- [Treatment of scapular fractures with lateral incision and bridge combined internal fixation system]. [Journal Article]
- ZGZhongguo Gu Shang 2017 Oct 25; 30(10):952-956
- CONCLUSIONS: Lateral incision approach combined with bridge internal fixation system for scapula fractures has the advantages of easy operation, revealed clearly, and the incision can be arbitrary to extend on both sides, to provide favorable conditions for the reduction and fixation of fracture. Bridge combined internal fixation system has the advantages of flexible operation, reliable fixation strength, is a good choice for treatment of scapula fracture.
- Facial Weakness, Diplopia, and Fever in a 31-Year-Old: An Atypical Case of Tuberculous Meningitis. [Journal Article]
- CCureus 2017 Dec 07; 9(12):e1918
- Tuberculous meningitis (TBM) is an infection of the central nervous system (CNS) meninges that carries high morbidity and mortality. It is important to recognize, as patients may present with atypica...
Tuberculous meningitis (TBM) is an infection of the central nervous system (CNS) meninges that carries high morbidity and mortality. It is important to recognize, as patients may present with atypical symptoms. We describe the case of a 31-year-old man with a history of diabetes who presented with a sub-acute onset of right-sided facial weakness and right gaze difficulty with diplopia. History revealed low-grade fever, right-sided headache, fatigue and moderate weight loss for the past several weeks. The patient did not report neck stiffness, rigidity, fever, chills or cough. The physical exam revealed sixth nerve palsy with a right Horner's syndrome. Magnetic resonance imaging (MRI) of the brain showed pachymeningeal enhancement. A spinal tap revealed elevated white blood cells (WBCs), glucose and protein; cerebrospinal fluid (CSF) culture showed Mycobacterium tuberculosis. The patient was diagnosed with TBM and treated with isoniazid, rifampin, pyrazinamide, ethambutol and vitamin B6 for 12 months. The timely diagnosis of TBM can be challenging due to a nonspecific clinical presentation. In patients with a sub-acute onset of headache, fever and meningeal signs, TBM should be considered in the differential. If suspected, treatment should be initiated immediately to prevent further neurological impairment and death.
- A Rare Presentation of Cryptococcal Meningitis and Cerebellitis in an Asplenic Patient, Seronegative for Human Immunodeficiency Virus (HIV). [Journal Article]
- AJAm J Case Rep 2018 Feb 19; 19:183-186
- CONCLUSIONS: The occurrence of meningeal and cerebellar cryptococcosis in an asplenic patient is rare, and few cases have been previously reported. This case report highlights the possibility of invasive cryptococcal infection, or cryptococcosis, in asplenic individuals in the absence of HIV infection.
- Assessment of cervical stiffness in axial rotation among chronic neck pain patients: A trial in the framework of a non-manipulative osteopathic management. [Journal Article]
- CBClin Biomech (Bristol, Avon) 2018 Feb 12; 53:65-71
- CONCLUSIONS: Stiffness characteristics of the cervical spine in axial rotation are prone to be altered in patients with neck pain, but seem to be relieved after a session of non-manipulative manual therapeutic techniques. Further investigations, including randomized clinical trials with various clinical populations and therapeutic modalities, are needed to confirm these preliminary findings.
- Exploring novel objective functions for simulating muscle coactivation in the neck. [Journal Article]
- JBJ Biomech 2018 Feb 08
- Musculoskeletal modeling allows for analysis of individual muscles in various situations. However, current techniques to realistically simulate muscle response when significant amounts of intentional...
Musculoskeletal modeling allows for analysis of individual muscles in various situations. However, current techniques to realistically simulate muscle response when significant amounts of intentional coactivation is required are inadequate. This would include stiffening the neck or spine through muscle coactivation in preparation for perturbations or impacts. Muscle coactivation has been modeled previously in the neck and spine using optimization techniques that seek to maximize the joint stiffness by maximizing total muscle activation or muscle force. These approaches have not sought to replicate human response, but rather to explore the possible effects of active muscle. Coactivation remains a challenging feature to include in musculoskeletal models, and may be improved by extracting optimization objective functions from experimental data. However, the components of such an objective function must be known before fitting to experimental data. This study explores the effect of components in several objective functions, in order to recommend components to be used for fitting to experimental data. Four novel approaches to modeling coactivation through optimization techniques are presented, two of which produce greater levels of stiffness than previous techniques. Simulations were performed using OpenSim and MATLAB cooperatively. Results show that maximizing the moment generated by a particular muscle appears analogous to maximizing joint stiffness. The approach of optimizing for maximum moment generated by individual muscles may be a good candidate for developing objective functions that accurately simulate muscle coactivation in complex joints. This new approach will be the focus of future studies with human subjects.
- Outcome of Patients with Meningitis and Encephalitis at Tertiary Care Hospital in Eastern Nepal. [Journal Article]
- KUKathmandu Univ Med J (KUMJ) 2017 Jan.-Mar.; 15(57):40-44
- Background There are several etiologies of meningitis and encephalitis which must be considered in any patient presenting with fever, headache, neck stiffness and vomiting. Bacterial meningitis and v...
Background There are several etiologies of meningitis and encephalitis which must be considered in any patient presenting with fever, headache, neck stiffness and vomiting. Bacterial meningitis and viral encephalitis are medical emergencies and need urgent attention and treatment. Any delay in diagnosis and treatment has been shown to increase morbidity and mortality. Some of the survivors also have neurological sequel with a need for long term physical and occupational rehabilitation. Objective To find out common causes of meningitis, encephalitis, predictors of outcome, early and late complications of meningitis and encephalitis at Tertiary Care Hospital in Eastern Nepal. Method It is a prospective study which was conducted at Nobel Medical College Teaching Hospital from April 2015 to March 2016. Result A total of 52 patients participated in the study. Bacterial meningitis was the most common type of neuroinfection (40.4%) followed by tubercular meningitis (27%), viral encephalitis (17.3%) and viral meningitis (15.4%). Pneumococcus was the most common identified cause of meningitis accounting for 28.9% of bacterial meningitis. Japanese encephalitis was the most common identifiable cause of encephalitis accounting for 33% of cases. Low Glasgow Coma Scale at admission was significantly associated with worse neurological outcome (P<0.001). Similarly, high white blood cell count in blood was associated with worse neurological outcome (P=0.001). Conclusion Meningitis and encephalitis are neurological emergency. Prompt diagnosis and treatment is needed to improve survival. Neurological sequel is common after those infections which require long term rehabilitation.
- Physical Therapy Challenges in Head and Neck Cancer. [Journal Article]
- CTCancer Treat Res 2018; 174:209-223
- Treatment sequelae such as trismus, shoulder dysfunction syndrome resulting from spinal accessory nerve palsy, and radiotherapy-induced neck fibrosis are often overlooked when in the management of he...
Treatment sequelae such as trismus, shoulder dysfunction syndrome resulting from spinal accessory nerve palsy, and radiotherapy-induced neck fibrosis are often overlooked when in the management of head and neck cancer patients. This chapter examines these underappreciated issues and their corresponding physical therapy intervention based on current evidence. Head and neck cancer survivors must contend with these disabilities for years after treatment has been concluded. A few quit their jobs which puts a tremendous burden on them and their families with a diminished quality of life. The physical rehabilitative needs of head and neck cancer patients and useful interventions to help meet them are addressed.
- Community-Acquired Meningitis in HIV-Infected Patients in the United States. [Journal Article]
- APAIDS Patient Care STDS 2018; 32(2):42-47
- We conducted a retrospective study of 549 adults admitted with community-acquired meningitis (CAM) to several hospitals in New Orleans, LA and Houston, TX between 1999 and 2014 to characterize the cu...
We conducted a retrospective study of 549 adults admitted with community-acquired meningitis (CAM) to several hospitals in New Orleans, LA and Houston, TX between 1999 and 2014 to characterize the current epidemiology, clinical manifestations, cerebrospinal fluid (CSF) characteristics, and outcomes of CAM between HIV-infected and uninfected patients and to identify risk factors for adverse outcomes in CAM. Bivariate analysis and logistic regression analysis were used to identify prognostic factors. A total of 1022 patients with CAM were screened. Only 549 (53.7%) subjects had an HIV test and were included in the study. Of those, 138 (25%) had HIV infection. HIV-infected patients presented with less meningeal symptoms (headache, neck stiffness, and Kernig sign), but with higher rates of hypoglycorrhachia, elevated CSF protein, and an abnormal cranial imaging (p < 0.05). More than 50% of all the patients had an unknown etiology. Cryptococcal meningitis was the most common identified etiology of CAM in HIV-infected patients followed by neurosyphilis and varicella-zoster virus (VZV). Viral and bacterial etiologies were the most frequent etiologies in non-HIV-infected patients. Streptococcus pneumoniae was the most common bacterial pathogen in both groups, but it was rare overall (2%). Adverse clinical outcomes were similar in both groups (27% vs. 24%). Logistic regression identified hypoglycorrhachia and an abnormal neurological examination as independent predictor factors of worse outcome in all patients with meningitis. Our results demonstrate that the etiology, clinical presentation, and CSF findings differ between HIV-infected and HIV-uninfected adults with CAM, but clinical outcomes are similar.
- Ideal Characteristics of a Laser-Protected Endotracheal Tube: ABEA and AHNS Member Survey and Biomechanical Testing. [Journal Article]
- AOAnn Otol Rhinol Laryngol 2018 Feb 01; :3489418757549
- CONCLUSIONS: Members of the ABEA and AHNS, particularly FTLs, highly value distinguishing properties of the now discontinued MLST. Manufacturers should consider this in the design of new LPETs.
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- A new configuration of cannulated screw fixation in the treatment of vertical femoral neck fractures. [Journal Article]
- IOInt Orthop 2018 Feb 08
- CONCLUSIONS: Our results suggested that using new configuration of an OCCS plus two HCCSs improved the outcome of vertical femoral neck fractures (FNF) patients compared to those using OCCS alone, which provides a new choice for treatment of FNF.