Search results for: midline

Authors: Kanza Tahir, Mubassar Fida, Rashna Hoshang Sukhia

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Background/Objective: A contemporary concept states that dental midline deviation towards the direction of facial flow line (FFL) can mask the compromised smile esthetics. This study aimed to identify a range of midline deviations that can be perceived towards or away from the FFL influencing smile esthetics. Materials and methods: A cross-sectional study was conducted using a frontal smile photograph of an adult female. The photograph was altered on Adobe Photoshop software into six different photographs by deviating the dental midlines towards and away from the FFL. A constant deviation of the chin towards the left side was incorporated in all the photographs. Forty-three laypersons (LP)and dental professionals (DPs) evaluated those photographs onVisual Analog Scale (VAS). An Independent t-test was used to compare the perception of dental midline deviation between LP and DPs. Simple linear regression was run to identify the factors associated with the VAS scoring. Results: A statistically significant difference was observed for picture two with 4 mm towards FFL in the perception of midline deviation between LP and DPs. LP could not perceive the midline deviations up to 4 mm, while DPs were able to perceive deviations above 2 mm. Age was positively associated with the VAS score, while the female gender had a negative association. Limitations: Only one component of mini-esthetics was studied. This study did not include an ideal picture for comparison. Only one female subject was studied of normal facial type. Conclusions: 2-4 mm of midline deviation towards the facial flow line can be tolerated by laypersons and dental professionals.

Keywords: midline, facial flow line, smile esthetics, female

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Authors: Karima Merchant

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The aim of this study was to analyze the impact of the Writing Eight Exercise, an exercise from the Brain Integration Therapy, with Kindergartners who are struggling with writing tasks in school. With the help of this exercise, children were able to cross the midline, an invisible line running from our brain to our feet, which separates the body’s right from left. Crossing the midline integrates the brain hemispheres, thus encouraging bilateral movement. The study was spread over 15 weeks where the children were required to do the Writing Eight Exercise 4 times a week. The data collection methods included observations, student work samples and feedback from teachers and parents. Based on the results of this study, it can be concluded that the Writing Eight Exercise had a positive impact on students’ approach towards writing tasks, letter formation, and fine motor skills.

Keywords: crossing the midline, fine motor skills, letter formation, writing

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Authors: Nikita Sankhe

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A Frenum is a band or fold of mucous membrane, which is usually with enclosed muscle fibers, that attaches the lip and cheek to the alveolar mucosa or the gingiva and the underlying periosteum. It curbs or limits the movements of an organ. A frenum becomes a problem if its attachment is too close to the marginal or papillary gingiva, namely localized gingival recession and a midline diastema or it may pull the gingival margin away from the tooth allowing plaque accumulation and inhibit toothbrushing. Frenectomy is the complete removal of the frenum including its attachment to the underlying bone. Miller suggested a technique where by a closure was done across the midline by laterally positioned gingiva. Healing by primary intention resulted in aesthetically acceptable attached gingiva across the midline. This paper aims at showing how a lateral pedicle graft technique combined with frenectomy proves to be more advantageous than any other technique.

Keywords: frenum , frenectomy , lateral pedicle graft , classical frenectomy

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Authors: Mohd Ali Abbas Zaidi, Meenu Sachdeva, Jonaki Sen

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In the vertebrate embryo, the forebrain anlagen develops from the anterior-most region of the neural tube which is the precursor of the central nervous system (CNS). The roof plate located at the dorsal midline region of the forebrain anlagen, acts as a source of several secreted molecules involved in patterning and morphogenesis of the forebrain. One such key morphogenetic event is the invagination of the forebrain roof plate which results in separation of the single forebrain vesicle into two cerebral hemispheres. Retinoic acid (RA) signaling plays a key role in this process. Blocking RA signaling at the dorsal forebrain midline inhibits dorsal invagination and results in the absence of certain key features of this region, such as thinning of the neuroepithelium and a lowering of cell proliferation. At present we are investigating the possibility of other signaling pathways acting in concert with RA signaling to regulate this process. We have focused on BMP signaling, which we found to be active in a mutually exclusive domain to that of RA signaling within the roof plate. We have also observed that there is a change in BMP signaling activity on modulation of RA signaling indicating an antagonistic relationship between the two. Moreover, constitutive activation of BMP signaling seems to completely inhibit thinning and partially affect invagination, leaving the lowering of cell proliferation in the midline unaffected. We are employing in-silico modeling as well as molecular manipulations to investigate the relative contribution if any, of regional differences in rates of cell proliferation and thinning of the neuroepithelium towards the process of invagination. We have found expression of certain cell adhesion molecules in forebrain roof-plate whose mRNA localization across the thickness of neuroepithelium is influenced by Bmp and RA signaling, giving regional rigidity to roof plate and assisting invagination. We also found expression of certain cytoskeleton modifiers in a localized small domains in invaginating forebrain roof plate suggesting that midline invagination is under control of many factors.

Keywords: bone morphogenetic signaling, cytoskeleton, cell adhesion molecules, forebrain roof plate, retinoic acid signaling

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Authors: S. Yesmin, N. F.Rahman, R. Akther, T. Begum, T. Tahmid, T. Chowdury, S. Afrin, J. D. Hamadani

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Abstract: Maternal depression is one of the risk factors of developmental delay in young children in low-income countries. Maternal depressions during pregnancy are rarely reported in Bangladesh. Objectives: The purpose of the present study was to examine the efficacy of a community based psychosocial intervention on women with mild to moderate depressive illness during the perinatal period and on their children from birth to 12 months on mothers’ mental status and their infants’ growth and development. Methodology: The study followed a prospective longitudinal approach with a randomized controlled design. Total 250 pregnant women aged between 15 and 40 years were enrolled in their third trimester of pregnancy of which 125 women were in the intervention group and 125 in the control group. Women in the intervention group received the “Thinking Healthy (CBT based) program” at their home setting, from their last month of pregnancy till 10 months after delivery. Their children received psychosocial stimulation from birth till 12 months. The following instruments were applied to get the outcome information- Bangla version of Edinburgh Postnatal Depression Scale (BEPDS), Prenatal Attachment Inventory (PAI), Maternal Attachment Inventory (MAI), Bayley Scale of Infant Development-Third version (Bayley–III) and Family Care Indicator (FCI). In addition, sever morbidity; breastfeeding, immunization, socio-economic and demographic information were collected. Data were collected at three time points viz. baseline, midline (6 months after delivery) and endline (12 months after delivery). Results: There was no significant difference between any of the socioeconomic and demographic variables at baseline. A very preliminary analysis of the data shows an intervention effect on Socioemotional behaviour of children at endline (p<0.001), motor development at midline (p=0.016) and at endline (p=0.065), language development at midline (p=0.004) and at endline (p=0.023), cognitive development at midline (p=0.008) and at endline (p=0.002), and quality of psychosocial stimulation at midline (p=0.023) and at endline (p=0.010). EPDS at baseline was not different between the groups (p=0.419), but there was a significant improvement at midline (p=0.027) and at endline (p=0.024) between the groups following the intervention. Conclusion: Psychosocial intervention is found effective in reducing women’s low and moderate depressive illness to cope with mental health problem and improving development of young children in Bangladesh.

Keywords: mental health, maternal depression, infant development, CBT, EPDS

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Authors: Dhivyalakshmi Gnanasekaran, Sonali Adole Prasante, Raveendranath Veeramamani, H. Y. Suma

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A rare case of intestinal malrotation with midline descending colon and right sided sigmoid colon was observed in an adult male cadaver aged around 55 years during routine dissection. The descending colon began from the splenic flexure and gradually descended downwards to occupy the midline position and turned to the right side to be continued as sigmoid colon at the level of the fifth lumbar vertebra. In the right iliac fossa some part of loop of sigmoid colon displaced into the right lumbar region before entering into the true pelvis to continue as rectum. This anomalous descending and sigmoid colon was supplied by varying branching pattern of inferior mesenteric artery. It is extremely important to consider this embryological anomaly before any interventional diagnostic procedures like colonoscopy and to enhance the safety of colonic surgery.

Keywords: sigmoid colon, descending colon, hindgut, malrotation

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Authors: K. D. Candido, A. Lissounov, I. Knezevic, N. Knezevic

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Background: The most commonly performed pain procedures in the USA is Lumbar Epidural Steroid Injections (LESI). There are three main types of these procedures: transforaminal (TF), interlaminar (IL) and caudal injections. It is expected for TF injections to have better outcomes than IL injections, based on the recently published systematic review. The studies presented in that review used a midline IL approach, but those with parasagittal IL approach were not taken into consideration. Our aim is to emphasize the efficacy of the lateral parasagittal (paramedian) IL approach in this review. Methods: We included five studies in this systematic review, which compared Parasagittal-IL (PIL) with either Midline-IL (MIL) or TF LESI. Total of 296 patients who had undergone different types of LESI were observed across the five studies, and the average pain and functional improvements were calculated and compared among groups. Results: Pain and function improvements with PIL approach is superior on 12 months follow up to MIL approach (53.4% vs. 14.7%) and (55% vs. 27.7%), respectively. A 12 months follow-up results between PIL and TF shows a near equivalent effectiveness for pain (58.9% vs. 63.2%) and function improvement (47.3% vs. 48.1%). An average follow-up of 17.1 days have shown better short-term pain relief for PIL than TF approach (45.8% vs. 19.2%), respectively. Number of repeated injections is lower for PIL injections than MIL. Number of weeks between 1st and 2nd injections: PIL averaged 15.8 weeks and MIL averaged 9.7 weeks. Third LESI injection is more common in TF group (30%) than PIL group (18.8%). Conclusion: Higher complication rates are associated with TF injections for which FDA7 issued an official warning. We have recorded better outcomes in pain and function improvement of Parasagittal-IL LESI as compared to midline-IL injection, in the presented systematic review. Parasagittal and TF injections have equivalent efficacy in Pain and Function improvements thus we advocate for Parasagittal-IL approach consideration as an alternative for TF injections.

Keywords: parasagital approach, lumbar, back pain, epidural steroid injection

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Authors: Angelis P. Barlampas, Ghita Bianca-Andreea

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A case of a prostatic midline cyst is presented, which was found during a routine general ultrasound examination in an otherwise healthy young man. The incidence of prostatic cysts discovered in suprapubic ultrasound examination has constantly been rising over the previous decades. Despite the fact that the majority of them are benign, a significant amount is related to symptoms, such as pain, dysuria, infertility, and even cancer. The wide use of ultrasound examination and the increasing availability of high-resolution ultrasound systems have rendered new diagnostic challenges. Once upon a time a suprapubic ultrasound was only useful for measuring only the size and the dimensions of the prostatic gland. It did not have the ability to analyze and resolve structures such as cystic or solid nodules. The current machine equipment has managed to depict the imaging characteristics of lesions with high acuity that compares of an intrarectal ultrasound. But the last one is a specialized examination, which demands expertise and good knowledge. Maybe the time has come for the general radiologist and, especially the one who uses suprapubic ultrasound, to pay more attention to the examination of the prostate gland and to take advantage of the superb abilities and the high resolution of the new ultrasound systems. That is exactly, what this case is emphasizing. The incidental discovery of prostatic cysts, and the relatively little available literature about managing them turns them into an interesting theme for exploring and studying. The prostatic cysts are further divided into midline and paramidline cysts, with the first being usually utricle cysts. A more precise categorization is as follows: A midline cystic lesion usually regards a Mullerian duct cyst, a prostatic utricle cyst, an ejaculatory duct cyst, a prostatic cystadenoma, a ductus deferens cyst, and a TURP. On the other hand, a lateral cystic lesion usually refers to a cystic degeneration of benign prostatic hyperplasia, a prostatic retention cyst, a seminal vesicle cyst, diverticular prostatitis, a prostatic abscess, cavitatory prostatitis from chronic prostatitis, a parasitic prostatic cyst, a cystic prostatic carcinoma, e.t.c.

Keywords: prostatic cyst, radiology, benign prostatic lesions, prostatic cancer, suprapubic prostatic ultrasound

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Authors: L. Sun, O. Bloom, K. Anderson

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The medial and lateral sural artery perforator flaps (MSAP and LSAP, respectively) are two recently described flaps that are less commonly used in lower limb trauma reconstructive surgeries compared to flaps such as the anterolateral thigh (ALT) flap or the gastrocnemius flap. The LSAP flap has several theoretical benefits over the MSAP, including the ability to be sensate and being more easily manoeuvred into position as a local flap for coverage of lateral knee or leg defects. It is less commonly used in part due to a lack of documented studies of the anatomical reliability of the perforator, and an unquantified average length of the pedicle used for microsurgical anastomosis (if used as a free flap) or flap rotation (if used as a pedicled flap). It has been shown to have significantly lower donor site morbidity compared to other flaps such as the ALT, due to the decreased need for intramuscular dissection and resulting in less muscle loss at the donor site. 11 cadaveric lower limbs were dissected, with a mean of 1.6 perforators per leg, with an average pedicle length of 45mm to the sural artery and 70mm to the popliteal artery. While the majority of perforating arteries lay close to the midline (average of 19mm lateral to the midline), there were patients whose artery was significantly lateral and would have been likely injured by the initial incision during an operation. Adding to the literature base of documented LSAP dissections provides a greater understanding of the anatomical basis of these perforator flaps, and the authors hope this will establish them as a more commonly used and discussed option when managing complicated lower limb trauma requiring soft tissue reconstruction.

Keywords: cadaveric, dissection, lateral, perforator flap, sural artery, surface anatomy

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Authors: Angelis P. Barlampas

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An 89 years old woman came to the emergency department complaining of long-lasting headaches and nausea. A CT examination was performed, and a homogeneous midline anterior cranial fossa lesion was revealed, which was situated near the base and measured 2,4 cm in diameter. The patient was allergic, and an i.v.c injection could not be done on the spot, and neither could an MRI exam because of metallic implants. How could someone narrow down the differential diagnosis? The interhemispheric meningioma is usually a silent midline lesion with no edema, and most often presents as a homogeneous, solid type, isodense, or slightly hyperdense mass ( usually the smallest lesions as this one ). Of them, 20-30% have some calcifications. Hyperostosis is typical for meningiomas that abut the base of the skull but is absent in the current case, presumably of a more cephalad location that is borderline away from the bone. Because further investigation could not be done, as the patient was allergic to the contrast media, some other differential options should be considered. Regarding the site of the lesion, the most common other entities to keep in mind are the following: Metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma, giant aneurysm of the anterior cerebral artery, midline lesion. Appearance will depend on whether the aneurysm is non-thrombosed, or partially, or completely thrombosed. Non-contrast: slightly hyperdense, well-defined round extra-axial mass, may demonstrate a peripheral calcified rim, olfactory neuroblastoma, midline lesion. The mass is of soft tissue attenuation and is relatively homogeneous. Focal calcifications are occasionally present. When an intracranial extension is present, peritumoral cysts between it and the overlying brain are often present. Final diagnosis interhemispheric meningioma (Known from the previous patient’s history). Meningiomas come from the meningocytes or the arachnoid cells of the meninges. They are usually found incidentally, have an indolent course, and their most common location is extra-axial, parasagittal, and supratentorial. Other locations include the sphenoid ridge, olfactory groove, juxtasellar, infratentorial, intraventricular, pineal gland area, and optic nerve meningioma. They are clinically silent entities, except for large ones, which can present with headaches, changes in personality status, paresis, or symptomatology according to their specific site and may cause edema of the surrounding brain tissue. Imaging findings include the presence of calcifications, the CSF cleft sign, hyperostosis of adjacent bone, dural tail, and white matter buckling sign. After i.v.c. injection, they enhance brightly and homogenously, except for large ones, which may exhibit necrotic areas or may be heavily calcified. Malignant or cystic variants demonstrate more heterogeneity and less intense enhancement. Sometimes, it is inevitable that the needed CT protocol cannot be performed, especially in the emergency department. In these cases, the radiologist must focus on the characteristic imaging features of the unenhanced lesion, as well as in previous examinations or a known lesion history, in order to come to the right report conclusion.

Keywords: computed tomography, emergency radiology, metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma

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Authors: Parul Garg

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Bouveret Syndrome is a rare presentation described as Gastric Outlet Obstruction secondary to Gallstone Ileus. Here we describe the 3-year progression of disease from cholelithiasis to gallstone ileus with relevant imaging findings. The patient was treated under an Upper Gastrointestinal Surgery service with surgical intervention in the form of a laparoscopic assisted procedure with midline laparotomy. She recovered well and was discharged 1 week post operatively. No complications occurred.

Keywords: Cholelithiasis, Bouveret syndrome, Gallstone Ileus, gastric outlet obstruction

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Authors: Hadi S. Hosseini, Larry A. Taber

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In the embryo, heart is initially a simple tubular structure that undergoes complex morphological changes as it transforms into a four-chambered pump. This work focuses on mechanisms that create heart tube (HT). The early embryo is composed of three relatively flat primary germ layers called endoderm, mesoderm, and ectoderm. Precardiac cells located within bilateral regions of the mesoderm called heart fields (HFs) fold and fuse along the embryonic midline to create the HT. The right and left halves of this plate fold symmetrically to bring their upper edges into contact along the midline, where they fuse. In a region near the fusion line, these layers then separate to generate the primitive HT and foregut, which then extend vertically. The anterior intestinal portal (AIP) is the opening at the caudal end of the foregut, which descends as the HT lengthens. The biomechanical mechanisms that drive this folding are poorly understood. Our central hypothesis is that folding is caused by differences in growth between the endoderm and mesoderm while subsequent extension is driven by contraction along the AIP. The feasibility of this hypothesis is examined using experiments with chick embryos and finite-element modeling (FEM). Fertilized white Leghorn chicken eggs were incubated for approximately 22-33 hours until appropriate Hamburger and Hamilton stage (HH5 to HH9) was reached. To inhibit contraction, embryos were cultured in media containing blebbistatin (myosin II inhibitor) for 18h. Three-dimensional models were created using ABAQUS (D. S. Simulia). The initial geometry consists of a flat plate including two layers representing the mesoderm and endoderm. Tissue was considered as a nonlinear elastic material with growth and contraction (negative growth) simulated using a theory, in which the total deformation gradient is given by F=F^*.G, where G is growth tensor and F* is the elastic deformation gradient tensor. In embryos exposed to blebbistatin, initial folding and AIP descension occurred normally. However, after HFs partially fused to create the upper part of the HT, fusion, and AIP descension stopped, and the HT failed to grow longer. These results suggest that cytoskeletal contraction is required only for the later stages of HT formation. In the model, a larger biaxial growth rate in the mesoderm compared to the endoderm causes the bilayered plate to bend ventrally, as the upper edge moves toward the midline, where it 'fuses' with the other half . This folding creates the upper section of the HT, as well as the foregut pocket bordered by the AIP. After this phase completes by stage HH7, contraction along the arch-shaped AIP pulls the lower edge of the plate downward, stretching the two layers. Results given by model are in reasonable agreement with experimental data for the shape of HT, as well as patterns of stress and strain. In conclusion, results of our study support our hypothesis for the creation of the heart tube.

Keywords: heart tube formation, FEM, chick embryo, biomechanics

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Authors: Oday A. Al-Juhaishi, Sa`ad M. Ismail, Hung-Hsun Yen, Christina M. Murray, Helen M. S. Davies

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The functional anatomy of the fascia in the greyhound is still poorly understood, and incompletely described. The basic knowledge of fascia stems mainly from anatomical, histological and ultrastructural analyses. In this study, twelve specimens of hindlimbs from six fresh greyhound cadavers (3 male, 3 female) were used to examine the topographical relationships of the superficial fascia with the skin and underlying tissue. The first incision was made along the dorsal midline from the level of the thoracolumbar junction caudally to the level of the mid sacrum. The second incision was begun at the level of the first incision and extended along the midline of the lateral aspect of the hindlimb distally, to just proximal to the tarsus, and, the skin margins carefully separated to observe connective tissue links between the skin and superficial fascia, attachment points of the fascia and the relationships of the fascia with blood vessels that supply the skin. A digital camera was used to record the anatomical features as they were revealed. The dissections identified fibrous septa connecting the skin with the superficial fascia and deep fascia in specific areas. The presence of the adipose tissue was found to be very rare within the superficial fascia in these specimens. On the extensor aspects of some joints, a fusion between the superficial fascia and deep fascia was observed. This fusion created a subcutaneous bursa in the following areas: a prepatellar bursa of the stifle, a tarsal bursa caudal to the calcaneus bone, and an ischiatic bursa caudal to the ischiatic tuberosity. The evaluation of blood vessels showed that the perforating vessels passed through fibrous septa in a perpendicular direction to supply the skin, with the largest branch noted in the gluteal area. The attachment points between the superficial fascia and skin were mainly found in the region of the flexor aspect of the joints, such as caudal to the stifle joint. The numerous fibrous septa between the superficial fascia and skin that have been identified in some areas, may create support for the blood vessels that penetrate fascia and into the skin, while allowing for movement between the tissue planes. The subcutaneous bursae between the skin and the superficial fascia where it is fused with the deep fascia may be useful to decrease friction between moving areas. The adhesion points may be related to the integrity and loading of the skin. The attachment points fix the skin and appear to divide the hindlimb into anatomical compartments.

Keywords: attachment points, fibrous septa, greyhound, subcutaneous bursa, superficial fascia

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Authors: Ruth Nalugya, Claire Nimusiima, Elizabeth Kawesa, Harriet Nambejja, Geert van Hove, Janet Seeley, Femke Bannink Mbazzi

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Background: ‘Obuntu bulamu’, an intervention for children, parents, and teachers to improve the participation and inclusion of children with disabilities (CwD) through peer-to-peer support, was developed and tested in central Uganda between 2017 and 2019. The intervention consisted of children, parents, and teachers' training sessions and peer to peer support activities directed at disability inclusion using an African disability framework. In this paper, we discuss parent participation in and parent evaluation of the ‘Obuntu bulamu’ intervention. Methods: This qualitative Afrocentric intervention study was implemented in 10 communities in the Wakiso district in Central Uganda. We purposely selected children aged 8 to 14 years with different impairments, their peers, and parents, with different levels of household income and familial support, who were enrolled in primary schools in the ten communities with on average three children with disabilities per community. Sixty four parents (33 parents of CwDs and 31 peers) participating in the ‘Obuntu bulamu’ study were interviewed at baseline and endline. Two focus group discussions were held with parents at the midline. Parents also participated in a consultative meeting about the intervention design at baseline, and two evaluation workshops held at midline and endline. Thematic data analysis of the interview and focus group data was conducted. Results: Findings showed parents found the group-based activities inspiring and said they built hope and confidence. Parents felt the intervention was acceptable, culturally appropriate, and supportive as it built on values and practices from their own traditions. Parents reported the intervention enhanced a sense of togetherness and belonging through the group meetings and follow-up activities. Parents also mentioned that the training helped them develop more positive attitudes towards CwD and disability inclusion. Parents felt that the invention increased a child’s participation and inclusion at home, school, and in communities. Conclusion: The Obuntu bulamu peer to peer support intervention is an acceptable, culturally appropriate intervention that has the potential to improve the inclusion of CwD. A larger randomized control trial is needed to evaluate the impact of the intervention model.

Keywords: inclusion, participation, inclusive education, peer support, belonging, Ubuntu, ‘Obuntu bulamu’

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Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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Authors: Felipe H. Sanders, Bryan A. Edwards, Matthew Fusco, Rod J. Oskouian, R. Shane Tubbs

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Introduction: Sinus pericranii is a rare vascular malformation that connects the intracranial dural sinuses to the extracranial venous drainage system and is caused by either trauma or congenital defects. Although the majority of these vascular structures are due to trauma, some are congenital. Case report: Herein, we report a 5-month-old patient with a very large and fluctuating subcutaneous mass over the occiput and the diagnosis of Crouzon’s syndrome. The child presented with a large midline mass that on imaging, connected to the underlying torcular and was diagnosed as a sinus pericranii. At long-term follow up and without operative intervention, the sinus pericranii resolved. This uncommon relationship is reviewed. Conclusion: Premature closure of posterior fossa sutures as part of Crouzon syndrome can present with large sinus pericranii. Such subcutaneous swellings might resolve spontaneously.

Keywords: congenital, craniosynostosis, pediatric, vascular malformation

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Authors: R. M. Korzerzer, J. O. Hambolu, S. O. Salami, S. B. Oladele

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Twelve apparently healthy grasscutters between the ages of three and seven months were used for this study. The animals were purchased from local breeders in Oturkpo, Benue state, Nigeria and transported to the research laboratory in the Department of Veterinary Anatomy, Ahmadu Bello University, Zaria by means of constructed cages. The animals were divided into three groups according to their ages and acclimatised. Sacrifice was done using chloroform gaseous inhalation anaesthesia. An incision was made at the neck region and the thymus located and identified by its prominent bilateral nature. Extirpated thymuses from each animal were immediately weighed and fixed in Bouin’s fluid for 48 hours. The tissues were then prepared using standard methods. Haematoxilin and eosin was used for routine histology and Rhodamine B aniline methylene blue was for studying the architecture of the elastic and reticular fibres of the thymus. Grossly, the thymus appeared as a bilateral organ on either side of the thoracic midline. The organ size decreased consistently as the animals advanced in age. Mean ± SEM values for thymic weights were 1.23 ± 0.048 g, 0.53 ± 0.019 g and 0.30 ± 0.042 g at three, five and seven months of age respectively.

Keywords: gross, histological, thymus, grasscutter

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Authors: Lalitchandra J. Shah, Katarzyna Bialek, Melinda L. Clarke, Jessica L. Jansson

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Handwriting is essential to academic success; however, the current literature is limited in the identification of pre-handwriting skills. The purpose of this study was to identify the pre-handwriting skills, which occupational therapy practitioners deem important to handwriting success, as well as those which aid in intervention planning. The online survey instrument consisted of 33 questions that assessed various skills related to the development of handwriting, as well as captured demographic information. Both occupational therapists and occupational therapy assistants were included in the survey study. The survey found that the respondents were in agreement that purposeful scribbling, the ability of a child to copy (vertical/horizontal lines, circle, squares, and triangles), imitating an oblique cross, cognitive skills (attention, praxis, self-regulation, sequencing), grasp patterns, hand dominance, in hand manipulation skills (shift, translation, rotation), bilateral integration, stabilization of paper, crossing midline, and visual perception were important indicators of handwriting readiness. The results of the survey support existing research regarding the skills necessary for the successful development of handwriting in children.

Keywords: development, handwriting, occupational therapy, visual perceptual skills

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Authors: Santhosh K. S. Annayappa, Nupur Pruthi

Abstract:

The region of dentate nucleus is a common site for various pathologies like hematomas, tumours, etc. We aimed to study in detail the relationship of this region with the vermis, especially the pyramid using microscopic fibre dissection technique. To achieve this aim, 20 cerebellar hemispheres were studied from the 11 cerebellums. Dissection was performed using wooden spatulas and micro dissectors under a microscope following Klingler’s preservation technique. The relationship between the pyramid of vermis and the dentate nucleus was studied in detail. A similar relationship was studied on the MRI of randomly selected trigeminal neuralgia patients and correlated with anatomical findings. Results show the mean distance of the lateral margin of the dentate nucleus from the midline on anatomic specimens was 21.4 ± 1.8 mm (19-25 mm) and 23.4 ± 3.4 mm (15-29 mm) on right and left side, respectively. Similar measurements made on the MRI were 22.97 ± 2.0 mm (20.03-26.15 mm) on the right side and 23.98 ± 2.1 mm (21.47-27.67 mm) on the left side. The amount of white matter dissection required to reach the dentate nucleus at the pyramidal attachment area was 7.3 ± 1.0 mm (6-9 mm) on the right side and 6.8 ± 1.4 mm (5-10 mm) on the left side. It was concluded that the pyramid of vermis has a constant relationship with the dentate nucleus and can be used as an excellent landmark during surgery to localise the dentate nucleus on the suboccipital surface.

Keywords: fiber dissection, micro neurosurgery, the dentate nucleus of cerebellum, the pyramid of vermis

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Authors: Michelangelo Liban, Debbie Liquete

Abstract:

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: Fui Ping Lim, Wen Choong Chua, Toan Thang Phan

Abstract:

Aim: This study investigates the roles of Cord Lining Stem Cells (CLSCs) as potential therapeutic agents for diabetic wounds. Method: 20 genetically diabetic db/db mice were randomly assigned to two arms; (i) control group received placebo treatment (sham media or cells delivery material), and (ii) active comparator received CLSCs. Two full-thickness wounds, each sized 10mm X 10mm were created, one on each side of the midline on the back of the mice. Digital pictures were taken on day 1, 3, 7, 10, 14, 17, 21, 24, 28. Wound areas were analyzed with ImageJ TM software and calculated as percentage of the original wound. Time to closure was defined as the day the wound bed was completely epithelized and filled with new tissues. Results: The CLSCs-treated wounds, showed a significant increase in the percentage of wound closure and achieved 100% closure of the wound sooner than the control group by an average of 3.7 days. The mice treated with CLSCs have a shorter wound closure time (mean closure day: 19.8 days) as compared to the control group (mean closure day: 23.5 days). Conclusion: Our preliminary findings inferred that CLSCs treated wound achieved higher percentage of wound closure within a shorter duration of time.

Keywords: cord lining stem cell, diabetic wound, stem cell, wound

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Authors: M. K. Yusuf, W. O. Hamman, U. E. Umana, S. B. Oladele

Abstract:

Background: Dilatation of the inferior vena cava (IVC) is used as the ultrasonic diagnostic feature in patients suspected of congestive heart failure. The IVC diameter has been reported to vary among the various body mass indexes (BMI) and body shape indexes (ABSI). Knowledge of these variations is useful in precision diagnoses of CHF by imaging scientists. Aim: The study aimed to establish an equation for predicting the ultrasonic mean diameter of the IVC among the various BMI/ABSI of inhabitants of Azare, Bauchi State-Nigeria. Methodology: Two hundred physically healthy adult subjects of both sexes were classified into under, normal, over, and obese weights using their BMIs after selection using a structured questionnaire following their informed consent for an abdominal ultrasound scan. The probe was placed on the midline of the body, halfway between the xiphoid process and the umbilicus, with the marker on the probe directed towards the patient's head to obtain a longitudinal view of the IVC. The maximum IVC diameter was measured from the subcostal view using the electronic caliper of the scan machine. The mean value of each group was obtained, and the results were analysed. Results: A novel equation {(IVC Diameter = 1.04 +0.01(X) where X= BMI} has been generated for determining the IVC diameter among the populace. Conclusion: An equation for predicting the IVC diameter from individual BMI values in apparently healthy subjects has been established.

Keywords: equation, ultrasonic, IVC diameter, body adiposities

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Authors: Arun Prasad

Abstract:

Background: Robotic Bariatric Surgery is a good option for the super obese where laparoscopy demands challenging technical skills. Gastric bypass can be difficult due to inability of the robot to work in two quadrants at the same time. Lonroth technique of gastric bypass involves a totally supracolic surgery where all anastomosis are done in one quadrant only. Methods: We have done 78 robotic gastric bypass surgeries using the modified Lonroth technique. The robot is docked above the head of the patient in the midline. Camera port is placed supra umbilically. Two ports are placed on the left side of the patient and one port on the right side of the patient. An assistant port is placed between the camera port and right sided robotic port for use of stapler. Gastric pouch is made first followed by the gastrojejunostomy that is a four layered sutured anastomosis. Jejuno jejunostomy is then performed followed by a leak test and then the jejunum is divided. A 150 cm biliopancreatic limb and a 75 cm alimentary limb are finally obtained. Mesenteric and Petersen’s defects are then closed. Results: All patients had a successful robotic procedure. Mean time taken in the first 5 cases was 130 minutes. This reduced to a mean of 95 minutes in the last five cases. There were no intraoperative or post operative complications. Conclusions: While a hybrid technique of partly laparoscopic and partly robotic gastric bypass has been done at many centres, we feel using the modified Lonroth technique, a totally robotic gastric bypass surgery fully utilizes the potential of robotic bariatric surgery.

Keywords: robot, bariatric, totally robotic, gastric bypass

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Authors: M. Elder, L. Beech, A. Mackie

Abstract:

Heterotopic pregnancy is an uncommon and potentially life-threatening condition in which there is simultaneous occurrence of intrauterine and ectopic pregnancies. It has an incidence of approximately 1:3900 pregnancies, occurring in only 1:30000 spontaneous pregnancies. This study presents a rare case of spontaneous heterotopic pregnancy in a 34-year-old primiparous woman who was brought in by ambulance to the emergency department following collapse at 20+1 weeks gestation after normal first trimester screening and morphology scan. She was hemodynamically unstable and fetal heart rate was 60bpm. Initial resuscitation included transfusion of 2 units packed red blood cells and 1g intravenous tranexamic acid. Bedside ultrasound revealed evidence of approximately 1000ml clot in the right upper quadrant. She underwent a diagnostic laparoscopy and washout, which proceeded to a midline exploratory laparotomy. This revealed a 2.6L hemoperitoneum and query right ectopic pregnancy with calcified areas and clot, with no other cause of bleeding identified. Right salpingectomy was performed, and pathology later confirmed ectopic pregnancy. The intrauterine pregnancy had no complications, and she delivered a healthy full-term baby. This case demonstrates that ultrasound confirmation of intrauterine pregnancy does not exclude coexisting ectopic pregnancy. Heterotopic pregnancy should be considered in any pregnant woman presenting with abdominal pain or signs of hemorrhagic shock, as prompt diagnosis and treatment is essential to minimize foetal and maternal morbidity and mortality.

Keywords: ectopic pregnancy, hemorrhagic shock, salpingectomy, spontaneous heterotopic pregnancy

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Authors: Vinay Kumar Theendra

Abstract:

The main objective of the study is to evaluate the effectiveness of hesperidin in the treatment of breast cancer and causing less (or) no bone marrow depression which is the major side effect of the present anticancer drugs treating breast cancer, also to evaluate the mechanisms through which these compounds are exerting their effect. Breast cancer is induced by administering N-methyl N-Nitrosourea (MNU) at a dose of 50mg/kg body weight. Upon the termination of the experiment, the animals were sacrificed by the method of cervical dislocation. The animals were dissected along the ventral midline and were grossly examined for the presence of tumors. Then the tumours were removed along with the stroma. Vascular endothelial growth factor (VEGF) levels were estimated by using ELISA method. The first occurrence of palpable tumors was eight weeks after carcinogen treatment and the final tumour incidence was 100% in the MNU alone and topical treated rats. Whereas in rats of other treatment groups there is decreased tumour incidence which might be due to their antitumour activity. Hesperidin therapy inhibited angiogenesis which can be evident from the significant reduction in serum as well as tumour VEGF concentrations in comparison to the untreated mammary carcinoma bearing rats. Hesperidin is promising agents that exert direct antitumor and also antiangiogenic, antiproliferative and anti-inflammatory activities. Even though the potency is little lesser than standard drug vincristine, it has been proved to be safe without effecting haematological count.

Keywords: hesperidin, VEGF, COX 2, N-methyl N-nitrosourea

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Authors: Tarik Ozmen

Abstract:

The soccer players need good dynamic balance and jumping performance for dribbling, crossing rival, and to be effective in high balls during soccer game. The quadriceps angle (Q-angle) is used to assess biomechanics of the patellofemoral joint in the musculoskeletal medicine. The Q angle is formed by the intersection of two lines drawing from the anterior superior iliac spine to the centre of the patella and to the midline of the tibia tuberosity. Studies have shown that the Q angle is inversely associated with quadriceps femoris strength. The purpose of this study was to investigate relationship between dynamic balance, jumping performance and Q-angle in soccer players. Thirty male soccer players (mean ± SD: age, 15.23 ± 0.56 years, height, 170 ± 8.37 cm, weight, 61.36 ± 6.04 kg) participated as volunteer in this study. Dynamic balance of the participants were evaluated at directions of anterior (A), posteromedial (PM) and posterolateral (PL) with Star Excursion Balance Test (SEBT). Each participant was instructed to reach as far as with the non-dominant leg in each of the 3 directions while maintaining dominant leg stance. Leg length was used to normalize excursion distances by dividing the distance reached by leg length and then multiplying the result by 100. The jumping performance was evaluated by squat jump using a contact mat. A universal (standard) goniometer was used to measure the Q angle in standing position. The Q angle was not correlated with directions of SEBT (A: p = 0.32, PM: p = 0.06, PL: p = 0.37). The squat jump height was not correlated with Q-angle (p = 0.21). The findings of this study suggest that there are no significant relationships between dynamic balance, jumping performance and Q-angle in soccer players. Further studies should investigate relationship between balance ability, athletic performance and Q-angle with larger sample size in soccer players.

Keywords: balance, jump height, Q angle, soccer

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Authors: Yuchien Lin

Abstract:

This study attempted to investigate the changes in electroencephalography (EEG) and emotion regulation following eight-week inward-attention meditation training program. The subjects were 24 adults without meditation experiences divided into meditation and control groups. The quantitatively analyzed changes in psychophysiological parameters during inward-attention meditation, and evaluated the emotion scores assessed by the State-Trait Anxiety Inventory (STAI), the Positive and Negative Affect Schedule (PANAS), and the Emotion Regulation Scale (ERS). The results were found: (1) During meditation, significant EEG increased for theta-band activity in the frontal and the bilateral temporal areas, for alpha-band activity in the left and central frontal areas, and for gamma-band activity in the left frontal and the left temporal areas. (2) The meditation group had significantly higher positive affect in posttest than in pretest. (3) There was no significant difference in the changes of EEG spectral characteristics and emotion scores in posttest and pretest for the control group. In the present study, a unique meditative concentration task with a constant level of moderate mental effort focusing on the center of brain was used, so as to enhance frontal midline theta, alpha, and gamma-band activity. These results suggest that this mental training allows individual reach a specific mental state of relaxed but focused awareness. The gamma-band activity, in particular, enhanced over left frontoparietal area may suggest that inward-attention meditation training involves temporal integrative mechanisms and may induce short-term and long-term emotion regulation abilities.

Keywords: meditation, EEG, emotion regulation, gamma activity

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Authors: Adenike O. Olatunji-Akioye, Emmanual B Farayola

Abstract:

In order to improve the animal protein recommended daily intake of Nigerians, there is an upsurge in breeding of hitherto shunned food animals one of which is the rabbit. Radiography and ultrasonography are tools for diagnosing disease and evaluating the anatomical architecture of parts of the body non-invasively. As the rabbit is becoming a more important food animal, to achieve improved breeding of these animals, the best of the species form a breeding stock and will usually depend on breeding soundness which may be evaluated by assessment of the male reproductive organs by these tools. Four male intact rabbits weighing between 1.2 to 1.5 kg were acquired and acclimatized for 2 weeks. Dorsoventral views of the testes were acquired using a digital radiographic machine and a 5 MHz portable ultrasound scanner was used to acquire images of the testes in longitudinal, sagittal and transverse planes. Radiographic images acquired revealed soft tissue images of the testes in all rabbits. The testes lie in individual scrotal sacs sides on both sides of the midline at the level of the caudal vertebrae and thus are superimposed by caudal vertebrae and the caudal limits of the pelvic girdle. The ultrasonographic images revealed mostly homogenously hypoechogenic testes and a hyperechogenic mediastinum testis. The dorsal and ventral poles of the testes were heterogeneously hypoechogenic and correspond to the epididymis and spermatic cord. The rabbit is unique in the ability to retract the testes particularly when stressed and so careful and stressless handling during the procedures is of paramount importance. The imaging of rabbit testes can be safely done using both imaging methods but ultrasonography is a better method of assessment and evaluation of soundness for breeding.

Keywords: breeding soundness, rabbit, radiography, ultrasonography

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Authors: Devendra Gupta, Sushilk K. Agarwal, Amit Kesari, P. K. Singh

Abstract:

Objectives: Pediatric patients often may experience persistent respiratory failure that requires tracheostomy placement in Pediatric ICU. We have designed a technique of tracheostomy in pediatric patients with S-shaped incision on the tracheal wall with higher success rate and lower complication rate. Technique: Following general anesthesia and positioning of the patient, the trachea was exposed in midline by a vertical skin incision. In order to make S-shaped tracheostoma, second tracheal ring was identified. The conventional vertical incision was made in second tracheal ring and then extended at both its ends laterally in the inter-cartilaginous space parallel to the tracheal cartilage in the opposite direction to make the incision S-shaped. The trachea was dilated with tracheal dilator and appropriate size of tracheostomy tube was then placed into the trachea. Results: S-shaped tracheostomy was performed in 20 children with mean age of 6.25 years (age range is 2-7) requiring tracheostomy placement. The tracheostomy tubes were successfully placed in all the patients in single attempt. There was no incidence of significant intra-operative bleeding, subcutaneous emphysema, vocal cord palsy or pneumothorax. Two patients developed pneumonia and expired within a year. However, there was no incidence of tracheo-esophageal fistula, suprastomal collapse or difficulty in decannulation on one year of follow up related to our technique. One patient developed late trachietis managed conservatively. Conclusion: S-shaped tracheoplasty was associated with high success rate, reduced risk of the early and late complications in pediatric patients requiring tracheostomy.

Keywords: peatrics, tracheostomy, ICU, tracheostoma

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Authors: Lakmali Anthony, Madeline Gillies

Abstract:

Background: Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods: This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare, and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results: There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for the population was 182 per 100,000; this increased by 9.578 per year during the study period (95% CI = 8.431- 10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year. (95% CI = 0.654- 1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95% CI = 0.510 -0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions: Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Keywords: ventral, incisional, hernia, trends

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