiology. A long course of intravenous antibiotics and multiple drainages was required to drain the abscess. His blood culture and fluid culture grew Proteus species suggesting a urinary source, likely from his non-functioning kidney, which had a partial nephrectomy. Such a huge retroperitoneal abscess has rarely been described in the literature. The learning point here is that the basic principle of source control and antibiotics is paramount in treating retroperitoneal abscesses regardless of the size of the abscess.

Keywords: retroperitoneal abscess, retroperitoneal mass, sepsis, genitourinary infection

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Authors: R. Jannat, N. S. Juyena, F. Y. Bari, M. N. Islam

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Understanding anatomy of female reproductive organs is very much important to identify any variation in disease condition. Therefore, this study was conducted to determine the morphometry of female reproductive tract in small ruminant using ultrasonography. The reproductive tracts of 2l does and 20 ewes were collected, and both gross and ultrasonographic image measurements were performed to study morphometry of cervix, body of uterus, horn of uterus and ovary. Water bath ultrasonography technique was used with trans-abdominal linear probe for image measurements. Results revealed significant (P<0.001) variation among gross and image measurements of cervix, body of uterus and ovaries in does whereas, significant (P<0.001) variation existed between gross and image measurements of ovaries diameter in ewes. Gross measurements were proportionately higher than image measurements in both species. The mean length and width were found higher in right ovaries than those of left ovaries. In addition, the diameter of right ovaries was higher than those of left ovaries in both species. Pearson's correlation revealed a positive relation between two measurements. Moreover, it was found that echogenicity varied with reproductive organs. This is a model study. This study may help to identify female reproductive structures by trans-abdominal ultrasonography.

Keywords: female reproductive tract, morphometry, small ruminants, ultrasonography

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Authors: Faris M. Altaf, Abdullah M Elkeshy

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Forty-two albino male rats aged between 30 and 40 days (weighted 200 g to 250 g) were used in the present study. The left sural nerves of 36 rats were subjected to crush injury at 1 to 6 weeks intervals using 6 animals at each interval. The right and left sural nerves of the rest 6 rats were used as a control. After 2 weeks of the crush injury, the endoneurium showed channel-like spaces that were lined by the fibroblast-like cells and collagen bundles. These channels contained degenerated myelin and were connected with the perivascular and subperineurial spaces. Some of the flattened fibroblast-like cells were arranged in several layers in the subperineurial and perivascular spaces, forming barrier-like cellular sheets localizing the endoneurial edema in these spaces. Fibroblast-like cells also wrapped the regenerating nerve fibers by their branching cytoplasmic processes. At the end of the third week, the flattened fibroblasts formed nearly continuous sheets in the subperineurial and perivascular spaces. Macrophages were frequently noticed between these cellular barrier-like sheets and in the subperineurial and perivascular spaces. Conclusion: it could be concluded that the endoneurial fibroblast-like cells form barrier-like cellular sheets that localized the endoneurial edema in the subperineurial and perivascular spaces and create also the endoneurial channel-like spaces containing degenerated myelin and endoneurial edema helping the resolution of such edema.

Keywords: sural nerve, endoneurial fibroblast-like cells, endoneurial edema, barrier-like and channel-like spaces

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Authors: Ji Jiazheng, Wang Jingrao, Jin Xin, Zhang Hong

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Diabetes mellitus is a metabolic disease characterized by high blood sugar. A long-standing hyperglycemic state can lead to various tissue damage. Diabetic retinopathy is the most common and widely studied ocular complication and has become the leading cause of blindness in my country. At the same time, diabetes has profound clinically relevant effects on the cornea, leading to keratopathy and vision-threatening. The cornea is an avascular tissue and is sensitive to hyperglycemia, Keratopathy caused by diabetes is usually chronic, they are called diabetic keratopathy or diabetic neurotrophic keratopathy, leading to several diabetic corneal complications including delayed epithelial wound healing, recurrent erosions, neuropathy, loss of sensitivity. Corneal stem cell dysfunction in diabetic patients as an important influencing factor of diabetic keratopathy. The consequences of this condition are often underestimated. The limbus is located between the cornea and the sclera tissue. The limbal stroma consists of a series of radial elevations with fibrovascular centers known as palisades of Vogt (POV). Previous studies have shown that palisades of Vogt (POV), as the main site of limbal stem cells, plays an important role in the homeostasis of the corneal epithelium. Therefore, POV plays a vital role in the healing of corneal epithelial surgery and postoperative evaluation. IVCM can observe the condition of the corneal epithelium at the cellular level. It has profound significance and guidance for the evaluation of limbal and limbal stem cells. We have previously observed structural changes in POV in HSK and HZO patients on IVCM. At present, there have been reports involving limbal stem cell dysfunction in diabetic patients, but the specific pathogenesis is still unclear. However, there are no studies on POV morphological changes in patients with DM. Therefore, we performed statistics and compared the correlation between POV morphological changes and corneal epithelial basal cell density, corneal nerves, and length of disease in DM patients and normal humans using IVCM studies. At the same time, fundoscopy was used to observe the correlation between the thickness of RNFL and the thickness of GCC and POV in diabetic patients. And to observe the correlation between SVD, DVD and POV for research.

Keywords: confocal microscopy, fundus, limbal stem cells, diabetes

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Authors: John McNamara

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Growing up creative is an important idea in today’s classrooms. As education seeks to prepare children for their futures, it is important that the system considers traditional as well as non-traditional pathways. This poster describes the findings of a research study investigating creative potential in children with learning disabilities. Children with learning disabilities were administered the Torrance Test of Creative Problem Solving along with subtests from the Comprehensive Test of Phonological Processing. A quantitative comparative analysis was computed using paired-sample t-tests. Results indicated statistically significant difference between children’s creative problem-solving skills and their reading-based skills. The results lend support to the idea that children with learning disabilities have inherent strengths in the area of creativity. It can be hypothesized that the success of these children may be associated with the notion that they are using a type of neurological processing that is not otherwise used in academic tasks. Children with learning disabilities, a presumed left-side neurological processing problem, process information with the right side of the brain – even with tasks that should be processed with the left side (i.e. language). In over-using their right hemisphere, it is hypothesized that children with learning disabilities have well-developed right hemispheres and, as such, have strengths associated with this type of processing, such as innovation and creativity. The current study lends support to the notion that children with learning disabilities may be particularly primed to succeed in areas that call on creativity and creative thinking.

Keywords: learning disabilities, educational psychology, education, creativity

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: Hisham A. Hashem, Sameh Galal, Bassem M. Moeshed

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A 36 years old male patient presented to our unit with a history of motor-car accident from 7 months complaining of disfigurement and double vision. On examination and investigations, there was an orbital floor fracture in the left eye with inferior rectus muscle entrapment causing diplopia, dystopia and enophthalmos. Under general anesthesia, a sub-ciliary incision was performed, and the orbital floor fracture was repaired with a double layer Medpor sheet (30x50x15) with removing and freeing fibrosis that was present and freeing of the inferior rectus muscle. Remarkable improvement of the dystopia was noticed, however, there was a residual diplopia in upgaze and enophthalmos. He was then referred to a strabismologist, which upon examination found left hypotropia of 8 ΔD corrected by 8 ΔD base up prism and positive forced duction test on elevation and pseudoptosis. Under local anesthesia, a limbal incision approach with hangback 4mm recession of inferior rectus muscle was performed after identifying an inferior rectus muscle structure. Improvement was noted shortly postoperative with correction of both diplopia and pseudoptosis. Follow up after 1, 4 and 8 months was done showing a stable condition. Delayed surgery in cases of orbital floor fracture may still hold good results provided proper assessment of the case with management of each sign separately.

Keywords: diplopia, dystopia, late surgery, orbital floor fracture

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Authors: Parul Jindal, Shubhi Singh, Priya Ramakrishnan, Shailender Raghuvanshi

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Background: Knowledge of the influence of the age of the child on laryngeal dimensions is essential for all practitioners who are dealing with paediatric airway. Choosing the correct endotracheal tube (ETT) size is a crucial step in pediatric patients because a large-sized tube may cause complications like post-extubation stridor and subglottic stenosis. On the other hand with a smaller tube, there will be increased gas flow resistance, aspiration risk, poor ventilation, inaccurate monitoring of end-tidal gases and reintubation may also be required with a different size of the tracheal tube. Recent advancement in ultrasonography (USG) techniques should now allow for accurate and descriptive evaluation of pediatric airway. Aims and objectives: This study was planned to determine the accuracy of Ultrasonography (USG) to assess the appropriate ETT size and compare it with physical indices based formulae. Methods: After obtaining approval from Institute’s Ethical and Research committee, and parental written and informed consent, the study was conducted on 100 subjects of either sex between 12-60 months of age, undergoing various elective surgeries under general anesthesia requiring endotracheal intubation. The same experienced radiologist performed ultrasonography. The transverse diameter was measured at the level of cricoids cartilage by USG. After USG, general anesthesia was administered using standard techniques followed by the institute. An experienced anesthesiologist performed the endotracheal intubations with uncuffed endotracheal tube (Portex Tracheal Tube Smiths Medical India Pvt. Ltd.) with Murphy’s eye. He was unaware of the finding of the ultrasonography. The tracheal tube was considered best fit if air leak was satisfactory at 15-20 cm H₂O of airway pressure. The obtained values were compared with the values of endotracheal tube size calculated by ultrasonography, various age, height, weight-based formulas and diameter of right and left little finger. The correlation of the size of the endotracheal tube by different modalities was done and Pearson's correlation coefficient was obtained. The comparison of the mean size of the endotracheal tube by ultrasonography and by traditional formula was done by the Friedman’s test and Wilcoxon sign-rank test. Results: The predicted tube size was equal to best fit and best determined by ultrasonography (100%) followed by comparison to left little finger (98%) and right little finger (97%) and age-based formula (95%) followed by multivariate formula (83%) and body length (81%) formula. According to Pearson`s correlation, there was a moderate correlation of best fit endotracheal tube with endotracheal tube size by age-based formula (r=0.743), body length based formula (r=0.683), right little finger based formula (r=0.587), left little finger based formula (r=0.587) and multivariate formula (r=0.741). There was a strong correlation with ultrasonography (r=0.943). Ultrasonography was the most sensitive (100%) method of prediction followed by comparison to left (98%) and right (97%) little finger and age-based formula (95%), the multivariate formula had an even lesser sensitivity (83%) whereas body length based formula was least sensitive with a sensitivity of 78%. Conclusion: USG is a reliable method of estimation of subglottic diameter and for prediction of ETT size in children.

Keywords: endotracheal intubation, pediatric airway, subglottic diameter, traditional formulas, ultrasonography

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Authors: Sandeep Santosh, O. P. Sahu

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In this paper, performance comparison of wideband covariance matrix sparse representation (W-CMSR) method with other existing wideband Direction of Arrival (DOA) estimation methods has been made.W-CMSR relies less on a priori information of the incident signal number than the ordinary subspace based methods.Consider the perturbation free covariance matrix of the wideband array output. The diagonal covariance elements are contaminated by unknown noise variance. The covariance matrix of array output is conjugate symmetric i.e its upper right triangular elements can be represented by lower left triangular ones.As the main diagonal elements are contaminated by unknown noise variance,slide over them and align the lower left triangular elements column by column to obtain a measurement vector.Simulation results for W-CMSR are compared with simulation results of other wideband DOA estimation methods like Coherent signal subspace method (CSSM), Capon, l1-SVD, and JLZA-DOA. W-CMSR separate two signals very clearly and CSSM, Capon, L1-SVD and JLZA-DOA fail to separate two signals clearly and an amount of pseudo peaks exist in the spectrum of L1-SVD.

Keywords: W-CMSR, wideband direction of arrival (DOA), covariance matrix, electrical and computer engineering

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Authors: Anna Słupik, Krzysztof Jaworski, Anna Mosiołek, Dariusz Białoszewski

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Background: Maintaining the correct body balance is essential in the prevention of falls in the elderly, which is especially important for women because of postmenopausal osteoporosis and the serious consequences of falls. One of the exercise methods which is very popular among adults, and which may affect body balance in a positive way is the pilates method. The aim of the study was to evaluate the effect of regular pilates exercises on the ability to maintain body balance in static conditions in adult healthy women. Material and methods: The study group consisted of 20 healthy women attending pilates twice a week for at least 1 year. The control group consisted of 20 healthy women physically inactive. Women in the age range from 35 to 50 years old without pain in musculoskeletal system or other pain were only qualified to the groups. Body balance was assessed using MatScan VersaTek platform with Sway Analysis Module based on Matscan Clinical 6.7 software. The balance was evaluated under the following conditions: standing on both feet with eyes open, standing on both feet with eyes closed, one-leg standing (separately on the right and left foot) with eyes open. Each test lasted 30 seconds. The following parameters were calculated: estimated size of the ellipse of 95% confidence, the distance covered by the Center of Gravity (COG), the size of the maximum shift in the sagittal and frontal planes and load distribution between the left and right foot, as well as between rear- and forefoot. Results: It was found that there is significant difference between the groups in favor of the study group in the size of the confidence ellipse and maximum shifts of COG in the sagittal plane during standing on both feet, both with the eyes open and closed (p < 0.05). While standing on one leg both on the right and left leg, with eyes opened there was a significant difference in favor of the study group, in terms of the size of confidence ellipse, the size of the maximum shifts in the sagittal and in the frontal plane (p < 0.05). There were no differences between the distribution of load between the right and left foot (standing with both feet), nor between fore- and rear foot (in standing with both feet or one-leg). Conclusions: 1. Static balance in women exercising regularly by pilates method is better than in inactive women, which may in the future prevent falls and their consequences. 2. The observed differences in maintaining balance in frontal plane in one-leg standing may indicate a positive impact of pilates exercises on the ability to maintain global balance in terms of the reduced support surface. 3. Pilates method can be used as a form preventive therapy for all people who are expected to have problems with body balance in the future, for example in chronic neurological disorders or vestibular problems. 4. The results have shown that further prospective randomized research on a larger and more representative group is needed.

Keywords: balance exercises, body balance, pilates, pressure distribution, women

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Authors: Nadzeya Marozkina, Joe Zein, Benjamin Gaston

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Introduction: We have observed that many patients with Primary Ciliary Dyskinesia (PCD) benefit from asthma medications. In healthy airways, the ciliary function is normal. Antigens and irritants are rapidly cleared, and NO enters the gas phase normally to be exhaled. In the PCD airways, however, antigens, such as Dermatophagoides, are not as well cleared. This defect leads to oxidative stress, marked by increased DUOX1 expression and decreased superoxide dismutase [SOD] activity (manuscript under revision). H₂O₂, in high concentrations in the PCD airway, injures the airway. NO is oxidized rather than being exhaled, forming cytotoxic peroxynitrous acid. Thus, antigen stasis on PCD airway epithelium leads to airway injury and may predispose PCD patients to asthma. Indeed, recent population genetics suggest that PCD genes may be associated with asthma. We therefore hypothesized that PCD patients would be predisposed to having asthma. Methods. We analyzed our database of 18 million individual electronic medical records (EMRs) in the Indiana Network for Patient Care research database (INPCR). There is not an ICD10 code for PCD itself; code Q34.8 is most commonly used clinically. To validate analysis of this code, we queried patients who had an ICD10 code for both bronchiectasis and situs inversus totalis in INPCR. We also studied a validation cohort using the IBM Explorys® database (over 80 million individuals). Analyses were adjusted for age, sex and race using a 1 PCD: 3 controls matching method in INPCR and multivariable logistic regression in the IBM Explorys® database. Results. The prevalence of asthma ICD10 codes in subjects with a code Q34.8 was 67% vs 19% in controls (P < 0.0001) (Regenstrief Institute). Similarly, in IBM*Explorys, the OR [95% CI] for having asthma if a patient also had ICD10 code 34.8, relative to controls, was =4.04 [3.99; 4.09]. For situs inversus alone the OR [95% CI] was 4.42 [4.14; 4.71]; and bronchiectasis alone the OR [95% CI] =10.68 (10.56; 10.79). For both bronchiectasis and situs inversus together, the OR [95% CI] =28.80 (23.17; 35.81). Conclusions: PCD causes antigen stasis in the human airway (under review), likely predisposing to asthma in addition to oxidative and nitrosative stress and to airway injury. Here, we show that, by several different population-based metrics, and using two large databases, patients with PCD appear to have between a three- and 28-fold increased risk of having asthma. These data suggest that additional studies should be undertaken to understand the role of ciliary dysfunction in the pathogenesis and genetics of asthma. Decreased antigen clearance caused by ciliary dysfunction may be a risk factor for asthma development.

Keywords: antigen, PCD, asthma, nitric oxide

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Authors: Abdou Elhendy

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Numerous study have shown the efficacy of the percutaneous intervention (PCI) and coronary stenting in improving left ventricular function and relieving exertional angina. Furthermore, PCI remains the main line of therapy in acute myocardial infarction. Improvement of procedural techniques and new devices have resulted in an increased number of PCI in those with difficult and extensive lesions, multivessel disease as well as total occlusion. Immediate and late outcome may be compromised by acute thrombosis or the development of fibro-intimal hyperplasia. In addition, progression of coronary artery disease proximal or distal to the stent as well as in non-stented arteries is not uncommon. As a result, complications can occur, such as acute myocardial infarction, worsened heart failure or recurrence of angina. In a stent, restenosis can occur without symptoms or with atypical complaints rendering the clinical diagnosis difficult. Routine invasive angiography is not appropriate as a follow up tool due to associated risk and cost and the limited functional assessment. Exercise and pharmacologic stress testing are increasingly used to evaluate the myocardial function, perfusion and adequacy of revascularization. Information obtained by these techniques provide important clues regarding presence and severity of compromise in myocardial blood flow. Stress echocardiography can be performed in conjunction with exercise or dobutamine infusion. The diagnostic accuracy has been moderate, but the results provide excellent prognostic stratification. Adding myocardial contrast agents can improve imaging quality and allows assessment of both function and perfusion. Stress radionuclide myocardial perfusion imaging is an alternative to evaluate these patients. The extent and severity of wall motion and perfusion abnormalities observed during exercise or pharmacologic stress are predictors of survival and risk of cardiac events. According to current guidelines, stress echocardiography and radionuclide imaging are considered to have appropriate indication among patients after PCI who have cardiac symptoms and those who underwent incomplete revascularization. Stress testing is not recommended in asymptomatic patients, particularly early after revascularization, Coronary CT angiography is increasingly used and provides high sensitive for the diagnosis of coronary artery stenosis. Average sensitivity and specificity for the diagnosis of in stent stenosis in pooled data are 79% and 81%, respectively. Limitations include blooming artifacts and low feasibility in patients with small stents or thick struts. Anatomical and functional cardiac imaging modalities are corner stone for the assessment of patients after PCI and provide salient diagnostic and prognostic information. Current imaging techniques cans serve as gate keeper for coronary angiography, thus limiting the risk of invasive procedures to those who are likely to benefit from subsequent revascularization. The determination of which modality to apply requires careful identification of merits and limitation of each technique as well as the unique characteristic of each individual patient.

Keywords: coronary artery disease, stress testing, cardiac imaging, restenosis

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Authors: Helan Satish, M. Ramasubba Reddy

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The simulation of an endocardial cell for gene mutation in the cardiac sodium ion channel NaV1.5, encoded by SCN5A gene, is discussed. The characterization of Brugada Syndrome by loss of function effect on SCN5A mutation due to L812Q mutant present in the DII-S4 transmembrane region of the NaV1.5 channel protein and its effect in an endocardial cell is studied. Ten Tusscher model of human ventricular action potential is modified to incorporate the changes contributed by L812Q mutant in the endocardial cells. Results show that BrS-associated SCN5A mutation causes reduction in the inward sodium current by modifications in the channel gating dynamics such as delayed activation, enhanced inactivation, and slowed recovery from inactivation in the endocardial cell. A decrease in the inward sodium current was also observed, which affects depolarization phase (Phase 0) that leads to reduction in the spike amplitude of the cardiac action potential.

Keywords: SCN5A gene mutation, sodium channel, Brugada syndrome, cardiac arrhythmia, action potential

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Authors: Seokbeen Lim, Gilwon Yoon

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The readiness potential in brain waves is a brain activity related with an intention whose potential arises even before its conscious intention. This study was carried out in order to understand the generation and mechanism of the readiness potential more. The experiment with two subjects was conducted in two ways following the Oddball task protocol. Firstly, auditory stimuli were randomly presented to the subjects. The subject was allowed to press the keyboard with the right index finger only when the subject heard the target stimulus but not the standard stimulus. Secondly, unlike the first one, the auditory stimuli were randomly presented, and the subjects pressed the keyboard in the same manner, but at the same time with grasping action of the left hand. The readiness potential showed up for both of these experiments. In the first Oddball experiment, the readiness potential was detected only when the target stimulus was presented. However, in the second Oddball experiment with the left hand action of grasping something, the readiness potential was detected at the presentation of for both standard and target stimuli. However, detected readiness potentials with the target stimuli were larger than those of the standard stimuli. We found an interesting phenomenon that the readiness potential was able to be detected even the standard stimulus. This indicates that motor-related readiness potentials can be generated only by the intention to move. These results present a new perspective in psychology and brain engineering since subconscious brain action may be prior to conscious recognition of the intention.

Keywords: readiness potential, auditory stimuli, event-related potential, electroencephalography, oddball task

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Authors: Sumit Kanwar, Manisha Chand, Gregory Gilot

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Background: Septic arthritis of the shoulder has infrequently been discussed. Focus on infection of the untouched shoulder has not heretofore been described. We present four patients with glenohumeral septic arthritis. Methods: Case 1: A 59 year old male with left shoulder pain in the anterior, posterior and superior aspects. Case 2: A 60 year old male with fever, chills, and generalized muscle aches. Case 3: A 70 year old male with right shoulder pain about the anterior and posterior aspects. Case 4: A 55 year old male with global right shoulder pain, swelling, and limited ROM. Results: In case 1, the left shoulder was affected. Physical examination, swelling was notable, there was global tenderness with a painful range of motion (ROM). The lab values indicated an erythrocyte sedimentation rate (ESR) of 96, and a C-reactive protein (CRP) of 304.30. Imaging studies were performed and MRI indicated a high suspicion for an abscess with osteomyelitis of the humeral head. Our second case’s left arm was affected. He had swelling, global tenderness and painful ROM. His ESR was 38, CRP was 14.9. X-ray showed severe arthritis. Case 3 differed with the right arm being affected. Again, global tenderness and painful ROM was observed. His ESR was 94, and CRP was 10.6. X-ray displayed an eroded glenoid space. Our fourth case’s right shoulder was affected. He had global tenderness and painful, limited ROM. ESR was 108 and CRP was 2.4. X-ray was non-significant. Discussion: Monoarticular septic arthritis of the virgin glenohumeral joint is seldom diagnosed in clinical practice. Common denominators include elevated ESR, painful, limited ROM, and involvement of the dominant arm. The male population is more frequently affected with an average age of 57. Septic arthritis is managed with incision and drainage or needle aspiration of synovial fluid supplemented with 3-6 weeks of intravenous antibiotics. Due to better irrigation and joint visualization, arthroscopy is preferred. Open surgical drainage may be indicated if the above methods fail. Conclusion: If a middle-aged male presents with vague anterior or posterior shoulder pain, elevated inflammatory markers and a low grade fever, an x-ray should be performed. If this displays degenerative joint disease, the complete further workup with advanced imaging, such as an MRI, CT scan, or an ultrasound. If these imaging modalities display anterior space joint effusion with soft tissue involvement, we can suspect septic arthritis of the untouched glenohumeral joint and surgery is indicated.

Keywords: glenohumeral joint, identification, infection, septic arthritis, shoulder

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Authors: Phillip Thebe

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African traders in China have generated magnanimous attention from scholars because of their choices to take short-term trips to Guangzhou and other places in search of cheaper products taking advantage of the status of China as a "global manufacturing hub". Nevertheless, their activities only gained traction at the turn of the millennium, with their presence in China incrementally dwindling over the next two decades. Now, with the devastating effects of COVID-19, their journeys have had to be totally cut short by unending lockdowns and stiff migration rules due to China's zero-tolerance of COVID-19 policy. This unfortunate yet untimely occurrence has left many scholars wondering if this marks the end of African traders in China and, indeed, the end of their business careers. Between March and September 2022, 20 traders were followed back to Africa, Zimbabwe, to find out what they are doing after having been shut out of China. Data was collected through ethnographic immersion and purposive in-depth interviewing in and around the city of Bulawayo. Snowballing was employed to reach out to the traders until a saturation point was reached and interview transcripts were filed for analysis. The findings revealed that some still trading online in China, report different opinions and feelings about doing business during COVID-19. Others have left the Chinese marketplace, now pursuing European industries in Turkey and other places. Others are still getting Chinese goods but in African countries such as Tanzania, Mozambique, South Africa, and Botswana. Some are now into the second-hand clothing trade, whereas others have stopped doing business to pursue other life-course interests. These and other issues are addressed in this paper from the anthropology of migration and globalization perspectives.

Keywords: entrepreneurship, African traders, China, COVID-19, Africans in China

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