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Aneurysmal dilatation secondary to HIV vasculitis is well described being more common in patients under 45 years of age with advanced stage HIV infection (CD4 200 cells/µl). Tuberculous meningitis is far more common than previously anticipated with centres in Cape Town publishing that more than half of all cases of adult meningitis were secondary to tuberculosis. But aneurysmal dilatation of the cerebral vessels is exceedingly rare complication in this population. We report a 14-year-old male presenting to Robert Mangaliso Sobukwe Hospital in South Africa, with a first seizure and Tuberculous Meningitis. The patient was lost to follow-up with subsequent representation 2 years later with worsening clinical picture and imaging revealing marked anterior circulation aneurysmal dilatation. The patient was newly diagnosed as being HIV positive giving uncertainty of the aetiology of his vascular malformations. Aneurysmal dilatation in HIV associated cerebral vasculitis is rare. It is more frequently encountered in young adults with advanced disease who are severely immunocompromised. Tuberculous involvement in the central nervous system is thought to be due to secondary reactivation of quiescent foci of micro infection. Aneurysmal dilatation in the setting of Tuberculous Meningitis is infrequently reported in medical literature.

Aim The purpose of this study was to survey all United States Air Force (USAF) general dentists regarding their experience with computer-aided design/computer-aided manufacturing (CAD/CAM) while in a dental school. Dental school graduation year and location was compared to the type and amount of CAD/CAM training and clinical experience during dental school to better understand the differences and influence of this technology. Materials and methods A survey consisting of six questions was sent through e-mail to 546 general dentists in the AF Dental Corps in 2018 of which 306 replied (56% response rate). Results Dentists who graduated in 2005 or earlier and between 2006 and 2009 stated they did not receive CAD/CAM training in dental school, while more respondents in the group of graduation years 2014-2017 stated that they did receive training. About 11% of the respondents who graduated in 2014-2017 completed 6-10 restorations and 9% completed 11 or more restorations compared to the other year groups. More respondents who graduated from a dental school in the southwest and southeast regions of the United States reported completing more restorations compared to other school regions. Conclusion Computer-aided design/computer-aided manufacturing is now becoming a prevalent curriculum in US dental schools, both as a core requirement and an elective. Its training platforms varied from lectures and literature reviews to preclinical laboratory. Clinical significance More respondents in the groups of graduation years 2014-2017 had completed more CAD/CAM restorations compared to other year groups; however, most of the respondents did not feel their training was sufficient enough to use CAD/CAM technology independently.

Background: Sudden cardiac death in a young athlete is a catastrophic event with an incidence of approximately 1:40,000 to 1:80,000. Pre-participation sports screening in adolescents and young adults utilizes a history, physical, and 14-point targeted questionnaire. Countries such as Italy and Japan have added electrocardiogram (EKG) screening programs, however, in the USA no national mandate exists. The reasons for this include concerns for the constraints on the healthcare system, manpower, cost, access to follow-up care, and false-positive results. Recently, some states and local municipalities have implemented pre-participation EKG screenings. …

Ensuring reliable gastrointestinal drug absorption of orally administered immunosuppressive medications posttransplant is critical to ensuring graft survival.A 66-year-old man of East Asian origin with a previous total gastrectomy was evaluated for living donor kidney transplantation. Pretransplant pharmacokinetic testing was performed to determine the most appropriate posttransplant medication strategy. The Gastrointestinal Quality of Life Index and Gastrointestinal Rating Scale questionnaires were administered to gauge immunosuppressive medication-related side effects in the absence of a stomach.The patient's ability to absorb cyclosporin, tacrolimus (Tac), enteric-coated mycophenolate sodium (EC-MPS) and sirolimus (SRL) in oral dosage forms was well-preserved. Compared to nongastrectomy reference populations, the rate and extent of absorption of SRL and mycophenolic acid from EC-MPS were similar. The absorption of Tac and cyclosporin was greater than expected. Mycophenolate mofetil did not provide mycophenolic acid absorption as well as EC-MPS. The patient had worsened gastrointestinal symptoms with mycophenolate mofetil or EC-MPS in combination with Tac and cyclosporin, but this was not seen with isolated SRL.This case demonstrates that commonly used postkidney transplantation immunosuppressive regimes may be prescribed after total gastrectomy as long as their limitations are noted.

Magnetic resonance imaging (MRI) is commonly used to evaluate soft tissue pathology of the foot and ankle. Prior investigations have reported limitations of this modality, however, in evaluation of pathologies related to the peroneal tendons. This article investigates the correlation of pre-operative MRI studies with intraoperative findings. Five board-certified radiologists interpreted MRIs of 80 ankles that subsequently underwent surgical procedures performed by one board-certified foot and ankle surgeon, after which comparison was made between their findings. Statistically significant disagreement was found between radiologist and surgeon findings of a normal peroneus brevis (PB), PB and peroneus longus (PL) tendinosis, PB and PL hypertrophy, PB and PL partial linear tears, PB and PL flattening, PB longitudinal split tears, and the PB attritional spectrum (combined analysis of flattening, partial linear tearing, and longitudinal split tears). These results suggest that given the disconcordance between MRI and intraoperative findings, surgeons should remain cautious in their reliance upon this imaging modality when evaluating this anatomic region.

Background A survey of infection preventionists was conducted to determine the frequency of outbreak investigations in US hospitals. Methods A 2-part electronic survey was sent to Association for Professionals in Infection Control and Epidemiology, Inc, members in US hospitals in January 2010. Part 1 of the survey tool involved hospital demographics and the infection prevention/control program. Part 2 explored specific outbreak investigations allowing responses for up to 8 investigations within the previous 24 months. Results A final sample of 822 responses was analyzed representing 386 outbreak investigations in 289 US hospitals. Nearly 60% of the outbreaks were caused by 4 organisms: norovirus (18%), Staphylococcus aureus (17%), Acinetobactor spp (14%), and Clostridium difficile (10%). Norovirus occurred most often in behavioral health and rehabilitation/long-term acute care units, whereas the other organisms occurred in medical/surgical units. Unit/department closure was reported in 22.6% of investigations and most often associated with norovirus. Outbreak investigations are triggered by unusual organisms, rate above baseline for specific site of infection, and rate above baseline for specific unit. Investigations were most frequently conducted in community/nonteaching hospitals and facilities with 201 to 300 beds. Mean number of confirmed cases was 10; mean duration was 58 days. Conclusion Norovirus is emerging as an increasingly common hospital-associated organism causing outbreaks in nonacute settings and may lead to unit/department closures.

Assessment of nutritional status in children with cancer is important but measures based on weight can be problematic at diagnosis, especially in those with advanced disease. Likewise, dual energy x-ray absorptiometry may be confounded by other radiological procedures and is not commonly available in low-income countries where most children with cancer live. Arm anthropometry is not subject to these constraints. In a study sample of 99 Canadian patients with cancer at diagnosis, mid-upper arm circumference correlated well with lean body mass as measured by dual energy x-ray absorptiometry but triceps skin fold thickness was a poor predictor of fat mass. Arm anthropometry can be a useful tool for the measurement of nutritional status in children with cancer. However, further studies, particularly in low-income countries and in children with solid tumors at diagnosis, are required to determine the full extent of its utility.

The nutritional status of children with cancer is clinically important. In an effort to separate the influences of disease and treatment, we studied children at the time of diagnosis. A total of 99 children underwent assessment by 24 hours dietary recall, measurement of body mass index (BMI), and analysis of body composition by dual energy x-ray absorptiometry (DXA scan). The group averages for calorie intake and BMI were close to the median population norms but ranged widely among individuals. As a group the study participants exceeded the Dietary Reference Intake for protein. Nine children (9%) had a BMIfifth percentile. There were statistically significant but at best moderate correlations between dietary intake and body composition by DXA scan. Twenty-four hours dietary recall may not provide accurate assessment of nutritional status in individual children with cancer at diagnosis. However, DXA scans cannot be undertaken in a timely fashion on all children at this point. Alternative methods of assessment are being explored.

Aim: To review the literature relating to the treatment and prevention of postoperative nausea and vomiting (PONV). Method: Literature searches were conducted using MEDLINE, International Pharmaceutical Abstracts and Embase. Reference lists were also checked for additional relevant articles. Results: The 5-HT3 antagonists are popular because they are well tolerated. Droperidol is commonly used but dose has been an important issue given its dose-dependent adverse effect profile. Metoclopramide is commonly used but with many disappointing results in formal trials. Transdermal hyoscine may have a promising future in the prophylaxis of PONV. Dexamethasone and clonidine are relatively new agents used for PONV but are promising. Midazolam may be useful in the treatment of protracted, resistant PONV. Conclusion: Further study of many of these drugs is required, especially with regard to their use in the treatment of established PONV. (author abstract)

on robotics and the challenges facing minimallyinvasive surgery programs with interest. I have 2 commentsregarding a statement in his abstract: “.the best currentlyavailable science suggests that, in the hands of experts, roboticsoffers little in surgical advantage over laparoscopy, at increasedexpense..” The 3 randomized controlled trials cited in sup-port of this statement all found longer operative times, thelargest driver of cost, with robotics. Since each study comparedrobotic and laparoscopic surgeries performed by expert lapa-roscopists who had relatively little robotic experience (10-30robotic cases), all 3 authors, I believe, made the assumptionthat experienced laparoscopists can transition to robotics witha short learning curve. There is evidence that this assumptionis incorrect. For example, Payne and Dauterive

Maintenance of adequate nutrition is important in the care of children with cancer. In clinical practice, determination of nutritional status can be accomplished with measurement of body composition by dual-energy x-ray absorptiometry (DXA). However, DXA is seldom available in low-income countries where most children with cancer live. This study sought to provide predictive equations for lean body mass and fat mass, measured by DXA, on the basis of simple arm anthropometry providing measures of mid-upper arm circumference and triceps skin-fold thickness in a population (N=99) of children diagnosed with cancer. Such equations were derived successfully with the inclusion of absolute body weight, the body weight Z-score, and the predicted whole-body bone mineral content on the basis of age and sex. Attempted validation in a small sample (N=7) of children who completed therapy for acute lymphoblastic leukemia revealed disparities reflective of the prevalence of obesity in such survivors. Further validation must be undertaken in large samples of children with a variety of malignant diseases to assess the robustness of the equations predictive of body composition.

Twenty-four individuals who were referred to inpatient psychiatric treatment for sex-offending behavior or professional sexual misconduct were tested with quantitative electroencephalogram (QEEG) to determine if there is support for the hypothesis that there is underlying neuro-organicity contributing to sexually offending behaviors. All subjects participated in a program ranging from six weeks to more than one year. Insurance coverage, personal resources, and other payment methods to cover the cost of the test were the only criteria used in determining which patient received the QEEG. The subjects covered all socioeconomic, education, and IQ levels. Significant abnormalities were found in all the QEEGs. In every case, some type of abnormality was noted in the left posterior hemisphere, compared with a normal control population. These findings are consistent with an hypothesis that sex-offending behavior results from misperception of an inappropriate sex object as appropriate by structures in the...

To discover whether chiropractors consider that emotional factors are associated with pain presentations in their patients and if so, what methods they use to investigate these factors and what strategies they use to manage them.A telephone survey of chiropractors in Australasia (Australia and New Zealand) and North America (America and Canada). A database of practitioners was obtained for each region. A phoning protocol was established in each region to standardize the survey approach.Private practice of chiropractic.Chiropractic centers were telephoned and the attending chiropractor(s) were asked to complete a phone survey. The survey consisted of a series of short questions designed to establish the main techniques used in the practice. Questions focused on whether emotional factors of the patient were recognized and addressed and what role emotional factors play in the management of the patient.Subjects were registered/licensed chiropractors listed in a publication of the largest association of practitioners in their region.In Australasia and North America just under half of practitioners surveyed (45.8% and 50.5% respectively) used a technique to evaluate any impacting emotions on the presenting condition. Additionally, 36.3% of Australasia and 33.3% of North America practitioners had a technique to treat emotional factors in the patient. The study also suggests that over 90% of Australasian chiropractors and 80% of North America chiropractors consider emotional factors important in pain presentations.This study found that a substantial number (80-90%) of the chiropractors surveyed believe that emotional factors influence pain syndromes. However, less than half of these practitioners report that they are able to evaluate emotional factors and approximately only a third report that they are able to treat them. This study shows there is a need for further research of chiropractors to be able to evaluate emotional factors and techniques that can be used to rectify emotional components of their patients' pain syndromes.

Methods: A 2-part survey was developed and sent via email to APICmembers in US hospitals in early 2010. Part 1 of the survey involved information on hospital demographics and the infection prevention/control program; Part 2 included questions about specific outbreak investigations including unit/department closures. The survey could accommodate information for up to 8 outbreak investigations and specified activities within the previous 24 months.

3-Deoxy-D-arabino-heptulosonate 7-phosphate (DAH7P) synthase catalyses the aldol-like addition of phosphoenolpyruvate (PEP) to D-erythrose 4-phosphate in the first step of the shikimate pathway to aromatic amino acids. A series of compounds, designed to mimic intermediates in the enzyme-catalysed reaction, have been synthesised and tested as inhibitors for the DAH7P synthase from Escherichia coli. The most potent inhibitor was the vinyl phosphonate, (E)-2-methyl-3-phosphonoacrylic acid, with a Ki of 4.7 µM.

Indomethacin (IN) has been reported to increase the risk of neonatal complications such as intraventricular hemorrhage (IVH) and renal failure. Recently other non-steroidal anti-inflammatory agents such as sulindac (SU) have been shown to be effective tocolytics, but the neonatal effects have not been described. Objective: investigate the outcome of infants born to mothers receiving IN and SU for tocolysis. Methods: Case control study of infants 1.4mg/dl in the 1st week of life), NEC, PVL, sepsis or length of hospital stay between infants in the SU and IN group as compared to each other or the control group. On univariate analysis the IN group was more likely to develop BPD (75%) compared to SU (40%, p=.05) and control (41%, p=.01). The IN (92%) and SU group (95%) were both more likely to require mechanical ventilation compared to controls(74%, p=.03). However, after controlling for potential confounding variables by multivariate analysis, infants in the IN group did not have an increased odds of developing BPD (odds ratio, 1.9, 95% Confidence Interval,.7-5.3) and neither IN (OR 1.1,CI.3-3.8) or SU (OR 2.7,CI.5-14) were associated with an increased odds of requiring mechanical ventilation. Conclusions: In our population of infants

Summary Forty-five normal subjects (36 control subjects, four wrestlers and five cross country runners) and 21 patients with symptoms of cardiovascular disease (11 without and 10 with significant arteriographic evidence for coronary artery disease (CAD) underwent maximal exercise treadmill tests. Twelve lead ECGs were recorded and the voltage amplitude of the ventricular depolarization wave (ΣR), the frontal plane axis (FPA) and horizontal plane axis (HPA) were measured immediately before exercise in the supine (SP) and standing positions (ST), during exercise at a heart rate of 120 bpm (120), at peak exercise (MX), and in the supine position 1 minute after the completion of exercise (1R). In normal subjects (controls and athletes) there was a decrease in ΣR (p Athletes involved in intense aerobic activity have increased R wave amplitude as compared with other normal subjects, but they otherwise react normally to exercise by diminishing R wave amplitude above a heart rate of 120. The R wave amplitude changes with exercise are accompanied by posterior axis shifts of the R wave in the horizontal plane in all subjects. Patients with CAD do not demonstrate an exercise-induced decrease in R wave amplitude even though they shift their R wave axis posteriorly. The presence or absence of significant coronary disease by coronary arteriography or ischemic ST segment depression did not influence the results in this small group of patients.

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SUMMARYSTRENGTH AND CONDITIONING PROFESSIONALS WORKING WITH SOCCER TEAMS MUST BE ABLE TO ADMINISTER A TIME-EFFICIENT, VALID, AND RELIABLE FITNESS TEST, WITH HIGH CONTENT VALIDITY. BASED ON THESE CRITERIA AND THE RESEARCH HEREIN, THE FOLLOWING BATTERY IS ADVISED: ANTHROPOMETRY, SQUAT JUMP, COUNTER MO