Unravelling the Complexity of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune disorder characterized by recurrent episodes of demyelination affecting the central nervous system. The following case report showcases a thorough analysis of a 21-year-old female patient presenting with MOGAD, outlining her clinical presentation, diagnostic workup, treatment protocol, and long-term management outcomes. Through a multidisciplinary approach, we aim to augment the understanding of this complex neurological entity and steer optimal therapeutic interventions.

Internet addiction among MBBS students at a New Delhi medical college: Prevalence and determinants of a silent pandemic.

Background and Objective: The 21st century has witnessed a surge in global internet usage, particularly in developing nations like India. Internet addiction, also known as pathological internet use (PIU) or internet addiction (IA), has emerged as a mental health concern, especially among university students. This study aimed to investigate the prevalence of IA among MBBS students in a medical college in Delhi, India, and explore the association of IA with sociodemographic and internet usage patterns. Materials and Methods: A cross-sectional observational study was conducted among 300 undergraduate medical students. Data was collected using a self-administered questionnaire, which included the Internet Addiction Test (IAT) developed by Dr. Kimberley Young. The IAT measures various aspects of internet use, and scores are categorized as normal user, mild addiction, moderate addiction, and severe addiction. Descriptive statistics and chi-square tests were used for data analysis. Results: The mean age of onset of internet use was 14.4 ± 1.6 years. Smartphones were the most common devices used for internet access (96.3%), and the mean daily internet usage was 2.9 h ± 0.9 (standard deviation [SD]). The study found that 70.7% of students maintained a permanent login status. The majority of subjects used the Internet for coursework (89.7%) and information searches (88.7%). The prevalence of IA was significant, with 90% of participants being addicted to varying degrees. The grading of IA revealed 10% with no addiction, 54.6% with mild addiction, 32% with moderate addiction, and 3.3% with severe addiction. Conclusion: IA is a prevalent public health concern among medical students in Delhi, with a majority of participants being addicted to some extent. Females showed a higher proportion of addiction compared to males. Certain internet activities, such as social networking and watching online videos, were significantly associated with IA. The study highlights the need for recognizing IA as a public health concern and further research to understand its impact on the youth. Longitudinal studies are recommended to observe the development and progression of IA over time.

A Rare Presentation of Undifferentiated Pleomorphic Sarcoma in the Subpectoral Space.

Soft tissue sarcomas (STS) are often described as asymptomatic, rapidly expanding masses, particularly in the extremities or trunk. Undifferentiated pleomorphic sarcoma (UPS), a high-grade variant of STS, ranks as the second most prevalent subtype in the United States. It predominantly affects males between their fifth and seventh decades. Its often benign symptomatology, however, can lead to initial misdiagnosis and subsequent mismanagement. We present the case of a 57-year-old Caucasian male, previously in good health, who experienced a recurring subpectoral lesion causing discomfort and mass-related effects. Initial management included incision and drainage, which provided temporary relief. The biopsy revealed a diagnosis of grade 3 UPS. The lesion's recurrence two months later was accompanied by local invasion into adjacent skin and musculature as well as metastasis to the right hemiliver. A comprehensive understanding of UPS among medical professionals is vital for accurate diagnosis and facilitating prompt intervention to prevent avoidable complications and optimize patient outcomes.

Hybrid Steel/NSM/GFRP System versus GFRP Wrapping for Upgrading RC Wall-like Columns.

Reinforced concrete (RC) wall-like columns are commonly employed in structures in Saudi Arabia. These columns are preferred by architects owing to their minimum projection in the usable space. However, they often need strengthening due to several reasons, such as the addition of more stories and increasing the live load as a result of changing the usage of the building. This research aimed to obtain the best scheme for the axial strengthening of RC wall-like columns. The challenge in this research is to develop strengthening schemes for RC wall-like columns, which are favored by architects. Accordingly, these schemes were designed so that the dimensions of the column cross-section are not increased. In this regard, six wall-like columns were experimentally examined in the event of axial compression with zero eccentricity. Two specimens were not retrofitted to be used as control columns, whereas four specimens were retrofitted with four schemes. The first scheme incorporated traditional glass fiber-reinforced polymer (GFRP) wrapping, while the second one utilized GFRP wrapping combined with steel plates. The last two schemes involved the addition of near-surface mounted (NSM) steel bars combined with GFRP wrapping and steel plates. The strengthened specimens were compared with regard to axial stiffness, maximum load, and dissipated energy. Besides column testing, two analytical approaches were suggested for computing the axial capacity of tested columns. Moreover, finite element (FE) analysis was performed for evaluating the axial load versus displacement response of tested columns. As an outcome of the study, the best strengthening scheme was proposed to be used by practicing engineers for axial upgrading of wall-like columns.

Performance of Concentrically Loaded RC Wall-like Columns Upgraded with Innovative Hybrid NSM/CFRP System.

In RC (reinforced concrete) frame structures, wall-like columns are laid within the space occupied by masonry walls to maximize usable space and thus minimize the column projections into the usable area. These columns often require strengthening owing to various reasons, including increasing the number of stories, changes in building usage, and others. The use of a hybrid system comprising NSM (near-surface mounted) steel rebars combined with CFRP (carbon-fiber reinforced polymer) laminates may be considered a sound technique for strengthening such wall-like building columns. The prime aim of this study is to devise an efficient scheme using a hybrid NSM/CFRP system to strengthen existing RC wall-like columns. Six half-scale RC wall-like columns were prepared and tested under monotonic concentric axial compression. Two columns were unstrengthened to serve as control specimens (CW1 and CW2), and four specimens were strengthened using four different schemes (SW1, SW2, SW3, and SW4). As favored by architects, all strengthening schemes were designed so that the dimensions of the column cross-section were not increased. The effects of strengthening schemes on the enhancement of axial capacity, energy dissipated, and stiffness were evaluated to find the most efficient scheme. Among the four studied schemes, using vertical continuous NSM rebars in combination with the wrapping of the three CFRP layers onto the exterior column surface (in specimen SW2) was the most efficient as it enhanced the ultimate load capacity by 80%. Three-dimensional FE (finite element) analysis was also conducted to predict the response of test specimens. The test results matched well with the FE outputs, which justified the accuracy of the used constitutive models for concrete, steel rebars, and CFRP sheets.

Concrete Performance Produced Using Recycled Construction and By-Product Industrial Waste Coarse Aggregates.

Concrete is classified as a multi-composite material comprising three phases: coarse aggregate, mortar, and interfacial transition zone (ITZ). Fine and coarse aggregates occupy approximately 70-85% by volume, of which coarse aggregate typically constitutes more than two-thirds of the total quantity of aggregate by volume. The current study investigates the concrete performance produced using various recycled construction and by-product industrial waste coarse aggregates. Six types of coarse aggregates: manufactured limestone, quartzite, natural scoria, by-product industrial waste aggregate, and two sources of recycled concrete aggregates with densities ranging from 860 to 2300 kg/m3 and with different strength properties were studied. To determine the coarse aggregate contribution to the overall concrete performance, lean and rich concrete mixtures (Mix 1 and Mix 2) were used. Mix 1 (lean mixture) consisted of a ratio of water to cement (w/c) of 0.5 and cement content of 300 kg/m3, whereas a higher quantity of cement of 500 kg/m3 and a lower w/c ratio of 0.3 were used for Mix 2 (rich mixture). The results showed that while the compressive strength for different aggregate types in Mix 1 was comparable, the contribution of aggregate to concrete performance was very significant for Mix 2. Heavyweight aggregate produced the highest strength, while the lightweight and recycled aggregates resulted in lower mechanical properties compared to normal weight aggregates. The modulus of elasticity was also substantially affected by the coarse aggregate characteristics and even for Mix 1. The ACI 363R-92 and CSA A23.3-04 appeared to have the best model for predicting the modulus of elasticity, followed by the ACI-318-19 (density-based formula) and AS-3600-09. The density of coarse aggregate, and hence concrete, greatly influenced the mechanical properties of concrete. The water absorption percentage for the concrete produced from various types of aggregates was found to be higher for the aggregates of higher absorption capacity.

Small Bowel Intussusception Caused by Metastatic Melanoma: A Case Report.

Intussusception, as a rare cause of small bowel obstruction, can be secondary to benign or malignant pathology. Malignant lesions causing intussusception can be primary or metastatic lesions. Metastasis can occur many years later. We present a case of metastatic melanoma in a 69-year-old man as the underlying etiology of his intussusception. The patient had laparoscopic Roux-en-Y gastric bypass four years prior to his presentation and did recall excision of a skin melanoma at age 64. Laparoscopic or open surgical resection is the best therapeutic option in cases such as this.

Free open access medical education applications: a critical appraisal of techniques for quality assessment and content discovery

No abstract available.

Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity.

INTRODUCTION: Athletic pubalgia is a syndrome of chronic lower abdomen and groin pain that occurs in athletes. It is the direct result of stress and microtears of the rectus abdominis inserting on the pubis from the antagonizing adductor longus muscles, and weakness of the posterior transversalis fascia and bulging of the inguinal floor. METHODS: Under IRB approval, we conducted a retrospective review of our prospectively competitive athlete patients with athletic pubalgia from 2007 to 2013. RESULTS: A cohort of 54 patients was examined. Mean age was 22.4 years. Most patients were football players (n = 23), triathlon (n = 11), track and field (n = 6), soccer players (n = 5), baseball players (n = 4), swimmers (n = 3), golfer (n = 1), and tennis player (n = 1). Fifty one were males and three were females. All patients failed medical therapy with physiotherapy prior to surgery. 76 % of patients had an MRI performed with 26 % having a right rectus abdominis stripping injury with concomitant strain at the adductor longus musculotendinous junction. 7 % of patients had mild nonspecific edema in the distal bilateral rectus abdominis muscles without evidence of a tear. Twenty patients had no findings on their preoperative MRI, and only one patient was noted to have an inguinal hernia on MRI. All patients underwent laparoscopic totally extraperitoneal inguinal hernia repair with synthetic mesh and ipsilateral adductor longus tenotomy. All patients were able to return to full sports-related activity in 24 days (range 21-28 days). One patient experienced urinary retention and another sustained an adductor brevis hematoma 3 months after completion of rehabilitation and surgical intervention. Mean follow up was 18 months. CONCLUSION: Athletic pubalgia is a disease with a multifactorial etiology that can be treated surgically by a laparoscopic totally extraperitoneal hernia repair with synthetic mesh accompanied with an ipsilateral adductor longus tenotomy allowing patients to return to sports-related activity early with minimal complications.

Minimally invasive esophagectomy is safe in patients with previous gastric bypass.

BACKGROUND: The prevalence of morbid obesity in the United States has been steadily increasing, and there is an established relationship between obesity and the risk of developing certain cancers. Patients who have undergone prior gastric bypass (GB) and present with newly diagnosed esophageal cancer represent a new and challenging cohort for surgical resection of their disease. We present our case series of consecutive patients with previous GB who underwent minimally invasive esophagectomy (MIE). METHODS: Retrospective review of consecutive patients with a history of GB who underwent a MIE for esophageal cancer between July 2010 and August 2012. RESULTS: Five patients were identified with a mean age of 57 years. Mean follow-up was 9.1 months. Four patients had undergone laparoscopic GB, and 1 patient had an open GB. Two patients received neoadjuvant chemoradiation therapy for locally advanced disease. Minimally invasive procedures were thoracoscopic/laparoscopic esophagectomy with cervical anastomosis in 4 patients and colonic interposition in 1 patient. Mean operative time was 6 hours and 52 minutes. Median length of stay was 7 days. There was no mortality. Postoperative complications occurred in 3 patients and included pneumonia/respiratory failure, recurrent laryngeal nerve injury, and pyloric stenosis. All patients are alive and disease free at last follow-up. CONCLUSIONS: Minimally invasive esophagectomy after prior GB is well tolerated, is technically feasible, and has acceptable oncologic and perioperative outcomes. We conclude that precise endoscopic evaluation before bariatric surgery in patients with gastroesophageal reflux disease is essential, as is the necessity for continuing postsurgical surveillance in patients with known Barrett's esophagitis and for early evaluation in patients who develop new symptoms of gastroesophageal reflux disease after bariatric surgery.