Search results for: rare sports injuries
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1938

Search results for: rare sports injuries

528 Methane Plasma Modified Polyvinyl Alcohol Scaffolds for Melanocytes Cultivation

Authors: B. Kodedova, E. Filova, M. Kralovic, E. Amler

Abstract:

Vitiligo is the most common depigmentation disorder of the skin characterized by loss of melanocyte in the epidermis that leads to white lesions. One of the possible treatments is autologous transplantation of melanocytes. Biodegradable electrospun polymeric nanofibers provide good mechanical properties and could serve as suitable scaffold for epithelial cells cultivation and follow up transplantation. Moreover the microarchitecture of nanofibers mimics the structure of extracellular matrix and its porosity allows nutrients and waste exchange. The aim of this work was to develop biocompatible and biodegradable polymeric scaffolds suitable for autologous melanocytes transplantation. Electrospun polyvinyl alcohol (PVA) nanofibers were modified by cold methane plasma to lower their hydrofility and to achieve better adhesion, proliferation and viability of the murine melanocyte (Melan-a). Cells were seeded on the modified scaffolds and their adhesion, metabolic activity, proliferation and melanin synthesis was evaluated and compared to non-modified scaffolds. Results clearly indicate that cold methane plasma modified PVA nanofibers are suitable for melanocyte cultivation and may be future candidate for vitiligo treatment. Furthermore, the nanofibers can be functionalized with various bioactive substances, for enhancement of the melanocyte proliferation, melanogenesis or healing and regenerative processes. The project was supported by the Ministry of Education, Youth and Sports NPU I: LO1309 and by Grant Agency of Charles University (grant No. 1228214).

Keywords: melanocyte, nanofibers, polyvinyl alcohol, plasma modification

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527 Workers’ Prevention from Occupational Chemical Exposures during Container Handling

Authors: Balázs Ádám, Randi Nørgaard Fløe Pedersen, Jørgen Riis Jepsen

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Volatile chemicals that accumulate and release from freight containers constitute significant health risks. Fumigation to prevent spread of pests and off-gassing of freight are sources of hazardous chemicals. The aim of our study was to investigate the regulation and practice of container handling with focus on preventive measures applied against chemical exposures in Denmark. A comprehensive systematic search of scientific literature and organizational domains of international and Danish regulatory bodies was performed to explore regulations related to safe work with transport containers. The practice of container work was investigated in a series of semi-structured interviews with managers and health and safety representatives of organizations that handle transport containers. Although there are several international and national regulations and local safety instructions that relate to container handling, the provided information is not specific or up-to-date enough to conduct safe practice in many aspects. The interviewees estimate high frequency of containers with chemical exposure and deem that they can potentially damage health, although recognizable health effects are rare. Knowledge is limited about the chemicals and most of them cannot be measured by available devices. Typical preventive measures are passive ventilation and personal protective equipment but their use is not consistent and may not provide adequate protection. Hazardous chemicals are frequently present in transport containers; however, managers, workers and even occupational health professionals have limited knowledge about the problem. Detailed risk assessment and specific instructions on risk management are needed to provide safe conditions for work with containers.

Keywords: chemical exposure, fumigation, occupational health and safety regulation, transport container

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526 Alteration of Placental Development and Vascular Dysfunction in Gestational Diabetes Mellitus Has Impact on Maternal and Infant Health

Authors: Sadia Munir

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The aim of this study is to investigate changes in placental development and vascular dysfunction which subsequently affect feto-maternal health in pregnancies complicated by gestational diabetes mellitus (GDM). Fetal and postnatal adverse health outcomes of GDM are shown to be associated with disturbances in placental structure and function. Children of women with GDM are more likely to be obese and diabetic in childhood and adulthood. GDM also increases the risk of adverse pregnancy outcomes, including preeclampsia, birth injuries, macrosomia and neonatal hypoglycemia, respiratory distress syndrome, neonatal cardiac dysfunction and stillbirth. Incidences of type 2 diabetes in the MENA region are growing at an alarming rate which is estimated to become more than double by 2030. Five of the top 10 countries for diabetes prevalence in 2010 were in the Gulf region. GDM also increases the risk of development of type 2 diabetes. Interestingly, more than half of the women with GDM develop diabetes later in their life. The human placenta is a temporary organ located at the interface between mother and fetal blood circulation. Placenta has a central role as both a producer as well as a target of several molecules that are involved in placental development and function. We have investigated performed a Pubmed search with key words placenta, GDM, placental villi, vascularization, cytokines, growth factors, inflammation, hypoxia, oxidative stress and pathophysiology. We have investigated differences in the development and vascularization of placenta, their underlying causes and impact on feto-maternal health through literature review. We have also identified gaps in the literature and research questions that need to be answered to completely understand the central role of placenta in the GDM. This study is important in understanding the pathophysiology of placenta due to changes in the vascularization of villi, surface area and diameter of villous capillaries in pregnancies complicated by GDM. It is necessary to understand these mechanisms in order to develop treatments to reverse their effects on placental malfunctioning, which in turn, will result in improved mother and child health.

Keywords: gestational diabetes mellitus, placenta, vasculature, villi

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525 Study of Side Effects of Myopia Contact Correction by Soft Lenses and Orthokeratology Lenses among Medical Students

Authors: K. Iu. Hrizhymalska, O. Ol. Andrushkova, I. Iu. Pshenychna

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Aim. To study and copare the side effects of myopia contact correction by soft lenses and orthokeratology lenses among medical students. Patients and methods: 34 students (68 eyes) with moderate and severe myopia, who used contact correction of myopia for 2-4 years, were examined. Some of them used soft lenses, while others - orthokeratology lenses. Methods were used: biomicroscopy of the eye surface, Schirmer's test, Norn's test, survey regarding satisfaction with use. Results. Corneal vascularization along the limbus was noted in 4 (5%) eyes of the examined students. In 8 (11%) eyes, symptoms of mild dry eye disease were detected. 2 (3%) eyes showed signs of meibomitis. Allergic conjunctivitis was observed in 4 (5%) eyes, and a purulent corneal ulcer was present in 1 eye. Surveys have shown that orthokeratology lenses unlike soft lenses don't limit everyday activity (in sports, tourism, swimming etc.), they also don't cause discomfort during temperature changes and reduce existing symptoms of dry eye disease. Conclusion. Thus, myopia contact correction is one of the optimal options among students, which allows to expand physical and mental activity. However, taking into account the frequency of side effects in users of soft contact lenses, it is necessary to carry out prevention and treatment of myopia in medical students, follow the recommendations for use, instill preservative-free tear substitutes with trehalose when symptoms of dry eye appear. Also when side reactions occur, contact correction with soft lenses should be changed to orthokeratology lenses.

Keywords: correction, myopia, soft lenses, orthokeratology, specracles, cornea, dry eye, side effects, refractive errors

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524 Profiles of Physical Fitness and Enjoyment among Children: Associations with Sport Participation

Authors: Norjali Wazir M. R. W., Pion P., Mostaert M., De Meester A., Lenoir M., Bardid F.

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Background and study aim: Most of the people assume that someone will perform well on something they like. A tool evaluating how much an individual likes an activity can also be guidance for talent detection and to keep youngster doing what they like as a recreational sport. The purpose of this study was to identify the relationship between physical performances with something that they like. Material and methods: In this cross-sectional study, 558 pupils age between 8 years to 11 years were tested using test battery containing 7 physical performance tests (I Do) compared to a pictorial scale containing 7 pictures (I Like) referring to the physical performance tests. Pearson correlation was computed to investigate the relation between the actual performance and the enjoyment. Results: Moderate significant correlations between each of the respective I Do, and I Like components were found. It appears that the correlation between the endurance items is higher as compared to the other six characteristics. Rerunning the analysis for age and sex groups separately resulted in only one significant correlation across all age group, namely between the evaluations of cardiovascular endurance. Conclusions: Information on enjoyment appears to be a useful and cost-effective addition to current multidimensional test batteries in a sport. By providing a clear picture on activities the young child or athlete likes or dislikes, attrition can be increased if a child starts his ‘career’ in a sport that alludes to skills or tasks he/she likes. This enjoyment will increase the intrinsic motivation, which is beneficial for sustained sports participation as well as for avoiding dropout in promising young athletes.

Keywords: I Do, I Like, physical performance, enjoyment

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523 Multiple Organ Manifestation in Neonatal Lupus Erythematous: Report of Two Cases

Authors: A. Lubis, R. Widayanti, Z. Hikmah, A. Endaryanto, A. Harsono, A. Harianto, R. Etika, D. K. Handayani, M. Sampurna

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Neonatal lupus erythematous (NLE) is a rare disease marked by clinical characteristic and specific maternal autoantibody. Many cutaneous, cardiac, liver, and hematological manifestations could happen with affect of one organ or multiple. In this case, both babies were premature, low birth weight (LBW), small for gestational age (SGA) and born through caesarean section from a systemic lupus erythematous (SLE) mother. In the first case, we found a baby girl with dyspnea and grunting. Chest X ray showed respiratory distress syndrome (RDS) great I and echocardiography showed small atrial septal defect (ASD) and ventricular septal defect (VSD). She also developed anemia, thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, increasing coagulation factors, hyperbilirubinemia, and positive blood culture of Klebsiella pneumonia. Anti-Ro/SSA and Anti-nRNP/sm were positive. Intravenous fluid, antibiotic, transfusion of blood, thrombocyte concentrate, and fresh frozen plasma were given. The second baby, male presented with necrotic tissue on the left ear and skin rashes, erythematous macula, athropic scarring, hyperpigmentation on all of his body with various size and facial haemorrhage. He also suffered from thrombocytopenia, mild elevated transaminase enzyme, hyperbilirubinemia, anti-Ro/SSA was positive. Intravenous fluid, methyprednisolone, intravenous immunoglobulin (IVIG), blood, and thrombocyte concentrate transfution were given. Two cases of neonatal lupus erythematous had been presented. Diagnosis based on clinical presentation and maternal auto antibody on neonate. Organ involvement in NLE can occur as single or multiple manifestations.

Keywords: neonatus lupus erythematous, maternal autoantibody, clinical characteristic, multiple organ manifestation

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522 Biomechanical Study of a Type II Superior Labral Anterior to Posterior Lesion in the Glenohumeral Joint Using Finite Element Analysis

Authors: Javier A. Maldonado E., Duvert A. Puentes T., Diego F. Villegas B.

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The SLAP lesion (Superior Labral Anterior to Posterior) involves the labrum, causing pain and mobility problems in the glenohumeral joint. This injury is common in athletes practicing sports that requires throwing or those who receive traumatic impacts on the shoulder area. This paper determines the biomechanical behavior of soft tissues of the glenohumeral joint when type II SLAP lesion is present. This pathology is characterized for a tear in the superior labrum which is simulated in a 3D model of the shoulder joint. A 3D model of the glenohumeral joint was obtained using the free software Slice. Then, a Finite Element analysis was done using a general purpose software which simulates a compression test with external rotation. First, a validation was done assuming a healthy joint shoulder with a previous study. Once the initial model was validated, a lesion of the labrum built using a CAD software and the same test was done again. The results obtained were stress and strain distribution of the synovial capsule and the injured labrum. ANOVA was done for the healthy and injured glenohumeral joint finding significant differences between them. This study will help orthopedic surgeons to know the biomechanics involving this type of lesion and also the other surrounding structures affected by loading the injured joint.

Keywords: biomechanics, computational model, finite elements, glenohumeral joint, superior labral anterior to posterior lesion

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521 Genetic Association and Functional Significance of Matrix Metalloproteinase-14 Promoter Variants rs1004030 and rs1003349 in Gallbladder Cancer Pathogenesis

Authors: J. Vinay , Kusumbati Besra, Niharika Pattnaik, Shivaram Prasad Singh, Manjusha Dixit

Abstract:

Gallbladder cancer (GBC) is rare but highly malignant cancer; its prevalence is more in certain geographical regions and ethnic groups, which include the Northern and Eastern states of India. Previous studies in India have reported genetic predisposition as one of the risk factors in GBC pathogenesis. Although the matrix metalloproteinase-14 (MMP14) is a well-known modulator of the tumor microenvironment and tumorigenesis and TCGA data also suggests its upregulation yet, its role in the genetic predisposition for GBC is completely unknown. We elucidated the role of MMP14 promoter variants as genetic risk factors and their implications in expression modulation. We screened MMP14 promoter variants association with GBC using Sanger’s sequencing in approximately 300 GBC and 300 control subjects and 26 GBC tissue samples of Indian ethnicity. The immunohistochemistry was used to check the MMP14 protein expression in GBC tissue samples. The role of promoter variants on expression levels was elucidated using a luciferase reporter assay. The variants rs1004030 (p-value = 0.0001) and rs1003349 (p-value = 0.0008) were significantly associated with gallbladder cancer. The luciferase assay in two different cell lines, HEK-293 (p = 0.0006) and TGBC1TKB (p = 0.0036) showed a significant increase in relative luciferase activity in the presence of risk alleles for both the single nucleotide polymorphisms (SNPs). Similarly, genotype-phenotype correlation in patients samples confirmed that the presence of risk alleles at rs1004030 and rs1003349 increased MMP14 expression. Overall, this study unravels the genetic association of MMP14 promoter variants with gallbladder cancer, which may contribute to pathogenesis by increasing its expression.

Keywords: gallbladder cancer, matrix metalloproteinase-14, single nucleotide polymorphism, case control study, genetic association study

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520 Kinesio Taping in Treatment Patients with Intermittent Claudication

Authors: Izabela Zielinska

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Kinesio Taping is classified as physiotherapy method supporting rehabilitation and modulating some physiological processes. It is commonly used in sports medicine and orthopedics. This sensory method has influence on muscle function, pain sensation, intensifies lymphatic system as well as improves microcirculation. The aim of this study was to assess the effect of Kinesio Taping in patients with ongoing treatment of peripheral artery disease (PAD). The study group comprised 60 patients (stadium II B at Fontain's scale). All patients were divided into two groups (30 person/each), where 12 weeks long treadmill training was administrated. In the second group, the Kinesio Taping was applied to support the function of the gastrocnemius muscle. The measurements of distance and time until claudication pain, blood flow of arteries in lower limbs and ankle brachial index were taken under evaluation. Examination performed after Kinesio Taping therapy showed statistically significant increase in gait parameters and muscle strength in patients with intermittent claudication. The Kinesio Taping method has clinically significant effects on enhancement of pain-free distance and time until claudication pain in patients with peripheral artery disease. Kinesio Taping application can be used to support non-invasive treatment in patients with intermittent claudication. Kinesio Taping can be employed as an alternative way of therapy for patients with orthopedic or cardiac contraindications to be treated with treadmill training.

Keywords: intermittent claudication, kinesiotaping, peripheral artery disease, treadmill training

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519 Environmental Assessment of Roll-to-Roll Printed Smart Label

Authors: M. Torres, A. Moulay, M. Zhuldybina, M. Rozel, N. D. Trinh, C. Bois

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Printed electronics are a fast-growing market as their applications cover a large range of industrial needs, their production cost is low, and the additive printing techniques consume less materials than subtractive manufacturing methods used in traditional electronics. With the growing demand for printed electronics, there are concerns about their harmful and irreversible contribution to the environment. Indeed, it is estimated that 80% of the environmental load of a product is determined by the choices made at the conception stage. Therefore, examination through a life cycle approach at the developing stage of a novel product is the best way to identify potential environmental issues and make proactive decisions. Life cycle analysis (LCA) is a comprehensive scientific method to assess the environmental impacts of a product in its different stages of life: extraction of raw materials, manufacture and distribution, use, and end-of-life. Impacts and major hotspots are identified and evaluated through a broad range of environmental impact categories of the ReCiPe (H) middle point method. At the conception stage, the LCA is a tool that provides an environmental point of view on the choice of materials and processes and weights-in on the balance between performance materials and eco-friendly materials. Using the life cycle approach, the current work aims to provide a cradle-to-grave life cycle assessment of a roll-to-roll hybrid printed smart label designed for the food cold chain. Furthermore, this presentation will present the environmental impact of metallic conductive inks, a comparison with promising conductive polymers, evaluation of energy vs. performance of industrial printing processes, a full assessment of the impact from the smart label applied on a cellulosic-based substrate during the recycling process and the possible recovery of precious metals and rare earth elements.

Keywords: Eco-design, label, life cycle assessment, printed electronics

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518 Inclusive Practices in Physical Education: A Survey of Pre-Service Teachers' Attitudes and Self-Efficacy in the Context of Teachers' Training

Authors: Teresa M. Odipo

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Inclusive physical education and an inclusive educational approach in German schools have received much attention in recent years due to the UN Convention on the rights of persons with disabilities proposals, which came into force in Germany in 2009. The aim of inclusive PE is to include children with disabilities and able bodied children, based on the idea, that all children should attend school together. While PE mostly took place in a heterogeneous environment, introducing children with all kinds of disabilities posed more challenges to the teachers, when children with disabilities were included. Therefore it is important that the educational approach should include pre-service teachers’ (PST) self-efficacy for and their attitudes towards inclusive practices. The PSTs’ self-efficacy for inclusive practices is one of the strongest predictors of the success of the inclusion reforms introduced in 2009, in order to improve PSTs’ ability to handle these very new challenges. PE stands out because the very nature of sport involves the body which means that all children, especially those with special needs should be treated in an appropriate manner. Up till now, it has been mostly English-speaking countries that have been assessed for inclusive practices in PE. Due to the lack of research in Germany, there is a strong need to question PSTs’ prepared-ness. This paper presents results from the 2016 survey conducted on around 100 PSTs by the German University of Sports in Cologne and opens up new directions within PSTs’ education, concerning their attitudes and self-efficacy towards inclusive PE. These new aspects will be included in the construction of new learning and teaching tools to improve pre-service teachers’ education for inclusive Physical Education.

Keywords: attitudes, inclusive physical education, pre-service teachers, self-efficacy

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517 Examining the Relationship between Preferred Leadership Style and Motivation of Female Volleyball Players in Ethiopian Primer League Clubs

Authors: Meseret Mulugeta, Alemmebrat Kiflu, Belaynehchikle

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The purpose of the present study was to examine the preferred leadership style and motivation of premier league volleyball players. The sample encompassed 46 female premier league volleyball players whose ages ranged between 15 and 35 years. The data were collected using standardized questionnaires. The questionnaires were distributed to 46 female players from five volleyball clubs in the Premier League. To evaluate the motivational level of the players, the Sports Motivation Scale (SMS-6) was used. The leadership scale for sport was used to evaluate leadership. Descriptive statistics and the person correlation coefficient (P <0.05) were used to validate the relationship between leadership style and motivation. The result showed that there is a meaningful and significant relationship between leadership style and motivation. Concerning preferred coaching styles, the most preferred style was training and instruction, with a mean score of 4.10, and the least preferred style was autocratic, with a mean score of 3.37. The result of the Pearson correlation coefficient showed that the correlation between motivation types and leadership styles showed that motivation was significantly and positively correlated with all independent variables except autocratic leadership style, which is negatively correlated with motivation. This study’s nobility is to provide evidence for the most effective coaching to practice the training and instruction behaviour and social support behaviour leadership styles and refrain from using the autocratic leadership style.

Keywords: autocratic, training and instruction, motivation, leadership style

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516 An Exploration of Architecture Design Methods in Urban Fringe Belt Based on Typo-Morphological Research- A Case of Expansion Project of the Second Middle School in Xuancheng, China

Authors: Dong Yinan, Zhou Zijie

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Urban fringe belt is an important part of urban morphology research. Different from the relatively fixed central district of city, the position of fringe belt is changing. In the process of urban expansion, the original fringe belt is likely to be merged by the new-built city, even become new city public center. During the change, we are facing the dialectic between restoring the organicity of old urban form and creating new urban image. There are lots of relevant research in urban scale, but when we focus on building scale, rare design method can be proposed, thus some new individual building cannot match the overall urban planning intent. The expansion project of the second middle school in Xuancheng is facing this situation. The existing campus is located in the south fringe belt of Xuancheng, Anhui province, China, adjacent to farmland and ponds. While based on the Xucheng urban planning, the farmland and ponds will be transformed into a big lake, around which new public center will be built; the expansion of the school becomes an important part of the boundary of the new public center. Therefore, the expansion project faces challenges from both urban and building scale. In urban scale, we analyze and summarize the fringe belt characters through the reading of existing and future urban organism, in order to determine the form of the expansion project. Meanwhile, in building scale, we study on different types of school buildings and select appropriate type which can satisfy to both urban form and school function. This research attempts to investigate design methods based on an under construction project in Xuancheng, a historic city in southeast China. It also aims to bridge the gap from urban design to individual building design through the typo-morphological research.

Keywords: design methods, urban fringe belt, typo-morphological research, middle school

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515 Different Types of Amyloidosis Revealed with Positive Cardiac Scintigraphy with Tc-99M DPD-SPECT

Authors: Ioannis Panagiotopoulos, Efstathios Kastritis, Anastasia Katinioti, Georgios Efthymiadis, Argyrios Doumas, Maria Koutelou

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Introduction: Transthyretin amyloidosis (ATTR) is a rare but serious infiltrative disease. Myocardial scintigraphy with DPD has emerged as the most effective, non-invasive, highly sensitive, and highly specific diagnostic method for cardiac ATTR amyloidosis. However, there are cases in which additional laboratory investigations reveal AL amyloidosis or other diseases despite a positive DPD scintigraphy. We describe the experience from the Onassis Cardiac Surgery Center and the monitoring center for infiltrative myocardial diseases of the cardiology clinic at AHEPA. Materials and Methods: All patients with clinical suspicion of cardiac or extracardiac amyloidosis undergo a myocardial scintigraphy scan with Tc-99m DPD. In this way, over 500 patients have been examined. Further diagnostic approach based on clinical and imaging findings includes laboratory investigation and invasive techniques (e.g., biopsy). Results: Out of 76 patients in total with positive myocardial scintigraphy Grade 2 or 3 according to the Perugini scale, 8 were proven to suffer from AL Amyloidosis during the investigation of paraproteinemia. Among these patients, 3 showed Grade 3 uptake, while the rest were graded as Grade 2, or 2 to 3. Additionally, one patient presented diffuse and unusual radiopharmaceutical uptake in soft tissues throughout the body without cardiac involvement. These findings raised suspicions, leading to the analysis of κ and λ light chains in the serum, as well as immunostaining of proteins in the serum and urine of these specific patients. The final diagnosis was AL amyloidosis. Conclusion: The value of DPD scintigraphy in the diagnosis of cardiac amyloidosis from transthyretin is undisputed. However, positive myocardial scintigraphy with DPD should not automatically lead to the diagnosis of ATTR amyloidosis. Laboratory differentiation between ATTR and AL amyloidosis is crucial, as both prognosis and therapeutic strategy are dramatically altered. Laboratory exclusion of paraproteinemia is a necessary and essential step in the diagnostic algorithm of ATTR amyloidosis for all positive myocardial scintigraphy with diphosphonate tracers since >20% of patients with Grade 3 and 2 uptake may conceal AL amyloidosis.

Keywords: AL amyloidosis, amyloidosis, ATTR, myocardial scintigraphy, Tc-99m DPD

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514 A Rare Entity: Case Report on Anaesthetic Management in Robinow Syndrome

Authors: Vidhi Chandra, Arshpreet Singh Grewal

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A five-year-old male child born from non-consanguineous marriage, who presented with complaints of growth retardation and no appreciable increase in the penile size since birth and he was posted for de-gloving of penis with dissection of corpora under anaesthesia. After thorough preoperative evaluation it was revealed that patient had peculiar facial dysmorphism that of Robinow Syndrome, high arched palate, Mallampati grade III, mesomelic limbs, scoliotic spine and short stature. All routine investigation were within normal limit, electrocardiography (ECG) and 2D-Echocardiography (ECHO) were normal. In antero-posterior roentgenogram chest showed butterfly and hemivertebrae at multiple levels. The patient was considered to be ASA II. On the day of surgery after ensuring fasting of 6 hours, patient was taken in operation theatre, all standard ASA monitoring was done with ECG, non-invasive blood pressure, peripheral oxygen saturation (SpO2) and body temperature. The patient was pre-oxygenated with 100% oxygen with anatomical face mask. General anaesthesia was induced with Sevoflurane 1-8%, and airway was secured with an appropriate size supraglottic airway and anaesthesia was maintained with nitrous oxide and oxygen in 1:1 ratio along with sevoflurane 2%. An ultrasound guided caudal block was given owing to the skeletal deformities making it difficult even under USG guidance. Post operatively patient was given supportive care with proper hydration, antibiotics, anti-inflammatory and analgesics. He was discharged the next day and followed up weekly for a month. DISCUSSION Robinow syndrome is genetically inherited as autosomal dominant, autosomal recessive or heterogenous disorder involving tyrosine kinase ROR2 gene located on chromosome 9. It has low incidence with no preponderance for any gender. Though intelligence is normal but developmental delay and mental retardation occurs in 20%cases

Keywords: Robinow Syndrome, dwarfism, paediatric, anaesthesia

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513 Patent on Brian: Brain Waves Stimulation

Authors: Jalil Qoulizadeh, Hasan Sadeghi

Abstract:

Brain waves are electrical wave patterns that are produced in the human brain. Knowing these waves and activating them can have a positive effect on brain function and ultimately create an ideal life. The brain has the ability to produce waves from 0.1 to above 65 Hz. (The Beta One device produces exactly these waves) This is because it is said that the waves produced by the Beta One device exactly match the waves produced by the brain. The function and method of this device is based on the magnetic stimulation of the brain. The technology used in the design and producƟon of this device works in a way to strengthen and improve the frequencies of brain waves with a pre-defined algorithm according to the type of requested function, so that the person can access the expected functions in life activities. to perform better. The effect of this field on neurons and their stimulation: In order to evaluate the effect of this field created by the device, on the neurons, the main tests are by conducting electroencephalography before and after stimulation and comparing these two baselines by qEEG or quantitative electroencephalography method using paired t-test in 39 subjects. It confirms the significant effect of this field on the change of electrical activity recorded after 30 minutes of stimulation in all subjects. The Beta One device is able to induce the appropriate pattern of the expected functions in a soft and effective way to the brain in a healthy and effective way (exactly in accordance with the harmony of brain waves), the process of brain activities first to a normal state and then to a powerful one. Production of inexpensive neuroscience equipment (compared to existing rTMS equipment) Magnetic brain stimulation for clinics - homes - factories and companies - professional sports clubs.

Keywords: stimulation, brain, waves, betaOne

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512 Humans’ Physical Strength Capacities on Different Handwheel Diameters and Angles

Authors: Saif K. Al-Qaisi, Jad R. Mansour, Aseel W. Sakka, Yousef Al-Abdallat

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Handwheels are common to numerous industries, such as power generation plants, oil refineries, and chemical processing plants. The forces required to manually turn handwheels have been shown to exceed operators’ physical strengths, posing risks for injuries. Therefore, the objectives of this research were twofold: (1) to determine humans’ physical strengths on handwheels of different sizes and angles and (2) to subsequently propose recommended torque limits (RTLs) that accommodate the strengths of even the weaker segment of the population. Thirty male and thirty female participants were recruited from a university student population. Participants were asked to exert their maximum possible forces in a counter-clockwise direction on handwheels of different sizes (35 cm, 45 cm, 60 cm, and 70 cm) and angles (0°-horizontal, 45°-slanted, and 90°-vertical). The participant’s posture was controlled by adjusting the handwheel to be at the elbow level of each participant, requiring the participant to stand erect, and restricting the hand placements to be in the 10-11 o’clock position for the left hand and the 4-5 o’clock position for the right hand. A torque transducer (Futek TDF600) was used to measure the maximum torques generated by the human. Three repetitions were performed for each handwheel condition, and the average was computed. Results showed that, at all handwheel angles, as the handwheel diameter increased, the maximum torques generated also increased, while the underlying forces decreased. In controlling the handwheel diameter, the 0° handwheel was associated with the largest torques and forces, and the 45° handwheel was associated with the lowest torques and forces. Hence, a larger handwheel diameter –as large as 70 cm– in a 0° angle is favored for increasing the torque production capacities of users. Also, it was recognized that, regardless of the handwheel diameter size and angle, the torque demands in the field are much greater than humans’ torque production capabilities. As such, this research proposed RTLs for the different handwheel conditions by using the 25th percentile values of the females’ torque strengths. The proposed recommendations may serve future standard developers in defining torque limits that accommodate humans’ strengths.

Keywords: handwheel angle, handwheel diameter, humans’ torque production strengths, recommended torque limits

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511 Prevalence of Down Syndrome: A Single-Center Study in Bandung, Indonesia

Authors: Bremmy Laksono, Riksa Parikrama, Nur A. Rosyada, Willyanti Soewondo, Dadang S. H. Effendi, Eriska Rianti, Arlette S. Setiawan, Ine Sasmita, Risti S. Primanti, Erna Kurnikasari, Yunia Sribudiani

Abstract:

Down syndrome (DS) is a chromosomal abnormality characterised by complete 21 chromosome trisomy (classical or non-disjunction), or partial 21 chromosome trisomy (mosaicism), or chromosome rearrangement involving chromosome 21 (translocation). This study was carried out to describe the frequency of DS patients in a research institution in the city of Bandung, Indonesia. This descriptive study also provides a picture of the residential location and surrounding area of their dwellings. This study involved people with DS in various age whose chromosome were evaluated by conventional karyotyping method and FISH. Data were collected from 60 patients with DS from a total 150 patients during the period of September 2015 to August 2016 who were referred to Cell Culture and Cytogenetics Laboratory, Faculty of Medicine Universitas Padjadjaran, Indonesia. Results showed that the most common type of DS was non-disjunction (93%), followed by mosaicism (5%), no patient with translocation DS (0%), and a very rare type of tetrasomy 21 (2%). There were 39 males (65%) and 21 females (35%) of DS patient. Most of them live in suburban area beyond Bandung city (55%) while the rest live inside urban area of Bandung city (45%). They live mostly in dense area of greater Bandung area (65%) and only a few live in mid-density area (25%) and the least live in sparse populated area (10%). Their houses are mostly located in residential estate area (55%), nearby industrial area (37%), and around agricultural area (8%). Based on the study, it could be concluded that non-disjunction DS is the most common type. DS patients referred to the laboratory mostly came from dense residential zone in suburban area outside Bandung city. The low number of DS patients referred to the laboratory for chromosome analysis was the highlight to improve health service for people with genetic disorder. This study offered several information regarding area of DS patients’ residence and the condition of neighbourhood in Bandung city where they live as well.

Keywords: chromosome, descriptive, Down syndrome, prevalence

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510 Changing Patterns of Colorectal Cancer in Hail Region

Authors: Laila Salah Seada, Ashraf Ibrahim, Fawaz Al Rashid, Ihab Abdo, Hassan Kasim, Waleed Al Mansi, Saud Al Shabli

Abstract:

Background and Objectives: Colorectal carcinoma is increasing among both men and women worldwide. It has a multifactorial etiology including genetic factors, environmental factors and inflammatory conditions of the digestive tract. A clinicopathologic assessment of colorectal carcinoma in Hail region is done, considering any changing patterns in two 5-year periods from 2005-2009 (A) and from 2012 to 2017 (B). All data had been retrieved from histopathology files of King Khalid Hospital, Hail. Results: During period (A), 75 cases were diagnosed as colorectal carcinoma. Male patients comprised 56/75 (74.7%) of the study, with a mean age of 58.4 (36-97), while females were 19/75 (25.3%) with a mean age of 50.3(30-85) and the difference was significant (p = 0.05). M:F ratio was 2.9:1. Most common histological type was adenocarcioma in 68/75 (90.7%) patients mostly well differentiated in 44/68 (64.7%). Mucinous neoplasms comprised only 7/75 (9.3%) of cases and tended to have a higher stage (p = 0.04). During period (B), 115 cases were diagnosed with an increase of 53.3% in number of cases than period (A). Male to female ratio also decreased to 1.35:1, females being 44.83% more affected. Adenocarcinoma remained the prevalent type (93.9%), while mucinous type was still rare (5.2%). No distal metastases found at time of presentation. Localization of tumors was rectosigmoid in group (A) in 41.4%, which increased to 56.6% in group (B), with an increase of 15.2%. Iliocecal location also decreased from 8% to 3.5%, being 56.25% less. Other proximal areas of the colon were decreased by 25.75%, from 53.9% in group (A) to 40% in group (B). Conclusion: Colorectal carcinoma in Hail region has increased by 53.3% in the past 5 years, with more females being diagnosed. Localization has also shifted distally by 15.2%. These findings are different from Western world patterns which experienced a decrease in incidence and proximal shift of the colon cancer localization. This might be due to better diagnostic tools, population awareness of the disease, as well as changing of life style and/or food habits in the region.

Keywords: colorectal cancer, Hail Region, changing pattern, distal shift

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509 Learning from Flood: A Case Study of a Frequently Flooded Village in Hubei, China

Authors: Da Kuang

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Resilience is a hotly debated topic in many research fields (e.g., engineering, ecology, society, psychology). In flood management studies, we are experiencing the paradigm shift from flood resistance to flood resilience. Flood resilience refers to tolerate flooding through adaptation or transformation. It is increasingly argued that our city as a social-ecological system holds the ability to learn from experience and adapt to flood rather than simply resist it. This research aims to investigate what kinds of adaptation knowledge the frequently flooded village learned from past experience and its advantages and limitations in coping with floods. The study area – Xinnongcun village, located in the west of Wuhan city, is a linear village and continuously suffered from both flash flood and drainage flood during the past 30 years. We have a field trip to the site in June 2017 and conducted semi-structured interviews with local residents. Our research summarizes two types of adaptation knowledge that people learned from the past floods. Firstly, at the village scale, it has formed a collective urban form which could help people live during both flood and dry season. All houses and front yards were elevated about 2m higher than the road. All the front yards in the village are linked and there is no barrier. During flooding time, people walk to neighbors through houses yards and boat to outside village on the lower road. Secondly, at individual scale, local people learned tacit knowledge of preparedness and emergency response to flood. Regarding the advantages and limitations, the adaptation knowledge could effectively help people to live with flood and reduce the chances of getting injuries. However, it cannot reduce local farmers’ losses on their agricultural land. After flood, it is impossible for local people to recover to the pre-disaster state as flood emerges during June and July will result in no harvest. Therefore, we argue that learning from past flood experience could increase people’s adaptive capacity. However, once the adaptive capacity cannot reduce people’s losses, it requires a transformation to a better regime.

Keywords: adaptation, flood resilience, tacit knowledge, transformation

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508 An Engineered Epidemic: Big Pharma's Role in the Opioid Crisis

Authors: Donna L. Roberts

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2019 marked 23 years since Purdue Pharma launched its flagship drug, OxyContin, that unleashed an unprecedented epidemic touching both celebrities and common citizens, metropolitan, suburbia and rural areas and all levels of socioeconomic status. From rural Appalachia to East LA individuals, families and communities have been devastated by a trajectory of addiction that often began with the legitimate prescription of a pain killer for anything from a tooth extraction to a sports injury to recovery from surgery or chronic arthritis. Far from being a serendipitous progression of events, the proliferation of this new breed of 'miracle drug' was instead a carefully crafted marketing program aimed at both the medical community and common citizens. This research represents and in-depth investigation of the evolution of the marketing, distribution and promotion of prescription opioids by pharmaceutical companies and its relationship to the propagation of the opioid crisis. Specifically, key components of Purdue Pharma’s aggressive marketing campaign, including its bonus system and sales incentives, were analyzed in the context of the sociopolitical environment that essential created the proverbial 'perfect storm' for the changing manner in which pain is treated in the U.S. The analyses of these series of events clearly indicate their role in first, the increase in prescription of opioids for non-terminal pain relief and subsequently, the incidence of related addiction, overdose, and death. Through this examination of the conditions that facilitated and maintained this drug crisis, perhaps we can begin to chart a course toward its resolution.

Keywords: addiction, opioid, opioid crisis, Purdue Pharma

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507 Perception of Pre-Clinical Students towards Doctors Lifestyle

Authors: Shalinawati Ramli, Khairani Omar, Nurul Azmawati Mohamed, Zarini Ismail, Nur Syahrina Rahim, Nurul Hayati Chamhuri

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Medical doctors’ work to prevent, diagnose, treat diseases, disorders, and injuries as well as prescribing medication. Many people are attracted to this profession because it gives them the opportunity to help others. Doctors’ improve quality of life by providing advice, healing physical ailments and performing complex surgeries. Medicine is a profession in which dedication to the wellbeing of others is of paramount importance. Balancing the requirements of work and personal life can be a struggle as the demand of work as a doctors’ is great. Perception and expectation of medical students regarding the lifestyle of doctors’ is important to ensure that they had made the right career choice. Thus, the aim of this study is to assess the perception of pre-clinical students regarding doctors’ lifestyle. This study is a cross-sectional study involving all third-year pre-clinical medical students at University Sains Islam Malaysia. A total of 81 students participated in this study. Participants were given a set of questionnaire consisting of demographic data, open-ended questions on their perception on doctors’ lifestyle of working environment, salary expectation and family life. Thematic analysis were used to analyse the data. The participants comprised 69% female and their age range was between 20-21 years old. Majority of them were from middle-income families. Majority of the students perceived that the doctors’ lifestyle would be busy (72%). Approximately 30% of them expected that the time schedule will be unpredictable, 21% mentioned that sacrifice is required and 16% perceived it as a tiring job. Other themes emerged were ‘requiring high commitment’ (6%), challenging (7%) and risky (4%). With regards to salary expectation, 48% expected reasonable salary, 33% high salary and 12% described it as 'not worth compared to the workload'. Majority of them perceived that their family life will be restricted (62%) and time management is important (33%). Only 15% mentioned that family members have to sacrifice and spousal understanding is important (7%). About 10% of them perceived that their family will not be affected by their profession. Majority of the medical students perceived a busy doctors’ lifestyle, reasonable salary and restricted family life. However, there was a significant proportion of them who required counselling for better preparation of their future lifestyle.

Keywords: doctors lifestyle, pre-clinical students, perception, understanding

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506 Information Retrieval from Internet Using Hand Gestures

Authors: Aniket S. Joshi, Aditya R. Mane, Arjun Tukaram

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In the 21st century, in the era of e-world, people are continuously getting updated by daily information such as weather conditions, news, stock exchange market updates, new projects, cricket updates, sports and other such applications. In the busy situation, they want this information on the little use of keyboard, time. Today in order to get such information user have to repeat same mouse and keyboard actions which includes time and inconvenience. In India due to rural background many people are not much familiar about the use of computer and internet also. Also in small clinics, small offices, and hotels and in the airport there should be a system which retrieves daily information with the minimum use of keyboard and mouse actions. We plan to design application based project that can easily retrieve information with minimum use of keyboard and mouse actions and make our task more convenient and easier. This can be possible with an image processing application which takes real time hand gestures which will get matched by system and retrieve information. Once selected the functions with hand gestures, the system will report action information to user. In this project we use real time hand gesture movements to select required option which is stored on the screen in the form of RSS Feeds. Gesture will select the required option and the information will be popped and we got the information. A real time hand gesture makes the application handier and easier to use.

Keywords: hand detection, hand tracking, hand gesture recognition, HSV color model, Blob detection

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505 Post-Operative Pain Management in Ehlers-Danlos Hypermobile-Type Syndrome Following Wisdom Teeth Extraction: A Case Report and Literature Review

Authors: Aikaterini Amanatidou

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We describe the case of a 20-year-old female patient diagnosed with Ehlers-Danlos Syndrome (EDS) who was scheduled to undergo a wisdom teeth extraction in outpatient surgery. EDS is a hereditary connective tissue disorder characterized by joint hypermobility, skin hyper-extensibility, and vascular and soft tissue fragility. There are six subtypes of Ehlers-Danlos, and in our case, the patient had EDS hyper-mobility (HT) type disorder. One important clinical feature of this syndrome is chronic pain, which is often poorly understood and treated. Our patient had a long history of articular and lumbar pain when she was diagnosed. She was prescribed analgesic treatment for acute and neuropathic pain and had multiple sessions of psychotherapy and physiotherapy to ease the pain. Unfortunately, her extensive medical history was underrated by our anesthetic team, and no further measures were taken for the operation. Despite an uneventful intra-operative phase, the patient experienced several episodes of hyperalgesia during the immediate post-operative care. Management of pain was challenging for the anesthetic team: initial opioid treatment had only a temporary effect and a paradoxical reaction after a while. Final pain relief was eventually obtained with psycho-physiologic treatment, high doses of ketamine, and patient-controlled analgesia infusion of morphine-ketamine-dehydrobenzperidol. We suspected an episode of Opioid-Induced hyperalgesia. This case report supports the hypothesis that anti-hyperalgesics such as ketamine as well as lidocaine, and dexmedetomidine should be considered intra-operatively to avoid opioid-induced hyperalgesia and may be an alternative solution to manage complex chronic pain like others in neuropathic pain syndromes.

Keywords: Ehlers-Danlos, post-operative management, hyperalgesia, opioid-induced hyperalgesia, rare disease

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504 Traumatic Chiasmal Syndrome Following Traumatic Brain Injury

Authors: Jiping Cai, Ningzhi Wangyang, Jun Shao

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Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality that leads to structural and functional damage in several parts of the brain, such as cranial nerves, optic nerve tract or other circuitry involved in vision and occipital lobe, depending on its location and severity. As a result, the function associated with vision processing and perception are significantly affected and cause blurred vision, double vision, decreased peripheral vision and blindness. Here two cases complaining of monocular vision loss (actually temporal hemianopia) due to traumatic chiasmal syndrome after frontal head injury were reported, and were compared the findings with individual case reports published in the literature. Reported cases of traumatic chiasmal syndrome appear to share some common features, such as injury to the frontal bone and fracture of the anterior skull base. The degree of bitemporal hemianopia and visual loss acuity have a variable presentation and was not necessarily related to the severity of the craniocerebral trauma. Chiasmal injury may occur even in the absence bony chip impingement. Isolated bitemporal hemianopia is rare and clinical improvement usually may not occur. Mechanisms of damage to the optic chiasm after trauma include direct tearing, contusion haemorrhage and contusion necrosis, and secondary mechanisms such as cell death, inflammation, edema, neurogenesis impairment and axonal damage associated with TBI. Beside visual field test, MRI evaluation of optic pathways seems to the strong objective evidence to demonstrate the impairment of the integrity of visual systems following TBI. Therefore, traumatic chiasmal syndrome should be considered as a differential diagnosis by both neurosurgeons and ophthalmologists in patients presenting with visual impairment, especially bitemporal hemianopia after head injury causing frontal and anterior skull base fracture.

Keywords: bitemporal hemianopia, brain injury, optic chiasma, traumatic chiasmal syndrome.

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503 An In Situ Exploration of Practising Rugby Coaches’ Cognitions, Higher Psychological Functions and Actions Using Think Aloud Protocol

Authors: Simon Quick, John Lyle

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Psychology-based research has been a characteristic of empirical enquiry in sport coaching for over fifty years and cognitive function is widely accepted as a fundamental component of sport coaching expertise. Within the academic literature, much empirical research on coaches’ cognitions has tended to adopt retrospective approaches, such as post-session interviews or stimulated recall, thus capturing coaches’ cognitions after the incident, training session or competition. Such methods are prone to a variety of issues, including memory decay and the reordering of accounts. The aim of this research was to overcome the limitations that exist with retrospective approaches and, rather, to capture coaching cognitions in situ using Think Aloud Protocol. Data that were captured was broken down into meaning units and analysed using a Thematic Analysis. Situated in the practice of 6 experienced rugby coaches, findings revealed that Think Aloud Protocol generated rich data, although problematic in a site of enquiry confounded by multiple social interactions and requiring coaches to provide frequent instruction and feedback. The resultant interaction between cognition and action is conceptualised by the tentative offering of a model that situates these elements in conjunction with cognitive triggers and thresholds. The implications of these findings can help academics and coaches to understand the dynamic relationship between types of coaching cognitions and the complexity of the coaching environment.

Keywords: sports coaching, Psychology, Pedagogy, cognition

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502 Assessment of Nigerian Newspapers' Reportage of Violence against Children: Case Study of Daily Sun and Punch National Newspapers

Authors: Adline Nkwam-Uwaoma, Mishack Ndukwu

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Traditionally, child rearing in Nigeria closely reflects the ‘spare the rod and spoil the child’ maxim and as such spanking, flogging, slapping, beating and even starving a child as a form of punishment for wrongdoing and as a method of behaviour modification are common. These are not necessarily considered as maltreatment or abuse of the child. Despite the adoption and implementation of the child rights act in Nigeria, violence against children seems to be on a steady increase. Stories of sexual molestation, rape, child labour, infliction of physical injuries and use of children for rituals by parents, guardians or other members of the society abound. Violence against children is considered as those acts by other persons especially adults that undermine and threaten the healthy life and existence of children or those that violet their rights as humans. In Nigeria newspapers are a major source of News, second only to radio and television in coverage, currency and content. National dailies are newspapers with daily publications and national spread or coverage. This study analysed the frequency, length, prominence level, direction and sources of information reported on violence against children in the selected national daily newspapers. It then provided information on the role of the newspapers in Nigeria in the fight against child violence and public awareness of the impact of violence against children on the development of the nation and the attempts to curtail such violence. The composite week sampling technique in which the four weeks of the month are reduced to one and a sample is randomly selected from each day of the week was used. As such 168 editions of Daily Sun and Punch newspapers published from January to December of 2016 were selected. Data were collected using code sheet and analyzed via content analysis. The result showed that the frequency of the newspapers’ reportage of violence against children in Nigeria was low. Again, it was found that the length or space given to reports on violence against children was inadequate, the direction of the few reports on violence against children was in favour of the course or fight against child violence, and these newspapers gave no prominence to reports on violence against children. Finally, it was found that a major source of News about violence against children was through journalism; government and individual sources provided only minimal information.

Keywords: children, newspapers' reportage, Nigeria, violence

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501 The Analysis of the Effect of Brand Image on Creating Brand Loyalty with the Structural Equation Model: A Research Study on the Sports Equipment Brand Users

Authors: Murat Erdoğdu, Murat Koçyiğit

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Brand image and brand loyalty are among the most important relational marketing elements for brand owners to be able to set up long – term relationships with their customers and to maintain these relationships. Brand owners improve their brand images with the positive perceptions remaining in the consumers’ minds. In addition, they try to find the customers that are both emotionally and behaviourally faithful to themselves in order to set up long – term relationships. Therefore, the aim of this study is to analyse the effects of the brand image that has a very important role among relational marketing elements on the brand loyalty in terms of the variables such as the perceived value, the trust in brand and the brand satisfaction. In this context, a conceptual model was created to determine the effect of the brand image on the brand loyalty thanks to the Structural Equation Model (SEM). According to this aim and this model, the study was carried out in the scope of the data collected through the questionnaires in Konya with the method of convenience sampling. The results of the research showed that the brand image has positive significant effects on the perceived value and the trust in brand and that the trust in brand has positive significant effects on the brand satisfaction, and that the brand satisfaction has positive significant effects on the brand loyalty. Thus, the hypotheses that the brand image has direct effects on the perceived value and the trust in brand and that the trust in brand has direct effects on the brand satisfaction and that the brand satisfaction has direct effects on the brand loyalty were supported. In addition, the findings about whether the perceived value has a significant effect on the brand satisfaction were also acquired.

Keywords: brand image, brand loyalty, perceived value, satisfaction, trust

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500 Design and Development of Optical Sensor Based Ground Reaction Force Measurement Platform for GAIT and Geriatric Studies

Authors: K. Chethana, A. S. Guru Prasad, S. N. Omkar, B. Vadiraj, S. Asokan

Abstract:

This paper describes an ab-initio design, development and calibration results of an Optical Sensor Ground Reaction Force Measurement Platform (OSGRFP) for gait and geriatric studies. The developed system employs an array of FBG sensors to measure the respective ground reaction forces from all three axes (X, Y and Z), which are perpendicular to each other. The novelty of this work is two folded. One is in its uniqueness to resolve the tri axial resultant forces during the stance in to the respective pure axis loads and the other is the applicability of inherently advantageous FBG sensors which are most suitable for biomechanical instrumentation. To validate the response of the FBG sensors installed in OSGRFP and to measure the cross sensitivity of the force applied in other directions, load sensors with indicators are used. Further in this work, relevant mathematical formulations are presented for extracting respective ground reaction forces from wavelength shifts/strain of FBG sensors on the OSGRFP. The result of this device has implications in understanding the foot function, identifying issues in gait cycle and measuring discrepancies between left and right foot. The device also provides a method to quantify and compare relative postural stability of different subjects under test, which has implications in post surgical rehabilitation, geriatrics and optimizing training protocols for sports personnel.

Keywords: balance and stability, gait analysis, FBG applications, optical sensor ground reaction force platform

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499 Tibial Hemimelia Type VIIa: A Case Report

Authors: M. Medrano, M. D. M. S., L. Younes, M. D.

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Introduction: Incidence of tibial hemimelia is 1:1,000,000. Due to pre-existing case studies and literature, there is now a better understanding of the genetics, etiology and pathoanatomy of tibial hemimelia, but an underlying cause is generally unknown. This presentation aims to discuss a rare, congenital lower limb deficiency observed in a patient in order to identify potential prenatal risk factors and future considerations for the patient’s well-being. Observation: A newborn female child, born full term via spontaneous vaginal delivery after induction of labor to unaffected and non-consanguineous parents. The prenatal course was notable for limited and disjointed prenatal care as well as maternal tobacco and marijuana use, anemia of pregnancy, and inadequate weight gain. Prenatal imaging showed lower extremity deformity with the inability to visualize tibia and bilateral clubfeet in the setting of Intrauterine Growth Restriction (IUGR). The patient presented with right equino varus deformity of the foot and right knee joint deformity. Radiological imaging showed the absence of the right tibia and varus angulation of the right foot with dislocation of the tibiotalar joint. Normal femur with lateral and mild anterior displacement of a wide fibula (Weber Type VIIa). Due to the absence of the patient’s tibia and knee extensor mechanism, the patient was not a candidate for reconstructive surgery and ultimately underwent successful right knee disarticulation. Discussion and Conclusion: By utilizing a retrospective chart review of this case, possible risk factors in prenatal care may be identified and add to existing knowledge on etiology. Hopefully, a cause can be clearly identified in the future and, thus, addressed in the prenatal period. In addition, we can investigate the patient’s well-being and adjustment post-operatively to support outpatient management of an uncommon anomaly.

Keywords: Tibial hemimelia, prenatal care, pediatric orthopedics, congenital deformity

Procedia PDF Downloads 142