Search

Summary:. We report the case of a 43-year-old woman who presented with combined radial, median, and ulnar nerve palsies and a spiral humeral shaft fracture after falling down stairs. Postinjury, the patient did not recover full median, ulnar, and radial nerve function despite aggressive hand therapy. Electrodiagnostic studies and imaging findings were concerning for traction neuropraxia or transection, radial nerve neuroma, and scar encasement of the radial, median, and ulnar nerves. The patient underwent radial, median, ulnar, and musculocutaneous nerve neuroplasty, nerve wrap application, nerve stimulation and laser angiography. Surgical exploration revealed no transection injuries to the median, ulnar, or musculocutaneous nerves. The radial nerve was tethered to the fracture site and enlarged, but no neuroma was observed. Laser angiography demonstrated intact perfusion to all nerves. The patient went on to recover full nerve function. Although isolated radial nerve palsies associated with closed humeral shaft fractures are typically observed initially, management of combined nerve palsies is controversial. This case serves to caution surgeons to perform a thorough neurovascular examination on patients with humeral shaft fractures to identify combined nerve palsies.

OBJECTIVES:. Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019. DESIGN:. Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways. SETTING:. ICU Recovery Clinic in an academic medical center. PATIENTS:. Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019. INTERVENTIONS:. Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training. MEASUREMENTS AND MAIN RESULTS:. Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life. CONCLUSIONS:. A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.

Mechanical thrombectomy 6–24 h after the last time where a patient was known to be without signs or symptoms of a stroke is the standard of care for patients with a stroke due to large vessel occlusion. This is referred to as thrombectomy within an extended time window. There have been very few studies looking at patients who had seizures within the first week (early post-stroke seizures) following mechanical thrombectomy in this extended time window. Our study suggests that this group of patients does not have a higher incidence of early post stroke seizures. Our findings do reveal however, that patients who do have early post-stroke seizures may have a less favorable functional outcome at 90 days than those who did not develop early seizures. Hence, rapid identification and subsequent treatment of seizures in these patients is important.

Abstract A single, rapid and reproducible diagnostic test to predict the type of azoospermia and outcome of sperm retrieval is not yet available. So the feasibility of employing DNA flow cytometry for rapid investigation of the status of spermatogenesis in the patients with azoospermia was investigated. Testicular biopsies of 44 patients with azoospermia undergoing sperm-retrieval surgery and 4 controls were analyzed by flow cytometry to ascertain their testicular germ-cell patterns. The observed germ-cell pattern was further confirmed by RT-PCR analysis of the cell-specific markers and histology for some patients. The patients with Obstructive Azoospermia (OA) exhibited normal spermatogenesis similar to the control fertile patients showing the presence of diploid, double-diploid and haploid cells. The non-obstructive azoospermia (NOA) patients exhibited disrupted spermatogenesis with arrest at the pre-meiotic (only diploid cells present) or meiotic (diploid and double-diploid cells present) stages. The germ-cell pattern, as ascertained by flow cytometry, provided a clear picture of the intra-testicular spermatogenesis and the presence of spermatozoa in the patients’ testes, which was prognostic of their sperm-retrieval. DNA flow cytometry test to ascertain the testicular germ-cell pattern is simple in execution, analysis and interpretation, requires small amount of tissue and provides quantitative data about the status of spermatogenesis in patients. This test would allow comparable analysis of the status of spermatogenesis in patients across clinics and may form the basis for deciding future treatment and intervention strategies.

In this paper we obtain a sharp (improved) lower bound on the locating-total domination number of a graph, and show that the decision problem for the locating-total domination is NP-complete.

Since occupation is a major determinant of health, traffic police personnel face multiple occupational hazards. They are continuously exposed to vehicular emissions and work in a noisy and polluted environment. The objective of the present review is to explore the impact of occupational health hazards on the health of traffic police personnel. Published research papers on traffic police reporting occupational health issues were accessed and reviewed. Attempts were made to access papers that reported negative associations in order to present a balanced review. The majority of the studies have reported a decrease in the lung function and increased respiratory morbidity. The research on the cytogenetic abnormalities or genotoxic effect of vehicular emissions arising due to long-term exposure to benzene and other polyaromatic hydrocarbons has provided conflicting results, since more or less equal numbers of studies have given evidence for and against the causal association. There is a vast accumulation of epidemiological evidence on the casual association between vehicular pollution and its carcinogenic effect. Multiple studies have concluded that traffic police are highly stressed. A number of occupational factors have been attributed to stress among traffic police. Occupational health studies help us to understand the effects of vehicular pollution and its adverse influence on workers. They also provide opportunity for defined exposures measurements and precise risk assessment. The findings from these studies are easily generalizable and can help us understand the impact of air pollution on the general population.

The incidence of dementia is on the rise and expected to continue to increase in the foreseeable future. Two of the most common subtypes of dementia are Alzheimer’s subtype and vascular dementia. Hyperhomocysteinemia has been shown to serve as a risk factor for dementia due to an associated blood−brain barrier dysfunction and subsequent small-vessel disease pathology. There are varying causes for hyperhomocysteinemia, including genetic and dietary, among others. We highlight the importance of identifying hyperhomocysteinemia as a potential etiologic and therapeutic target for the most common subtypes of dementia.

Objective. A Socio-economic-political-cultural (SEPC) study was undertaken under the Roll Back Malaria (RBM) initiative to understand the process of programme implementation and how far in the changing malaria context, the broader environment has been understood and programme components have undergone changes. Material and Methods. Two studies were carried out; first in four villages under the primary health unit (PHU) Banavaralu in Tiptur Taluka in September 2002 and the second one in April 2003 in four villages in Chitradurga district, namely, Kappagere, Kellodu in Hosadurga Taluka, and Vani Vilas Puram and Kathrikenhally in Hiriyur Taluka. Focus group discussion and key interviews were adopted to collect the qualitative data. Results. Gender discrimination and lack of empowerment of women came out strongly in social analysis. In the rural elected bodies called Panchayats, the concept of health committees was not known. Health committees as one of the important statutory committees under every Panchayat were nonexistent in reality in these villages. Financial difficulties at Grama Panchayat level and also meager budget allocation for health have led to indifferent attitude of Panchayat members towards health. It was observed that there were generally no specific cultural practices in relation to malaria cure. Cultural and traditional practices in malaria-related issues were not predominant in the community except for some sporadic instances. Conclusion and Recommendation. SEPC study is an important indicator in malaria control programme. It is ultimately the community that takes the major decision directly or indirectly and the health authority must guide them in right direction.

An important tool for the execution of parallel algorithms and the simulation of interconnection networks is graph embedding. The quality of an embedding can be assessed using some cost metrics. The dilation and wirelength are the commonly used parameters. The Knödel graph W Δ , n is a minimum linear gossip network and has minimum broadcasting. It has n vertices, n Δ 2 edges, where n is even, and 1 ≤ Δ ≤ ⌊ log 2   n ⌋. In this study, we solve the dilation problem of embedding the Knödel graph into certain cube-like architectures such as hypercube, folded hypercube, and augmented cube. In [G. Fertin, A. Raspaud, A survey on Knödel graphs, Discrete Applied Mathematics 137 (2004) 173–195], it is proved that the dilation of embedding the Knödel graph W Δ , 2 Δ into the hypercube Q Δ is at most 4. In this study, we obtain an improved upper bound for dilation of embedding the Knödel graph into the hypercube and it is equal to 3. Also, we calculate the wirelength of embedding the Knödel graph into the above-said cube-like architectures using dilation. [ABSTRACT FROM AUTHOR]