The finite element method (FEM) is an engineering resource used to predict the stresses in structures that have complex geometries, specific material properties and are subject to complex loading patterns, being widely used in medical and biological research. It has the advantage of being a noninvasive and accurate method, which provides quantitative and detailed data about the physiological reactions that can occur in the tissues [1-5].
The aim of this publication is to present case reports to show what is possible with pterygoid implants for the rehabilitation of edentulous space in the jaw (maxilla) while avoiding sinus lifts and bone grafting procedures. In addition, the added value of one-piece implants for screwed retention is elucidated.
Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports injuries and remains a difficult diagnostic and therapeutic challenge in the athlete. Accurate diagnosis is critical as 40% of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Implementing evidence supported diagnostic and treatment strategies is the goal for ensuring safe and rapid return to play.
The Lateral Ankle Sprain (LAS) is among the most common type of ankle sprains suffered during athletic activities. Up to 80% of LAS are of the inversion type, and 75% lead to recurrence and instability. Although most individuals experiencing a LAS return to activity within six weeks, many report continued pain, diminished function, and instability.
The purpose of this review is to highlight the epidemiology, pathoetiology, pathoanatomy, and biomechanics of the LAS, enabling sports physicians to implement the best practice guidelines and protocols to manage this common enigma.
With the global population predicted to grow by at least 25% by 2050, the need for sustainable production of nutritious foods is important for human and environmental health. Recent progress demonstrate that membrane transporters can be used to improve yields of staple crops, increase nutrient content and resistance to key stresses, including salinity, which in turn could expand available arable land. Exposure to salt stress affects plant water relations and creates ionic stress in the form of the cellular accumulation of Na+ and Cl− ions. However, salt stress also impacts heavily on the homeostasis of other ions such as Ca2+, K+, and NO3- and therefore requires insights into how transport and compartmentation of these nutrients are altered during salinity stress. Since Na+ interferes with K+ homeostasis, maintaining a balanced cytosolic Na+/K+ ratio has become a key salinity tolerance mechanism. Achieving this homeostatic balance requires the activity of Na+ and K+ transporters and/or channels. The aim of this review is to seek answers to this question by examining the role of major ions transporters and channels in ions uptake, translocation and intracellular homeostasis in plants.
In the research of steam turbine rotor, start-up optimization is a very key research problem. A series of start-up optimization research can greatly improve the start-up efficiency of steam turbine and the safety performance of the unit. The start-up optimization of steam turbine is inseparable from the analysis of the start-up process of steam turbine and the mathematical model of the startup process of steam turbine unit, because the optimization of steam turbine unit can be regarded as a function to find the optimal solution. This paper analyzes the start-up process of 300 MW steam turbine, analyzes the start-up process of steam turbine unit through the data used in the actual power plant, and gives the mathematical model of cold start-up of steam turbine according to the start-up process of steam turbine, so as to further study the start-up optimization of steam turbine. Finally, the optimization model is determined by several key parameters, which are three weight coefficients α1,α2,α3, the actual damage value Di and damage limit value Dlim, and the start-up time ti and total start-up time t0 of each stage.
Plasma stability is the biggest challenge facing the nuclear fusion industry. One of the best methods of stability study is magnetohydrodynamic (MHD) equations, which has two linear and nonlinear states. Usually linear stability analysis is used to describe the MHD state, which is obtained by linearizing nonlinear equations. The reactor under study is the W7-X reactor, which is an optimal example of a stellaratoric system.
The question raised in this research is how to create suitable conditions for the formation of plasma and heat transfer produced by the melting reaction. Many efforts have been made in this direction, but still the record holder for plasma state maintenance belongs to the international ITER project and around 1000. However, IPP researchers at the Max Planck Institute in Germany (maker of the W7-X reactor) predicted that by 2020 they would produce a pulse of 30 minutes.
The numerical method is used to investigate the stability of the reactor. In this paper, boundary conditions were expressed in terms of resistance wall. With the help of the mathematical Matlab software, magnetic field values were obtained from experimental reports extracted from the Max Planck Institute for various values of β. From the values obtained, it was concluded that the appropriate field value is β = 5 according to the ideal MagnetoHydroDynamic state and the interval defined by the Max Planck Institute.
Microvillositary inclusion disease also known as microvillositary atrophy is a rare congenital enteropathy containing a border abnormality in the brushes of enterocytes, manifesting as severe rebellious diarrhea in newborns and infants. It was first described in 1978 by Davidson, et al. The autosomal recessive mode of transmission is suggested because of the frequency of familial cases and inbreeding. Histopathology plays an essential role in establishing the diagnosis. In 2008, a common mutation was identified in most of the patients studied in the MYO5B gene that codes for the Myosin Vb protein, which helped in understanding the etiopathogeny of this pathology poorly described in the literature. The prognosis for this pathology is extremely bleak, requiring total parenteral nutrition for child survival. Intestinal transplantation is for the moment the only long-term solution.
Materials and methods: We report the case of an infant aged 6 months, with no perinatal antecedent. There is 1st degree consanguinity, the mother has a history of deaths in younger siblings in undetermined circumstances. Who since the age of 3 days presents profuse liquid diarrhoea with malnutrition, dehydration and enormous abdominal distension? Several diagnoses were suspected before the jejune biopsy was carried out, which led to the diagnosis of a microvilliositary inclusion disease.
The aim of our work is to highlight the rarest cause of neonatal rebel diarrhoea and to know how to include it among other differential diagnoses.
Artificial intelligence (AI) is the emulation of human intelligence in computers that have been trained to think and behave like humans. The word may also refer to any computer that exhibits human-like characteristics like learning and problem-solving. Artificial intelligence is intelligence demonstrated by machines, as opposed to natural intelligence, which involves consciousness and emotionality and is demonstrated by humans and animals [1].
Background: Rapidly involuting congenital hemangioma (RICH) is a rare vascular tumor that is present at birth and involutes during the first year of life. Kasabach-Merritt syndrome (KMS) is a complication of some vascular tumors such as kaposiform hemangioendothelioma and tufted angioma associated with thrombocytopenia and coagulopathy.
Results: The case of a 2-month-old infant with a diagnosis of RICH with thrombocytopenia and coagulation disorder, successfully treated with surgical excision without complications or recurrence is presented.
Conclusion: The association between RICH and KMS is rare. Histopathological study, immunohistochemistry and ultrasound findings are important for the diagnosis.
Brief summary: This report covers the rare association between rapidly involuting congenital hemangioma and Kasabach-Merritt syndrome in a 2-months-old female infant.
Introduction: In Madagascar, plague is a highly contagious acute endemic infectious disease. The diagnosis of the most severe form of pneumonic plague remains difficult in children, hence the objectives of the present study; which is to identify the clinical signs of this clinical form in children and to describe its epidemiological and evolutionary profile.
Methods: A retrospective case-control study was conducted in four pediatric wards in Antananarivo during the urban pneumonic plague outbreak from September 2017 to January 2018.
Those cases were defined as children aged 0-15 years old suspected of having plague with positive RDT and PCR, and they were defined as children aged 0-15 years old with negative RDT and PCR.
Results: Fifty-two cases of pneumonic plague were identified, half of which (50%) were under 24 months of age.
A male predominance was noted with a sex ratio of 1.23 and 86.54% of the patients were from urban areas.
Several clinical signs were found but none was specific for pneumonic plague: cough (59.62% p: 0.5), dyspnea (3.85% p: 0.16), chest pain (3.85% p: 0.26%), hemoptysis (7.69% p: 0.17), vomiting (9.62% p: 0.14), diarrhea (11.54% p: 0.45), altered general condition (38.46% p: 0.24%).
Two deaths were noted (3.8%).
Conclusion: No specific clinical warning signs have been identified in childhood pneumonic plague. In the event of an epidemic of urban pneumonic plague, any bacterial pneumonia should at least initially include active treatment against Yersinia pestis.
Fascioliasis is a one of the most important serious parasitic zoonotic disease which caused by trematode giant liver fluke Fasciola hepatica and F. gigantica among cattle’s and humans. The infection of Fasciola can be control by the use of phytochemicals as anthelmintic components. The anthelmintic activities of dried root powder of medicinal plant Potentilla fulgens and their different preparations (organic extracts and column purified fraction) are uses in vitro against liver fluke F. gigantica. The dried root powder, different organic extract, and column fractions were time and concentration-dependent. Among all the organic extracts, ethanol extract was high toxic than other organic extracts. The toxic effect of ethanolic extract of P. fulgens after 2h exposure the LC50 value is 5.22 mg/ml against F. gigantica. The column purified fraction of dried root powder of P. fulgens shows more toxicity. The 2h LC50 of column purified fraction was 3.25 mg/ml whereas in 8h exposure the LC50 is 1.24 mg/ml. The phytochemicals of the P. fulgens may be used as anthelmintic components against liver fluke F. gigantica.
Oral cavity is the gateway of the human body, and also provides vital clues of our systemic health. Here in this COVID-19 pandemic, oral manifestations such as dysgeusia, ulcers, xerostomia are noticed and are an an important predictors of this viral disease. This short review describes the oral manifestations of this new disease.
Follicular psoriasis is an uncommon diagnosis and probably the least well-known subtype of psoriasis. Hence, we report the clinical and histological findings of follicular psoriasis in one patient to raise awareness of this rare entity.
Aim: To assess the efficacy of decompressive craniectomy in patients with large basal ganglia (BG) bleed. To establish predictive criteria of mortality after surgery in patients with BG bleed.
Materials: This prospective study includes all patients of large spontaneous BG bleed operated by decompressive craniectomy without hematoma evacuation from October 2012 to September 2015. Data was collected on patient age, gender, distribution of bleed, affected hemisphere dominancy, preexisting medical conditions, admission Glasgow Coma Score (GCS), midline shift on CT or MRI Brain, hematoma volume and anisocoria, duration (hours) between the onset of stroke and operation, post-operative complications, and the duration of hospital stay. This data was correlated with one month mortality of the patients.
Results: Total number of patients were 27. Mean age was 51 years and mean GCS was 7.55(range 5-11). The mean volume of the bleed was 68.51 ml. Mortality was noted in 17 out of 27 patients (63%) in 30 days. Thirteen of the 16 patients with intraventricular extension of BG bleed had mortality. The factors that showed statistically significant correlation with one month mortality were age, GCS at admission, volume of the bleed and the intraventricular extension.
Conclusion: Large BG bleed was associated with high mortality and morbidity. Age of 50 years or more and GCS ≤ 8 at presentation were poor prognostic factors for decompressive craniectomy in patients with BG bleed. Patients with large BG bleed of volume > 60 ml and intraventricular extension had poor prognosis.
Four mestranol moieties were chemically linked to Zn(II) phthalocyanine (4) by cycloaddition “Click” reaction using a tetra-azidoethoxy substituted Zn(II)-phthalocyanine (3). The alkyl-azido coupling reaction was realized between azido groups of 3 and alkyl group of mestranol. The alkylation reaction was carried out to obtain cationic Zn(II) phthalocyanine derivative (5). The new compounds were chemically characterized by the known analytical methods. The absorption and fluorescence properties were studied in comparison. The absorption maxima of phthalocyanines 3, 4 and 5 were recorded at approx. shifts of 8 - 12 nm in the far- red region (680 - 684 nm) and the fluorescence maxima (692 - 693 nm) as compared to unsubstituted ZnPc (672 nm, 680 nm) in DMSO. The studies of singlet oxygen generation of 3, 4 and 5 showed relatively high values such as 0.52 for 3; 0.51 for 4 and 0.46 for 5. The fluorescence lifetime of 3.15 ns (3), 3.25 ns (4) and 3.46 ns (5) were determined with lower than the value than for the used standard ZnPc (3.99 ns). The high photo stability was observed for compounds 3, 4 and 5. In addition, the photosensitized oxidation of cholesterol was compared for 3 and 4 with much lower values of oxidation potential than for unsubstituted ZnPc which suggests that the substitution groups influenced on the photooxidation index of the target molecule.
Introduction: Suicidal behavior in teenagers constitutes a health problem that, given the necessary measures of social isolation taken by the global emergency of the COVID-19 pandemic, must generate timely actions for its prevention and control from the public health services.
Objective: To propose an action plan for the prevention of suicide in teenagers of the Remedios municipality, subjected to voluntary home confinement during the COVID-19 pandemic.
Methods: an observational, descriptive, cross-sectional study was carried out in the “XXX Anniversary” Teaching Community Polyclinic of the municipality Remedios. We worked with the population of 25 teenagers between 12 and 19 years old who made suicide attempts in the period 2019-2021. The empirical methods used were: bibliographic and documentary review, participant observation, focus group, semi-structured interview and questionnaire.
Results: The suicide attempt was common in female teenagers aged 17 to 19 years not identified as risk, the lack of motivation due to the study activity and the previous suicide attempts by ingesting psychotropic drugs without serious intention of dying predominated. The most frequent psychological disorders were emotional disorders, stress, depression, irritability, apathy and insomnia. Actions are presented for the prevention of suicide and promote behaviors that contribute to mental health in the context of COVID-19.
Conclusion: The prevention of suicidal behavior in teenagers in conditions of social isolation due to COVID-19, must include actions that facilitate the coping with stress, intra-family communication and resilience.
A 26 year nulliparous woman presented to the OPD with complaint of painless swelling in the vulva for the last 1.5 years which gradually increased in size causing difficulty in walking.
Objective: During aging, skin undergoes structural, cellular and molecular changes, which not only alter skin mechanical properties but also biological and physiological functions. Structurally the epidermis becomes thinner, the dermal epidermal junction flattens and the extra-cellular matrix component of the dermis is disorganized and degraded. The dermis is composed of two compartments: The Reticular dermis is the deepest and thickest part while the upper layer, the papillary dermis, which is much thinner and is in close contact with epidermis, plays an important role in the structure and function of the skin. We have recently shown that the papillary dermis was preferentially affected by skin aging because the activity of fibroblasts in this region was especially altered as a function of age. The purpose of this study was to investigate the capacity of a flax extract as anti-aging component.
Method: We investigated the capacity of a flax extract to stimulate or restore the activity of papillary fibroblasts from young and old donors in cultured monolayers and in reconstructed skin. Several biological markers of extracellular matrix homeostasis and mechanical properties were investigated.
Results: The tested flax extract seemed to improve parameters known to change with age: I/ In monolayers after treatment the number of aged fibroblasts increased II/ In reconstructed skin the flax extract appears to positively regulate some biological activities; particularly in aged fibroblasts where the deposition of laminin 5, fibrillin 1, procollagen I were increased in the dermis and the secretion of specific soluble factors like MMP1, MMP3 and KGF were regulated to levels similar to those observed in young fibroblasts III/ Mechanical properties were improved particularly for elastics parameters (R5, R2 and R7).
Conclusion: The flax extract is a promising anti-aging compound. The treatment of aged papillary fibroblasts resulted in a return to a younger-like profile for some of the studied parameters.
In Portugal, around 2500 patients with end-stage chronic kidney disease (CKD stage 5) start a renal replacement therapy (RRT) for the first time each year [1]. They have four main treatment options: kidney transplantation (TX); haemodialysis (HD); peritoneal dialysis (PD) and conservative treatment (CT). RRT selection is quite complex due to the specificities of each option and to their profound effect on patient’s quality of life. Patients must play a decisive role in the choice of treatment modality and select the option that best suits to their values and needs.
Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (< 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context.
The lumbar epidural analgesia is commonly used for labour analgesia. The “loss of resistance to air” LORA technique is commonly used for recognition of epidural space. One of the rare complications of this technique is Pneumocephalus (PC). We want to present a case of Pneumocephalus which the mother developed during epidural analgesia in labour. The patient complained of severe headache immediately after attempt at epidural catheter insertion. The symptoms progressively worsened following delivery. A postnatal anaesthetic review was performed and an urgent CT scan of the brain was arranged that showed pneumocephalus. A conservative management pathway was followed with liberal analgesia, oxygen inhalation and keeping the patient mostly in supine position. Her symptoms regressed in severity over the next three days and subsided after one week. We believe that the amount of air used for LORA should be minimized; LORA should not be used after dural puncture and the use of normal saline would alleviate the risk.
Primary umbilical cutaneous endometriosis is a rare umbilical endometrioma that affects women who are within the reproductive age group. It may be associated with infertility and severe dysmenorrhea and can be difficult to diagnosed in an asymptomatic patient.
We report a case of a 38-year-old nulliparous with seven years history of infertility and severe dysmenorrhea. Her hormonal profile assay and hysterosalpingogram results were normal while her husband semen analysis was also within normal range. She complained of monthly bleeding from a painful rubbery multilobate cutaneous nodule on the umbilicus of one year duration. She was diagnosed of cutaneous endometriosis. The diagnosis was confirmed histologically and she had surgical excision with good outcome.
Background: Obstetric fistula is a condition that results from obstructed labour, which occurs when the baby cannot pass through the mother’s birth canal because it either does not come head first or is too large for her pelvis. Prompt medical intervention, often including Caesarean section, permits a safe delivery for both mother and child. Despite this possibility, yearly, thousands of women across the country receive no such aid and their labour is a futile agony lasting between three and five days, with uterine contractions constantly forcing the baby, usually head first, against the organs of the pelvic and unyielding pelvic bone resulting in Vesico Vaginal Fistula (VVF). The main thrust of this study was to examine how health system factors affect health seeking behaviour of women with obstetric fistula in Akwa Ibom and Ebonyi States, Nigeria.
Methods: Qualitative and descriptive research approaches were adopted for the study and a total sample of two hundred and sixteen (216) respondents comprising of one hundred and fifty (150) post fistula repair operative patients and sixty six (66) health workers were purposively selected using simple random techniques. The data were analyzed using thematic analysis and tables of frequency.
Results: The respondents views showed that availability of treatment centre and quality of health care services influenced health seeking behaviour of women with obstetric fistula in Nigeria.
Conclusion: The study indicated that health seeking behaviour of women with obstetric fistula is a major challenge in Nigeria. Establishment and proper equipment of obstetric fistula treatment centres as well as subsidization of the cost of treatment to allow women with this health problem to access health care services are strongly recommended. Therefore, government at all level and non-governmental organizations need to educate the women and create awareness on the causes and dangers of VVF.
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Anas Wardeh
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Ivano- Frankivsk National Medical University, Ukraine
Nataliya Kitsera
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