Adult laryngeal haemangioma; a rare entity

Laryngeal haemangioma is commonly seen in children. Adult laryngeal haemangiomas are rare and usually involve the supraglottic region. Most common symptom includes dysphagia, dysphonia and shortness of breath. Detailed history, fiberoptic laryngoscopy and computerized scanning may suggest benign nature of the lesion but diagnosis is only confirmed by a biopsy. In comparison to infantile haemangiomas which usually respond to propronolol, the treatment of adult laryngeal haemangiomas is always surgical removal. We present a case report of a supraglottic haemangioma in an adult male, who was treated surgically without any complications

Anatomical variations of nose and para-nasal sinuses; CT scan review

Objective: To determine the frequency of anatomic variations on computed tomography scan of para-nasal sinuses.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised computed tomography scans of 77 patients who had presented between October 2007 and March 2011. All the scans were reviewed using Picture Archiving Communication System computer software. The scans were reviewed for the presence of deviated nasal septum, paradoxical middle turbinate, Haller cell, Onodi cell, and pneumatisation of the middle turbinate and uncinate process.Results: The mean age of the patients was 31±13.15 years. One or more types of anatomical variants were observed in 40 (51.9%) of the patients; the most frequent being the deviated nasal septum 20 (26%) and the Concha bullosa 14 (18.2%).Conclusion: Considering the wide range of variations in the anatomy, each and every para-nasal sinus case should be planned individually and carefully to avoid dreadful complications and maximise patients’ benefit

Post-traumatic pseudoaneurysm of internal carotid artery: a cause of intractable epistaxis.

In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400-500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examination including rigid endoscopy and coagulation investigation did not reveal any abnormality. CT with contrast of paranasal region showed blood within the right sphenoid sinus with linear fracture of the lateral wall with post-traumatic cavernous pseudoaneurysm of internal carotid artery localised to right sphenoid sinus. That was managed successfully by embolisation using a detachable balloon and a coil. She was followed up in the clinic at 6 weeks and 6 months interval with no symptoms

Low Private Investment and Government Failure as the Binding Constraints to Pakistan’s Economy Growth Diagnostics Analysis

This research targets the most binding constraints in the economy of Pakistan during the period from 2007 to 2013 using Husmann-Rodrick-Vilasco (2005) decision tree. The growth diagnostics proves that the economy of Pakistan undergoes and passes from the stages of dilemma and huge economic complexities during this period. The economic growth of Pakistan is continuously being affected by structural problems including domestic energy crisis, low investment, high inflation, and security issues. Growth diagnostics points out to four major constraints to economic growth of Pakistan and these are: energy crisis, inadequate market development, poor performance of institutions, and lack of efficient public sector management. Only two of these constraints are explained in this study including low level of private investment and government failure. For policy implications, several areas like private sector growth, good governance, institutional strength, market development, macroeconomic stability, infrastructure development are important to make considerable reforms

Has a change in established care pathways during the first wave of the COVID-19 pandemic led to an excess death rate in the fragility fracture population? A longitudinal cohort study of 1846 patients

Objective During the first wave of the COVID-19 pandemic, changes to established care pathways and discharge thresholds for patients with fragility fractures were made. This was to increase hospital bed capacity and minimise the inpatient risk of contracting COVID-19. This study aims to identify the excess death rate in this population during the first wave of the pandemic. Design A longitudinal cohort study of patients with fragility fractures identified by specific International Classification of Diseases (ICD)-10 codes. The first wave of the pandemic was defined as the 3-month period between 1 March and 1 June 2020. The control group presented between 1 March and 1 June 2019. Setting Two acute National Health Service hospitals within the East Midlands region of England. Participants 1846 patients with fragility fractures over the aforementioned two specified matched time points. Primary and secondary outcome measures Four-month mortality of all patients with fragility fractures with a subanalysis of patients with fragility hip fractures. Results 832 patients with fragility fracture were admitted during the pandemic period (104 diagnosed with COVID-19). 1014 patients presented with fragility fractures in the control group. Mortality in patients with fragility fracture without COVID-19 was significantly higher among pandemic period admissions (14.7%) than the pre-pandemic cohort (10.2%) (HR=1.86; 95% CI 1.41 to 2.45; pCopyright © 2022 Author(s) (or their employer(s)). Re-use permitted under CC BY. Published by BMJ.https://doi.org/10.1136/bmjopen-2021-05852

Trends in hospital admissions for childhood fractures in England

Purpose Fractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals.Design The study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children.Results During 2012–2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5–9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10–15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0–4) children has been increasing at a rate of 0.629 per 100 000 children per year.Implications The annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes

Preoperative inflammatory biomarkers reveal renal involvement in postsurgical mortality in hip fracture patients: an exploratory study

BackgroundHip fractures in frail patients result in excess mortality not accounted for by age or comorbidities. The mechanisms behind the high risk of mortality remain undetermined but are hypothesized to be related to the inflammatory status of frail patients.MethodsIn a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI). After correcting for multiple testing, adjustments for comorbidities and demographics were performed on the statistically significant markers.ResultsOf the 92 markers tested, circulating levels of fibroblast growth factor 23 (FGF-23) and interleukin-15 receptor alpha (IL15RA), both involved in renal disease, were significantly correlated with 6-month mortality (27.5% overall) after correcting for multiple testing. The incidence of postoperative AKI (25.4%) was strongly associated with 6-month mortality, odds ratio = 10.57; 95% CI [2.76–40.51], and with both markers plus estimated glomerular filtration rate (eGFR)– cystatin C (CYSC) but not eGFR-CRE. The effect of these markers on mortality was significantly mediated by their effect on postoperative AKI.ConclusionHigh postoperative mortality in frail hip fracture patients is highly correlated with preoperative biomarkers of renal function in this pilot study. The effect of preoperative circulating levels of FGF-23, IL15RA, and eGFR-CYSC on 6-month mortality is in part mediated by their effect on postoperative AKI. Creatinine-derived preoperative renal function measures were very poorly correlated with postoperative outcomes in this group

Two doses of the SARS-CoV-2 BNT162b2 vaccine enhance antibody responses to variants in individuals with prior SARS-CoV-2 infection

Understanding the impact of prior infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the response to vaccination is a priority for responding to the coronavirus disease 2019 (COVID-19) pandemic. In particular, it is necessary to understand how prior infection plus vaccination can modulate immune responses against variants of concern. To address this, we sampled 20 individuals with and 25 individuals without confirmed previous SARS-CoV-2 infection from a large cohort of health care workers followed serologically since April 2020. All 45 individuals had received two doses of the Pfizer-BioNTech BNT162b2 vaccine with a delayed booster at 10 weeks. Absolute and neutralizing antibody titers against wild-type SARS-CoV-2 and variants were measured using enzyme immunoassays and pseudotype neutralization assays. We observed antibody reactivity against lineage A, B.1.351, and P.1 variants with increasing antigenic exposure, through either vaccination or natural infection. This improvement was further confirmed in neutralization assays using fixed dilutions of serum samples. The impact of antigenic exposure was more evident in enzyme immunoassays measuring SARS-CoV-2 spike protein–specific IgG antibody concentrations. Our data show that multiple exposures to SARS-CoV-2 spike protein in the context of a delayed booster expand the neutralizing breadth of the antibody response to neutralization-resistant SARS-CoV-2 variants. This suggests that additional vaccine boosts may be beneficial in improving immune responses against future SARS-CoV-2 variants of concern

후판 적용을 위한 유도 가열 기반의 교류 전류-가스메탈 아크 용접에 관한 연구

학위논문(박사) - 한국과학기술원 : 기계공학과, 2018.2,[vi, 111 p. :]Competition in the shipbuilding and offshore industries has generated a demand for the use of materials that can provide high productivity with low manufacturing costs. One method to overcome these challenges is the use of high-strength steels, providing a better strength to weight ratio. However, the application of high strength materials is restricted by the need of cost effective low heat input welding process. The higher heat affected zone (HAZ) producing process deteriorates the weld joint properties of these thermally treated steels by large. Previously, alternating current gas metal arc welding (AC-GMAW) has been applied to thin sheets due to low heat input and higher material deposition rates. Quite recently, some unique findings of high penetration and stable welding arc have been reported on bead on plate (BOP) welding for steel by using an improved current waveform. Electrode negative (EN) region of the current waveform is divided into an EN base region and a peak regionresulting in a finger like penetration providing good root quality. The work is extended here and the AC-GMAW process is employed on thick steel plate welding ranging from 5 mm to 10 mm in a single pass. However a lack of fusion is reported on the joint sides for material thickness above 7 mm. The controlled induction pre-heating on the joint sides up to the desired depth can help in overcoming this problem. The induction heating source can pre-heat the workpiece in the desired manner to control the penetration properties. Different coil designs with appropriate power supply configuration can be used to rapidly pre-heat the joint in the desired patternfollowed by higher material deposition by the AC-GMAW process. The development in the proposed process of induction heating assisted alternating current gas metal arc welding (IH-ACGMAW) can pave the way for the welding of thick steel plates at reasonable welding speeds with minimum HAZ.한국과학기술원 :기계공학과

Musculoskeletal function and phenotyping in frail older patients having hip surgery following fracture

A hip fracture is a catastrophic injury to an elderly individual with a significant impact individually, on the family, and for health care services. Despite optimisation of medical comorbidities, effective skilled anaesthesia, and early surgery, the patient important outcomes of mobility, independence, and mortality have not improved. With an aging population comes increasing frailty, and those who are frail have the worst outcomes. However, frailty in existing literature has been difficult to quantify. Multiple methods have been used to ascertain and classify frailty status, utilising two different schools of thought: cumulative deficits and phenotype models. Frailty is the ability for an individual to bounce back from illness or injury. It is not known why those who are frail have the worst outcomes and what biological processes occur which underpin these poor outcomes in these individuals. This study describes and explains the effect of frailty on post-operative outcomes following hip fracture surgery. It evaluates local muscle gene expression using Vastus Lateralis muscle in both the non-injured and injured limb of a range of frail individuals to explain the underpinning biological process of frailty. Lastly it investigates the systemic inflammation secondary to trauma, and how this impacts mortality within this cohort. The first experimental chapter examined the subjective and objective measures of muscle function and performance. It showed that there are significant differences between the extreme ends of the spectrum of frailty, those with a greater frailty had a poorer health related quality of life both at day 7 and day 90, mobility, institutionalisation, and mortality. Patients with severe frailty, clinical frailty scale score of 7, do not improve in mobility outcomes from day 7 post-surgery. Timed up and go test provides a useful binary measure to predict discharge home in patients who are admitted from their own home. The second experimental chapter identifies significant differentially expressed genes in the Vastus Lateralis muscles when comparing the fractured leg with the non-fractured leg. It also demonstrates no significant difference in gene expression in the non-fractured leg when stratifying for frailty scores. However, in the fractured leg there is a significant difference in gene expression when comparing higher frailty states to lower frailty states. Key mechanisms of inhibition of apoptosis and cell death are reduced as frailty increases, and increased protein catabolism increases with increasing frailty. This highlights key mechanisms which may be potential targets to improve outcomes and prevent frailty. The third experimental chapter identifies the systemic inflammatory markers present at the time of hip fracture surgery and their relationship with 6-month mortality. Two biomarkers FGF-23 and IL-15RA are significantly raised and correlated with renal function which, are predictive of 6-month mortality. This highlights potential treatment targets for reducing inflammation and the role of optimisation of renal function in the peri and post operative management of hip fracture. This study is uniquely placed amongst the existing literature for a myriad of reasons. It is the first study to investigate gene expression in the vastus lateralis muscle in the non-fractured leg and fractured leg of the same participants. It is also the first study to investigate gene expression in a range of frail patients identifying mechanisms which potentially underpin frailty and poor outcomes following hip fracture surgery. It is also the first study to investigate and evaluate a range of inflammatory markers using proteomic analysis and their relationship with 6-month mortality. The identification of novel biomarkers, cellular functions and objective assessments now paves the way for further research in determining novel therapeutic agents and rehabilitation strategies to not only further improve outcomes for hip fracture surgery but is translatable to reduce the impact of frailty on homeostatic reserve of elderly patients