Chest Region Research Articles

Blunt Trauma and R on T Phenomenon Causing Cardiac Arrest

An injury inflicted by a blunt object, such as a car, a fist, or a bat, is referred to as blunt trauma. Usually, it causes tissue damage and discomfort. It also has the tendency to fracture bones. Blunt trauma can happen to the chest, head, abdomen, limbs, and other regions of the body. Lacerations (cuts), concussions (brain injuries), contusions (bruises), fractures (broken bones), and internal injuries are examples of blunt trauma injuries. The location of the trauma, the impact's force, and the victim's general health all got affected according to the severity of the damage. Blunt trauma to the chest can result in cardiac arrest or the abrupt blockage of the heart's pumping activity. Because the heart is a muscular organ, it needs oxygen to beat continuously. Blunt chest trauma can stop the heart from beating because of a lack of oxygen or blood supply, or because the heart muscle has been physically harmed. Pulmonary contusions (bruising of the lung tissue), rib fractures, injury to the heart or blood vessels, and other injuries caused by blunt trauma can result in cardiac arrest.

Patient-Specific Quality Assurance in Pencil Beam Scanning by 2-Dimensional Array

PurposeThis study aimed to determine the characteristics of 2D ionization chamber array and the confidence limits of the gamma passing rate in pencil beam scanning proton therapy. Materials and Methods:The Varian ProBeam Compact spot-scanning system and the PTW OCTAVIUS 1500XDR array were used as a proton therapy system and detector, respectively. Our methods consisted of 2 parts: (1) the characteristics of the detector were tested and (2) patient-specific quality assurance was performed and evaluated by gamma analysis using dose-difference and distance-to-agreement criteria of 3% and 2 mm, respectively, with 123 treatment plans in head and neck, breast, chest, abdomen, and pelvic regions. Results:The PTW OCTAVIUS 1500XDR array had good reproducibility, uniformity, linearity, repetition rate, and monitor unit per spot within 0.1%, with accuracy, energy dependence, and measurement depth within 0.5%. The overall uncertainty of the PTW OCTAVIUS 1500XDR array was 2.49%. For field size and range shifter, using gamma analysis, the passing rate was 100%. The overall results of patient-specific quality assurance with the gamma evaluation were 98.9% ± 1.6% in 123 plans and confidence limit was 95.7%. Conclusion:The PTW OTAVIUS 1500XDR offered effective performance in pencil beam scanning proton therapy.

Naturally occurring compounds in relieving symptoms and reducing perimenopausal risks

Metabolic disorders that are progressive in nature most significantly influence the health of postmenopausal women. Osteoporosis and cardiovascular diseases are the most important long-term consequences and seriously affect the menopausal women’s quality of life. Hot flashes, a sudden feeling of heat or burning that begins in the face, neck, upper chest or back regions, is a common reason to see a doctor. Sometimes, hot flashes are accompanied by redness of the skin, red blotches, or rapid heartbeat. In some cases, rises in local skin temperature are observed. The above symptoms are the result of impaired functioning of thermosensitive neurons in the hypothalamic region. Menopausal hormone therapy is the gold standard for pharmacotherapy of various menopausal symptoms. However, it has different absolute and relative contraindications, as well as patients’ refusal of treatment mainly due to hormone phobia, that have resulted in a situation where 30% of menopausal women take hormone replacement therapy and only 15% continue to take it for a long period. Patients often insist on a natural approach to symptom relief and need evidence-based information about different hormonal and non-hormonal treatment options. Concerns about potential side effects of the hormone replacement therapy resulted in increased interest rates for phytoestrogens to manage menopausal symptoms. A rational fixed dose combination of phytoestrogens and micronutrients is a well-tolerated alternative preparation to support the health of perimenopausal women, which can be used with virtually no restrictions.

99mTc-Labeled FAPI SPECT Imaging in Idiopathic Pulmonary Fibrosis: Preliminary Results.

Idiopathic pulmonary fibrosis (IPF) is associated with a poor prognosis, presenting the most aggressive form of interstitial lung diseases (ILDs). Activated fibroblasts are crucial for pathological processes. Fibroblast activation protein (FAP) inhibitor (FAPI) tracers would be promising imaging agents for these diseases. The purpose of this study was to evaluate a 99mTc-labeled FAPI tracer, 99mTc-HFAPI imaging in IPF patients. Eleven IPF patients (nine males and two females; age range 55-75 year) were included in this pilot study. 99mTc-HFAPI serial whole-body scintigraphy at 5 min, 20 min, 40 min, 1 h, 2 h, 3 h, 4 h, and 6 h was acquired for dynamic biodistribution and dosimetry estimation in seven representative patients. SPECT/CT tomography fusion imaging of the chest region was performed in all patients at 4 h post-injection, which was considered as the optimal acquisition time. Dosimetry was calculated using OLINDA/EXM software (version 2.0; HERMES Medical Solutions). The quantified or semi-quantified standardized uptake values (SUVs) and lesion-to-background ratios (LBRs) of affected lung parenchyma were also calculated. The high-resolution CT (HRCT) stage was determined with visual evaluation, and the total HRCT score of each patient was measured using a weighting factor formula. Pulmonary function tests (PFTs) were recorded as well. Then, the relationships between the 99mTc-HFAPI results, disease extent on HRCT, and PFT results were investigated. Normal physiological uptake of 99mTc-HFAPI was observed mainly in the liver, intestinal tract, pancreas, gallbladder, and to a lesser extent in the spleen, kidneys, and thyroid, with no apparent retention in the blood circulation at the late time point. The mean injected activity of 99mTc-HFAPI was 813.4 MBq (range 695.6-888.0 MBq). No subjective side effects were noticed. The average whole-body effective dose was 0.0041 mSv/MBq per patient. IPF patients exhibited elevated pulmonary 99mTc-HFAPI uptake in abnormal lung regions, which was correlated with fibrotic regions on HRCT. Among different HRCT stage groups, both SUVmax and LBR showed significant differences (p < 0.001). The higher HRCT stage demonstrated significantly higher SUVmax and LBR. A linear correlation between 99mTc-HFAPI uptake and total HRCT score was observed for SUVmax (r = 0.7839, F = 54.41, p = 0.0094) and LBR (r = 0.7402, F = 56.33, p = 0.0092). 99mTc-HFAPI uptake also had moderate correlations with PFT results. Our preliminary data show that the 99mTc-HFAPI SPECT imaging is a promising new imaging modality in IPF patients. Investigations of its clinical value in monitoring disease progression and treatment response are needed in the future.

Concurrent incidence of noma and necrotizing fasciitis in a male child: A rare clinical case report from a referral hospital in Northwest Nigeria

ABSTRACT Rationale: Noma and necrotizing fasciitis are rapidly destructive gangrenous infections with different patterns of spread. This study aimed to present a case of concurrently occurring noma and necrotizing fascitis in a 3-year-old child. Patient Concern: A 3-year-old child with a low socioeconomic background presented with a main complaint of a painful wound on the gum, upper lip, and chest region. Diagnosis: Thorough history and examination revealed simultaneously occurring noma lesion extending from the inner labial mucosa to the upper lip and NF on the chest region on background anemia and malnutrition. Intervention: The patient was successfully treated with antibiotics, serial wound debridement, and supportive therapy. Outcome: The length of hospital stay was 6 weeks and there was uneventful healing. The patient is being followed up for complete resolution. Lessons: In this study, noma and NF were found to occur concurrently in a patient with malnutrition and anemia and Klebsiella species were the isolates in both wounds and could have been the common causative agent for both.

Dose Coverage Variation Caused by Setup Uncertainties in VMAT-TBI Treatment

Volumetric Modulated Arc Therapy Total Body Irradiation (VMAT TBI) offers several advantages over conventional TBI techniques, including reduced cost of the treatment room (a normal-sized vault versus a large shielded vault), increased patient comfort during treatment, lung sparing without the need for physical blocks, and a more homogeneous dose distribution. In VMAT-TBI treatment, plans at multiple isocenters are utilized to cover the entire body, and patients are positioned with the aid of image guidance. However, aligning the patient's entire body during setup can be challenging due to its pliability, and the setup time is heavily dependent on the tolerance allowed by the image guidance. Therefore, studying the variation in dose coverage caused by setup uncertainties in VMAT-TBI treatments can help optimize the clinical workflow and determine the optimal tolerance for patient positioning. New plans were generated to simulate the uncertainties that occur during treatment setup for each patient. These plans were created by shifting the original VMAT TBI plans at the head, chest, abdomen (or pelvis) isocenters by 5mm and 1cm in the left-right (LR), inferior-superior (IS), and anterior-posterior (AP) directions, respectively. Dose DicomRT files were exported, and the dose change due to the shifts was analyzed. The statistical quantification of the percentage of the body that experienced a dose change of over 2%, 5%, and 10% of the prescription due to the shifts from the original plans was calculated for all patients. Histograms were generated, showing the percentage of body getting dose change of 1-2%, 2-3%, 3-5%, 5-7%, 7-10%, 10-15%. The table below displays the percent volume receiving a dose change of 2%, 5%, and 10% of the prescription for a 5mm shift. Among the shift directions, the dose change is most sensitive in the IS direction, with similar impact observed the in LR and AP directions. Among different sites, the chest experiences the largest dose change, followed by the pelvis. For a 5mm shift in the IS direction, the average percent volume receiving a dose change of 2%, 5%, and 10% in the chest is 9.25%, 2.64%, and 0.27%, respectively. For a 1cm shift, the numbers are 12.23%, 6.75%, and 1.29%. In the pelvis (abdomen), these values are 9.03%, 1.67%, and 0.17% for a 5mm shift and 13.28%, 6.1%, and 0.85% for a 1cm shift. For head plans, the values are 2.72%, 0.9%, and 0.14% for a 5mm shift and 3.77%, 1.66%, and 0.53% for a 1cm shift. Accurate alignment in the chest region is crucial in VMAT TBI treatment. Efforts should be made to minimize shifts over 1cm in the IS direction.

A Retrospective Analysis of Immediate Postoperative Electron Radiotherapy for Keloids

The increasing incidence of keloid has seriously affected people's physical and mental health, and the postoperative recurrence rate is as high as 50-80%. Postoperative radiotherapy has been shown to significantly reduce the recurrence of keloid. Given the different treatment patterns in different institutions, we tried to analyze the data of patients in our center. We retrospectively analyzed the clinical data of 455 patients with 498 keloids treated in our institution from 2010 to 2017. All patients received a four-fraction electron radiotherapy with single dose of 4 Gy within 24 hours of surgery. The recurrence and adverse reaction of immediate adjuvant radiotherapy in these patients was evaluated. At the last follow-up date, 130 (26.5%) keloids had recurred after a middle follow-up of 68.1 months (42.6-129.9 months). The recurrence rates of 1 year, 3 years and 5 years were respectively14.5%, 18.7% and 21%. Recurrence rates vary depending on the keloid location. Among them, the recurrence rate of ear was low with 14% (43/298). Face, head neck and limbs was moderate with 38.8% (17/44) and 33.3% (8/24). Chest and Suprapubic region had a high recurrence rate of 50.8% (32/64) and 47.8% (33/69). Among the patients with recurrence, 16.9% (22/130) felt that their symptoms were better than before treatment, and 37.7% (49/130) were not worsen, which was acceptable. Multivariate analysis showed that age and duration of postoperative pruritus pain were correlated with recurrence (P = 0.036; P = 0.02). Radiotherapy combined with steroid and silicone reduced the recurrence rate compared with radiotherapy alone (P = 0.015). During treatment and follow-up, Infection occurred in 2 patients and cutaneous fibroblastoma in 1 patient. Our radiotherapy regimen can effectively reduce the recurrence rate and improve the symptoms of patients with keloids, especially ear keloids. High recurrence sites need further improvement of radiotherapy dose and fraction. Combination of multiple treatments is better than single treatment.

Non-contact human respiratory rate measurement based on two-level fusions of video and FMCW radar information

In this paper, we propose a robust respiratory rate (RR) measurement method using a two-level fusion of video and FMCW (frequency modulated continuous wave) radar information. Specifically, the video pixel displacement signals and the radar phase variation signals are extracted independently in shoulders and chest regions, which are then denoised by the serial-CEEMDAN (SCEEMDAN) method to obtain the corresponding single modal RR values. Next, at the feature level, the multivariate singular spectrum analysis (MSSA) is employed to extract the shared respiratory components in the video and radar modalities. Finally, at the decision level, we calculate the target RR value based on a signal-to-noise ratio (SNR) weighting of all single-modality and MSSA results. The proposed two-level fusion method is evaluated on a self-collected dataset, which includes 15 healthy subjects acting five challenging activities. The experimental results show that the proposed fusion method significantly outperform that of the single modality.

Prevalence and Infestation of Ectoparasite in Dabung Ducks in Some Districts in Bangkalan Madura

Identify the type of ectoparasite prevalence and infestation pattern of ectoparasite on Dabung duck in Bangkalan Madura regency. This research conducted from February to April 2022 with sample of 55 tails and identified in parasitology laboratory of the Veterinary Parasitology Division, Faculty of Veterinary Medicine, Airlangga University, Surabaya with the permanent mounting method without coloring. This research was a descriptive research, study survey, and cross sectional study analytical. The type of ectoparasite that attacked Dabung duck in Geger subdistrict, Dabung village and Galis subdistrict, Pekaan Dajah village were Menacanthus stramineus, Menopon gallinae, Lipeurus caponis with a prevalence of 100% from a sample 55 tails of Dabung duck. The analysis results of infestation pattern of ectoparasite infestation on Dabung ducks used correspondence text on the body regions of Dabung ducks in Geger subdistrict, Dabung village showed that M. stramineus ticks on chest region, M. gallinae in head neck region and L. caponis in wing region. Burneh subdistrict, Burneh village founded M. stramineus ticks in abdomen region, M. gallinae in head-neck region, and L. caponis in wing region. Galis subdistrict, Pakaan Dajah village showed that M stramineus lice in head-neck region, L. caponis in wing region and M. gallinae in spine region.

Thyroid Ultrasound Screening in Childhood Cancer Survivors following Radiotherapy

Introduction: Childhood cancer survivors (CCS) are at risk for radiotherapy (RT) late effects, including second malignancies. Optimal screening for differentiated thyroid cancer (DTC) in CCS post-RT remains controversial. We assessed the outcome of thyroid ultrasound (US) surveillance in CCS exposed to RT. Methods: 306 CCS were surveilled with thyroid US between 2002–2021. Surveillance was dependent on age at the time of primary diagnosis, interval from receipt of RT, and individual provider. Thyroid US, clinicopathologic features, and outcomes were described. Cutpoints of CCS RT age associated with varying risk of nodule presentation were explored. The selected cutpoints were used to define age categories, which were then used to compare thyroid nodule-related outcomes. Risk factors for thyroid nodule(s) were evaluated using multivariate logistic regression (odds ratio [OR] [95% confidence interval]). Results: The most common CCS diagnoses were leukemia (32%), CNS tumor (26%), and neuroblastoma (18%). Patients received TBI (45%) and/or RT to craniospinal (44%), chest (11%), and neck regions (6%). About 49% (n = 150) of patients had thyroid nodule(s). Forty-four patients underwent surgery, and 28 had DTC: 19 with American Thyroid Association (ATA) low-risk classification, 2 with ATA intermediate-risk, and 7 with ATA high-risk disease. Age cutpoint analyses identified cutpoints 3 and 10; hence, ≤3, >3 to ≤10, and >10 years were used. Of the 9 patients with intermediate- or high-risk disease, 8 were ≤10 years and 1 was >10 years at the time of RT. Female sex (OR = 1.62 [1.13–2.12] p = 0.054) and greater interval between RT and first US (OR = 1.10 [1.04–1.16] p = 0.001) were independent risk factors for nodule presentation. Conclusions: Thyroid US surveillance may be beneficial for CCS exposed to RT at younger ages (≤10 years) for earlier detection of DTC, prior to developing advanced metastatic disease.

A rare case of intracardiac hydatid cyst in the interventricular septum of the heart

Hydatid disease, also known as cystic , occurs due to tapeworm. It is an endemic disease in certain livestock-raising countries. Cardiac involvement is seen rarely, in around 0.5% to 2% of patients with hydatid disease. Interventricular septum is involved in around 4% of cardiac cases. According to Yaman et al., cardiac is a rare condition with a prevalence ranging between 0.5 to 2 percent. Here we report a case of a hydatid cyst in the heart. A 57-year-old male patient came to Gowri Gopal hospital, Kurnool, Andhra Pradesh on 29 July 2023 with complaints of shortness of breath for 6 months. He also complained about pain in the chest region for 6 months.ECG findings include sinus tachycardia, probable left atrial enlargement, left ventricular hypertrophy, nonspecific T abnormalities and ST elevation. Chest X-ray PA View revealed left mild fibrosis. Echocardiography showed a hydatid cyst sized 3x2.8 cm., grade I diastolic dysfunction and trivial mitral regurgitation. The patient underwent surgical excision and mitral valve repair. He recovered and was discharged successfully. We conclude that surgical resection, washout of the cavity with saline solution, and albendazole treatment can produce excellent outcomes in interventricular cardiac hydatid cyst cases.

AYURVED MANAGEMENT OF HERPES ZOSTER w.s.r. VISARPA: A CASE RE-PORT

In the present era there is many diseases are dominating, skin disease is the one of them and most common worldwide due to changes in lifestyle, faulty dietary habits, excessive uses of junk foods, modernisation. Visarp is one of them. The case presented here is 54-year-old female patient came with complaints of blisters over chest and back region with severe pain and burning and patient also consult a dermatologist and take allopathic medi-cine since last 2 weeks but no relief in symptoms then she came to at Rajkiya Ayurved Chikitsalaya, Moticho-ahtta Udaipur. Acc. to modern science visarpa correlates with herpes zoster with symptoms of Prodromal pain, itching, tingling, or burning feeling in an area of your skin. Assessment of the treatments was done based on im-provement of signs and symptoms of Visarpa.

Diabetic Retinopathy Severity Identification Using 3D Dual-Domain Attention Approach

The diabetic retinopathy (DR) is one of prominent reason of visual impairment among the people around the globe suffers from diabetes. Early and timely diagnosis of this problem can minimise the risk of proliferated diabetic retinopathy. Diabetes is caused by persistently high blood glucose levels, which leads to blood vessel aggravations and vision loss. Therefore, it becomes important to classify DR stages. An automated system for this purpose contains several phases like identification and classification of DR stages in fundus images. Deep learning techniques based on extraction of features and automatic extraction of features with a hybrid network have been presented for diabetic retinopathy detection. This method effectively identify diabetic retinopathy identification from the chest region by using the 3D Dual-Domain Attention Approach. The dual-domain attention module propised learns local and global information in spatial and context domains from encoding feature maps in Unet. Our attention module generates refined feature maps from the enlarged reception field at every stage by attention mechanisms and residual learning to focus on complex tumor regions. Experimental results show that the proposed network can identify the DR stages with high accuracy. The proposed method attains an F1-score of 91.34%, precision of 92.34%, accuracy of 98.65%, on the healthy retina, stage 1, stage 2, and stage 3 fundus images. Compared with other models, our proposed network achieves comparable performance.

Rib Stress Fractures and a Novel Muscle-Sparing Rib Fixation Plating in an Elite Tennis Player: A Systematic Review of the Literature and Case Report.

A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during a routine overhead movement. The patient was eventually diagnosed with 2 lower rib stress fractures. After unsuccessful conservative management, the player underwent an open reduction and internal fixation and autologous bone grafting of the sixth and seventh ribs with a muscle-sparing approach and was able to return to full competition. We present this case along with a systematic review of the literature regarding rib stress fractures, which included 6 separate online data sources (PubMed, EMBASE, Cochrane, CINAHL, SportDiscus, and Medline). The successful surgical intervention demonstrates a significant option for elite athletes who wish to return to competition but have been unable to with standard of care conservative management of rib stress fractures.

Differential privacy preserved federated transfer learning for multi-institutional 68Ga-PET image artefact detection and disentanglement

PurposeImage artefacts continue to pose challenges in clinical molecular imaging, resulting in misdiagnoses, additional radiation doses to patients and financial costs. Mismatch and halo artefacts occur frequently in gallium-68 (68Ga)-labelled compounds whole-body PET/CT imaging. Correcting for these artefacts is not straightforward and requires algorithmic developments, given that conventional techniques have failed to address them adequately. In the current study, we employed differential privacy-preserving federated transfer learning (FTL) to manage clinical data sharing and tackle privacy issues for building centre-specific models that detect and correct artefacts present in PET images.MethodsAltogether, 1413 patients with 68Ga prostate-specific membrane antigen (PSMA)/DOTA-TATE (TOC) PET/CT scans from 3 countries, including 8 different centres, were enrolled in this study. CT-based attenuation and scatter correction (CT-ASC) was used in all centres for quantitative PET reconstruction. Prior to model training, an experienced nuclear medicine physician reviewed all images to ensure the use of high-quality, artefact-free PET images (421 patients’ images). A deep neural network (modified U2Net) was trained on 80% of the artefact-free PET images to utilize centre-based (CeBa), centralized (CeZe) and the proposed differential privacy FTL frameworks. Quantitative analysis was performed in 20% of the clean data (with no artefacts) in each centre. A panel of two nuclear medicine physicians conducted qualitative assessment of image quality, diagnostic confidence and image artefacts in 128 patients with artefacts (256 images for CT-ASC and FTL-ASC).ResultsThe three approaches investigated in this study for 68Ga-PET imaging (CeBa, CeZe and FTL) resulted in a mean absolute error (MAE) of 0.42 ± 0.21 (CI 95%: 0.38 to 0.47), 0.32 ± 0.23 (CI 95%: 0.27 to 0.37) and 0.28 ± 0.15 (CI 95%: 0.25 to 0.31), respectively. Statistical analysis using the Wilcoxon test revealed significant differences between the three approaches, with FTL outperforming CeBa and CeZe (p-value < 0.05) in the clean test set. The qualitative assessment demonstrated that FTL-ASC significantly improved image quality and diagnostic confidence and decreased image artefacts, compared to CT-ASC in 68Ga-PET imaging. In addition, mismatch and halo artefacts were successfully detected and disentangled in the chest, abdomen and pelvic regions in 68Ga-PET imaging.ConclusionThe proposed approach benefits from using large datasets from multiple centres while preserving patient privacy. Qualitative assessment by nuclear medicine physicians showed that the proposed model correctly addressed two main challenging artefacts in 68Ga-PET imaging. This technique could be integrated in the clinic for 68Ga-PET imaging artefact detection and disentanglement using multicentric heterogeneous datasets.

Aesthetic transaxillary subpectoral placement of vagus nerve stimulator in children and young adults: A technical note

IntroductionVagus nerve stimulation (VNS) is a neuromodulation therapy for drug-resistant epilepsy (DRE), refractory status epilepticus, and treatment-resistant depression. The lead is tunneled into the subcutaneous space and connected to the generator, which is usually implanted in a subcutaneous pocket below the clavicle. Surgical complications in the chest region include skin breakdown or infection. An alternative approach is to perform a subclavear subpectoral implantation. In our surgical series, we report a new aesthetic implantation method for VNS generators in children and young patients: the transaxillary subpectoral placement. Materials and methodsFrom May 2021 to May 2023, 10 vagus nerve stimulation generators were placed subpectorally with a transaxillary approach by the authors. We considered operative time, surgical complications such as blood loss, infections, device migration, pain, and adverse events at follow-up. ResultsIn this surgical series, we reviewed all cases of subpectoral implantation of VNS generators in children and young adults at our institution in the last 2 years. All patients were treated with subpectoral Sentiva 1000 (Livanova PLC) insertion with axillary access by a neurosurgeon and a pediatric surgeon. The operative time was slightly longer compared to the traditional subcutaneous implant. All generators reported impedances within the optimal range. Blood loss was not significant and no other perioperative complications were reported. Patients and families were highly satisfied with the outcomes in terms of comfort and aesthetic results after surgery and at the last follow-up. No cases of infection occurred, and no malfunctions or displacements of the generator were registered at clinical follow-up. ConclusionThe transaxillary subpectoral placement of theVNS generator is an aesthetic and anatomic approach, which provides several benefits to children and young adults.

The Role of &lt;i&gt;Ayurveda Kshara Karma&lt;/i&gt; in the Management of &lt;i&gt;Keloid&lt;/i&gt;: A Case Study

Keloids, the benign dermal fibro-proliferative nodular lesions, which often tend to cause socio-economic and psycho-somatic stress pose a major challenge to clinicians till date. Apprehending and analyzing keloids under the concept of Vranagranthi described in the ancient science of Ayurveda and amalgamating the therapeutic principles explained in the classics can emerge as a ray of hope in the condition. Kshara karma (chemical cauterization) is an important para-surgical procedure which can be effectively incorporated into the treatment of wounds, Keloids and hypertrophic scars. An 18-year-old client who presented with overgrowth of scar tissue at the right anterolateral part of the chest region was treated at the OPD of the Division of Ayurveda, MAHE, Manipal. Kshara karma, which included the painting of Teekshna Apamarga kshara (ashes of Achyranthes aspera) for a duration of 100 Matra kala (approximately 2 mins), in two sittings brought about total regression of the Vranagranthi and the associated symptoms. No signs of recurrence were noticed during the follow-ups. Thus, Kshara karma can emerge as a promising solution in the stress-filled life of Keloid patients.

Evaluation of risk injury in pedestrians’ head and chest region during collision with an autonomous bus

Autonomous vehicle (AV) can detect pedestrians with high accuracy by utilising various sensors. Although it is an undesirable condition, traffic crashes can occur if any sensor misfunctions. This paper focuses to measure the severity of pedestrian injury during autonomous bus-pedestrian crashes via finite element simulation as pedestrians are very vulnerable in traffic crashes. Two types of vehicle impact were considered (frontal and side), and risk injury in head and chest region were evaluated. Effect of vehicle velocity (ranging from 5–10 m/s) on risk probability were evaluated. It was found that higher velocity caused more damage to pedestrian body, and frontal impact was more severe than the side impact. Maximum values of head-injury-criteria and chest acceleration were 248 and 36 g, respectively, when vehicle speed was 10 m/s. AV developers can use these results to implement a safer AV design and reduce pedestrian risk injury.

Deaths due to locomotive injuries in Jaffna district- eight-year retrospective study are we prepared to change our attitude?

Railway-related fatalities were rising and reported throughout the year. Reckless behavior and using the train as a suicide tool are the primary cause of these tragic deaths.A retrospective descriptive study based on decedents of locomotive trauma was carried out at the JMO office, Jaffna, from January 2015 to January 2022.Thirty decedents were included in this study. Among them, twenty-nine were male, and the age of the individuals ranged from 16 to 73 years. Fifty-seven percent(n=17) of them were between 20 to 40 years. Most were married (57%. n=17) and unemployed (57%, n=17). There were 20(67%) accidents, 09(30%) suicides, and manner could not be ascertained in one (03%) death. Among the accidental deaths, 60%(n=12) were due to vehicle-train collisions, and 80%(n=16) of the deaths occurred at railway crossings. Most (67%, n=06) of the suicidal deaths happened alongside the railway track, away from stations, or rail crossings. All the decedents in both accidents (100%, n=20) and suicides (100%, n=09) had lacerations over the head and neck area. Hundred percent (n=20) of accident cases sustained fractures of the head and neck, 33% (n=03) One (10%) case of decapitation was noted in the self-harmed group. Over the chest region, more than 50% of the deaths had fractures in both accidents (80%, n=16) and suicides (56%, n=05). One (10%) case of transection of the body at the level of the chest was seen in a suicide case. Transection of the body at the level of the abdomen was seen in the accident (05%, n=01) and suicide (10%, n=01). The distribution and nature of injuries were almost identical in both upper and lower limbs. The brain is the internal organ that is primarily affected in both accidents (90%, n=19) and suicides (78%, n=07). In eighty percent (n=24) of the cases cause of death has been determined as craniocerebral injuries, while in 20% (n=06) of the cases, multiple injuries were given as the cause of death.The majority of railroad deaths were accidental. Transections of the neck and chest were commoner in suicides than in accidents. The nature of external injuries and internal organ damage were not showing a significant difference in accidents and suicides.

A surgical case of abscess of the sternal region due to synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome

BackgroundSynovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare chronic inflammatory disorder characterized by cystic skin disease, aseptic osteomyelitis, and hyperostosis. It is rarely associated with subcutaneous abscesses in the anterior chest wall. Herein, we describe a case of a sternal abscess due to SAPHO syndrome that was successfully treated with debridement.Case presentationA 62-year-old female patient presented with a chief complaint of a mass in the right anterior chest region. Computed tomography showed the presence of an abscess around the sternum. Magnetic resonance imaging revealed inflammation of the spine. The patient also had a history of palmoplantar pustulosis, raising the suspicion of SAPHO syndrome; however, sternoclavicular joint infection could not be excluded. Abscess drainage and wall debridement were performed. However, reaccumulation of the abscess occurred early after surgery. Although culture tests of the abscess were negative, histopathological examination of the abscess wall revealed a tuberculoid granuloma. Owing to unsuccessful open wound management, debridement of the anterior thoracic skin and abscess wall and partial sternal resection were performed 2 months after the initial surgery. Negative-pressure wound therapy (NPWT) was applied for 4 weeks after surgery, followed by immunosuppressant administration. The patient underwent split-thickness skin grafting on postoperative day 65 and had no abscess recurrence at 18 months post-surgery.ConclusionsAbscesses in the sternal region caused by SAPHO syndrome can be difficult to differentiate from infectious arthritis. Therefore, drainage and debridement should be considered if infection cannot be excluded.