Lithosphere atmosphere ionosphere coupling associated with the 2019 Mw 7.1 California earthquake using GNSS and multiple satellites.

Global Navigation Satellite System (GNSS)-based Earthquake (EQ) anomalies in the ionosphere and troposphere provide explicit evidences to study the coupling between seismic events, atmosphere, and ionosphere in epicentral breeding regions consequent to the EQ day in the preparation period. EQs are still not predicted, but the space-based EQ anomalies aid in the development of monitoring pre- and post-seismic precursors around the seismogenic zone and associated fault lineament regions. In this paper, tropospheric and ionospheric anomalies are investigated for the July 06, 2019, Mw 7.1 California EQ from GNSS tropospheric delays and Total Electron Content (TEC), respectively. We noticed that atmospheric and ionospheric anomalies from GNSS stations within 5-10 days before the main shock and storm-induced ionospheric variations occur beyond the 5th day after the EQ. Similarly, synchronized and collocated lower atmospheric anomalies are also recorded in the long-term temporal values of SO2 and SO4 within 1-month before and after July 2019, which validates the existence of Lithosphere-Atmosphere-Ionosphere Coupling (LAIC) over the EQ epicenter. On the other hand, EQ anomalies occur during quiet geomagnetic storm activity (Kp < 3; Dst < - 20 nT) and geomagnetic storm triggered high-intensity ionospheric variations during Kp > 3. All these atmospheric and ionospheric perturbations support the development in EQ precursors with satellite measurements, which are indispensable towards the forecasting of future EQ.

Empty Bursa SIGN: Significance in arthroscopic sub acromial decompression - an audit of consecutive patients 2003 to 2020.

OBJECTIVE: To establish a relationship between sub acromial bursa and shoulder impingement by determining its presence or absence in sub acromial space. To determine the novel prospects and favourable outcome after surgery in shoulder impingement syndrome. METHODS: Over 1000 patients with the diagnosis of shoulder impingement were studied from 2003 to 2020 at Manor Teaching Hospital, Walsall, UK. During Arthroscopy, the findings were noted and documented. The sub acromial bursa and its presence or absence was noted along with kissing lesion of supraspinatus confirmed at Arthroscopy. Functional outcome in all patients was assessed with q-Dash score and pain relief was documented with VAS (Visual Analogue Scale). RESULTS: Sub acromial decompression did not completely resolve symptoms in 649(64.9%) patients having adequate bursa and no kissing lesion. Therefore, a cause other than acromion impingement was considered. However, in 351(35.1%) patients without any bursal tissue, sub acromial decompression alone had better results. Mean post-operative q-DASH score in group A (Bursa present) was 49.21±41 and in group B (Empty Bursa) it was 35.73±23. Mean post-operative VAS (Visual Analogue Scale) score in group A was 6.5±2.3 and in group B, it was 4.1±2.1. CONCLUSIONS: We report that the presence of kissing lesion and an empty Bursal space under the acromion is a high predictor of successful outcome after arthroscopic decompression.

Frequency of CD34 and CD10 Expression in Adolescent and Young Adult Patients Having Precursor B-cell Acute Lymphoblastic Leukemia and Its Correlation With Clinical Outcomes: A Single-Center Study.

BACKGROUND: The clinical outcomes of CD34 and CD10 antigens expression in adolescent and young adult (AYA) precursor B-cell acute lymphoblastic leukemia (pre-B-ALL) is not still well established. In the present study, we analyzed the laboratory characteristics and clinical outcomes of 123 AYA pre-B-ALL patients in order to evaluate the possible clinical significance of these markers. MATERIALS AND METHODS: In the current study clinical data of 123 consecutive AYA pre-B-ALL patients aged 18-39 years old, enrolled in adult hematology-oncology unit from December 2014 to April 2019 was analyzed. Patient clinical outcome was calculated as overall survival and disease-free survival. RESULTS: Overall, 76.4% of patients showed CD34 expression and CD10 expression was found in 90.2%. CD34 and CD10 expression was associated with higher total leucocyte count, increased peripheral blood blast percentage, and decreased platelet count. Overall survival and disease-free survival were both significantly better in CD34 negative and CD10 negative patients compared to their CD34 positive and CD10 positive counterparts. INTERPRETATION AND CONCLUSION: Expressions of CD34 and CD10 are adverse prognostic factors in AYA pre-B-ALL patients and the presence of these antigens influences the clinical outcome of these patients.

Impact of COVID-19 Pandemic on Trauma Theatre Efficiency.

Introduction A large transformation in the management of trauma has ensued following the COVID-19 (coronavirus disease 2019) pandemic. There has been an increase in reliance on guidance for decision-making and alterations in the working of the trauma theatre. This has largely been due to the safety measures implemented. Theatre efficiency has gained increasing importance over the years, and with the added pressure of the pandemic, it is essential that trauma theatres operate efficiently. There has been no data analysing the efficiency of trauma theatre during this pandemic. Methods and Results We retrospectively analyzed the data at our hospital and looked into the parameters to assess trauma theatre efficiency. It was noted that the operative time and anaesthetic time went up significantly in 2020 in comparison to 2019. Also, the change over time and the late start time was significantly high in 2020. A large proportion of cases did not start on time in 2020. This resulted in a decrease in the efficiency of theatre usage. Discussion Reduced productivity of the trauma theatre has been due to several reasons, many of which include implementation of safety measures, such as personal protective equipment (PPE), theatre cleaning, recovery of patients, using designated routes for transfer, and many others. The challenge lies in applying these new measures into our daily practice at the same time while providing efficient care. Conclusion Our study highlights the key areas of concern and improvement which need to be addressed in order to render effective trauma care.

Scaphoid fracture with ipsilateral fracture dislocation of the metacarpals: a rare fracture pattern.

Scaphoid fracture with ipsilateral metacarpal fracture dislocation is very rare. A unique case of this injury is reported. It is important to be aware of this fracture pattern so that appropriate evaluation and treatment can be instituted. Thorough clinical and radiographic examination at the initial presentation of the patient is the key to identify uncommon combination of injuries.

Incidental finding of tuberculous pleural effusion in patient undergoing coronary artery bypass grafting: Case report.

INTRODUCTION: Pleural effusion is common in patient with coronary artery bypass grafting (CABG) usually due to heart failure in preoperative and trauma of surgery in postoperative patient. Tuberculous Pleural effusion is most common form of extra pulmonary Tuberculosis. Preoperatively Tuberculous pleural effusion in CABG patients has rarely been described in literature. PRESENTATION OF CASE: A 62 years old gentleman with ischemic heart disease was admitted for coronary artery bypass grafting surgery. Preoperative workup showed left sided pleural. Intraoperatively left sided turbid yellowish colour effusion with loculation was noted while harvesting left internal mammary artery. Loculation were broken down, effusion was drained and tissues were sent for microbiology and histopathology. CABG was performed smoothly. Microbiology of pleural tissue revealed Mycobacterium tuberculosis while histopathology showed chronic granulomatous inflammation. Patient was started on antituberculous therapy and remained well six months postoperatively. CONCLUSION: In developing countries even without any constitutional symptoms of Tuberculosis high index of suspicion for Tuberculosis should be made for patient with pleural effusion especially in cases of cardiac surgery as to prevent morbidity and mortality.

Minimising Tourniquet Time and Post-operative Pain During Carpal Tunnel Decompression.

Background Pain and discomfort at the tourniquet and wound site are recognised complications of carpal tunnel surgery. Studies have shown that longer tourniquet times lead to increased pain, local and systematic complications. We hypothesise that minimising the intraoperative tourniquet time will reduce post-operative pain and complications. Objective Our aim is to present the results of our novel operative technique for carpal tunnel decompression which minimises tourniquet time. Method The study represented a prospective case series in which 55 consecutive and unselected patients with positive nerve conduction study results were operated on by a single surgeon at a single hospital site over a period of 12 months. The patients filled in a questionnaire based on a visual analogue score (VAS) (1-10) for pain at (1) first presentation at the clinic, (2) recovery in theatre post-operatively and (3) on discharge from care at 12 weeks post-operatively. Questions included the perception of pain at the tourniquet site and at the wound site. Results  A total of 55 (female 39 and male 16) patients participated in the study. The average tourniquet time was 5 minutes 50 seconds. 98% of patients had a VAS of 1 at both the wound and tourniquet site post-operatively. One patent had a score of 3 at the tourniquet site. Eleven patients had undergone contralateral carpal tunnel decompression surgery. Of the remaining 43 patients, all said they would have the other side operated on in the same way. Conclusion  We have demonstrated a safe and efficient technique to reduce post-operative pain by minimising tourniquet inflation time. Our patient cohort experienced no significant complications and minimal pain post-operatively.

Estrogen receptors in human thyroid gland. An immunohistochemical study.

OBJECTIVE: Thyroid diseases affect women approximately 3 times more frequently than men. It has been suggested that the female sex steroids stimulate thyroid growth such as in the breast. Seventeen beta-estradiol, the major estrogen in the body acts via estrogen receptors (ER) present in the nucleus of the cell. The aim of the study is to determine the ER status in the thyroid gland tissues. METHODS: Our study was based on immunohistochemical staining for ER. Fifty previously diagnosed cases of various thyroid lesions were selected from the Surgical Pathology Records of Pathology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center, Karachi, Pakistan between March and August 2000. The staining was performed on formalin-fixed paraffin embedded tissues using monoclonal anti-ER antibody (clone 1D5). Out of 50 cases, 8 were nodular goiter, 9 cases of adenoma, 19 papillary carcinoma, 10 follicular and 4 cases were of medullary carcinoma. Surrounding normal tissue was available in 25 (50%) cases, 4 non-neoplastic and 21 neoplastic lesions. Out of 50 cases, 10 (20%) were males and 40 (80%) were females, the youngest patient was a 14-year-old female and the eldest patient was a 56-year-old male. RESULTS: Despite the availability of normal thyroid tissue and a wide range of lesions, none of our cases showed positive staining. CONCLUSION: In contrary to many earlier reports by immunohistochemical method using monoclonal antibody (clone 1D5) on formalin-fixed paraffin-embedded thyroid tissues, the ER are not detectable. The effect of estrogen on thyroid gland may be indirect one.

Analytical solutions and moment analysis of chromatographic models for rectangular pulse injections.

This work focuses on the analysis of two standard liquid chromatographic models, namely the lumped kinetic model and the equilibrium dispersive model. Analytical solutions, obtained by means of Laplace transformation, are derived for rectangular single solute concentration pulses of finite length and breakthrough curves injected under linear conditions. In order to analyze the solute transport behavior by means of the two models, the temporal moments up to fourth order are calculated from the Laplace-transformed solutions. The limiting cases of continuous injection and negligible mass transfer limitations are evaluated. For validation, the analytical solutions are compared with the numerical solutions of models using the discontinuous Galerkin finite element method. Results of different case studies are discussed for linear and nonlinear adsorption isotherms. The discontinuous Galerkin method is employed to obtain moments for both linear and nonlinear models numerically. Analytically and numerically determined concentration profiles and moments were found to be in good agreement.