Gender Disparity in Academic Trauma Surgery: The Current State of Affairs.

INTRODUCTION: Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America. MATERIAL AND METHODS: FRIEDA was used to identify trauma surgery programs. A thorough website review of each program obtained further information on faculty members, including their name, age, gender, and faculty rank. Trauma surgeons with an MD or DO qualification and a faculty rank of Professor, Associate Professor, or Assistant Professor were selected for inclusion in this study. SCOPUS was used to assess the H-index and the number of publications and citations of surgeons. RESULTS: The total number of programs included was 136, consisting of 715 faculty members. Less than a quarter (n = 166; 23.2%) comprised females and less than one-fifth (n = 30; 19%) of female surgeons were Professors. The difference in the research productivity of male and female trauma surgeons was statistically significant (P < .05), with the average H-index being 10 vs 7.5, respectively, amongst the top 50 surgeons of both genders. Based on a multiple regression analysis, academic rank was significantly associated (P < .05), and gender was not significantly associated (P > .05) with H-index. CONCLUSION: Gender disparity exists in the field of trauma surgery, as noted in senior faculty ranks and leadership positions. Female-inclusive state policies, appropriate mentorship, and supportive institutions can help to bridge this gap.

A rare concurrent incidence of adult-onset acute disseminated encephalomyelitis and antiphospholipid antibody syndrome: A case report.

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is a demyelinating immune-mediated condition of the central nervous system, whereas antiphospholipid antibody syndrome (APLA) is an autoimmune disorder accompanied by thrombosis and pregnancy-related problems. We present a unique case of a 30-year-old female with ADEM coexisting with APLA, highlighting the importance of early identification and specialized care. PRESENTATION OF CASE: We present a case of a 30-year-old woman with a history of hypertension, multiple miscarriages, and non-compliance with medication, who presented with altered consciousness and weakness in all four limbs. Laboratory tests revealed positive anti-cardiolipin and lupus anticoagulant antibodies, confirming APLA. A neurological examination revealed increased limb tone, heightened reflexes, and extensor plantar responses. MRI revealed confluent white matter lesions that were consistent with ADEM. The patient received prompt treatment with intravenous methylprednisolone and then received oral prednisone, leading to a rapid improvement in neurological status. DISCUSSION: The intricate interaction between ADEM and APLA remains enigmatic. The plausible connection between "molecular mimicry" and weakened blood-brain barrier, substantiated by antiphospholipid antibodies, may help explain their concurrent occurrence. CONCLUSION: This case highlights the significance of early diagnosis and management of the rare and complex coexistence of ADEM and APLA to attain optimal outcomes, as well as the significance of careful examination for simultaneous autoimmune markers in individuals presenting with neurological disturbances.

Irreversibility analysis with hybrid cross nanofluid of stagnation point and radiative flow ( T i O 2 + C u O ) based on engine oil past a stretchable sheet.

The present study addressed the physical significance of the entropy generation for the mixed convection time-dependent flow of cross-hybrid nanoliquid due to the stretched surface at a stagnation point. The Plot for heat transport is discoursed by applying the role of thermal radiation under convective conditions. For hybrid nanofluid, engine oil is used as a base liquid with copper (II) oxide C u O and titanium dioxide T i O 2 nanoparticles. The existing model is framed in the highly partial differential equation system. The governing equations have been transformed into a set of ODS's using a similar scaling operation. Following this, the resulting ODEs are solved numerically through the BVP4c. The primary goal of this research is to analyze the results of varying the stretching ratio parameter ( λ ), Weissenberg parameter ( W e ), thermal radiation ( R d ), and Biot number ( B i ) for both pure T i O 2 and CuO +  T i O 2 / E O hybrid nanofluid, on the velocity, temperature, drag force, heat transfer as well as entropy generation, and Bejan number was studied. A drop in velocity is observed with increasing values of the W e and upsurge in velocity for rising value of unsteady parameter ( A ), while increasing values of both of these parameters are associated with rising temperatures. Copper and titanium oxide nanoparticles are used to increase Engine oil (EO) thermal enactment, making it a more useful base fluid. Further, some significant industrial and engineering applications are related to the present problem discourse.

Numerical analysis of magnetohydrodynamics Casson nanofluid flow with activation energy, Hall current and thermal radiation.

In this study we analyzed the flow, heat and mass transfer behavior of Casson nanofluid past an exponentially stretching surface under the impact of activation energy, Hall current, thermal radiation, heat source/sink, Brownian motion and thermophoresis. Transverse magnetic field with the assumption of small Reynolds number is implemented vertically. The governing partial nonlinear differential equations of the flow, heat and mass transfer are transformed into ordinary differential equations by using similarity transformation and solved numerically by using Matlab bvp4c package. The impact of each of the Hall current parameter, thermal radiation parameter, heat source/sink parameter, Brownian motion parameter, Prandtl number, thermophoresis parameter and magnetic parameter on velocity, concentration and temperature, is discussed through graphs. The skin friction coefficient along the x-and z-directions, the local Nusselt number and the Sherwood number are calculated numerically to look into the inside behavior of the emerging parameters. It is witnessed that the flow velocity is a diminishing function of the thermal radiation parameter and the behavior has observed in the case of Hall parameter. Moreover, mounting values of Brownian motion parameter reduce the nanoparticle concentration profile.

Acute dysphagia: A rare initial symptom of lateral medullary syndrome: A case report.

Introduction and importance: A unique etiology of stroke, lateral medullary syndrome (LMS), is a consequence of posterior inferior cerebellar artery or vertebral artery thromboembolic conditions. LMS patients present particularly with ipsilateral hyperalgesia, ipsilateral ataxia, and Horner's syndrome. Our case signifies that neurogenic origin should always be considered in the absence of local causes of dysphagia. Early diagnosis could prevent LMS complications, including neurological disabilities. A scarcity of research related to dysphagia in LMS, and its outcomes exists. Therefore, the objective is to investigate the clinical course in a patient afflicted with severe dysphagia following a diagnosis of (LMS). This would encourage further research, thus improving management and treatment strategies. Case presentation: We report a case of a 45-year-old male, a smoker for 20 years, who presented with a single, unique complaint of acute dysphagia for 9 days. According to our knowledge, this is among very few reported cases of LMS with dysphagia being the rare initial complaint. The neurological issues associated with dysphagia gradually improved with the administration of antiplatelet; clopidogrel and lipid-lowering drug; rosuvastatin and the patient was discharged. Atypical presentation in LMS could be supported by the presence of lateral medullary infarct which was confirmed by MRI (Magnetic Resonance Imaging). Clinical discussion: Dysphagia is a common complaint in multiple gastrointestinal (GI) settings. However, in cases where the GI causes are excluded, as described here, diagnosis of LMS becomes tough. Conclusion: The diagnosis of LMS was queried owing to the presentation of the single most important common symptom, with no other characteristic manifestations of LMS.

Rare Manifestation Of Anti-Nmdar Encephalitis.

N-methyl-d-aspartate receptor (NMDAR) antibody encephalitis is an autoimmune syndrome with the development of antibody production against the NMDAR, affecting synaptic plasticity and cognition. It has a common association with ovarian teratomas with women being affected disproportionately. We present a case of an eight-year-old female child presented with complaints of fever, altered level of consciousness and choreiform movements. Owing to its common occurrence in the developing world, initially, rheumatic fever was kept in the differential diagnosis and was treated accordingly, but through a series of investigations, was diagnosed as a case of N methyl-d-aspartate receptor (NMDAR) antibody encephalitis. This case report urges the healthcare providers to keep Anti NMDAR encephalitis as a differential in their minds, while dealing with patients, having chorea as their main clinical manifestation. Owing to its rarity, we have primarily reported it here.

A misdiagnosis of choledochal cyst type IB and recommendation to use gold-standard imaging techniques: A case report.

A choledochal cyst (CC) is a rare congenital dilation of the biliary ductal system that can cause troublesome complications when left untreated. CC in children classically manifests as a rare triad of the right upper quadrant mass, jaundice, and abdominal pain. Here, we report the case of an eight-year-old boy seen in Paediatric Unit I of Dr Ruth K. M. Pfau Civil Hospital Karachi, Pakistan, on October 9, 2019, who was initially misdiagnosed for liver abscess due to the non-specific symptoms and managed appropriately with antibiotics, which failed to improve the symptoms. Moreover, a hydatid cyst was considered based on ultrasonography (USG) which was later ruled out by the negative serology. A definitive diagnosis of CC was established on magnetic resonance cholangiopancreatography (MRCP). In resource-limited countries, USG is always the first line screening tool for biliary duct abnormalities which in some cases is comprehensibly enough for the diagnosis of a rare entity like CC, thus requiring a highly specific imaging test like MRCP to be performed to devise an effective treatment and surgical plan.

Plant pathogen-mediated rapid acclimation of a host-specialized aphid to a non-host plant.

Polyphagous aphids often consist of host-specialized lineages, which have greater fitness on their native hosts than on others. The underlying causes are important for understanding of the evolution of diet breadth and host shift of aphids. The cotton-melon aphid Aphis gossypii Glover is extremely polyphagous with many strict host-specialized lineages. Whether and how the lineage specialized on the primary host hibiscus shifts to the secondary host cucumber remains elusive. We found that the hibiscus-specialized lineage suffered high mortality and gave birth to very few nymphs developing into yellow dwarfs on fresh cucumber leaves, and did not inflict any damage symptoms on cucumber plants. The poor performance did not improve with prolonged exposure to cucumber; however, it did significantly improve when the cucumber leaves were pre-infected with a biotrophic phytopathogen Pseudoperonospora cubensis. More importantly, the hibiscus-specialized lineage with two-generation feeding experience on pre-infected cucumber leaves performed as well as the cucumber-specialized lineage did on fresh cucumber leaves, and inflicted typical damage symptoms on intact cucumber plants. Electrical penetration graph (EPG) indicated that the hibiscus-specialized lineage did not ingest phloem sap from fresh cucumber leaves but succeeded in ingesting phloem sap from pre-infected cucumber leaves, which explained the performance improvement of the hibiscus-specialized lineage on pre-infected cucumber leaves. This study revealed a new pathway for the hibiscus-specialized lineage to quickly acclimate to cucumber under the assistance of the phytopathogen. We considered that the short feeding experience on pre-infected cucumber may activate expression of effector genes that are related to specific host utilization. We suggest to identify host-specific effectors by comparing proteomes or/and transcriptomes of the hibiscus-specialized lineage before and after acclimating to cucumber.

Case report of a female child with right nasal chondromyxoid fibroma.

Chondromyxoid fibroma is a rare tumour, representing <1% of all primary bone neoplasm. We report the case of a four-year-old female child with a one-year history of nasal obstruction and facial swelling. A large enhanced lesion with amorphous densities spreading into the right cribriform plate and floor of sphenoid sinus, laterally into the right lamina papyracea, inferolaterally into the medial wall of maxillary sinus, posteriorly into the nasopharynx and superior aspect of oropharynx was observed on CT scan. The mass was excised by Caldwell Luc's endoscopic medial maxillectomy via sublabial approach. CMF was confirmed histopathologically.

Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting.

Post traumatic stress disorder is a psychiatric disease that is usually precipitated by life threatening stressors. Myocardial infarction, especially in the young can count as one such event. The development of post traumatic stress after a coronary event not only adversely effects psychiatric health, but leads to increased cardiovascular morbidity and mortality. There is increasing evidence that like major depression, post traumatic stress disorder is also a strong coronary risk factor. Early diagnosis and treatment of this disease in patients with acute manifestations of coronary artery disease can improve patient outcomes.

Efficacy of brow suspension with autogenous fascia lata in simple congenital ptosis.

OBJECTIVE: To assess the mean change in interpalpebral fissure height and marginal reflex distance after brow suspension with autogenous fascia lata sling in patients of ptosis. METHODS: This was a Quasi experimental study conducted at Department of Ophthalmology, Mayo Hospital, King Edwards Medical University Lahore, from Jan 2013 to June 2016. Included were the patients who had unilateral or bilateral ptosis with poor levator function (< 5 mm). Informed consent was obtained from all patients after explaining about the research project. Patients were admitted in ward and all of them underwent surgery by a single surgical team. The surgical procedure was performed in supine position under general anesthesia in children and uncooperative patients. Patients were followed at week 4, 8, 12 and 24 to observe vertical interpalpebral fissure height and marginal reflex distance. RESULTS: The mean age of the patients was 9.03 ± 5.26 years. The mean Inter palpebral fissure height (IPFH) was 4.40±0.91 mm and mean MRD was 0.50 ± 1.00 mm before surgery while after surgery it was 7.41±0.76 mm and 3.10 ± 1.50 mm respectively at 04 weeks. The mean IPFH and MRD at 24 weeks postoperatively were 8.43±0.98 mm and 3.60 + 1.50 mm respectively. The mean change in IPFH and MRD at 24th week, were 3.90 ± 0.34 mm and 3.50 ± 1.00 mm. CONCLUSION: Brow suspension with fascia lata sling is safe and effective technique for correction of ptosis with poor levator function.

A novel method for assessing postoperative femoral head reduction in developmental dysplasia of the hip.

PURPOSE: Developmental dysplasia of the hip (DDH) affects approximately 1 % of live births. Dislocated hips require reduction and stabilisation in a spica cast, and reduction efficacy is assessed radiologically. Numerous measurements are used to ascertain the adequacy of reduction but can be inconsistent in evaluating femoral head position. This study describes the morphology of the developing acetabulum in DDH and validates a novel method to assess adequate reduction of the dysplastic hip following closed or open reduction. METHODS: A retrospective review was performed of 66 consecutive patients undergoing reduction of hip dislocation over a 2-year period. Three independent reviewers evaluated postoperative CT scans to assess anterior-posterior (AP) displacement and modified Shenton's line. Acetabular morphology was also assessed along with hip congruency using a described novel 'posterior neck line'. RESULTS: Dislocated hips were successfully identified using the posterior neck line with a sensitivity of 0.71 and specificity of 0.88 giving a negative predictive value of 0.97. The interobserver reliability of this technique was higher in comparison against both (AP) displacement and modified Shenton's line. CONCLUSIONS: We have shown a novel approach in assessing the acetabular morphology of DDH and a novel technique to accurately confirm the reduction of dislocated hips following open or closed reduction.

Use of the Impella 2.5 for prophylactic circulatory support during elective high-risk percutaneous coronary intervention.

BACKGROUND: Patients undergoing percutaneous coronary intervention (PCI) who are at high risk for cardiovascular collapse during the procedure may benefit from prophylactic circulatory support. The objective was to evaluate the safety and feasibility of prophylactic use of the Impella 2.5 during high-risk PCI. METHODS AND MATERIALS: We used the Impella 2.5 for partial circulatory support during 60 consecutive elective high-risk PCI cases over 20 months. All patients either were deemed inoperable by the cardiac surgeons or were offered bypass surgery but declined. RESULTS: The patients had multiple risk factors including hypertension (95%), diabetes (52%), chronic pulmonary disease (23%), prior myocardial infarction (62%) and prior bypass surgery (18%). Forty-five percent presented with acute coronary syndrome. The mean left ventricular ejection fraction was 23%±15%. Nearly all patients had multivessel disease (93%), and 60% had left main disease. The average SYNTAX score was 30±9. Despite lesion complexity and high-risk factors, we achieved an angiographic success rate of 96%. Left main lesions were treated in 55% of the patients, and 83% of patients had multiple lesions treated. There was one procedural death. At 30 days postintervention, mortality was 5%, and rates of myocardial infarction, stroke, target vessel revascularization and urgent bypass surgery were 0%. CONCLUSIONS: The single-center experience reported here demonstrates that use of the Impella 2.5 during high-risk PCI in the "real world" - outside the controlled environment of a clinical trial - is safe and feasible.

Single screw fixation in stable and unstable slipped upper femoral epiphysis.

The aim of this single centre retrospective study was to assess the outcome of patients after the fixation of slipped upper femoral epiphysis (SUFE) using a single cannulated screw. Thirty-eight slips, 28 stable and 10 unstable were treated with single in-situ screw fixation. The minimum follow-up was 1 year. The overall adverse outcome in terms of avascular necrosis (AVN), chondrolysis and revision surgery for slip progression was 18%, which was considered satisfactory. Slip progression of more than 10° was higher in the unstable when compared with the stable group but not statistically significant. Two out of the nine satisfactorily fixed unstable slips required revision surgery as opposed to none in the stable group. The incidence of AVN in the unstable group was 20%. There were no cases of AVN in the stable group. The adverse outcome in terms of AVN, chondrolysis and revision surgery for slip progression was significantly higher in the unstable group. In our study, results of single screw fixation for SUFE were found to be satisfactory as shown by earlier studies with the unstable SUFEs as expected having a poorer outcome when compared with the stable SUFEs.

Therapeutic potential of vasopressin receptor antagonists.

Arginine vasopressin (AVP) is a neuropeptide hormone that plays an important role in circulatory and sodium homeostasis, and regulating serum osmolality. Several clinical conditions have been associated with inappropriately elevated levels of AVP including heart failure, cirrhosis of the liver and the syndrome of inappropriate secretion of antidiuretic hormone. Three receptor subtypes that mediate the actions of AVP have been identified (V(1A), V(2) and V(1B)). Activation of V(1A) receptors located in vascular smooth muscle cells and the myocardium results in vasoconstriction and increased afterload and hypertrophy. The V(2) receptors located primarily in the collecting tubules mediate free water absorption. The V(1B) receptors are located in the anterior pituitary and mediate adrenocorticotropin hormone release. The cardiovascular and renal effects of AVP are mediated primarily by V(1A) and V(2) receptors. Antagonism of V(1A) receptors results in vasodilatation and antagonism of V(2) receptors resulting in aquaresis, an electrolyte-sparing water excretion. Several non-peptide AVP antagonists (vasopressin receptor antagonists [VRAs]) also termed 'vaptans' have been developed and are vigorously being studied primarily for treating conditions characterised by hyponatraemia and fluid overload. Conivaptan is a combined V(1A)/V(2)-receptor antagonist that induces diuresis as well as haemodynamic improvement. It has been shown in clinical trials to correct euvolaemic and hypervolaemic hyponatraemia, and has been approved by the US FDA for the treatment of euvolaemic hyponatraemia as an intravenous infusion. Tolvaptan, a selective V(2)-receptor antagonist, has undergone extensive clinical studies in the treatment of hyponatraemia and heart failure. It has been shown to effectively decrease fluid in volume overloaded patients with heart failure and to correct hyponatraemia. A large outcome study (n = 4133 patients) will define its role in the management of heart failure. Lixivaptan and satavaptan (SR-121463) are other selective V(2)-receptor antagonists being evaluated for the treatment of hyponatraemia. In addition, a potential role for the vaptans in attenuating polyuria in nephrogenic diabetes insipidus and cyst development in polycystic kidney disease is being explored. Ongoing clinical trials should further define the scope of the potential therapeutic role of VRAs.

Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty.

The aim of this study was to assess the diagnostic accuracy of radiology department-based hip aspiration for the diagnosis of infection after total hip arthroplasty. Patient selection criteria were devised so that only patients with moderate to high risk of infection were selected for hip aspiration. Seventy-three patients are included in this study, all of whom underwent revision hip surgery after aspiration. Culture results of hip aspirates were compared with the intraoperative tissue cultures at the time of revision surgery, which was used as the gold standard for diagnosing infection. Seventeen patients (23%) had infected hip joints at operative culture. The sensitivity and specificity, positive and negative predictive values, and accuracy of the hip aspiration were 0.82 and 0.91, 0.74 and 0.94, and 0.89, respectively. We conclude that hip aspiration carried out in the radiology department is reliable, but appropriate patient selection is important to obtain accurate results.