Monostotic Scapular Caffey Disease: A Case Report With MRI Correlate.

Caffey disease, also referred to as infantile cortical hyperostosis, is a self-limiting inflammatory disease of bone, typically diagnosed in infancy (ages less than five months). This disease is characterized by asymmetric, often polyostotic bony hyperostosis and expansion, with a predilection for the mandible (70-90%). We present a unique case of a two-month-old boy with monostotic scapular hyperostosis. The disease is primarily diagnosed on plain film and further evaluated with bone scintigraphy or skeletal survey to identify the extent of osseous involvement. Accompanying MR imaging is not usually obtained due to lack of specificity and diagnostic utility, and when pursued, can potentially confound the diagnosis. MR findings of this case are presented to re-iterate the benignity of this disease process and obviate the need for further invasive procedures.

Hybrid Endovascular and Surgical Treatment of a Traumatic Scalp Arteriovenous Fistula.

Traumatic scalp arteriovenous fistula (AVF) is a relatively rare complication of scalp trauma. Patients most commonly present with a growing pulsatile head mass. History of trauma, clinical presentation, and diagnostic imaging, including digital subtraction angiography, aid in establishing the diagnosis. Endovascular embolization is the preferred treatment modality which may be combined with surgical excision for larger complex lesions. In this case, we report the clinical and radiological features of a traumatic scalp AVF in a middle-aged man with a remote history of trauma that was treated with a two-step hybrid approach combining transarterial embolization with surgical resection. We also present a brief overview of the various treatment modalities currently employed to treat scalp AVFs.

Does energy conversion contribute to economic development in emerging and growth leading economies (EAGLE's): evidence from panel ARDL approach.

Energy is an essential indication of productivity, usage, and nation-building in the development context. However, energy diversity that emphasizes renewables is still vital for economic development in emerging nations. This study examines the impact of renewable energy on economic development in emerging and growth-leading economies (EAGLE's) from 1980 to 2019. The econometric procedure used in this study is pooled mean group regression/Panel ARDL approach. The study's results support the growth-conservation theory and demonstrate that wealth creation is not dependent entirely on fossil fuels and that other energy sources may also be used. There is a positive association between renewable energy production and consumption and economic development in EAGLE countries. For the overall sample selected, the association between the long run and short is positive and significant, whereas individual analysis for each country provided mixed results. In the short run, the association between renewable energy consumption and economic development for Bangladesh, India, Indonesia, Mexico, and Philippines is negative. While in production, most countries showed positive and significant results except Brazil, Indonesia, Mexico, and Russia. The result of this study will help policy makers from the selected countries towards the use of renewable energy production and consumption, its importance and contribution to the economic development of these countries. However, some countries showed a negative relationship particularly Russian economy is rich in natural resources (oil, natural gas). While the remaining countries that showed negative relationship have number of problems associated with renewable energy consumption and production. This study refers the attention of policy makers from developing countries to consider the potential impact of renewable energy for the economic development. Energy transition can also contribute to the environmental protection and the reduction of greenhouse gases.

Vaccination coverage and breakthrough infections of COVID-19 during the second wave among staff of selected medical institutions in India.

India experienced the second wave of SARS-CoV-2 infection from April 3 to June 10, 2021. During the second wave, Delta variant B.1617.2 emerged as the predominant strain, spiking cases from 12.5 million to 29.3 million (cumulative) by the end of the surge in India. Vaccines against COVID-19 are a potent tool to control and end the pandemic in addition to other control measures. India rolled out its vaccination programme on January 16, 2021, initially with two vaccines that were given emergency authorization-Covaxin (BBV152) and Covishield (ChAdOx1 nCoV- 19). Vaccination was initially started for the elderly (60+) and front-line workers and then gradually opened to different age groups. The second wave hit when vaccination was picking up pace in India. There were instances of vaccinated people (fully and partially) getting infected, and reinfections were also reported. We undertook a survey of staff (front line health care workers and supporting) of 15 medical colleges and research institutes across India to assess the vaccination coverage, incidence of breakthrough infections, and reinfections among them from June 2 to July 10, 2021. A total of 1876 staff participated, and 1484 forms were selected for analysis after removing duplicates and erroneous entries (n = 392). We found that among the respondents at the time of response, 17.6% were unvaccinated, 19.8% were partially vaccinated (received the first dose), and 62.5% were fully vaccinated (received both doses). Incidence of breakthrough infections was 8.7% among the 801 individuals (70/801) tested at least 14 days after the 2nd dose of vaccine. Eight participants reported reinfection in the overall infected group and reinfection incidence rate was 5.1%. Out of (N = 349) infected individuals 243 (69.6%) were unvaccinated and 106 (30.3%) were vaccinated. Our findings reveal the protective effect of vaccination and its role as an essential tool in the struggle against this pandemic.

Dental age estimation of Malaysian children: a comparison of two-dimensional versus three-dimensional imaging analyses of the developing root apices.

AIM: This study compared the effectiveness of the three-dimensional (3D) cone beam computed tomography (CBCT) method of age estimation developed by Asif et al. with two-dimensional Cameriere's method. SUBJECTS AND METHODS: CBCT images belonging to 129 Malaysian Chinese and Malay ethnic groups aged 7-14 years were investigated and analysed. RESULTS: The results indicated a strong correlation between chronological age and the predictor variables for both Cameriere's (r = 0.984) and Asif's (r = 0.988) methods of age estimation. Fisher Z test analysis indicated no statistically significant difference in the correlation values between the two methods. Mean absolute error (MAE) value of 0.613 was observed for Cameriere's and 0.290 was observed for Asif's method. CONCLUSIONS: The results indicated that the methods of age estimation from both Asif et al. and Cameriere et al. are applicable on Malaysian children. However, Asif et al.'s 3D CBCT method of age estimation resulted in greater accuracy and reliability in estimating chronological age.

Environmental concerns of financial inclusion and economic policy uncertainty in the era of globalization: evidence from low & high globalized OECD economies.

Environmental consequences of financial aspects, policy uncertainties and rapid globalization is the topic of intense debate in present years. However, this study contribute to existing literature in an innovative way. We classified the 33 OECD economies in two group's lower globalized economies (LGE) and highly globalized economies (HGE), based on their level of globalization. Considering the cross-sectional dependency and slope heterogeneity in the data this study employed the Augmented Mean Group method to estimate the influence of financial inclusion, economic policy uncertainty and globalization on the environment quality of both groups for the period 1996-2019. The results revealed a negative significant impact of financial inclusion, while a positive significant impact of economic policy uncertainty on CO2 emissions in both groups, LGE and HGE. However the globalization estimated to have positive impact on CO2 emission in LGE's, in HGE's it is significantly impeding the CO2 emission. The interaction of globalization with financial inclusion and economic policy uncertainty respectively found negative and positive to effect the CO2 in both LGE's and HGE's. The study suggests that, LGE's are need to prepare for economic globalization, move toward adopting energy-efficient technology and promote trade in less-polluting products in order to sustain their environment quality. The outcomes of this study are robust by employing different model specifications.

Patients with falls from standing height and head or neck injury may not require body CT in the absence of signs or symptoms of body injury.

PURPOSE: To determine the rate of clinically impactful body injury among patients who had a fall from standing height with an associated head/neck injury, but without evidence of body injury on physical exam or plain radiographs. We also examine surgical/endovascular intervention related to body injury and mortality rates for head/neck and body injury. METHODS: Retrospective study of 288 patients with CT evidence of acute head/neck injury that underwent body CT despite the absence of clinical or radiographic evidence of body injury. Predictor variables were age, sex, race/ethnicity, and body mass index (BMI). RESULTS: There were 11.5% (n = 33) with body injury on CT (n = 33). There were 3.1% (n = 9) with clinically impactful body injury. No patient had either surgical/endovascular intervention or mortality related to body injury. Additionally, 8.7% (n = 25) had mortality from head/neck injury. Increased age (OR = 1.05, 95% CI: 1.01, 1.08, p = 0.01) and overweight BMI (25-29.99 kg/m2) (OR = 2.85, 95% CI: 1.07, 7.62, p = 0.04) were each significantly associated with increased odds for mortality from head/neck injury. CONCLUSION: Patients with falls from standing height and known head/neck injury had a low rate of clinically impactful body injury. None of the studied variables were associated with increased risk of body injury in this patient population. The low rate of clinically impactful body injury and the lack of any mortality, procedure, or transfusion resulting from body injury suggest that body CT may not be necessary in patients with head/neck injury in the absence of clinical or radiographic evidence of body injury.

Hemosuccus Pancreaticus in Chronic Pancreatitis: An Uncommon Cause of Gastrointestinal Bleeding.

We present a case of a 69-year-old female who arrived in hemorrhagic shock with symptoms of upper gastrointestinal bleeding. Imaging on admission was diagnostic of a large splenic artery pseudoaneurysm, which was presumed to have bled into the pancreatic duct given clinical symptoms of upper gastrointestinal bleeding. The pseudoaneurysm was successfully treated with coil embolization resulting in resolution of clinical symptoms.

Giant subserosal myoma causing deep venous thrombosis in a patient with pre-existing May-Thurner syndrome.

One of the rare sequelae of large pelvic masses is direct compression of the inferior vena cava with formation of a deep venous thrombosis (DVT). Although uncommon, multiple cases of thrombosis secondary to pelvic mass compression of the venous system have been reported in the literature. However, our patient showed a disproportionate degree of thrombus and subsequent postthrombotic stricture/stenosis limited to the left iliofemoral system, sparing the right side. These findings make it exceedingly likely that she had some degree of pre-existing May-Thurner syndrome. The superimposed nature of these 2 rare causes of DVT make this presentation remarkably unique. Our case illustrates the advances in endovascular techniques and their application toward DVT treatment for even the most complicated and unique cases.

Baseline characteristics of infected foot ulcers in patients with diabetes at a tertiary care hospital in Pakistan.

OBJECTIVE:: Studies on diabetic foot ulcers (DFU) involving a representative sample of patients in Pakistan are scarce. This study aimed to determine baseline characteristics of infected DFUs in patients hospitalised at the Pakistan Institute of Medical Sciences Islamabad. METHOD:: In this cross-sectional study, carried out during May 2015 and June 2016, foot ulcer characteristics of patients with DFUs were investigated and documented. From infected DFUs, aerobic bacterial pathogens were isolated, identified and evaluated for antimicrobial susceptibility. RESULTS:: A total of 214 patients were recruited to the study, 62.6% of which were male, 90.2% were aged ≥40 years, 76.2% had type 1 diabetes and 78.5% had poor glycaemic control at time of presentation to hospital. Most patients had grade 3/moderate ulceration (based on the Wagner and International Working Group on the Diabetic Foot/Infectious Diseases Society of America criteria). Over half of the DFUs (57.9%) were of ≤3 months' duration and 70.1% were ≥3 cm2. Of the patients with deep infection grade ulcers, 26.6% underwent amputation, accounting for their prolonged hospital stay (≥20 days). Significant differences were observed between patients with type 1 and type 2 diabetes with DFUs in relation to gender (p≤0.0001), ulcer size (p=0.0421) and duration of hospital stay (p=0.0253). The most significant predictors for lower extremity amputation were osteomyelitis (p=0.0114), retinopathy (p=0.0001) and neuropathy (p=0.0001. Piperacillin/tazobactam was found to be an effective antibiotic against the most commonly isolated Staphylococcus non-aureus (35.48%), Pseudomonas aeruginosa (22.26%), and Staphylococcus aureus (20.96%) species indentified in the DFU infections. CONCLUSION:: The findings of this study may be helpful in the optimal management and appropriate treatment of patients with infected DFUs.

Prophylactic absorbable gelatin sponge embolization for angiographically occult splenic hemorrhage.

Nonoperative management of traumatic splenic hemorrhage includes the targeted administration of embolic agents. In certain instances where computed tomography angiography cannot exclude a bleed, prophylactic embolization with absorbable gelatin sponge has been used. In this retrospective case series review, we characterized the demographic data and clinical outcomes associated with 4 patients who underwent prophylactic transarterial splenic artery embolization after blunt abdominal trauma. Embolization was employed in cases where computed tomography angiography findings suggested at least a moderate splenic injury, and simultaneously where hemorrhage was not apparent during fluoroscopic angiography. Periprocedural hemodynamic status, technical success, and postoperative complications are discussed. The goal of this report was to discuss the safety and efficacy of prophylactic gelatin sponge embolization for occult splenic hemorrhage. In cases where a hemorrhagic site might be occult, this approach has the potential to minimize bleeding complications and the need for further intervention.

Successful sclerotherapy of a recurrent, benign parotid cyst.

Benign parotid lesions can grow to be a cosmetic deformation with psychological sequelae for a patient. Although surgical resection is the treatment of choice, cyst aspiration has also been attempted. This, however, has been shown to recur, requiring repeat intervention. An alternative therapeutic method not as widely recognized, but which has been reported to be both effective and less invasive than surgery for treating parotid cyst lesions, is sclerotherapy. Here we describe a report of a patient with a benign, localized, cystic neck mass refractory to 2 trials of fine needle aspiration. After the patient refused surgical resection, a trial of sterile ethanol sclerotherapy was performed. Our patient tolerated the procedure well with a significant reduction in the size of the lesion.

A Unique Occurrence During Treatment of an Intraoral Arteriovenous Malformation: A Case Report and Discussion.

This is the report of a case of arteriovenous malformation (AVM) of the tongue in a 13-year-old female patient. The clinical course is outlined; an intraoperative dilemma is discussed; and a review of the literature is presented. Vascular lesions demand heightened attention by all practitioners throughout the planning and diagnostic phase, during surgical treatment, as well as postoperatively. Careful attention to detail can help avoid poor patient outcomes and, even, fatal consequences.

Analysis of dental erosion induced by different beverages and validity of equipment for identifying early dental erosion, in vitro study.

OBJECTIVE: To understand early dental erosion induced by different beverages and the equipment for its detection. METHODS: The study was conducted at the University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June to September 2014, and comprised single-rooted, unpolished teeth divided into six groups. Electron micrographs and other baseline readings for further analyses were taken before and after the exposure to different beverages. The teeth were exposed to the beverages using a modified Nordini's artificial mouth model. The positioning of the teeth on the motorised stage of the equipment was standardised. RESULTS: Of the several beverages used, CocaCola had the lowest pH value of 2.53, while tap water had the highest pH of 5.4. Deionised distilled water, which was used as a reference, had a pH near to neutral /alkaline of 7.3. The fluoride content ranged between 9.38ppm in tea and 0.005ppm in orange juice. Teeth exposed to beverages with low pH and considerably high fluoride underwent slight remineralisation (roughness increase 8% from tea), while beverages with no fluoride content and low pH roughened the enamel surface (Coca Cola roughened upto 37%). Quantitative analyses of tooth erosion, micro-hardness, surface-roughness, and surface-height showed that all beverages exhibited positive erosive effect on the tooth enamel surface (p<0.005). CONCLUSIONS: CocaCola was found to be the most erosive agent among both hot and cold beverages (37%), while coffee was more erosive among the hot beverages (29%).

Is synthetic mouthwash the final choice to treat oral malodour?

The aim of the review was to critically appraise the various pros and cons of the synthetic and herbal agents used in mouthwashes against halitosis and facilitate users to choose appropriate mouthwashes according to their need. Oral Malodour (OMO) or halitosis is a global epidemic with social and psychological impact. Use of mouthwash has been adopted worldwide to control halitosis within a past few decades. Alcohol and Chlorhexidine are common agents in synthetic mouthwashes, while Tannins and Eugenol are derived traditional herbal extracts. Each agent signifies some unique properties distinguishing them from others. Herbal ingredients are gaining the attention of the profession due to its mild side effects and competitive results. Herbal mouthwashes can be a safer choice in combating OMO, as an alternate to synthetic mouthwashes.

Spontaneous tibioperoneal trunk and anterior tibial artery pseudoaneurysms.

Aneurysms of the tibioperoneal trunk and anterior tibial artery are extremely rare. There are only a few case reports of this entity, for which the majority are secondary to prior trauma or bacteremia and endocarditis. We describe a case of spontaneous pseudoaneurysms of the right anterior tibial artery and tibioperoneal trunk. The pseudoaneurysms were thrombosed on follow-up computed tomography angiography and the patient has been asymptomatic. The patient is being treated conservatively and remains asymptomatic at 1 year of follow-up.

Retrospective analysis of local sensorimotor deficits after radial artery harvesting for coronary artery bypass grafting.

OBJECTIVES: The radial artery (RA) has gained widespread acceptance as a conduit for coronary artery bypass. We analyze patient-based data to determine risk factors for long-term upper limb morbidities associated with RA harvest for coronary artery bypass grafting. STUDY DESIGN/METHODS: Between April 1997 and March 2004, a total of 1030 patients underwent RA harvesting for coronary artery bypass grafting for a total of 1704 harvest sites. Patients were contacted by telephone and asked to report any ongoing severe sensory and functional motor deficits for each harvest site since surgery. Retrospective chart review was performed and preoperative risk factors were evaluated. Patient-based risk factors were evaluated for development of significant long-term local sensorimotor deficits including gender, elderly age (>70 y), diabetes, smoking, and whether the RA was harvested from the dominant hand. RESULTS: Successful evaluation of 629 patients for a total of 1048 RA harvest sites was completed. The mean follow-up time was 48.3 mo (range, 2 to 86 mo). The mean age of the patients analyzed was 62.2 y. On statistical analysis, diabetics and elderly did not report significantly greater functional or sensory deficits than nondiabetics and nonelderly, respectively. There was a significantly higher incidence of sensory deficits in smokers compared with nonsmoker patients (4.2% versus 1.4%; P = 0.005) but no difference in their functional impairment was noted. Harvesting from the dominant hand did not influence the occurrence of sensory or motor functional deficits. CONCLUSIONS: RA harvesting for coronary artery bypass grafting can be done with minimal serious long-term upper limb morbidity in higher risk patients. Based on our findings, harvesting of the RA from the dominant hand is not contraindicated in these patients.

Clinical outcomes of 84 children with congenital heart disease managed with extracorporeal membrane oxygenation after cardiac surgery.

The purpose of our research was to study the clinical outcomes of children with congenital heart disease (CHD) requiring extracorporeal membrane oxygenation (ECMO) support after cardiac surgery at a tertiary care children's hospital. Retrospective review of all patients with CHD who required postcardiotomy ECMO between January 2001 and September 2004 (45 months) was undertaken. Various outcome predictors were tested for any association with survival to hospital discharge using univariate analysis. A total of 84 children were placed on ECMO after CHD surgery; 39 (46.4%) were placed on ECMO in the operating room. Median age of the patients was 128 days (1 day to 5 years) and median weight was 4.53 kg (2-18 kg). Active cardiopulmonary resuscitation was ongoing at the time of cannulation in 27 children (32%). Fifty-two children (61.9) survived > 24 hours after decannulation and 31 (36.9%) survived to discharge. High arterial serum lactate levels at the time of ECMO initiation were strongly correlated with nonsurvival (p = 0.004). Nonsurvivors had longer duration on ECMO than survivors (p = 0.003). The odds of survival dropped significantly after 144 hours (day 6) of ECMO. ECMO support results in improved outcomes in patients who suffered hemodynamic collapse post cardiac surgery. Underlying cardiac lesion, age, weight, gender, initial arterial pH, location of ECMO initiation, need for hemofiltration and placement of ECMO after active ongoing cardiopulmonary resuscitation did not increase the mortality risk. Initial arterial serum lactate level and inability to wean off by 6 days were strongly correlated with nonsurvival.