Left Deviation Research Articles

NEUMOCÉFALO INTRAVENTRICULAR ESPONTÁNEO ASOCIADO A AFASIA TRANSITORIA: REPORTE DE CASO Y REVISIÓN DE LA LITERATURA

Introduction: Pneumocephalus or the presence of air in the cranial cavity is common after a craniotomy and in patients with traumatic brain injury; however, its spontaneous appearance is extremely rare. So far, very few cases of spontaneous intraventricular pneumocephalus have been reported. We present the case of a patient who developed spontaneous intraventricular pneumocephalus, which required a craniotomy for surgical correction. Clinical Case: A 59-year-old female patient with a history of left suboccipital craniotomy and resection of the left vestibular Schwannoma who after 2 years presented headache of 3 weeks duration and aphasia of expression. On examination: Mild expressive aphasia, surgical scar with no evidence of cerebrospinal fluid (CSF) leakage. Brain tomography (CT) showed pneumoventricle in the frontal and temporal horns of the left lateral ventricle and deviation from the midline; radionuclide cisternography was negative for CSF fistula and CSF analysis was normal. A left subtemporal craniotomy was performed, finding a bone defect in the petrous portion of the temporal bone above the internal auditory canal associated with a meningocele of the medial base of the skull, which was sealed with bone wax, fat, fascia lata, and biological glue. Conclusion: The first case of spontaneous intraventricular pneumocephalus without identifiable CSF fistula is described, which made this case extremely rare. The treatment performed was a surgical correction of the meningocele through a subtemporal extradural approach, and the patient presented a favorable evolution with the improvement of the aphasia. Keywords: Pneumocephalus, Aphasia, Meningocele, Craniotomy, Temporal Bone (source: MeSH NLM)

Rompi Penyedia Informasi bagi Penyandang Tunanetra Menggunakan Multisensor HC-SR04

Various electronic travel aids for people having visual impairment have been developed based on ultrasonic object detection employing the HC-SR04 ultrasonic proximity sensor. However, most of them do not consider blind spots where harmful objects cannot be detected. This study discusses the development of a vest that can detect objects in front of the blinds more widely and provide sound alert if an object in front is detected. This detector was developed based on an Arduino Uno equipped with five HC-SR04 ultrasonic sensors, and a mini DFPlayer module. In addition, blind area analysis of sensor detection is carried out to overcome objects that are not detected by similar studies. Horizontally, this travel vest sweeps objects up to 150 cm in distance with a 25o right or left angle deviation from forward direction. Vertically, object detection reaches up to 150 cm in distance with both upward and downward deviation of 30o from the vest.

Anthropometric Evaluation of Volume of Maxillary Sinus and Nasal Septum Patterns as an AID in Personal Identification Using CBCT-A Retrospective Study

Aims: To determine the reliability and accuracy of maxillary sinus volume and nasal septum patterns in personal identification in forensics using CBCT (cone beam computed tomography).
 Study Design: Retrospective Study
 Place and Duration of Study: Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital Nagpur, from September 2019-December 2019.
 Methodology: 110 CBCT scans of bilateral maxillary sinuses and nasal septum images were retrospectively obtained from the Oral Medicine and Radiology database (68 men and 42 females). The study was divided into two groups based on age. Group
 -I consists of 58 CBCT scans taken between the ages of 20 and 40, while Group -II consists of 52 CBCT scans taken between the ages of 41 and 80. The height, breadth, and depth of the maxillary sinus were measured linearly. The nasal septum was classed as simple deviation to the right or left, sigmoid type, reverse sigmoid type, and straight based on the septa's deviations. Each person's combined maxillary sinus and nasal septum pattern was documented.
 Results: The difference in maxillary sinus volume between two age groups was significant (P<0.5). In age group I, there was a substantial change in the left deviation pattern, and there was a significant change in the reverse sigmoid pattern in males and the straight nasal septum pattern in females. With whatever nasal septum configuration, there were no volumetric alterations(P>0.5).
 Conclusion: In future, further research will be needed with a larger number of images to compare in order to arrive at a definitive identification.

Acute posterior reversible encephalopathy syndrome (PRES) in setting of interferon-beta use: case presentation with reduction of edema in 72\u2009h after cessation of interferon-beta therapy with sub-clinical inflammation

BackgroundPosterior reversible encephalopathy syndrome (PRES) represents a transient change in mental status with associated vasogenic edema of cortical and subcortical brain structures. It is often attributed to multifactorial etiology including hypertension and altered hemodynamics and disruption of vessel integrity. Patients with autoimmune disease and certain immune modulator therapies are at greater risk.Case presentationA 54-year-old female with past medical history of well-controlled multiple sclerosis on interferon-beta since 2013, presented with witnessed tonic colonic seizure. She also was noted to demonstrate left gaze deviation and left-sided hemiparesis. MRI fluid-attenuated inversion recovery sequence showed hyperintensity of the subcortical U fibers, concentrated in the occipital, parietal lobes and frontal lobes. Systolic blood pressure was 160 mmHg on arrival. The patient was started on seizure prophylxis and Interferon beta was discontinued. The patient’s mentation, seizures and hemiapresis significantly improved in next 72 h with tight blood pressure control, and had notble improvement on MRI imaging and inflammatory markers. Lumbar puncture CSF results were devoid of infectious and autoimmune pathology.ConclusionsA middle-aged female with multiple sclerosis who was on chronic IFN-beta presented to the emergency room with a witnessed tonic-clonic seizure, with MRI T2 FLAIR imaging consistent with PRES. She had notable clinical improvement with decreased edema on imaging and improved inflammatory markers 72 h after cessation of IFN-beta therapy.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

BackgroundUreterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options.Case presentationWe report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient’s hemodynamic status gradually improved.ConclusionsAlthough ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

ФОРМИРОВАНИЕ СИГНАЛОВ ТЕКУЩИХ ТРАЕКТОРИЙ В АВТОМАТИЗИРОВАННОЙ СИСТЕМЕ МОДАЛЬНОГО УПРАВЛЕНИЯ ДВИЖЕНИЕМ БЕСПИЛОТНЫХ ТРАНСПОРТНЫХ СРЕДСТВ В УСЛОВИЯХ ОТКРЫТЫХ ГОРНЫХ РАБОТ

The article defines the object of control in the form of signals of current trajectories (CT), along which unmanned vehicles (UMV) move. It describes the subject field of research – the principle and technology of forming the signals generated by the computer-aided system for modal controlling the UMVs during their movement along quarry routes. In order to develop procedures for identifying an upcoming trajectory of the UMV when bypassing some static or dynamic obsta-cles, conditions are included in the software and hardware complex for the formation of the UMV corresponding trajectory direction based on assigned sinusoidal-like frequency-time-dependent functions (chirp signals) responsible for redirecting the UMV along a particular trajectory. The cor-responding chirp signals for the left and right deviation trajectories of the UMV are fixed. The no-tion of sporadic disturbances and force-modal transient processes (TP) is introduced. There has been also reviewed a new description of TP, whose signal contains the variable frequency changing by a certain law depending on the direction and nature of a CT deviation and the environment of UMV. The essence and reasons for the effects of structural and parametric nonstationarity of the control object (CO) are explained. Analytical and graphical interpretations of the emerging non-stationarity caused by the introduction of additional stationary and dynamic-type poles into the CO are presented. It is noted that the stationary poles characterize the inertia of the aperiodic components of the trajectory chirp signals, and the dynamic ones determine the permanently varied frequency of transients (their chirp form). The properties of both sporadic and forced-modal TPs’ poles localized on the complex plane are characterized. Calibration characteristics are determined that establish a relationship between the instantaneous frequency of TP and the metric deviation of UMV CT relative to the nominal axial trajectory. The difference between the procedures of localization and re-localization of poles for modal upward and downward reverse TP, on which the efficiency and safety of UMV moving along the quarry routes, depends, is functionally identified and considered. All the procedures mentioned above make it possible to monitor online and control effectively the dynamics of operative and safe UMV trajectory moving along technological quarry routes in open pit mining

Unilateral Isolated Inferior Rectus Palsy: A Rare Presentation of Ocular Myasthenia Gravis

Ocular Myasthenia Gravis with unilateral isolated Inferior Rectus palsy and no ptosis is rarely encountered. We present a case of 25-year-old male with sudden onset binocular diplopia and no features of ptosis. Deviations in primary gaze were 3-8 Prism Dioptre (PD) with left hypertropia. Right and left head tilt deviations were 5PD and 3PD left hypertropia respectively with increase in hypertropia in left gazes. Acetylcholine receptor binding antibodies were found to be raised. Repetitive Nerve Stimulation showed decreased amplitude. Patient was managed with Oral Pyridostigmine with excellent symptomatic relief and drug tolerance. No features of Myasthenia Gravis (Systemic or Ocular) were noted on follow-up.

Anaesthesia management of a case of huge neck mass due to cervical spine chondrosarcoma with distorted anatomy

Chondrosarcoma is the tumor which affects bone and soft tissue with only 2% spinal involvement. Anesthetic management becomes challenging in patients with cervical chondrosarcoma. Here, we are presenting a case of huge neck mass due to cervical spine chondrosarcoma in 70 year old male hypertensive patient. The patient has distorted anatomy with mucosal edema with left tracheal deviation and compression from right side. Awake Nasal Fiberoptic intubation was done with cuffed ETT no 8. The neck mass was removed and Anterior Cervical Discectomy and Fusion (ACDF) with bone grafting. The case was managed with adequate analgesia, replacement of fluids and Blood and Blood products. Considering complex cervical spine surgery and airway edema the patient was shifted to Surgical Intensive Care Unit (ICU) for elective ventilation and advanced monitoring. After serial ABG and proper weaning the patient was extubated next morning smoothly. Extensive preoperative evaluation, planning, clinical judgement and skilled experienced personale are essential for proper execution of difficult airway cases.

Prediction of sites of wall thickening and abnormal late enhancement on cardiac CT and magnetic resonance imaging using electrocardiography findings in patients with confirmed cardiac amyloidosis

Abstract Background Left ventricular (LV) wall thickening and diastolic dysfunction on a transthoracic echocardiogram (TTE) without high voltage R wave in V5 leads on ECG leads to a diagnosis of cardiac amyloidosis. A final diagnosis is made by endomyocardial biopsy. However, amyloid sometimes invade the right ventricle (RV), and left (LA) and right (RA) atria to cause ECG changes such as sick sinus syndrome (SSS), arrhythmia, and QRS wave axis deviation. Purpose To predict sites of wall thickening and abnormal late enhancement (LE) on cardiac computed tomography (CT) and magnetic resonance imaging (MRI), suggesting amyloid invasion, using cardiac rhythm and other ECG findings in patients with cardiac amyloidosis confirmed by biopsy. Methods A total of 26 patients (11 females) with suspected cardiac amyloidosis, showing LV wall thickening by TTE without a high voltage R wave in V5 leads on ECG, underwent cardiac enhanced CT. LV wall thickening on CT in the early phase led to late phase acquisition to detect LE. Five patients (3 females, mean age 73 years) were diagnosed with cardiac amyloidosis: complicated multiple myeloma, 2; senile ATTR (transthyretin) amyloidosis, 1; immunoglobulin light chain (AL) amyloidosis 1; and transthyretin mutation, 1. Four patients underwent cardiac MRI. Results Two patients (cases 1 and 2) had SSS (junctional rhythm), one had atrial tachycardia, and the remaining two (cases 4 and 5) had a normal sinus rhythm. In case 1, ECG showed a left axis QRS wave deviation, no low voltage R wave in limb leads and a mild LA load. Wall thickening in the basal interventricular septum (IVS), LV inferior-posterior wall, LA on CT, LE in the endocardium in whole LV, RV, and RA on CT, and LE in the endocardium in whole LV, RV, LA, and IVS on MRI were observed. In case 2, ECG showed a normal QRS wave axis, no low voltage R wave in limb leads, no LA load, wall thickening in whole LV, RV, LA, and IVS on CT, and unclear (CT) or no (MRI) LE. In case 3, ECG showed a normal QRS wave axis, with low voltage R wave in limb leads, no LA load, wall thickening in LA and basal IVS on CT, LE in LA and basal IVS on CT, and LE in LA only on MRI. In case 4, ECG showed left axis QRS wave deviation, a low voltage R wave in limb leads, and no LA load, wall thickening in the LA and RV moderator band on CT, unclear LE on CT, and LE in whole LV, endocardium in the RV, and whole IVS on MRI. In case 5, ECG showed a right axis QRS wave deviation, low voltage R wave in limb leads, and a mild LA load, wall thickening in the IVS, LV lateral wall, LV anterior wall, RA, RV outflow tract, and RA appendage, and no LE on CT (MRI not performed). Conclusions This pilot study of a few patients with cardiac amyloidosis revealed few links between cardiac rhythm and other ECG findings with sites of wall thickening and abnormal LE. However, a longer-term study of more patients may lead to detecting an association between these variables with this methodology. Funding Acknowledgement Type of funding sources: None.

Spontaneous Orbital Hematoma: A Rare Complication of Vaginal Delivery

A 34-year-old healthy woman, gesta2 para1, complains, after an uncomplicated, term, vaginal delivery, of left ocular pressure associated with double vision. On physical examination, an orbital asymmetry with left eye proptosis and inferior deviation was observed. Ophthalmological examination revealed a left vertical diplopia with normal visual acuity (10/10, bilaterally).

The Array Optimization of Vertical Axis Wind Turbine Based on a New Asymmetric Wake Model

With the increasing demand for wind energy, the vertical axis wind turbine (VAWT) is attracting more and more attention. In order to design the VAWT array for better performance, the VAWT wake model needs to reflect the wake characteristics well. Based on the asymmetric wake characteristic, a new VAWT wake model is proposed in this paper, which is a combination of two semi Gaussian functions with different deviations, and can be called the “double semi Gaussian functions wake model”. The model is simple and has only four parameters (mean, amplitude, left deviation and right deviation). Compared with the traditional Gaussian and Top-hat model, this model can better reflect the asymmetric characteristic of the VAWT wake. In particular, it can describe the behavior of wake merging in the case of counter-rotating twin turbines. Based on this wake model, the velocity field of VAWT array can be reproduced accurately. The goal function is mainly based on the performance of a basic array unit, and it can ensure the rapidity of the optimization process. The optimal arrangements under two different criteria are analyzed. Moreover, the truncation ratio is introduced to ensure that the downstream turbine works at the rated condition, and the optimal arrangements under different truncation ratios are analyzed. In this paper, the proposed wake model provides a good choice for the preliminary design of the VAWT array, and some relevant suggestions on the array arrangement have been put forward.

Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BackgroundAutonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor.Case presentationThe patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started.ConclusionsAD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

Two heads are not always better than one: Craniofacial and axial bifurcation in cheloniid embryos and hatchlings (Chelonia mydas and Caretta caretta).

Morphological data on craniofacial and axial bifurcation in sea turtles is not well documented in the literature. Here, we use micro-computed tomography (μ-CT) imaging to describe the body, skull, and vertebral morphology in axially-bifurcated cheloniid sea turtle embryos and hatchlings (Chelonia mydas and Caretta caretta) from south Florida beaches. We describe three types of craniofacial and axial bifurcations: bifacial, bicephalic, and bicephalic with biaxial duplication ranging from facial bones to the sacrum. We predicted smaller body dimensions in bifacial and bicephalic embryos and hatchlings compared with their normal counterparts. In addition, we hypothesized that bicephalic individuals would have greater rostral deviation angles than bifacial animals, and that vertebral dimensions would vary between the control and anomalous embryos and hatchlings. Among hatchlings (developmental Stage 31), we found that maximum curved carapace length and curved carapace width were greatest in the control specimens when compared with the anomalous specimens. Overall, we found that rostral deviations were smaller in bifacial animals compared with their bicephalic counterparts. Right and left rostral deviations were symmetrical or nearly symmetrical in all bifacial and bicephalic specimens. Among C. caretta, we found that bicephalic animals had greater standardized vertebral measurements than their bifacial conspecifics. In bifacial animals, bifurcation extended to either the frontal or parietal skull bones, while duplication extended to C5 vertebrae and T8 vertebrae in bicephalic animals. This study provides an in-depth description of anatomical alterations associated with these abnormalities. Prognosis of these organisms is poor; however, understanding the prevalence of these malformations can allow for better assessments of population health, as numerous environmental factors are known to lead to these changes.

Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

While the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

WHEN NOT TO NEGOTIATE RHYMES WITH TAKING RISKS

Objective: The ESH/ESC 2018 guidelines recommend lifestyle modifications in subjects with high-normal blood pressure (BP) values and low-moderate cardiovascular risk. The purpose of this study was to assess whether a population of subjects with high-normal BP could develop arterial hypertension or organ damage over a three-year follow-up. Design and method: In this study, 98 subjects (60 M), with mean age 42 ± 12.7 years, were randomized. In 34 subjects, silent signs of organ damage were highlighted, in the remaining 64 no anomalies were highlighted. ABPM (Ambulatory Blood Pressure Monitoring) was applied to the 64 subjects and, repeated annually. Results: Twelve of the 64 subjects, during the 3 years of follow up, became hypertensive grade 1, with no evidence of organ damage; 15 presented echography changes (rhythm disturbances, left anterior hemiblock, left axial deviation, left ventricular hypertrophy); 2 paroxysmal AF and only 1 subject, was subjected to tomography computerized investigations with evidence of adrenal adenoma. The remaining 34 subjects, with only lifestyle changes, presented, BP values controlled both by clinical measurement and by ABPM. Conclusions: Our results, in a small sample, show an evolution of high-normal BP in arterial hypertension grade 1, as well as the appearance of organ damage. The follow up of subjects with high-normal BP, must be constant over time, with visits, also carried out by dedicated nursing staff. In addition, a complete initial assessment would be desirable, for the exclusion of concomitant pathologies.

A profit jump inventory model for imperfect quality items with receiving reparative batch and order overlapping in dense fuzzy environment

This paper presents an economic order quantity (EOQ) inventory model for imperfect quality items with receiving a reparative batch and order overlapping in a dense fuzzy environment Here, the imperfect items are identified by screening and are divided into either scrap or reworkable items. The reworkable items are kept in store until the next items are received. Afterwards, the items are returned to the supplier to be reworked. Also, discount on the purchasing cost is employed as an offer of cooperation from a supplier to a buyer to compensate for all additional holding costs incurred to the buyer. The rework process is error free. An order overlapping scheme is employed so that the vendor is allowed to use the previous shipment to meet the demand by the inspection period. However, we assume the total monthly demand quantity as the dense fuzzy number because of learning effect. Moreover, first of all a profit maximization deterministic model is developed and solve by classical method. Fuzzifying the final optimized function via dense fuzzy demand quantity we have employed extended ranking index rule for its defuzzification. During the process of defuzzification we make an extensive study on the paradoxical unit square of the left and right deviations of dense fuzzy numbers. A comparative study is made after splitting the model into general fuzzy and dense fuzzy environment. Finally numerical and graphical illustrations and sensitivity analysis have been made for its global justifications.

Descripción del patrón y el recorrido de la apertura mandibular en niños con dentición mixta

Introducción: El recorrido de la apertura mandibular y las desviaciones que se presentan al abrir la boca, pueden ser un parámetro excelente para detectar de manera oportuna cualquier anomalía a nivel de del complejo temporomandibular. El recorrido normal de la apertura mandibular en el adulto se encuentra entre los 53 y los 58 mm, con un promedio de 40 mm, un niño a partir de los 7 años puede lograr estos promedios de apertura mandibular. Solo el 1.2% de los adultos jóvenes abren menos de 40 mm, por lo tanto una apertura mandibular menor puede ser calificada como restringida de acuerdo a la edad y la talla del paciente. Con el objetivo de determinar el patrón y el recorrido de la apertura mandibular con un método de diagnóstico validado, en un estudio observacional, descriptivo, se incluyeron 139 niños sanos con dentición mixta completa de 8 a 12 años de edad. Los resultados demostraron que el 30.9% de los niños presentó un patrón de apertura mandibular alterado, siendo la desviación mandibular izquierda corregida la más frecuente (16.5%), la apertura mandibularl promedio fue de 50±4.77mm, y las lateralidades; derecha 8.3±3,1 mm, y la izquierda 8.45±3.00mm. Lo cual permite concluir que la apertura mandibular en la dentición mixta, se encuentra dentro del recorrido descrito para los adultos en la literatura, con un porcentaje considerable de alteración en el patrón de apertura mandibular, lo cual puede ser considerado uno de los primeros signos de alteración en la función del sistema Temporomandibular.

Bioelectrical impedance vector analysis (BIVA) in university athletes

BackgroundBioelectrical impedance vector analysis (BIVA) is able to identify differences in hydration status and body composition components, such as body cell mass (BCM) by means of plotting individuals in ellipses, when comparing groups with different characteristics.ObjectiveCompare the confidence and tolerance ellipses of BIVA in individual and team sports athletes with a non-athlete reference population.Design and participantsOne hundred sixty-seven college athletes (team sports: 117 athletes, individual sports: 50 athletes) aged between 18 and 35 years. Bioelectrical impedance was used to measure resistance (R) and reactance (Xc) values that were used in the BIVA analysis to identify hydration status and BCM, respectively. Hotelling’s t-test was used to identify differences between groups in the confidence ellipses and the comparison was made with a non-athlete Italian reference population.ResultsThere were no differences between male team sports and individual athletes (p = 0.151) and for female athletes (p = 0.624). Most athletes were located in the 50% tolerance ellipses, indicating adequate hydration. Compared to the Italian a non-athlete population, athletes of both sexes presented left impedance vector deviation in the minor axis (Xc) of the tolerance ellipses, indicating higher BCM.ConclusionThere were no differences in BIVA between team and individual sports athletes, but most athletes presented an adequate hydration state and, compared to a non-athlete population, the athletes of the present study presented higher BCM.

Does the Side of Deviation of Nasal Septum have Concomitant Predictive Relation with Side of Sphenoid Septum Deviation?

Introduction: The asymmetric hidden sphenoid sinuses get separated by a bony septum which rarely lies in the median plane. Deviated Nasal Septum (DNS) formed by bony and cartilaginous parts can be identified by clinical examination. Paucity of literature about the concomitant side deviation of both the septum, has been found. Aim: To find the predictive relation between the side deviation of nasal and sphenoid septum. Materials and Methods: A cross-sectional study was undertaken with coronal CT image sets of paranasal air sinuses at Chennai Medical College Hospital and Research Centre, Trichy, Tamil Nadu. Images of subjects above 18 years of age without chronic sinusitis blocking Infundibulo-osteal complex, space occupying lesion, previous sinonasal surgeries, and inflammatory polyps were included from December 2016 to January 2017. In 130 source image sets, side deviation of the nasal septum and sphenoid septum were observed and categorised. The data were analysed using IBM SPSS Statistics for Windows, version 26 and a p-value of <0.05 was considered as statistically significant. The agreement of corresponding side deviation of nasal and sphenoid septum was tested using chi-square and Kappa test. Results: The DNS was noted in 94.6% (123 of 130) of images. The right, left and median deviations were observed in 50.8% (66 of 130), 43.8% (57 of 130) and 5.4% (7 of 130), respectively. The sphenoid septum deviations of right, left and median was noted in 43.1% (56 of 130), 36.9% (48 of 130), and 19.2% (25 of 130), respectively. The right deviated sphenoid septum was seen in 39 out of 66 right DNS images and left deviated in 29 out of 57 left DNS images. Chi-square showed statistical significance (p-value=0.0031) and kappa [0.231 (SE of kappa=0.064, 95% confidence interval: from 0.104 to 0.357)] was assessed as a fair agreement between the observed values. Conclusion: The fair agreement between sides of DNS with position of sphenoid septum concludes that DNS could be a probable predictor of position of sphenoid septum.

Anesthesia for Osteosynthesis of Femur in a Cane Toad (Rhinella marina)

Background: The taxonomic order Anura is composed of frogs and toads, with approximately 6000 species worldwide, of which 900 species are found in Brazil. Rhinella marina, popularly known as “sapo-cururu,” is the most commonly found frog in Brazil. Although most of these animals are found in research laboratories and zoos, they are increasingly being reared as pets. Therefore, sedation or anesthesia is often necessary for these animals to facilitate medical care, complementary examinations, or surgical procedures. However, there are only a few reports of anesthesia in frogs. Therefore, the present report aimed to describe the anesthetic protocol for femoral osteosynthetic surgery in an adult cane toad.Case: An adult cane toad presented with a history of difficulty in moving the left hindlimb and loss of limb movements. Radiography showed a simple, complete, transverse, and closed average shaft of the left femur and bone shaft fracture deviation. The animal was referred for an osteosynthetic surgery to stabilize the fracture. Animal restraint was performed using humidified gloves on the operating table. As premedication, ketamine, meloxicam, and morphine were administered, and general anesthesia was induced with isoflurane through a face mask. The anesthesia was maintained with isoflurane through a drip on the animal's back for cutaneous absorption. Lidocaine (2%) anesthetic gel was applied on the incision line to complement the somatic analgesia. The fracture was fixed using an intramedullary Kirschner pin. The heart rate was measured based on the beep of the arterial pulse using a Doppler ultrasonic device, respiratory rate was recorded by visual observation of the animal’s respiratory motion, and body temperature was assessed using an esophageal digital thermometer—all of these remained stable during the procedure. Morphine, enrofloxacin, and meloxicam were administered postoperatively. The animal was discharged from the hospital seven days after the surgery, and 14 days later, the animal was deemed clinically stable with favorable wound healing.Discussion: Toads use their skin to breathe and maintain osmotic balance. Therefore, their skin is extremely sensitive to dehydration, requiring constant wetting. General anesthesia in amphibians is recommended for prolonged and painful procedures, as in the present case. Different anesthetics, analgesics, and associated drugs may be used. Ketamine is often used for chemical restraint in amphibians, and the induction and recovery times may vary due to sensitivity and drug resistance. Inhalational anesthesia with isoflurane may also be effective; in the present case, the anesthetic was administered using a mask placed on the frog’s skin, without any irritation. Analgesia is essential for any animal, and amphibians have opioid receptors that may be used as targets of non-steroidal anti-inflammatory agents. As indicated for all species, the animal was monitored throughout the procedure. Assessment of heartbeat is the simplest way to monitor anesthesia using Doppler (on the heart or throat); in the present case, was placed on the axillary artery for clear auscultation. In addition, other parameters, such as temperature and primary respiratory movements, were monitored. Anesthetic recovery can take hours or even days, whereas excretion depends on the metabolic rate of each animal. In the present case, recovery was observed 4 h after completion of the procedure, using fresh water on the animal’s body to accelerate recovery, as indicated in the literature. This case demonstrated that anesthesia and medications used for anesthesia induction, maintenance, and recovery are safe in toads. For cane toads, during femoral osteosynthesis, this anesthetic procedure has never been described previously in the literature. Finally, such information can aid veterinarians in performing safe and adequate analgesic and anesthetic procedures for the wellbeing of animals.Keywords: amphibians, analgesia, surgery, skin absorption.