Thumb Of Left Hand Research Articles

MUSCULOSKELETAL DISORDERS OF HAND IN HEALTHCARE WORKERS: A CROSS-SECTIONAL STUDY

Musculoskeletal disorders (MSDs) of the hand negatively affect the hand's functionality and lead to long periods of sick leave. MSDs of hand are associated with work absences and productivity loss more than other Musculoskeletal disorders (MSDs). The study aimed to assess the discomfort of hands in healthcare workers (HWs) and the relationship between demographics and discomfort. 217 HWs selected randomly in the Trakya University Hospital from Dec. 2019 to Feb. 2020 participated in this cross-sectional study. The study was carried out through a questionnaire for sociodemographic characteristics and Cornell Hand Discomfort Questionnaires for MSDs. SPSS v.24.0 software was used to analyze the data. The most common discomfort scores were in the right-hand wrist (1.79), right-hand thumb joint, right-hand thumb (1.65), left-hand wrist (0.86), and left-hand (index, middle, half ring) (0.87), and left-hand thumb (0.80) areas respectively. Right-hand discomfort scores were relatively higher than left-hand. While an association was detected between the level of education, years of work, and MSDs of hand, there was no relation with gender, marital status, or profession. The findings from the study indicate MSDs of hand among HWs. Further research is recommended to detect the prevalence and prevention of MSDs of hand on HWs.

Chemotherapy casted shadow: Mees' and Beau's lines.

A 28-year-old female received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy to treat diffuse large B-cell lymphoma. She completed her treatment (see Figure 1) 3 weeks before this photograph. Examination showed multiple white lines on the fingernails, known as Mees’ lines. Mees’ lines are transverse, nonblanching white bands that run parallel to the lunula around the entire nail bed. The lines matched the start of each cycle, with the distance between the lines representing the time interval between cycles. In this patient, four lines can be identified with consistent intervals on the body of her nails, while the fifth and sixth lines are seen at a more significant distance at the nail-free edge. This might be related to treatment delay after cycle 2 (40 days) due to intensive care unit admission with sepsis and coronavirus disease (COVID-19) pneumonia. In the third and fourth cycles (the outer lines on the nail bed), we can see roughness and indentation (on the left-hand thumb and index finger), representing Beau's lines. Beau's lines are transverse depressions in the nail plate caused by transient cell division interruption in the proximal nail matrix. Both lines are commonly seen in patients with a history of chemotherapy exposure. The authors declare they have no conflicts of interest. The photograph was taken with the patient's informed consent and in accordance with the declaration of Helsinki The authors received no specific funding for this work. Informed consent was obtained. The authors declare that the data supporting the findings of this report are available within the article.

Association between Dermatoglyphics and Early Childhood Caries among Preschool Children: A Pilot Study.

Context:Primary teeth and dermal ridges form around the same time in utero. Hereditary and intrauterine factors affecting the formation of primary teeth may affect dermal ridge formation also.Aims:This pilot study was conducted to see the association between dermatoglyphics and dental caries among preschool childrenSettings and Design:Cross sectional, case–control design.Materials and Methods:One hundred, healthy preschool children aged 3–6 years attending private kindergarten participated. They were divided equally into caries active and caries free group based on the oral examination. The fingerprint patterns were collected for all the fingers of both hands of children and categorized as loop, whorl or arch for each finger of the right and left hand.Statistical Analysis Used:Statistical analysis was performed using the Chi-square test and Independent t-test to compare the dermatoglyphics patterns between the caries-free group and the caries active group for each variable.Results:(1) Dental caries susceptibility of an individual decreases with an increase in the incidence of loop pattern, followed by whorl pattern and arch pattern; (2) Left hand loop was found statistically significant (P = 0.03); (3) Presence of loop pattern in left hand thumb predicts significantly lower risk of caries, whereas the presence of arch pattern in left hand thumb predicts significantly high risk of early childhood caries (P = 0.01).Conclusions:The caries free status of a preschool child increased with the presence of loop on the left thumb.

Fingerprint pattern of medical students: A study on left hand thumb

Fingerprint pattern of medical students: A study on left hand thumb

Biometric identification using fingertip electrocardiogram signals

In this research work, we present a newly fingertip electrocardiogram (ECG) data acquisition device capable of recording the lead-1 ECG signal through the right- and left-hand thumb fingers. The proposed device is high-sensitive, dry-contact, portable, user-friendly, inexpensive, and does not require using conventional components which are cumbersome and irritating such as wet adhesive Ag/AgCl electrodes. One of the other advantages of this device is to make it possible to record and use the lead-1 ECG signal easily in any condition and anywhere incorporating with any platform to use for advanced applications such as biometric recognition and clinical diagnostics. Furthermore, we proposed a biometric identification method based on combining autocorrelation and discrete cosine transform-based features, cepstral features, and QRS beat information. The proposed method was evaluated on three fingertip ECG signal databases recorded by utilizing the proposed device. The experimental results demonstrate that the proposed biometric identification method achieves person recognition rate values of 100% (30 out of 30), 100 $$\%$$ (45 out of 45), and 98.33 $$\%$$ (59 out of 60) for 30, 45, and 60 subjects, respectively.

Scintigraphic and Radiologic Findings of Pancake Kidney in a Patient with Fanconi Aplastic Anemia

In this case, we have presented that a patient has fankoni aplastic anemia with pancakes kidney in scintigraphy and ultrasonography. The patient is 10 years old and a girl who fanconi aplastic anemia had been diagnosed since three years. In physical examination her general status is good. There was not left hand thumb and she had double the distal phalanx in his right hand thumb in her inspection. We observed 2/6 sistolic murmur in cardiovascular system examination. Other systems were natural. Abdominal ultrasonography was observed that both the kidney were ectopic location and fused view in the left lower quadrant. Similarly in Tc-99m DTPA and DMSA renal scintigraphy, both kidneys were fused and in the left hemipelvis. The right kidney function were significantly lower by comparison with the left kidney functions . Radiological imaging is necessary in patients with Fanconi aplastic anemia without present clinical symptoms. The renal ultrasonography is important for determining pancakes. In addition, static and dynamic renal scintigraphy plays an important role in revealing the functional status of the kidneys.

Mystery of Double Murder Unraveled by Forensic Clues a Case Report

A mother and her teenage son living in a house in remote area were not seen around for a week. The father of the lady living in adjoining area became suspicious and visited her house. He smelled stench emanating from the locked house and immediately informed the police. On reaching the spot, the police opened the locked door by taking out conventional metallic loop from the wooden door plank and found dead body of lady in a pool of blood on the floor while that of her son on the double bed. The scene of occurrence was examined for vital clues by the forensic experts after a week. The forensic investigators tried to establish linkages between the victim, suspect, crime scene and individual items as with any form of evidence. The presence of palm prints on the wall, blood streaks and spatters on the wall and blood droplets/drip pattern on the iron box (trunk) lying adjacent to the wall helped in knowing etiology of crime and led to conclude that the assailant had suffered an injury on his/her hand. On the basis of evidences, the forensic team advised the police to make search for suspect (s) and the police succeeded in arresting stepdaughter of the deceased who had suffered an injury on the thumb of left hand.

Intubation Using a “Bonfils Fiberscope” in a Patient With Pfeiffer Syndrome

To the Editor: Pfeiffer syndrome is an autosomal dominant disorder characterized by craniosynostosis, brachicephaly, midface hypoplasia, low nasal bridge, flat occiput, severe ocular proptosis, over-sized tongue, and cerebral ventriculomegaly (Fig. 1).1FIGURE 1: A, Computed tomography scan reconstruction of the skull. B, The operator practices the intubation on a mannequin performing upward traction of the mandible by holding it between the left hand thumb and the forefinger.Providing general anesthesia in such patients could lead to complications in terms of airway management, due to potential difficulties in ventilation using the facial mask or tracheal intubation.2 A Bonfils fiberscope is a handy device to overcome difficulties of intubation, both in pediatric patients and in neonates. It is a rigid telescopic stylet with a 40-degree curved tip, which is inserted inside the endotracheal tube, keeping its distal end positioned just proximal to tip of the tube. The proximal eyepiece end of the device allows connections for a video monitor and a fixed or battery-operated light source. The instrument can be easily locked onto an endotracheal tube, while a special connector allows administration of the gases during intubation.3–4 The instrument is available in various sizes and its design makes intubation easy under direct visualization. The main limiting factor for its use is the rigidity, which may increase the risk of airway trauma. Obviously, it cannot be used for nasal intubation. We encountered the case of a 6-year-old patient, weighing 21 kg, who had Pfeiffer and Arnold Chiari syndromes, with caudal migration of cerebral tonsils to the level of the second cervical vertebra. Due to the presence of loud snoring and oxygen desaturation during sleep, the patient was required to undergo adenoidectomy under general anesthesia. The endotracheal intubation was found to be very challenging in this particular case. The induction was carried out with an intravenous administration of fentanyl 60 mcg and propofol 60 mg. At this stage, the anesthesiologist performed upward traction of the patient’s mandible by holding it between the left hand thumb and the forefinger (Fig. 1B) without using the laryngoscope. The Bonfils fiberscope, held in the right hand, was inserted through the oral cavity, the scope preloaded with size 5.5 mm, and the intubation was performed without any difficulty. Our case illustrates that the Bonfils fiberscope allows easy intubation in cases with a complicated upper airway anatomy without requiring a laryngoscope. Some authors do believe, however, that the use of a laryngoscope may be necessary when the Bonfils fiberscope is used in adult patients.5 We recommend that the operator practice the intubation on a mannequin, according to the aforementioned method before the actual procedure. In summary, we find the rigid Bonfils fiberscope a useful device for difficult intubation in pediatric patients with a complex upper airway anatomy. We recommend that this instrument be made available in operatory rooms where pediatric patients undergo general anesthesia. Marco Caruselli, MD Roberto Giretti Roberta Pallotto Giovanni Rocchi Anesthesia and Intensive Care Unit, “Salesi” Children’s Hospital, Ancona Laura Carboni Anesthesia and Intensive Care Unit, “Burlo Garofolo” Children’s Hospital, Trieste, Italy

Hierarchical control of static prehension: I. Biomechanics

We explored the action of digits during static prehension tasks involving one hand or two hands of one or two persons. Three hypotheses were tested: to prevent slippage of the object, grip force and safety margin (SM) would be largest in bimanual conditions, particularly involving two persons; the distribution of tangential forces would not differ among tested conditions, thus preserving the vertical orientation of the object in a stereotypical way; and the mechanical advantage of fingers would be used to maintain rotational equilibrium. The multi-digit synergies are discussed in the companion paper (Gorniak et al. 2009, in review). The subjects held vertical one of the two handles, a narrow one and a wide one. They used the four fingers of the right hand opposed by either the right hand thumb, the left hand thumb, the left hand index finger, the thumb of an experimenter, the index finger of an experimenter, or an inanimate object. Forces and moments of force produced by each digit were recorded. The first two hypotheses were falsified. Both grip force and SM were the largest in the one-hand task, and they were the lowest for the tasks involving two persons. The distribution of tangential forces among fingers was significantly different in the one-hand task. The mechanical advantage hypothesis was supported across all the tested conditions. The results suggest that the neural controller uses a different strategy in the one-hand task as compared to other tasks, while bimanual prehension involving two persons differs from one-person two-hand tasks. The findings do not support a hypothesis that normal (grip) forces are adjusted to ensure a particular value of the SM. Maintaining rotational equilibrium was achieved differently in different tasks. In particular, the one-hand task was characterized by large intercompensated adjustments in different contributors to the total moment of force, which could be described as chain effects; such adjustments were all but absent in the other conditions. The findings may be interpreted within the framework of the reference configuration hypothesis, in which digit forces emerge due to the discrepancies between the actual and the centrally defined (reference) hand aperture.

Hierarchical control of static prehension: II. Multi-digit synergies

The purpose of this study was to explore the ability of the central nervous system (CNS) to organize synergies at two levels of a hypothetical control hierarchy involved in two-hand multi-finger prehension tasks with one or more persons participating in the task together. At the higher level of the hierarchy, the total force and moment of force produced on an object are distributed between the thumb and the virtual finger (an imagined finger with mechanical output equal to the involved fingers of the hand), while at the lower level the virtual finger action is distributed among the four fingers. We tested a hypothesis that the CNS is able to organize synergies at only one level of the hierarchy. The subjects held vertically one of the two handles, a narrow one and a wide one. They used the four fingers of the right hand opposed by the right hand thumb, the left hand thumb, the left hand index finger, the thumb of an experimenter, the index finger of an experimenter, or an inanimate object. Forces and moments of force produced by each digit were recorded. Indices of synergies stabilizing the mechanical output variables at each of the two levels were computed. Contrary to the expectations, force and moment of force stabilizing synergies were found at one or both levels of the hierarchy across all tasks. Unimanual tasks exhibited higher synergy indices compared to all tasks, while intrapersonal synergy indices were higher than those of interpersonal synergies. The results suggest that both feed-forward and feedback mechanisms may be used to create force and moment of force stabilizing synergies. We invoke the notion of chain effects and generalize it for relations among variance components related to stabilization of different mechanical variables. The reference configuration hypothesis offers a fruitful framework for analysis of prehension synergies.

Treating the War Casualty: Case Reports of Polytrauma

The new generation of wounded Warriors is vastly different from those seen in the past, and military occupational therapists (OTs) must adapt to the challenges to meet the needs of these young men and women. Three case reports will be presented demonstrating the adaptability and flexibility of military OTs serving the combat wounded Warrior. The first case report reviews the rehabilitation process of a Sailor who was hit by an improvised explosive device (IED) and sustained an open shrapnel wound to his left upper extremity. The second case report presents the complex rehabilitation process of a Soldier who sustained an open distal radius and carpal fractures with soft tissue loss to his left hand from a gunshot wound after his helicopter was shot down. The final case report represents a Soldier who was injured using a table saw while in Iraq and sustained lacerations to his left hand thumb, index, and ring fingers. These case reports represent some of the demands and challenges that military OTs face when treating the war casualty.

Microscopic wire guide-based orotracheal mouse intubation: description, evaluation and comparison with transillumination

Airway access is needed for a number of experimental animal models, and the majority of animal research is based on mouse models. Anatomical conditions in mice are small, and the narrow glottic opening allows intubation only with a subtle technique. We therefore developed a microscopic endotracheal intubation method with a wire guide technique in mice anaesthetized with halothane in oxygen. The mouse is hung perpendicularly with its incisors on a thread fixed on a vertical plate. The tongue is placed with a pair of forceps between the left hand's thumb and forefinger and slightly pulled, while the neck and thorax are positioned using the third and fourth fingers. By doing so, the neck can be slightly stretched, which allows optimal visualization of the larynx and the vocal cords. To ensure a safe intubation, a fine wire guide is placed under vision between the vocal cords and advanced about 5 mm into the trachea. An intravenous 22G x 1 in. plastic or Teflon catheter is guided over this wire. In a series of 41 mice, between 21 and 38 g, the success rate for the first intubation attempt was >95%. Certainty of the judgement procedure was 100% and success rate was higher using the described method when compared with a transillumination method in a further series. The technique is safe, less invasive than tracheostomy and suitable for controlled ventilation and pulmonary substance application.

EPR Dosimetry in Recent Radiation Accident Cases

The use of Electron Paramagnetic Resonance (EPR) for dosimetry is based on the capability of the technique specifically and sensitively to measure unpaired electron species and the fact that ionizing radiation creates such species in exact proportion to absorbed dose. The lifetimes of these radiation-induced species can be extremely stable in non-aqueous media, such as teeth and bone (years). In addition, EPR signal in teeth and bones exhibits a good sensitivity to radiation dose, compatible with radiation accident dose level. Thus, teeth and bone are used as bio-indicator of the absorbed dose. EPR dosimetry on these materials can be very pertinent, especially when no dosimeter is worn by the victims and/or when irradiations are localized or highly heterogeneous, because giving absorbed dose in one or several localizations in the victim’s organism. In two recent cases of radiation accident, EPR dosimetry gave pertinent information for the medical management of the victims. The lost of 192Ir sources from a gammagraphy equipment is at the origin of the accident in both cases. First case occurred in December 2005 in Chile, involving one victim (patient A), and the second one, in Africa (Senegal and Ivory Coast) from June to August 2006 with four main victims (patients B, C, D, E). All victims were hospitalized in France at the Percy military training hospital. EPR dosimetry was performed on bone biopsies for patient A (left hand thumb) and B (left arm) who exhibited severe localized radiation burns. Tooth enamel samples were also measured from 4 patients (patients A, B, C, D). The methodology used for the dose assessment and the obtained results is presented. The contribution of EPR dosimetry in the management of radiation accident and the complementarity with the other techniques of dose reconstruction (biological dosimetry, numerical simulation) is discussed.

Dedifferentiated chondrosarcoma of the thumb: a case report

Dedifferentiated chondrosarcoma (DDCS) comprises approximately 10% of all chondrosarcomas and has the worst outcome with 5-year survival of 10%. The preferred localizations are femur, humerus and pelvis. We report a case of DDCS that arose in proximal phalanx of left-hand thumb of a 66-year-old man. He was admitted with a 2-month history of pain and swelling in his thumb. He had experienced a fracture 15 years ago in the same localization with a history of suspected preexisting enchondroma. Plain radiographs showed an expansive osteolytic lesion with milimetric calcifications while magnetic resonance imaging revealed intraosseous focal globular hyperintense spots consistent with chondroid areas as well as a surrounding soft tissue mass with intermediate signal intensity. In biopsy specimen we observed a low-grade chondrosarcoma next to a spindle cell sarcoma with an abrupt transition. He was treated with amputation and died of the disease within 9 months following the surgery. The presence of dedifferented chondrosarcoma in bones of hands was not previously reported. The presented case was provided with the macroscopic and microscopic features observed in amputation specimen in comparison with radiological findings.

Transdermal fentanyl: little absorption in two patients with systemic sclerosis?

Two patients suffering from systemic sclerosis (SSc) were treated with the 25 micro/hr transdermal fentanyl patch for pain from either deltoid muscle tendinitis of the left arm or from ischemia of the left-hand thumb. When the medication was changed to either oral morphine or oral methadone, the effects did not correspond to the drug conversion table. These findings suggest that patients with SSc and other systemic skin diseases may be at risk for limited absorption of transdermal fentanyl. In contrast, no restriction of the absorption of transdermal testosterone was observed.