Male Construction Worker Research Articles

Free medial femoral condyle osteocutaneous flap for repairing stage IIIB osteonecrosis of the lunate: a case report

BackgroundThere are several surgical options for osteonecrosis of the lunate, and confirming the effectiveness of various surgical methods remains challenging. Here, we present a case of stage IIIB osteonecrosis of the lunate repaired with a free medial femoral condyle osteocutaneous flap.Case presentationA 43-year-old male construction worker was admitted to our hospital due to right wrist pain, impaired mobility, and pain aggravated by activity for 10 months. The patient was diagnosed with stage IIIB osteonecrosis of the lunate based on the orthopantomogram and magnetic resonance imaging of the right wrist. Considering the patient’s medical history, physical examination, auxiliary examination, and wishes, reconstruction was performed using a free medial femoral condyle osteocutaneous flap. After the flap survived completely, the K-wires were removed one month after the operation, the external brace was removed two months after the operation, and functional wrist rehabilitation was initiated. After six months of follow-up, the wrist swelling and pain resolved, and the reconstructed lunate bone was viable. Additionally, the last follow-up was conducted in the sixth month after surgery; the affected hand grip strength improved from about 70% (28 kg) to 80% (32 kg) compared with the healthy side (40 kg); the visual analog scale score decreased from 6.5 points before the operation to 1 point; and the MAYO score increased from 60 points before the operation to 85 points.ConclusionsThe success of this case reinforces the potential of the free medial femoral condyle osteocutaneous flap as a new treatment option for stage IIIB osteonecrosis of the lunate and further expands the existing treatment options. Using a free medial femoral condyle osteocutaneous flap to reconstruct the lunate and restore the carpal anatomy may.

An impressive case of isolated thoracic impalement

A 61-year-old male construction worker was admitted to our Emergency Department due to being impaled in the chest after fall onto the long pole of his cement mixer. He was promptly scanned through the CT then transferred to theatre where unique technique for intubation was utilised prior to performing a Video Assisted Thoracoscopic Surgery exploration and extraction of the foreign object.Impalement injuries are classified into Types I or II depending on the direction of movement of the human body in relation to the foreign object. There currently is no consensus on the best management of chest wall injuries involving impalements. Our case utilised Video Assisted Thoracoscopic Surgery as the dominant method of intervention together with highly skilled anaesthetic preparation.The combined expert anaesthetic and surgical approach utilised collectively had a role in ensuring the best possible outcome for the patient.

Optimizing health and nutrition status of migrant construction workers consuming multiple micronutrient fortified rice in Singapore.

A well-nourished workforce is instrumental in eradicating hunger, alleviating poverty, and spurring economic growth. A fifth of the total workforce in high-income countries are migrant workers. Despite the accessibility of nutritious foods in high-income countries, migrant workers often rely on nutrient-poor diets largely consisting of empty calories, which in turn leads to vitamin and mineral deficiency, also called hidden hunger, and resultant productivity loss. Here, we study the magnitude of hidden hunger in male migrant construction workers in Singapore and investigate the impact of consuming fortified rice for 6 consecutive months on the nutrition and health status of these workers. 140 male migrant workers aged 20-51 years of either Bangladeshi or Indian ethnicity from a single dormitory in Singapore volunteered to participate in the study. In total, 133 blood samples were taken at the start of the study and were used to assess vitamin B12, hemoglobin, ferritin, folate, and zinc levels; a sub-sample underwent for homocysteine testing. Anthropometric measurements and vital signs, such as blood pressure, were recorded before and after the intervention. The results show that vitamin and mineral deficiency was present, especially folate (59% of workers deficient) and vitamin B12 (7% deficient, 31% marginally deficient). The consumption of fortified rice significantly improved the vitamin, iron and zinc level in the workers and significantly reduced the systolic blood pressure amongst the Bangladeshi migrant workers, specifically. Our study demonstrates that fortified rice may have a positive impact on male migrant construction worker health and nutrition status at the workplace.

Patient with Recurrent Acute Ischemic Strokes Found to have Cryptococcal Meningitis: A Case Report (P12-5.023)

<h3>Objective:</h3> n/a <h3>Background:</h3> Cryptococcal meningitis is a rare cause of ischemic stroke. Infections most often present in immunocompromised patients, classically AIDS or transplant patients. We present a case of a seemingly immunocompetent patient who presented with recurrent strokes found to have cryptococcal meningitis. <h3>Design/Methods:</h3> n/a <h3>Results:</h3> The patient was a 55-year-old male construction worker with hypertension. A year prior to admission, he was hospitalized for a week with mild SARS-COVID-19 infection. He had received two doses of the mRNA Covid vaccines. One month prior to admission, he developed headaches initially treated as sinus infection with oral antibiotics and steroids. Two weeks later, there was concern for acute-onset aphasia. He was afebrile with mild leukocytosis (13.6 B/L). MRI brain showed multiple, bilateral, scattered lacunar infarcts and left cerebellar infarcts. Transthoracic and transesophageal echocardiography were unremarkable. A loop recorder was placed. He was started on dual antiplatelet and statin therapy. A week later, he was encephalopathic and lethargic. Repeat MRI brain showed new acute lacunar and bilateral cerebellar infarcts. The loop recorder was negative for arrhythmias. A lumbar puncture (LP) was deferred for unclear reasons. Patient was transferred to our stroke service, where he was febrile (102.3°F) with leukocytosis (17.4 B/L). He was encephalopathic and had nuchal rigidity. LP showed elevated opening pressure (55 cm H2O) and tested positive for Cryptococcal antigen. Liposomal amphotericin B and flucytosine were initiated. Diagnostic angiogram was negative for vasculitis. His CD4 count was 332 (normal 410–1,590), however HIV testing was negative and pan-CT scan showed no signs of underlying malignancy. His prolonged hospital course was complicated by elevated intracranial pressure, further strokes, and poor mental status requiring placement of tracheostomy and enteral tube access. <h3>Conclusions:</h3> It is important to keep infection, including cryptococcal meningitis, in the differential for the cause of recurrent strokes even in seemingly immunocompetent patients. <b>Disclosure:</b> Lauren Thaete has nothing to disclose. Dr. Azuma has nothing to disclose.

OV16 MASSIVE COMPLEX INGUINAL HERNIA

Abstract Aim Massive complex inguinal hernias can be exceptionally difficult to repair, especially when they are associated with loss of domain (LOD). We aim to demonstrate an open preperitoneal approach to a complex massive inguinal hernia extending into the scrotum with severe LOD. Material and Methods Footage from clinic, diagnostic imaging, and all operative procedures was included. This included botulinum toxin A (BTA) injection, diagnostic laparoscopy and placement of a peritoneal catheter, outpatient pre-operative progressive pneumoperitoneum (PPP), and the preperitoneal hernia repair. Results A 53-year-old male construction worker with a known inguinal hernia presented with worsening groin and scrotal pain, associated with fever. CT imaging showed an abscess secondary to perforated diverticulitis within his massive inguinal hernia, as well as massive loss of domain with almost all small and large intestine within the hernia. He was treated with antibiotics and percutaneous drainage in preparation for surgery. He received pre-operative bilateral BTA injection in the oblique abdominal musculature. Subsequently, he underwent diagnostic laparoscopy and peritoneal catheter placement. He received 2 weeks of outpatient PPP. He then underwent open inguinal hernia repair with left orchiectomy and total abdominal colectomy. The hernia was repaired with a biologic mesh placed in the pre-peritoneal plane. The patient recovered very well and had no wound complications post-operatively. He has since followed up in clinic multiple times with no recurrence and excellent cosmetic results. Conclusions In this patient with a complex massive inguinal hernia and loss of domain, we demonstrate a successful open preperitoneal repair following pre-operative BTA injection and PPP.

DISSEMINATED HISTOPLASMOSIS IN A PATIENT WITH NEWLY DIAGNOSED AIDS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Disseminated Histoplasmosis (DH) is an AIDS-defining illness caused by the dimorphic fungus Histoplasma capsulatum. Outbreaks have been associated with exposure to bird or bat droppings and amongst construction workers. It remains unclear whether DH represents an acute infection or a reactivation of latent infection. We present a case of DH in a newly diagnosed AIDS patient. CASE PRESENTATION: A 50 year old male Hispanic construction worker presented with a month history of persisting fever, chills, diaphoresis, progressive shortness of breath on exertion, non-bloody diarrhea and 15lbs weight loss. HIV screen was positive (new diagnosis) and his CD4+ cell count was 3 per cubic millimeter with a viral load of over 1 million copies/ml. CXR showed diffuse interstitial infiltrates in both lung fields and CT chest showed numerous punctate miliary pattern pulmonary nodules in the lungs with necrotic appearing lymph nodes in the proximal jejunal mesentery. SARS-CoV2 PCR was negative. BAL culture grew Histoplasma capsulatum, Lung biopsy pathology showed broad based budding yeast and urine histoplasma antigen was positive at greater than 23 ng/ml. He was treated with highly active antiretroviral therapy (HAART), IV liposomal amphotericin, and steroid. Empiric anti-TB therapy was stopped with negative quantiferon TB gold, BAL AFB smear and BAL MTB complex PCR. Silver stain for PCP, serum cryptococcal antigen, serum galactomammanan and fungitell assays were all negative. Hospital course was complicated by pneumothorax, septic shock, line related bloodstream infections that resolved with line removal and antimicrobials. Despite appropriate antifungal therapy for 40 days with decrease in his urine histoplasma antigen to 11 ng/ml, and HIV viral load decreasing to 330 copies/ml after 3 weeks of HAART, he remained ventilator dependent, on chest tubes and could not be weaned off sedation. His family made him comfort care only on hospital day 43 and he died peacefully after. DISCUSSION: Histoplasmosis has been recognized as an opportunistic infection in patients with AIDS and typically presents as disseminated disease. DH in conjunction with HIV infection is particularly common among Hispanic persons in the United states. In AIDS patients, DH is associated with a nonspecific clinical presentation—usually unexplained fever and weight loss. Histoplasmosis causes significant morbidity and mortality. Fungal infections deaths in AIDS were estimated at more than 700, 000 deaths (47%) annually. The frequent occurence of histoplasmosis with other opportunistic infections especially tuberculosis requires that tuberculosis be ruled out even if histoplasmosis is diagnosed. CONCLUSIONS: This case highlights the fact that although miliary pattern on CT Chest typically signifies tuberculosis, it can also be seen in histoplasmosis. Also associated morbidity and mortality of DH remains high in AIDS patients not on HAART. REFERENCE #1: Rana A. Hajjeh. Disseminated Histoplasmosis in Persons Infected with Human Immunodeficiency Virus. Clinical Infectious Diseases 1995; 21(Suppl 1):S108 -10. REFERENCE #2: Stuart M. Levitz, and Eugene J. Mark. Case 38-1998 — A 19-Year-Old Man with the Acquired Immunodeficiency Syndrome and Persistent Fever. N Engl J Med 1998; 339:1835-1843. REFERENCE #3: David W. Denning. Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized. Philos Trans R Soc Lond B Biol Sci. 2016 Dec 5;371(1709). DISCLOSURES: No relevant relationships by Oluwadamilola Adeyemi, source=Web Response No relevant relationships by Ingrid Gils, source=Web Response No relevant relationships by Drew Ludwig, source=Web Response No relevant relationships by Biana Modilevsky, source=Web Response

Cryptococcal Abscess in the Pubic Region and Central Nervous System of an Immunocompetent Patient

&lt;i&gt;Cryptococcus neoformans&lt;/i&gt; usually causes an opportunistic infection in immunosuppressed patients. Immunocompetent patients may also develop the infection in the central nervous system or the lungs, but soft tissue infection is uncommon, and the development of a cryptococcal abscess in the pubic region is particularly rare. A 47-year-old male construction worker with headaches and fever visited the hospital due to a soft tissue mass in the pubic region with pus-like discharge. It was detected 6 months previously, and had gradually increased in size, tenderness, and erythema. The granulomatous lesion of the pubic area was excised &lt;i&gt;en bloc&lt;/i&gt;, and primary closure was performed. Antifungal agents were used for the systemic infection. Histological examination identified the specimen as a fungal infection suspected to be cryptococcosis. During the 3-month follow-up period, there was no recurrence, infections in other areas, or major wound complications. This case is an example of a cryptococcal abscess with dissemination in the pubic region of an immunocompetent patient. There is no established cure for subcutaneous cryptococcal abscesses, but surgical excision, which can simultaneously achieve accurate diagnosis and treatment, is considered to be an effective treatment method.

Acute Myocarditis in a Patient with Exertional Heat Illness: A Rare Association.

Exertional heat illness (EHI) is common in hot weather among young athletes, outdoor manual workers and military personnel. EHI can involve multiple organs of the body, including the muscles, kidneys and brain; however, myocardium involvement is infrequent. We present the case of a 26-year-old male construction worker who worked outdoors in a hot arid environment. He presented with acute kidney injury and rhabdomyolysis and was diagnosed with EHI. During his hospital stay, he developed complete heart block, and cardiac MRI showed features of myocarditis. Work-up to identify other aetiologies of myocarditis was normal. This case highlights the effects of EHI on the myocardium. It is important to keep in mind the various effects of EHI on the myocardium. Myocarditis due to EHI is rare, and conduction defects resulting from it might persist, necessitating specialist intervention. Exertional heat illness (EHI) can cause end-organ damage and it is imperative to keep in mind the various effects of EHI on the myocardium.Myocarditis due to EHI is rare, and conduction defects resulting from it might persist, requiring specialist intervention.

Unusual internal injuries induced by fatal low-voltage electrocution: About two cases report

Summary Electrical injuries consist mainly in external burn marks. Internal injuries are rarely observed especially in low-voltage electrocution. In this context, we report two fatal cases due to electrocution by low voltage current (220 volts), with a special emphasis on pathological internal changes. Case no. 1 A 30-year-old male construction worker died after a low-voltage electrocution in the workplace. A medico-legal autopsy was required by judicial authorities. An external examination of the body showed marked facial cyanosis and electrical burn marks on the chest. The autopsy findings showed necrotic lesions of the heart, the thoracic aorta and pulmonary artery. The ischemic lesions were confirmed by histological tests. Case 2 A 20-year-old male was admitted to the Intensive Care Unit for pneumothorax after an accidental low-voltage electrocution. Despite cardiopulmonary reanimation, he died two hours later. An external examination of the corpse showed an electrical burn mark on the right hand. The autopsy findings revealed mainly a right pneumothorax as well as some necrotic lesions in the inferior lobe of the right lung and the anterior face of the liver, which were confirmed microscopically. Discussion-conclusion Death during electrocution by a low-voltage current is uncommon. Visceral necrosis is rarely described in this situation.

Fatal deep venous thrombosis and pulmonary embolism secondary to melioidosis in China: case report and literature review

BackgroundBurkholderia pseudomallei is a gram-negative bacterium and the causative pathogen of melioidosis, which manifests a variety ranges of infection symptoms. However, deep venous thrombosis (DVT) and pulmonary embolism (PE) secondary to bacteremic melioidosis are rarely documented in the literature. Herein, we reported a fatal case of melioidosis combined with DVT and PE.Case presentationA 54-year-old male construction worker and farmer with a history of diabetes was febrile, painful in left thigh, swelling in left lower limb, with chest tightness and shortness of breath for 4 days. He was later diagnosed as DVT of left lower extremity and PE. The culture of his blood, sputum and bone marrow samples grew B. pseudomallei. The subject was administrated with antibiotics (levofloxacin, cefoperazone/tazobactam, and imipenem) according to antimicrobial susceptibility testing and low molecular heparin for venous thrombosis. However, even after appropriate treatment, the patient deteriorated rapidly, and died 2 weeks after admission.ConclusionsThis study enhanced awareness of the risk of B. pseudomallei bloodstream infection in those with diabetes. If a patient has predisposing factors of melioidosis, when DVT is suspected, active investigation and multiple therapeutic interventions should be implemented immediately to reduce mortality rate.

Dropsy and pyrexia of unknown origin: Tuberculosis myopericarditis, still the great pretender

Tuberculosis is an infectious disease with a global presence.[1][1] Primary myopericardial involvement presenting with congestive cardiac failure and pyrexia of unknown origin is extremely rare.[2][2] A 30-year-old, male Pakistani construction worker presented with a 2-month history of worsening

Combined penetrating trauma of the head, neck, chest, abdomen and scrotum caused by falling from a high altitude: A case report and literature review

This report describes an extremely rare case of combined penetrating trauma that includes the head, neck, chest, abdomen and scrotum. A 46-year-old male construction worker fell from a 5-metre-high platform, and a rebar that was fixed vertically on the ground penetrated the scrotum into the pelvic and abdominal cavities, passing through the chest, neck, mouth, and nose to the outside of the body through the left side of the head. The rebar penetrated the oral cavity and was palpable on the anterior side of the neck and abdomen. The head, neck, chest and abdominal CT scan and reconstruction showed brain contusion, fractures of the skull and skull base, subarachnoid haemorrhage, palate injury, tongue injury, injury to the right lobe of the thyroid, pleural effusion, pulmonary contusion, cardiac contusion, injury to the left lobe of the lung, neck and mediastinal emphysema, and pneumothorax. Emergency green channels provide a rescue process for urgent and severe cases and smooth and timely diagnostic and treatment process to save patients’ lives. The medical staff worked together as a team for the initial evaluation and rescue. Emergency nurses played an important role in communicating, cooperating, managing insulation and pain, and providing psychological counselling, which greatly enhanced the efficiency and quality of the nursing. After the patient underwent surgery, anti-infection treatment, sedatives, analgesics, nutritional therapy, psychological support, and other intensive treatment measures, he recovered well two months after the injury. Follow-up at 5 and 11 months after discharge showed good recovery.

Intrathecal injection of tigecycline in treatment of multidrug-resistant Acinetobacter baumannii meningitis: a case report

The ubiquitous Acinetobacter baumannii is an important and troublesome pathogen of nosocomial infection. Multidrug-resistant A baumannii meningitis is very difficult to treat, usually with high mortality. The disease is generally...

Occupational eye hazard – a case of perforating industrial nail injury to the eye

Purpose: To report the management and outcome of an unusual case of occupational perforating ocular industrial nail injury involving the posterior pole. Methods: Observational case report. A 48-year-old Chinese male construction worker presented with perforating industrial nail injury.Results: The patient underwent primary globe repair and foreign body removal followed by staged pars plana vitrectomy with endophotocoagulation and cyclopropane gas tamponade for repair of the vitreous incarceration at the posterior exit wound, a subsequent laser retinopexy with silicone oil tamponade for an inferior retinal detachment extending from the perforation site and finally silicone oil removal with a scleral fixated intraocular lens implant. His best-corrected visual acuity improved to 20/100 six months after the initial injury. Conclusion: Perforating ocular injuries involving the posterior pole often present with severe visual impairment and significant management challenges. We report a case of perforating ocular nail injury, which was managed successfully with staged surgical procedures.

Diffuse malignant peritoneal mesothelioma

Mesothelioma often originates in the pleura and less frequently in the peritoneum. This article describes a rare case of diffuse malignant peritoneal mesothelioma in a 54-year-old male construction worker who was admitted to our hospital with a 2-month history of progressive abdominal distention. Abdominal computed tomography revealed extensive peritoneal nodularity and omental cake along with massive ascites. Imaging findings initially suggested peritoneal carcinomatosis, primary peritoneal carcinoma, and tuberculous peritonitis. Laparoscopic biopsy of the omentum and peritoneum confirmed the diagnosis of malignant peritoneal mesothelioma of epitheloid type. Although systemic chemotherapy was administered, no tumor regression was found. The patient finally died of nosocomial infection.

Severe Chlorate Poisoning Successfully Treated with Methylene Blue

BackgroundChlorate poisoning as a cause of methemoglobinemia is regarded in current literature to be resistant to treatment by methylene blue due to the oxidizing and denaturing properties of the chlorate anion, and often leads to severe renal and hematological complications with a high mortality rate. Recent case studies suggest practitioners have eschewed the use of methylene blue in such situations. ObjectivesThis report describes a case of chlorate poisoning presenting as severe methemoglobinemia successfully treated with methylene blue alone, believed to be a first in reported literature. Case ReportA 34-year-old male construction worker presented 4 h after accidental ingestion of an industrial chemical, with giddiness and breathlessness. Physical examination did not reveal any abnormal cardiorespiratory findings, although arterial blood gas analysis and pulse oximetry revealed an “oxygen saturation gap.” Methemoglobin levels were found to be severely elevated at 66.8% 6 h after ingestion, and the patient was promptly treated with methylene blue. Clinical examination and laboratory tests suggested the absence of hemolysis at the time of treatment. The patient was discharged after a brief and uneventful hospital stay. Subsequent tests revealed the chemical ingested to be sodium chlorate. ConclusionThe successful outcome in our case suggests that a window of opportunity as long as 6 h may exist during which treatment of chlorate poisoning with methylene blue may be of clinical value. We postulate that the absence of significant hemolysis and hematological alterations at the time of antidote administration may be a necessary prerequisite for treatment success.

Successful Use of Posaconazole for Treatment of Blastomycosis

A 48-year-old male construction worker developed left hip pain of 6 months duration. Magnetic resonance imaging showed a destructive lesion in the left ischium with overlying soft tissue swelling. A chest computed tomography (CT) scan revealed a 2-cm spiculated mass at the base of the left lung. The

X-Ray Quiz: A Construction Worker with Blunt Chest Injury

A 34-year-old, previously healthy, male construction worker was sent to the emergency room immediately after a thoracic crushing injury. His vital signs were as follows: pulse rate, 90 beats/min; respiratory rate, 24 breaths/min; blood pressure, 126/61 mmHg; and body temperature, 35.8oC. The patient was conscious but had mild dyspnoea and complained of left-side chest pain. Palpation of the chest showed some crepitus on the left-side chest wall; auscultation revealed decreased breath sounds on the left side with dullness in percussion. He received immediate fluid resuscitation and oxygen supply. Focused Assessment with Sonography for Trauma (FAST) was performed and no ascites was visualised.

Illicit Drug, Ischemic Bowel

h m 2 PRESENTATION In the young adult or middle-aged patient with abdominal pain and bloody diarrhea, a history of cocaine abuse is an important consideration in the differential diagnosis, as illustrated in this case. A 44-year-old male construction worker presented to our general medicine clinic reporting 1 year of recurrent, sharp, left-sided abdominal pain associated with frequent loose stools. For a few days before presentation, he had been unable to sleep because of the pain. The painful episodes were associated with some rectal bleeding and a documented weight loss of 40 lb but no nausea, vomiting, abdominal distension, food intolerance, or change in appetite. The patient denied urinary problems (hematuria, frequency, urgency, dysuria) and fever. His medical and surgical history were unremarkable except for an appendectomy 15 years previously; he had never had a colonoscopy. His social history was significant for smoking (20 pack-years) and occasional alcohol use. He denied use of illicit drugs.

Spontaneous Bacterial Seeding of a Biceps Hematoma

A 19-year-old male construction worker presented with an injury to his left upper arm after lifting a heavy pipe. He reported an acute onset of sharp pain followed by swelling, warmth, and weakness with elbow flexion. The diagnosis of a distal biceps tendon rupture was made and elective repair was scheduled. Seventy-two hours later, the patient presented with a spontaneous draining wound on his anterior distal humerus. The wound was draining thick purulent material. The patient underwent surgery for irrigation and debridement of his abscess. Nearly 500 cc of hematoma and purulent fluid were evacuated. A large tear of both the biceps and brachialis muscle bellies were found. Cultures were obtained that revealed the infecting organism to be Streptococcus intermedius. Human immunodeficiency virus and hepatitis-C virus testing were negative, and no history, signs, or symptoms of any cause of underlying immunodeficiency were detected. No signs or history of drug use were present. He was discharged home on culture-specific oral antibiotics. At 4-month postoperative follow-up, the patient reported no pain or limitations. He has returned to full duty at his job. Elbow range of motion was measured from 7° to 150° of flexion. Strength of elbow flexion and extension was symmetric to the uninjured side. Pronation and supination of the forearm was symmetric on both sides. He has been released from scheduled follow-up and will be seen again on an as-needed basis.