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Masquelet Technique for Reconstruction of a Fourth Metatarsal Defect Following a Low-velocity Gunshot Wound: A Case Report
No full textThe Masquelet technique has become increasingly popular in reconstruction scenarios such as osteomyelitis, cancer, and nonunions. The procedure is a two-staged approach: first, a polymethylmethacrylate (PMMA) cement spacer is inserted to fill a bone void. The spacer induces a membrane to form around it, and 6-9 weeks later, the second stage involves carefully extracting the spacer and filling the membrane with bone graft. Most of the current literature has published either femoral or tibial involvement for Masquelet studies, with limited published data on foot reconstruction. Here, the authors used the procedure for the fourth metatarsal. Despite complications, this case proves a more excellent utility and warrants further investigation into Masquelet techniques in the foot
Monkeypox Virus, A Global Public Health Concern and Challenge for Low-income Countries including Pakistan: A Right Time to Nip the Evil in the Bud
No full textMonkeypox is a rare zoonotic infection originating in the regions of Central and West Africa. The global threat has been arising since monkeypox is spreading outside of the endemic regions. Pakistan has recently exhausted health funds in a quarrel against SARS-CoV-2, by supplying expensive COVID-19 vaccines to the general public, free of cost. Pakistan’s government has remarkably contributed to lowering the suffering of COVID-19-affected patients by granting the Sehat Sahulat Programme and similar health initiatives to restrict viral propagation in the general public. However, despite all efforts the major constraints are a lack of international funds and limitations on the budget of healthcare systems and medical facilities. Newly emerged cases of monkeypox are very threatening to Pakistan’s economy and health. Therefore, it is very necessary that healthcare authorities take effective measures like surveillance, early identification, separation, monitoring of contacts, immunization, and public awareness in order to stop the spread of the virus and control monkeypox outbreaks
Rare Case of Dense Deposition Disease with Combined C3 and C4d Deposits with MYH9-related Mutation
No full textBackground: The C3 glomerulopathies are a group of rare forms of glomerulonephritis with an incidence of 1-2 cases per million. It is mainly characterized by dysregulation of the alternative complement pathway. It is further classified morphologically based on electron microscopy ultrastructural findings into Dense Deposition Disease (DDD) and C3 glomerulonephritis. DDD is normally characterised by C3 Deposits. Case: We report a rare case of a young Emirati male who presented with sub nephrotic proteinuria and microscopic haematuria on routine evaluation. Renal biopsy showed features of DDD with combined C3 and C4 deposits. The retinal evaluation showed features of Drusen classically seen in DDD. Genomic study showed heterozygous mutation in c.5842G>C (p.Asp1948His) variant of uncertain significance in MYH9 gene. Discussion: C3 Glomerulopathy is a type of immune mediated disease previously classified as membranoproliferative glomerulonephritis. DDD is mainly characterised by C3 deposits in the glomerular basement Membrane. Our case has both C3 and C4d deposits, which is a rare entity. It shows the activation of both classical and alternate pathways. Conclusion: Dense deposition disease is a rare complement mediated glomerulopathy. It is characterised by C3 deposits. Dense deposition disease with combined C3 and C4d deposits is a new entity. The treatment and prognosis of such cases will be different and unique compared to the normal cases of DDD
Postpartum as the best time for physical recovery and health care
No full textAim: The current paper presents a subjective symptom survey regarding postpartum discomfort (Study 1) and a case study on postpartum care using the program developed based on the survey results (Study 2). Thereafter, health care during the postpartum period is discussed.Methods: Study 1 analyzed 1638 postpartum women who completed the Subjective Fatigue Symptom Scale (SFSS) over the period from June 2012 to December 2019. Study 2 detailed the case of a 33-year-old primiparous woman who answered questions regarding the rehabilitation care program.Results: The 1638 subjects included in Study 1 had a mean age of 32.4 ± 8.2 years and a mean postpartum duration of 4.3 ± 2.3 months. Subjective symptoms included lower back pain, shoulder stiffness, sleepiness, wanting to lie down, yawing, and eye strain. The case included in Study 2 showed certain psychological and physical changes following the exercise program. The results of Study 1 showed that motor system discomfort, such as stiff shoulders and lower back pain, occurred in women across all postpartum stages. Our results demonstrated that care and exercise geared toward improving motor system function are imperative after childbirth. Meanwhile, the results of Study 2 imply that our rehabilitation program based on postpartum physical conditions had positive psychological and physical effects.Conclusion: Taken together, our results suggest that continuing rehabilitative care based on the physical condition during each postpartum stage facilitates improvement in mothers’ physical and psychological discomfort
COVID-19 detection and classification: key AI challenges and recommendations for the way forward
No full textCoronavirus disease (COVID-19) is a viral pneumonia that is found in China and has spread globally. Early diagnosis is important for effective and timely treatment. Thus, many ongoing studies attempt to solve key COVID-19 problems such as workload classification, detection, and differentiation from other pneumonia and healthy lungs using different imaging modalities. Researchers have identified some limitations in the deployment of deep learning methods to detect COVID-19, but there are still unmet challenges to be addressed. The use of binary classifiers or building classifiers based on only a few classes is some of the limitations that most of the existing research on the COVID-19 classification problem suffers from. Additionally, most prior studies have focused on model or ensemble models that depend on a flat single-feature imaging modality without using any clinical information or benefiting from the hierarchical structure of pneumonia, which leads to clinical challenges, and evaluated their systems using a small public dataset. Additionally, reliance on diagnostic processes based on CT as the main imaging modality, ignoring chest X-rays. Radiologists, computer scientists, and physicians all need to come to an understanding of these interdisciplinary issues. This article first highlights the challenges of deep learning deployment for COVID-19 detection using a literature review and document analysis. Second, it provides six key recommendations that could assist future researchers in this field in improving the diagnostic process for COVID-19. However, there is a need for a collective effort from all of them to consider the provided recommendations to effectively solve these issues
Dalbavancin and moleculight in the COVID-19 pandemic
No full textThe COVID-19 Pandemic, which began in March 2020, and its associated surges, had an immense impact on our medical staff and their ability to perform their daily duties.The COVID-19 Pandemic necessitated hospital modifications, including the expansion of the Emergency Department, ICU, and Isolation units. The overwhelmed staff and overburdened ER and ICU required adjustments to deal with the Inpatient impasse. For example, temporary patient care rooms needed to be set up for the overflow of patients. The tsunami of the Pandemic almost overwhelmed our hospital.With the challenges presented to our hospital during the Pandemic, we needed a fresh perspective to our multi-disciplinary approach. Thus, we fathomed that the use and cost-effectiveness of both Dalbavancin, a long-acting lipoglycopeptide antibiotic combined with the diagnostic Moleculight Imaging Device would be a sound decision.We hypothesized that with the use of this cost-effective antibiotic in conjunction with the use of the Moleculight Imaging Device, with its fluorescent imaging, we could detect the presence of bacteria and assist our wound treatment and decision-making.A shift in patients from the Emergency Room/Inpatient Department to the Outpatient Department/Wound Care Center was made possible with the use of these two novel products
Child protection services during COVID-19 in Oman, child protection workers views
No full textIntroduction: Child Protection Services (CPSs) are dedicated to providing protection and responding to any threats a child could face as children worldwide could be abused. Recently, the COVID-19 pandemic affected all aspects of life. Procedures implemented to restrict the spread of the disease (such as reduced access to services, school closure, and social distancing measures) had an impact on child life and maltreatment. Therefore, it is important to know the impact of this pandemic on child abuse and protection. Aim and rationales: This study aimed to assess the impact of COVID-19 on CPSs in Oman by studying the change in the number of reported cases of child abuse and the change in the reporting procedure at the Ministry of Social Development (MOSD). In addition, know the impact of the restriction measures on child rights and risk factors of child maltreatment based on CPSs workers’ opinions and experience. To understand the adaptation of the CPSs to the change in work and life environment imposed by COVID-19. Method: A cross-section study was conducted using a semi-structured questionnaire, that was distributed to the workers involved in the CPSs at the MOSD in Oman. Data also were collected from the statistical bulletins on the Ministry’s website. Results: COVID-19 pandemic was not found associated with a significant change in the number and type of child abuse cases reported to the MOSD. The reporting procedures also did not change. In addition, the pattern of child abuse types did not change before and during the pandemic, as neglect cases were the most. The participants judged the restriction measures affecting family life through separation, cyber abuse, and reduced educational support. With regard to intervention and follow-up procedures, the main difference was in the communication processes by using online communication methods and reducing the fieldwork for mild cases.Conclusion: CPSs in Oman were not much affected by the COVID-19 pandemic, which may reflect the success of this system in dealing with the restriction measures. However, more solutions should be developed to adapt to these circumstances in the future altogether
Aseptic Meningitis in Pregnancy – A Case Study Detailing Potential Diagnostic Dilemmas
No full textThere are few reported cases of meningitis in pregnancy and presentation can be variable in each patient which may cause diagnostic challenges and potential delays in treatment. Here, we discuss a case of aseptic meningitis - a 36 years old Gravida 2 Para 1 pediatric physician with “the worst headache of her life” at 31+5 weeks of gestation. At presentation, she did not have any of the classic triads of meningitis (fever, neck stiffness, and/or a change in mental status) and did not report any neurological symptoms. In view of persistent headache, development of pyrexia, and evolving symptoms of photophobia, she was referred to a neurology specialist, and a lumbar puncture was performed. Findings were in line with meningitis and the polymerase chain reaction confirmed enterovirus meningitis. Although aseptic meningitis is rare, it should be considered as a differential diagnosis in patients with persistent complaints, development of associated symptoms of pyrexia, photophobia, and neck pain, as well as in patients with increased risk of exposure to viral illnesses
Using Model Classification to detect Bias in Hospital Triaging
No full textBackground: In light of the COVID-19 pandemic and the health crisis left in its wake, our goal is to develop extensive machine-learning techniques to provide a clear picture of the treatment, and possible mistreatment, of specific patient demographics during hospital triaging.Objective: We aim to reveal whether a patient’s treatment and hospital disposition is related to the following attributes - Emergency Severity Index (ESI), gender, employment status, insurance status, race, or ethnicity which our 100 MB dataset included.Materials and methods: Our work is separated into two parts - the classification task and data analysis. As part of the classification task, we used the k-Nearest-Neighbor classifier, the F1-score, and a random forest. We then analyze the data using SHapley Additive exPlanations (SHAP) values to determine the importance of each attribute.Results: Our findings show that significance varies for each attribute. Notably, we found that patients with private insurance programs receive better treatment compared to patients with federal-run healthcare programs (e.g. Medicaid, Medicare). Furthermore, a patient’s ethnicity has a greater impact on treatment for patients under 40 years of age for any given ESI level. Surprisingly, our findings show language is not a barrier during treatment.Discussion and conclusion: We, therefore, conclude that although hospitals may not be doing so intentionally, there is a systemic bias in hospital triaging for specific patient demographics. For future works, we hope to aggregate additional patient data from hospitals to find whether specific demographics of patients receive better healthcare in different parts of the United States
Development of qualitative GC MS method for simultaneous identification of PM-CCM a modified illicit drugs preparation and its modern-day application in drug-facilitated crimes
No full textPrescriptions for psychoactive substances such as Pregabalin, Methamphetamine, Caffeine, Clonazepam and Mirtazapine (PM-CCM) are common in the treatment of a variety of disorders. Indeed, the PM-CCM has been used in different therapeutic areas, including insomnia, anxiety, seizure disorders, etc. Unfortunately, these psychoactive substances are present in the illegal street market, leading to a lot of drug abuse among some addicted users, road insecurity and suicide. Hence, it has become essential to validate and develop a rapid and effective method to analyze the PM-CCM, a modified illicit drug, for drug abuse in the forensic sciences. A simple, rapid, specific and sensitive Gas Chromatography-Mass Spectrometry(GC-MS) method has been developed for the identification of Pregabalin, Methamphetamine, Caffeine, Clonazepam and Mirtazapine (PM-CCM) in forensic exhibits. At room temperature, the sample was ultrasonicated for 5 minutes before being extracted with methanol. A highly precise auto-injector is used to inject a very small quantity of samples for analysis. Helium is used as a carrier gas with a flow rate of 1 ml/min. The separation of PM-CCM was performed on SH-RXi-5 MS, ID.25 mm, film thickness. 25 µm, length of 30 m column. The constituents of PM-CCM were identified by the mass-to-charge ratio (m/z ratio) of fragments of the parent compound by comparing them with the NIST-17 MS Library. Separation and identification of PM-CCM were achieved within a 15-minute run. The proposed method has been successfully used for the routine analysis of PM-CCM in complex illicit drug preparations and in forensic exhibits as well. The application of above discussed qualitative analysis method and screening of PM-CCM, modified illicit drug samples demonstrates the potential and applicability of the technique to the fast chemical profiling of illicit samples.