Cases Research Articles

Estudo das quantidades de soluções para os casos V e VI dos triângulos esféricos oblíquos

Os entes humanos ao se tornarem sedentários começaram a perceber a necessidade de se conhecer a própria localização. Ao estudarem as estrelas, perceberam um referencial seguro para tal localização e passaram a utilizá-las para o cálculo da posição, surgindo assim a Astronomia de Posição. Para o cálculo da posição, por sua vez, foi necessário um modelo matemático, sendo natural pensar-se na Esfera. Natural ainda foi estender a Trigonometria Plana à Esfera, surgindo assim a Trigonometria Esférica. O estudo da Trigonometria Esférica se faz necessário para a formação dos engenheiros cartógrafos e agrimensores, pois o conhecimento das ferramentas para a resolução do Triângulo Esférico vai ser fundamental para a compreensão dos mecanismos de posicionamento quer seja pela Astronomia de Posição quer seja pela Geodésia. De modo a contribuir com o ensino da Trigonometria Esférica, a revisão conceitual apresentada neste trabalho se propõe a estudar a quantidade de soluções para os triângulos esféricos oblíquos do Caso V e do Caso VI, respectivamente, quando são conhecidos dois lados e o ângulo oposto a um dos lados e quando são conhecidos dois ângulos e o lado oposto a um dos ângulos. Os triângulos pertencentes a estes casos podem apresentar nenhuma, uma solução, duas ou infinitas soluções. O conhecimento sobre determinado assunto somente pode ser de caráter científico quando há o conhecimento sobre as etapas dedutivas relacionadas àquele assunto, por isso apresenta-se o presente trabalho para que o estudante possa conhecer cientificamente partes da Trigonometria Esférica.

Visual outcome of pediatric ocular trauma in a Latin American population

Objective: The aim is to assess associated factors regarding the type of pediatric ocular trauma and final visual acuity (VA) of the patients received ophthalmology service at tertiary care facility between 2013 and 2018. Methods: Retrospective cohort study. The clinical history of patients between 0 and 15 years of age diagnosed with ocular trauma was examined. The exposure variable was the type of ocular trauma (open or closed). Other variables related to ocular trauma were studied. Results: A total of 183 ocular trauma cases were studied. The median age was 9 years (interquartile range: 5–12), most patients were males (65.5%), blunt and sharp objects were the most frequent causes of ocular trauma (41% and 33.3%, respectively). Closed ocular trauma was found in 82.5% of the cases and zone 1 was the most frequently involved (76,5%). Sixty-four percent of cases required surgical management and 26% presented complications at the final follow-up. About 78.7% of the patients had VA equal or higher than 20/40. The risk factors associated with worse visual outcome (worse than 20/40) was found to be open ocular trauma (relative risk [RR] = 5.5; 95%IC: 3.3–9.2), the affected zone (higher risk in zone 3 with RR = 7.62; 95% confidence interval: 7.61–7.63) and time elapsed between the moment of trauma and receiving ophthalmological treatment (RR = 1.01; 95%IC: 1.01–1.01). Conclusion: Most patients that presented with ocular trauma had satisfactory final VA, considering that closed ocular trauma was more frequent. Open ocular trauma, the affected zone, and the time elapsed before starting treatment were associated with worse VA outcomes in our study.

An Empirical Study on the Determinants of the Debt Repayment Capability of Shipping Firms in Recession

In this study, an empirical analysis of 55 ship finance cases executed by a specific ship finance bank from 2009 to 2016 during the recession period was conducted. The purpose of this study was to find the factors affecting changes in the debt performance of Korean shipping companies. The main factors were the loan nature (investment purpose, loan-to-value (LTV), syndicated loans, loan terms, put-option, balloon, and spread), financial nature (total assets turnover, net profit-to-sales ratio , debt ratio, quick ratio, total borrowing, bonds payable to total assets, interest expenses-to-sales ratio, debt service coverage ratio (DSCR), and total assets), and the company nature (company age, chief executive officer’s (CEO's) shares, and listing status). In this study, the factors affecting the debt repayment capability of domestic shipping companies (loan nature, financial nature, and company nature) were verified. The credit rating was used to measure the dependent variable, debt repayment ability. The variables of investment purpose, put-option, balloon, and spread in the loan nature, debt ratio in the financial nature, and the CEO's shares and company age in the company nature were found to be significant.

The Columbo method—A rhetoric of inquiry practiced across professions

The increasing numbers of trade articles about the almost trademark “Columbo Method” evidences a growing phenomenon. As demonstrated by the fictional television detective of Columbo 1968-2003, the method is an approach to investigation characterized by rhetorical inquiry (system of questions and timing), an antipotent persona (nonauthoritative, unassuming Everyman), and tenacity in overcoming a responder’s resistance to collaboration or influence. The essay provides a theoretical analysis of Columbo’s informed but indirect questioning, pretense of ignorance, solicitation of help, folksy congeniality, and the false exit. A literature review presents applications of the Columbo Method by professionals to describe effective workplace interaction with resistant responders (conflicting values or allegiances, lifestyle and demographic differences, shyness, anxiety, fear of change, etc.). Third, the theory is applied in an in-depth rhetorical analysis of cases of communication in academia. Most importantly, the work strives to make an impact in ethical approaches to communication with implications for developing rhetorical pedagogy. ©Journal of Professional Communication, all rights reserved.

Cone-beam computed tomography evaluation of the root morphology of the maxillary and mandibular premolars in a Moroccan subpopulation: Number of roots and tooth length (part 1)

Introduction: The aim of the study was to evaluate the number of roots and tooth length of the maxillary and mandibular premolars of a Moroccan subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: The number of roots and tooth length of 919 maxillary and mandibular premolars (358 maxillary and 561 mandibular) examined by CBCT was evaluated using “Planmeca viewer” software. Statistical analysis was carried out using the Epi info software. Results: The study showed a high prevalence of two roots for maxillary first premolars, and single root for maxillary second premolars and mandibular first and second premolars. The mean length of the maxillary first premolars (single rooted) was 21.74 mm, that of the buccal roots was 21.92 mm, and that of the lingual roots of the two-rooted teeth was 20.67 mm. The maxillary second premolars (21.4 mm) and the mandibular premolars (21.5 mm) exhibited the same mean length. Conclusion: All premolars had a single root in most cases, except for the maxillary first premolars where two-rooted teeth were more frequent with an average length of 21.4 mm. CBCT is an exciting tool for endodontic diagnosis and treatment planning.

Demographic, clinical, and radiological features of healthcare workers and two index cases that were infected with COVID-19

Introduction: To evaluate the index cases leading to the transmission of healthcare workers (HCWs) in Rize/Turkey Recep Tayyip Erdogan University Faculty of Medicine Education and Research Hospital with COVID-19 infection and the clinical features of infected HCWs Method: The first two COVID-19 test positive patients treated at Rize/Turkey between 10 03 2020 and 12 04 2020 and HCWs those who examined these two patients whose COVID-19 PCR test results were positive were included in this study Results: In Rize/Turkey, the first and second cases of positive COVID-19 which was recorded on 13 03 2020 on 25 03 2020, 27 HCWs (female, 63%, n=17 and male, 37%, n=10 and the mean age was 33 2±6 9 years) who contacted during the treatment of these cases and became COVID-19 positive were examined The median of symptom duration (days) of the HCWs was 5 days (range: 0-17 days) Fever, 55 6% (n=15);malaise, 44 4% (n=12);cough, 40 7% (n=11);sore throat, 33 3% (n=9);myalgia, 33 3% (n=9);dyspnea, 14 8% (n=4);diarrhea, 22 2% (n=6);vomiting, 14 8% (n=4);anosmia, 18 5% (n=5);ageusia, 22 2% (n=6) and headache, 37% (n=10) of the cases The rates of headache in female HCWs infected with COVID-19 were found to be significantly higher compared to men (52 9%) None of them had severe clinical situation requiring intensive care follow-up or acute respiratory distress syndrome (ARDS) Laboratory measurements of HCWs were carried out at the first when they had symptoms and when they recovered, and results were compared accordingly The thorax computerized tomography (CT) findings of HCWs were normal in 74 1% (n=20) of total Conclusion: HCWs were initially affected by the COVID-19 pandemic Early measures provided by the Health authorities, access to diagnosis and treatment, and the young age average in HCWs prevented severe outcomes such as severe clinical course and mortality at the beginning of the outbreak

Pandemic anxiety stress scale for pregnant women(PASSP): Development and validation

Introduction Coronavirus disease (COVID-19) is a new pandemic caused by a newly discovered coronavirus. This pandemic has caused increase in anxiety among people globally and more the pregnant women. Elevated levels of anxiety and stress may adversely affect the outcome. Aim & Objective: This study aimed at developing and validating a tool to assess the stress and anxiety due to pandemic which helps the health care professionals to identify the probable cases of anxiety associated with the coronavirus and can take adequate measures to improve the emotional well-being of the antenatal women. Methods & Material: A cross-sectional survey was carried out among the pregnant women in Kerala using a 29-itemtool through google forms during the month of June. Statistical Analysis: Item analysis, Exploratory factor analysis and confirmatory factor analysis were done to evaluate scale dimensionality, factor loadings, and factor structure using the R Software version 4.0.2. Results: Factor analysis resulted in a 15-item short tool, Pandemic anxiety stress scale for pregnant women (PASSP) with the reliably index of Cronbach’s alpha of 0.93. Exploratory factor analysis extracted two factors. Confirmatory factor analysis confirmed the factor structure of the PASSP with Goodness of fit indices. Two factor model structure has good fit indices with GFI>0.90, DFI and TLI>0.95 and SRMR =0.04. Discussion: This study developed a new validated instrument PASSP for assessing the anxiety and stress due to a pandemic among pregnant women in Kerala. Keywords: COVID19, anxiety, pandemic, pregnancy, tool validation, factor analysis.

Dietary pattern amongst Medical college students, Delhi

Background: India is experiencing a transitional shift with more of new cases of Non Communicable Disease observed specially in young adults. One of the major reasons of this upsurge is faulty dietary habits, resulting in overweight and obesity and further rise in NCDs. The purpose of this study is to assess eating habits and nutritional risk factors for NCDs in a medical student of Medical college of Delhi. Methods: After explaining the purpose of the study in individual classroom explained questionnaire was mailed to all 300 medical college undergraduate students currently studying in this medical college. The form consists of questions on sociodemographic details including information about weights, height and eating habits including, drinking and smoking habits. Results: Filled forms were returned by 220 students out of which 204 were found to be complete and were considered for further analysis. Of total 204 students, 72 (35.3%) were females and 132 (64.7%) were males in our study. Regarding meals only 154 (75.5%) were found to be taking meals regularly i.e. more than 3 times a day and 82.4% (168) were having breakfast on regularly basis. Daily consumption of vegetable and legumes against recommended two times were found only in 41.2 (84) students, similarly daily fruit consumption against recommended two times was found only in 30.4% (62) students only. However fast-food consumption on daily basis was as high as 23.5% (48).Smoking was absent in students and alcohol intake was present in 3% of males (06) and reportedly absent in females. About 22.5% (46) was reported of doing some sort of exercise in a week but only 20 (9.8 %) were found to be doing exercise on daily basis. 156 (76.5%) sought some sort of information regarding balanced diet and 120 (58.8%) had reported to have adequate information about balance diet. Conclusion: Eating habits were found to be irregular among undergraduate medical students with regard to meals and daily intake of fruits and vegetables was found to be less than recommended norms. More efforts are required for improving eating practices of the students and also for adequate nutrition and its implication on health. Keywords: Eating Practices, MBBS students, Balanced diet, Junk food, Regular meals, Non comunicable diseases.

Solid-Lattice Stem Optimization Design for Hip Implants

The goal of this study is analyzed and design a methodology to reduce stem mass, through topology and lattice optimization of a Ti-6Al-4V hip implant, meeting yield stress requirements. Four optimization cases were studied: Topology optimization (1), Lattice design 100% (2), Lattice design 50% (3), Lattice design 25% (4). Five load cases from a study were applied for each optimization cases: Combined (LC1), standing-up (LC2), standing (LC3), going up stairs (LC4), jogging (LC5). The optimized cases design reduced stem mass approximately by 30% (1), 5% (2) ,8% (3) and 2% (4), compared with the total stem hip Ti-6Al-4V implant.

Phantom Shocks Associated With a Wearable Cardioverter Defibrillator

Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment. J Med Cases. 2021;12(2):49-53 doi: https://doi.org/10.14740/jmc3606

Hepatic Hodgkin Lymphoma Presenting as Solitary Hepatic Mass Following Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder in a Patient With Rheumatoid Arthritis

Lymphoproliferative disorders (LPDs) occur frequently in patients with rheumatoid arthritis (RA) under methotrexate treatment. Some LPDs spontaneously regressed after methotrexate discontinuation, but classic Hodgkin lymphoma (CHL)-type LPDs frequently relapse, and chemotherapy is usually required for the treatment. CHL usually spreads in contiguous lymph nodes and then infiltrates in organs at an advanced stage. Thus, hepatic Hodgkin lymphoma (HHL) without lymphadenopathy is extremely rare at diagnosis. We present a case of methotrexate-associated LPDs associated with systemic lymphadenopathy and hepatosplenic mass in a 71-year-old woman with RA under methotrexate treatment over 10 years. Although spontaneous remission occurred after methotrexate discontinuation, she developed HHL presenting as a solitary hepatic mass without lymphadenopathy 3 years after spontaneous regression. She received brentuximab vedotin (BV) combination chemotherapy without bleomycin to avoid pulmonary toxicity. Complete metabolic response was achieved after four courses of BV combination chemotherapy, and the activity of RA was kept to be in remission. Our case suggested that the recurrence lesions of LPDs may present at unexpected site, which is not coincide with the primary site, and BV combination chemotherapy is a promising regimen for limited-stage CHL-type LPDs in patients with RA owing to its anti-lymphoma effect on CHL-type LPDs and a possible targeted therapy for RA. J Med Cases. 2021;12(2):79-83 doi: https://doi.org/10.14740/jmc3636

Aerococcus urinae : A Rare Cause of Endocarditis Presenting With Acute Stroke

Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider. J Med Cases. 2021;12(2):65-70 doi: https://doi.org/10.14740/jmc3612

Transvaginal Resection of a Rectal Gastrointestinal Stromal Tumor: A Case Report

Gastrointestinal stromal tumors (GISTs) are a type of mesenchymal tumors. They are rare in rectum. This location is a surgical challenge due to the high morbidity after aggressive surgeries. We present the case of an 81-year-old female with a high-grade GIST treated with transvaginal excision and adjunctive therapy with imatinib. The postoperative period was uneventful without anal dysfunction. Within the types of surgical treatment available, transvaginal excision is an acceptable procedure in lesions located in the rectovaginal region. J Med Cases. 2021;12(2):57-60 doi: https://doi.org/10.14740/jmc3615

Debulking of Advanced Gastrointestinal Stromal Tumor With Peritoneal Carcinomatosis Refractory to Imatinib and Sunitinib: A Case Report

Gastrointestinal stromal tumors (GISTs) are non-epithelial stromal tumors that arise in the gastrointestinal tract. Pharmacological treatments for GIST are tyrosine kinase inhibitors. For metastatic disease, debulking may be helpful in reducing the tumor burden, thus increasing the effectiveness of tyrosine kinase inhibitors. Debate on whether resection would benefit the patient is still present. Here is a case of a 52-year-old African American male presenting with metastatic malignant GIST with peritoneal carcinomatosis refractory to imatinib and sunitinib. Since this patient had stage IV metastasis it was ultimately decided to proceed with a therapeutic debulking procedure. For this patient, the procedure increased the effectiveness of the medication and reduced mass effect symptoms, improving quality of life. J Med Cases. 2021;12(2):45-48 doi: https://doi.org/10.14740/jmc3598

Thymectomy in Pemphigus Foliaceous: A 30-Year Observation

Myasthenia gravis is an archetypal human autoimmune disease. Thymectomy is proven effective by controlled clinical trials, and is commonly part of the immunotherapeutic approach when myasthenia creates generalized weakness. Pemphigus foliaceus is also autoimmune but treated medically; and thymectomy is not part of therapy unless thymoma is discovered. Autoimmune mechanisms, age distribution, and response to therapy in autoimmune disorders are likely to be different with thymoma. The concurrence of generalized myasthenia with disfiguring pemphigus foliaceus in one young patient but without thymoma offered a natural experiment to assess immunologic antibody responsiveness postoperatively, and observe more than a quarter of a century of clinical remission of both following total thymectomy surgery. J Med Cases. 2021;12(2):41-44 doi: https://doi.org/10.14740/jmc3585

Gastrointestinal Stromal Tumor: An Uncommon but Serious Cause of Gastrointestinal Bleeding

Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract that can sometimes present as a gastrointestinal bleeding source. This report describes a patient presented with upper GI bleeding secondary to a gastric GIST, which was initially detected on endoscopy. The patient underwent surgical resection of the tumor and was started on adjuvant chemotherapy with imatinib. The patient’s postoperative course was complicated by an esophageal leak requiring re-exploratory laparotomy and esophageal stent placement. The stent was removed 5 weeks later and the patient remained stable for discharge after 60 days of inpatient care. J Med Cases. 2021;12(2):74-78 doi: https://doi.org/10.14740/jmc3631

Острое повреждение почек при COVID-19: клинико-морфологические сопоставления на основании данных аутопсийных исследований

Severe Acute Respiratory Syndrome (SARS-CoV-2) has spread rapidly throughout the world, causing high morbidity and mortality Analysis of clinical and autopsy data may allow to understand this disease The results of pulmonary and renal autopsies in 37 deceased patients from COVID-19 are presented Materials and methods An autopsy was performed in Moscow in 37 deceased patients aged from 28 to 94 years The microscopic features of the lungs and kidneys were examined using hematoxylin and eosin staining Results Important findings include diffuse alveolar injury, pulmonary thrombosis and microangiopathy, as well as acute kidney injury in all cases, varying in severity Conclusions We report the presence of acute kidney injury in all cases, which requires correction of renal function in patients with SARS-CoV-2, with control of serum creatinine levels, urine volume, proteinuria and hematuria Тяжелый острый респираторный синдром (SARS-CoV-2) быстро распространился по всему миру, вызвав высокую заболеваемость и смертность Анализ клинических данных и данных аутопсии может помочь нам разобраться в данной болезни Мы представляем результаты легочной и почечной аутопсии у 37 умерших от COVID-19 пациентов Материалы и методы В Москве произведена аутопсия 37 умершим пациентам в возрасте от 28 до 94 лет Были исследованы микроскопические особенности легких и почек с помощью окрашивания гематоксилином и эозином Результаты Важные результаты включают диффузное альвеолярное повреждение, тромбоз и микроангиопатию в легких, а также острое повреждение почек во всех случаях различной степени тяжести Выводы Мы сообщаем о наличии острого повреждения почек во всех исследуемых случаях, что требует коррекции функции почек у больных SARS-CоV-2 с контролем уровня креатинина в плазме крови, объема мочи, наличия протеинурии и гематурии

Comment on “is Phaeohyphomycosis an emerging fungal Infection in Iran? A Short Communication

Dear editor We recently read an interesting article entitled “Is Phaeohyphomycosis an emerging fungal Infection in Iran? A Short Communication” [1] which is published in your journal. This article discusses the prevalence of Phaeohyphomycosis cases in Iran. We published an article entitled “Cerebral Phaeohyphomycosis due to Rhinocladiella mackenziei in Persian Gulf region: A case and review” in 2018 [2]. Our case was a diabetic patient with the history of behcet's disease and with the diagnosis of brain abscesses due to Rhinocladiella mackenziei. For the patient we prescribed voriconazole at first then change the regimen to amphotericin b liposomal (5 mg/kg/day) with combination of posaconazole (200 mg every 6 hours). In the article published by zarrinfar et al recently [1], the authors have referenced our article [2] and instead of the original dose for posaconazole (200 mg every 6 hours), which we also had stated the dose in our article (200 mg every 6 hours), the authors have written wrong dose (200 mg daily) in the table. The dose of posaconazole for treatment is 200 mg every 6 hours and for prophylaxis is 200 mg every 8 hours. We request that this wrong dose be corrected in the table of article published in your journal.

Les habilitats per a la vida com a estratègia pedagògica de salut

<p>En aquest article les autores ens presenten l’enfocament dels determinants socials de la salut, juntament amb la mirada salutogènica i el treball de les habilitats per a la vida per a entendre millor el recorregut vital i emocional dels joves en contextos de migració, fugint de visions estereotipades i paternalistes. Les autores consideren clau que s’ofereixin espais als infants i joves per desenvolupar les seves habilitats per a la vida, que són aquelles competències necessàries per assolir un comportament adaptatiu que els permeti afrontar efectivament les demandes i els desafiaments de la vida diària. Argumenten també que una recerca recent duta a terme amb infants i joves migrats sense referents adults a Irlanda, constatava que la idea de continuïtat i de donar un sentit a les seves vides els ajudava, en la majoria dels casos, en els seus processos identitaris personals i els ajudava a augmentar la seva resiliència. D’aquí el valor que donen al treball de les 10 habilitats per a la vida i a l’enfortiment del Sentit de Coherència. Finalment les autores presenten de quina manera treballen aquestes habilitats, posant com a exemple el programa “Sigues tu, eines i actius per a la salut” de Dipsalut.</p>

Drugs Susceptibility Testing in Leprosy Patients from Côte d’Ivoire Reveals Multidrugs Resistance Combination Cases to Dapsone, Rifampicin and Ofloxacin

Leprosy is a chronic tropical infectious skin disease caused by an obligate intracellular pathogen called Mycobacterium leprae. Until now no vaccine was available so early diagnosis and treatment were the basic strategy for leprosy control. The treatment is based on combined drug therapy including Dapsone, Rifampicin, and Ofloxacin according protocols recommended by the WHO. However, anti-leprosy drugs resistance has been reported in several leprosy endemic region. The drug susceptibility testing was done by detecting mutation after sequencing of the drug resistance determining region. Cote d'Ivoire like many African countries has reaching the threshold of elimination of the disease and the PCT is available nationwide. On the basis of recurrences of therapeutic failures that could be due to misobservance of patients drug therapy or eventually due to circulating resistant strains, we evaluated the drug susceptibility in 155 patients from a leprosy care center in Cote d’Ivoire. Patients were previously diagnosed by clinicians and confirmed by PCR then the genetic drug susceptibility was done by PCR-direct sequencing of the drug resistance determining region of rifampicin, dapsone and ofloxacin used in the treatment. Our results showed multiple cases of multiresistance to anti-leprosy drugs in Cote d’Ivoire. This should be an alert for antibiotic resistance observatories, and policies so that more active surveillance was carried out for the control and surveillance of M. leprae resistance to drugs.