Proper Examination Research Articles

Unpacking the Dobbs Decision

The majority opinion in the Dobbs v. Jackson Women’s Health gave the nation a lesson in the history of the relevant caselaw, legal precedent, and common law traditions regarding abortion in the United States. It also presents a master class on the proper examination of cases in the Supreme Court and the meaning, strengths, and weaknesses of the principle of stare decisis. In this article, Blackwell gives readers a summary of this monumental opinion and its depth of information and analysis.

A DETAILED REVIEW OF 1000 CASES OF VERTIGO

INTRODUCTION Vertigo is a sensorimotor and multisensory s y n d r o m e w i t h v a r i o u s e t i o l o g i e s a n d pathogenesis, it is not a separate disease process. Early differential diagnosis between peripheral and central vertigo is of prime importance. Pharmacotherapy, rehabilitation, and surgical treatment are the main methods of treatment for vertigo. In the acute phase of attacks, pharmacotherapy is the treatment of choice for vertigo. One of the m o s t i m p o r t a n t m e t h o d s o f v e s t i b u l a r compensation support, required in vertigo treatment after the resolution of acute symptoms is rehabilitation. In patients where there is no improvement after pharmacotherapy, and in cervical, and vascular spine lesions and tumors, surgery may be required. Some patients with vertigo may require multidisciplinary cooperation for successful outcomes. MATERIAL AND METHODS 1000 patients who presented with complaints of dizziness or vertigo from 2014 to 2019 in our Mehrotra ENT Hospital, Kanpur, India were taken for study. After proper history and examination, the patients were subjected to vestibular tests. A proper diagnosis was made after consultation with our neuro equilibrium department and the appropriate maneuver was done. Surgery was performed wherever required. RESULTS 564 were females and 436 were males. Peripheral causes of dizzinessaccount for the majority of dizziness cases with migraine forming the bulk of central cases. Out of 1000 cases, BPPV forms the most number of cases of vertigo accounting for 38.8% of all cases, followed by migraine (21.8%) and Meniere's disease accounting for 13% of all cases. 89.8% of cases were managed conservatively either through maneuvers, medications, and exercises. Rest 9.2% of cases were managed surgically. 0.4% were referred to neuro consultants. Appropriate diagnosis with suitable required maneuvers was key to proper management. CONCLUSION Close multidisciplinary cooperation is essential in dizziness. A well-established neuro equilibrium centre was key to our proper management of vertigo/ dizziness cases. Keywords: vestibular disorder,vertigo, dizziness, Meniere's disease, migraine.

Evaluation Of Foreign Object Damage On The Fan Blades with Microscopic Techniques

Foreign object damage (FOD) is a common problem in gas turbine engines, particularly in the fan and compressor blades. FOD generally occurs when hard body particles are ingested into an aero-engine fan and compressor blade. High-speed impact on fan titanium alloy blades leads to foreign object damage, which weakens the fatigue performance of the blades. It is important to note that FOD can also cause damage that is not visible to the naked eye, such as internal cracks or fatigue damage. Therefore, regular inspections and maintenance are crucial to detect and prevent FOD damage in gas turbine engines. Also using a microscope for the inspection of blades is important. Proper examination of blades damaged by foreign or domestic object can shed light on blade status and prevent further damage in the future. Here are some of the benefits of using a microscope for blade inspection:
 Microscopes can provide high magnification and resolution, allowing for detailed inspection of the blade surface and any defects or damage.
 Microscopes can help detect and identify small cracks, chips, or other forms of damage that may not be visible to the naked eye.
 Microscopes can provide accurate measurements of the blade's dimensions, which can be important for quality control and maintenance purposes.
 Microscopes can help identify the root cause of any damage or wear on the blade, which can inform future design and manufacturing decisions.
 Microscopes can provide visual documentation of the blade's condition, which can be useful for tracking changes over time and for communicating with other stakeholders.
 Overall, using a microscope for blade inspection can help ensure the safety, reliability, and performance of gas turbine engines and other equipment that relies on blades.
 In this study, a comparison was made between visual inspection, borescope control, stereo microscope and SEM-EDX microscope methods used in the detection and removal of foreign material damage. The advantages and disadvantages of these 4 methods are comparatively examined and presented to the attention of the reader.

ПРИМЕНЕНИЕ ТЕХНОЛОГИИ АВТОМАТНОГО ПРОГРАММИРОВАНИЯ ДЛЯ РАЗРАБОТКИ СИСТЕМЫ АВТОМАТИЧЕСКОГО УПРАВЛЕНИЯ ПУНКТОМ ПРОПУСКА ЛЮДЕЙ И АВТОТРАНСПОРТА С ОДНИМ ВЪЕЗДОМ И ОДНИМ ВЫЕЗДОМ

An analysis of the access system, which can be installed and used for enterprises, buildings and territories, is carried out to find out how difficult it is to develop such control systems (barriers, gates and other control and security means) based on automatic programming models and tools for their implementation. The system has two barriers (designed for vehicles entering and exiting the territory) and one passage for people. Such access systems are used quite often, but, in the overwhelming majority, these control and security measures are rarely automated. Automation, due to the presence of smart devices, will reduce the time spent on vehicles and people’s passing, leaving the individual only to be an observer, with the right to intervene if it is necessary. When building a control system based on automatic programming, firstly, it is necessary to consider the technological process of the checkpoint, and secondly, to construct logic based on identifying the obvious states of the automatic system. With proper examination and detailed study of the technological process, there should be no problems with the construction of logic and the program code will work flawlessly, since it takes into account all possible behaviour options of the automated system.

Study of hsCRP in patients with acute exacerbation of COPD

Aim: To study the levels of hsCRP in patients with acute exacerbation of COPD as compared to healthy volunteers. Methods: This was a single centre case control cross-sectional observational study design including 50 cases and 50 controls. COPD patients more than 40 years of age, having acute exacerbation and presenting to SS Hospital, Varanasi were included in the study after screening. Proper history and physical examination was done and CBC, LFT, RFT, ABG, hsCRP, Spirometry, ECG, ECHO was performed and data was collected and recorded for analysis. Results: 43 patients had an increased level of hsCRP as compared to control in which only 7 patients had an increased level of hsCRP. Conclusion: Inflammatory markers like hsCRP rises during acute exacerbations of COPD. 90 % of patients had increased level of hsCRP in our study and statistically it was found significant.

Study of Frequency of Occurrence of Cor-pulmonale among COPD Patients

Abstract: Aim: To study the frequency of occurrence of cor-pulmonale among COPD patients. Methods: This was a single centre case control cross-sectional observational study design including 50 cases and 50 controls. COPD patients more than 40 years of age, having acute exacerbation and presenting to SS Hospital, Varanasi were included in the study after screening. Proper history and physical examination was done and CBC, LFT, RFT, ABG, hsCRP, Spirometry, ECG, ECHO was performed and data was collected and recorded for analysis. Results: 38 % (n=19 out of 50) of patients with COPD developed pulmonary hypertension class 3 i.e. secondary to chronic lung diseases leading to dilated Right Atrium and Right Ventricle (cor-pulmonale). Conclusion: This study showed that the frequency of cor-pulmonale among COPD patient was 38%.

Examination Approaches to Brachial Plexus Injury for Neurosurgical Residents.

Brachial plexus injury is a severe peripheral nerve injury that affects the upper extremities and causes functional damage and disability. A detailed and accurate clinical examination is required to accurately localise the site of injury. This video manuscript aims to provide guidelines for the structured assessment of a patient with brachial plexus injury, specifically tailored to Malaysian medical students and trainees. A video demonstrating the examination of the brachial plexus was made. This video, created at the School of Medical Sciences at Universiti Sains Malaysia (USM), demonstrates the proper examination technique for brachial plexus. We hope that this video will help students and young doctors evaluate patients with brachial plexus injury and reach accurate localisation of the injury.

Pigmented Pilomatricoma on the Ear Resembling Vascular Tumor before Surgery: A Case Report

Pilomatricoma is characterized by a semi-transparent epidermis, especially pigmented pilomatricoma, containing melanocytes in basaloid cells, which are dark and purple, resembling vessel-derived skin masses. If the vascularity at doppler ultrasound is high before surgery, it may be misdiagnosed.A 10-year-old female patient visited our clinic because of a mass in the right ear triangular fossa. Ultrasonography was performed, and a vascular-origin tumor was suspected because of the high vascularity. The excised mass was diagnosed as pigmented pilomatricoma by a pathologist.Pilomatricoma is mistaken for other masses owing to its various phenotypes. A misdiagnosis can lead to misdirected strategies which can cause delayed treatment and can result in an increase in the size of the pilomatricoma, making the sequalae of surgery more complicated. For proper treatment, careful examination and evaluation are required before surgery.

Management of Gadget Addiction Through Ayurveda in Pediatric Patient: A Single Case Study

11-year-old male patient brought by relatives in Kaumarbhritya OPD with complaints of spending excessive time on smartphones andcomputers with changes in the patient's behavior since 1 year. Relatives counseled the patient, but he didn't change his behavior. Previous Doctorsadvised Cognitive behavioral therapy, but that facility was not available at their place, and the parents could not afford it. Hence they came toAyurveda Hospital. The patient is assessed using the Internet addiction test scale and DSM-V scale for social behavior. The patient is diagnosed as acase of Gadget addiction (internet addiction) with abnormal social behavior. After proper physical examinations, the patient is counseled inexplaining the hazardous effects of excessive use of gadgets; along with this, he is advised daily Suryanamskara, &Dhyana(meditation) as a Yogaintervention. The patient was advised to play outdoor games daily, and his gadgets using time were reduced by systematic order. Parents wereadvised to be patient in family functions and social meetings & to spend time with children. All the training regarding intervention is given in PPTformat to the patient. The patient was asked to perform Suryanamaskara on follow-up days. On the 91st day, the patient was reassessed using theInternet addiction test scale and DSM-V scale for social behavior, which were normal. Gadget addiction is a common behavioral problem inchildren. Online gaming, gambling, excessive web browsing, and social media use are all included under the umbrella term "gadget addiction.". Evenif there is treatment for gadget addiction, people in remote areas may find it inconvenient due to a lack of infrastructure and specialized pediatricpsychologists. Hence, finding an effective and convenient treatment for Gadget addiction is necessary. This study aims to assess the efficacy ofAyurvedic management in Gadget addiction based on Ayurveda Non-pharmacological intervention. Any addiction results from bad decision-makingcapacity and less control over the mind. The intervention in this study, like Yoga, satvavajaya, proves beneficial to the patient.

Initial Treatment of Multiple Trauma

Head trauma is a common neurosurgical complication. It is encountered daily at neurosurgical outpatient departments or after-hour emergency outpatient departments. In addition, most cases of patients with trauma transported by ambulance involve those with head trauma. Head trauma is a common and unavoidable neurosurgical injury. In case of a head injury, the neurosurgeon should verify the level of consciousness and perform a proper neurological examination. A head computed tomography should be performed immediately for any abnormalities. However, currently, severe trauma is often complicated by head trauma and various other injuries. When medical examinations and treatments focus only on head trauma, preventable trauma death cannot be avoided. Functional prognosis due to secondary brain injury may be exacerbated. This article presents a standardized procedure for the initial care of patients with multiple trauma and head injuries.

A Cross-Cultural Validation of Psychology of Working Theory With Turkish Working Adults

Psychology of Working Theory (PWT) is a relatively new vocational theory applicable to various cultural contexts around the world. However, proper examination of the theory within a Turkish context has been limited due to measurement concerns. Thus, in the present studies, we aimed to first translate the most frequently used PWT measures into Turkish by following best practices for scale translation and proceeded to then examine the full PWT model among Turkish working adults. We conducted two separate studies to address our primary aims. In Study 1, we translated the scales and conducted initial validity, and data was collected from 390 Turkish working adults to test the dimensionality and reliability of the scales. Results indicated that both the Economic Constraints Scale and Lifetime Experiences of Marginalization Scale were unidimensional models and the Work Needs Satisfaction Scale had a higher-order model consistent with the original development studies. In Study 2, using these newly translated scales, we examined the full PWT model among a new group of 564 Turkish working adults. Results showed that overall, PWT propositions were largely supported by the sample except for the role of work volition. Limitations and implications of the studies are discussed.

Limiting temperatures of embryo growth and seed germination of Fraxinus excelsior L. (Oleaceae): a threshold model approach

Key messageWe have examined thermal control for embryo growth and seed germination in European ash. Using historical data (span of 36 years) of embryo index in matured seeds, we showed that maturation is not influenced by the annual average temperature. Secondary dormancy in ash’s seeds is easily induced, and the thermal window for both embryo growth and seed germination was between 10 and 20 °C.ContextSeed germination plays a crucial role in establishing plant communities. Ash seeds are characterized by deep morphophysiological dormancy, usually overcome by 32 weeks of stratification. Observed climate changes might disrupt ash’s thermal window for embryo growth and seed germination. Thus, proper examination of seed adaptability can be important for forest management.AimsWe investigated the effect of temperature on the embryo index (ratio between embryo and seed length) as well as embryo growth and germination of European ash (Fraxinus excelsior L.) seeds under different thermal conditions.MethodsWe used seeds collected at the same site in Poland between 1985 and 2021 to first analyze the influence of the growing season on the initial embryo index in mature seeds. Subsequently, we examined embryo growth and germination of seeds at constant temperatures of 3°, 10°, 15°, 20°, 25°, and 30 °C from seeds collected in 2021. Using the modeled rate of embryo growth and germination, we predicted the cardinal temperatures for those processes in ash seeds.ResultsThe embryo index of ash seeds varied; however, there was no relationship between the index and year of seed collection. The base temperature for embryo growth was 1.4 ± 1.1 °C, with a ceiling temperature of 29.9 ± 2.0 °C and an optimal temperature of 15.7 ± 0.3 °C. The base temperature for germination was at − 1.8 ± 0.3 °C. Due to the induction of secondary dormancy, the ceiling temperature of germination was impossible to establish.ConclusionsThe initial embryo index of mature ash seeds seems to be an individual trait and was not affected by local average annual temperatures. The most effective temperature ranges for embryo growth and germination were similar, however narrow (between 10 and 15 °C). Temperatures above 20 °C inducted secondary dormancy, hampering embryo growth as well as germination. Such a narrow thermal window for embryo growth can potentially act as a limiting factor for the natural regeneration of ash seeds.

When we Fight a Winnable Battle in an Unwinnable War? The Story of a Cancer - A Case Report

Introduction: Breast cancer is the most frequent malignancy in women and is curable in ~70-80% of patients with early-stage detection and without complication. Paraneoplastic neurologic syndrome of breast cancer is one such complication which is often hard to diagnose, severely debilitating, and also challenging to treat. Materials and Methods: A 57-year- old woman with no known co-morbidity presented with sudden onset altered sensorium. She was in status epilepticus when brought to emergency and progressed to super refractory status epilepticus in-spite of our efforts. MRI of the brain with contrast done revealed hyper intense signal in bilateral frontal, parietal, occipital, bilateral thalami, periaqueductal region and dorsal midbrain. Cerebrospinal fluid (CSF) study revealed only increased protein. The comprehensive infective panel of CSF was negative. The vasculitis marker, anti NMO and anti MOG antibody were absent. So, we suspected a possibility of autoimmune aetiology and started methylprednisolone along with intravenous immunoglobulin. Results: Her epileptic discharges settled in an electroencephalogram, and we weaned her off ventilation. We detected a right breast mass on clinical examination. The PET CT scan revealed metastasis in the liver, bones, right axillary lymph nodes, and bone marrow. Conclusion: Our patient, who had the first-time presentation, was diagnosed to have paraneoplastic encephalopathy in the background of breast cancer. The importance of proper clinical examination and whole-body PET CT scan, followed by a trial of immunomodulator therapy, is necessary in all patients with non-infective encephalitis.

A case of postoperative sclerotomy site infection secondary to hordeolum externum

Postoperative infective scleritis is a rare entity, often reported following pterygium surgery involving anti-metabolites. Infective scleritis following hordeolum has not been reported before. We report a case of hordeolum externum that developed 3 days post uneventful vitreoretinal surgery that led to sclerotomy site infection. The condition was managed successfully with topical and systemic antimicrobials based on microbiology. This case also highlights the importance of proper examination of the lid, adnexa, and sclerotomy sites in the postoperative period.

Knowledge and Awareness of Temporomandibular Disorders (TMDs) among Post-graduate residents

INTRODUCTION: Malocclusion and TMD were believed to have a correlation when it is associated that the alteration of form might cause alteration in the stomatognathic system function. A multidisciplinary approach is particularly important for the successful treatment of chronic TMD cases. Management of TMD involves the work of dentists from various specialities. It is multifactorial in nature and requires proper examination and treatment planning. Thus, the primary purpose of this study is to find out the awareness of TMDs among postgraduate students. MATERIALS AND METHODOLOGY: The present study was retrospective in nature. A questionnaire involving TMDs was sent to all postgraduates involved in patient treatment through google forms. All participants were asked to anonymously answer the structured questionnaire containing multiple-choice and open-text questions in google forms. The questionnaire was specially developed for students and was organized into three sections. RESULTS: 204 participants responded and returned the completed questionnaires. Results showed that 98 % of the respondent’s occlusal disturbance causes TMD and TMJ problems are associated with malocclusion. The majority of the participants were aware of the aetiology and diagnosis but only 53% of them were aware of the treatment protocols. CONCLUSION: The causes and diagnosis domains of the questionnaire yielded a high degree of agreement while the treatment modalities were not known. Most of them were not aware of the treatment modalities reason being a lack of knowledge during the course of their undergraduate and postgraduate study.

Medico-Legal Cases: An Overview

A Medico-Legal Case can be defined as a case of injury or ailment in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the injury or ailment. Once the attending doctor decides to treat the case as Medico Legal Case, immediately he is required to inform the jurisdictional police as provided under Section 39 of Criminal Procedure Code, failure to do so, may result in a prosecution under Sections 176 or 202 of Indian Penal Code. Based on the report, police visits the patient to verify details mentioned in Medico-Legal Case. If there is subsequent death of patient or if the relatives wish to take a legal action against the offender, then based on the Medico-Legal Report, a First Information Report is registered under the relevant Indian Penal Code section. Medical practitioners share the responsibility of action against crime by supporting the justice system. The best way for a medical practitioner to achieve this is by proper examination of victims and/or perpetrators, and completing the legal documents meticulously. Medico-legal documentation is more than the compilation of a medico-legal report. Inappropriate completion of medico-legal documentation may necessitate the practitioner having to explain the documentation to make it understandable to the court.

A Cross-sectional Study on the Aetiology and Predisposing Factors of Hoarseness of Voice.

The primary objective of the study was to find out the aetiology of hoarseness and analyse people with hoarseness based on socio-demographic profile like age, gender, occupation and socio-economic status. Secondary objective was to find out the predisposing factors of hoarseness and to see their association between benign and malignant causes of hoarseness. The study was conducted for a period of one and half years in 178 patients who were above the age of 18 years of age and presented with hoarseness lasting for more than 2 weeks to the Department of Otorhinolaryngology. After obtaining a written informed consent, history was taken using a structured proforma and a proper clinical examination was done including indirect laryngoscopy. Nasopharyngolarygoscopy was done where indirect laryngoscopy was difficult. In a sample of 178 patients with hoarseness, 159 patients had structural lesions and 19 patients had movement disorders. Of the structural lesions, 86 patients were due to malignancy, 64 due to non-neoplastic causes, and 9 were due to premalignant causes. The most common malignant cause for hoarseness was Malignancy glottis, which had a male predilection. Smoking and alcoholism were found to be the main predisposing factors. The most common non neoplastic cause were vocal cord nodule and vocal cord polyp. The main predisposing factor was vocal abuse and was seen mostly in females. Vocal cord palsy was found to be the most common movement disorder. Hoarseness as a symptom if taken lightly can lead to serious consequences. Therefore it is important to avoid predisposing factors like smoking, alcoholism and also to educate the people regarding the proper use of voice.

Diagnostic Criteria for Garbhasaya Grivamukhgata Vrana (Cervical Erosion)

In Ayurveda, Trisutra is the three modules which are, first Hetu (etiology), second Linga (signs and symptoms) and third Aushadh (treatment or management of disease). The aim of Ayurveda is to maintain Dhatusamya (equilibrium state of Dhatus) which in turn causes health. To know the Linga (sign and symptoms) of disease, there is a need of proper examination of patient. Various diagnostic method has been described in various Ayurvedic texts, out of which ‘Trividha Pariksha’ i.e., Darshana (inspection), Sparshana (Palpation, percussion), Prashana (questionnaire) has more importance for diagnostic purpose. All the other diagnostic method explains in Ayurveda as well as modern science can be categorized under these basic ‘Trividha Pariksha’. Cervical erosion is the common gynecological problem most likely in many women throughout their reproductive years. Due to its non-healing and recurrent nature of cervical erosion is the leading cause of cancer in cervix in women. So, these ‘Trividha Pariksha’ plays a key role in diagnosis of cervical erosion (Garbhasaya Grivamukhgata Vrana). It is used to determine the root cause of the Garbhasaya Grivamukhgata vrana and to determine the treatment of disease. The diagnosis process involves the assessment of several subjective and objective parameters pertaining to the disease as well as patient. Darshana pariksha and Sparshana pariksha come under objective parameter whereas Prashana pariksha come under subjective parameter.

Orthodontic Management of Anterior and Unilateral Posterior Crossbite: A Case Report

Crossbite refers to abnormal labiolingual and buccolingual relations between the opposing teeth. This results in the imbalanced facial appearance of the patient causing varied degrees of distress based on the individual's values and self-esteem. The management of skeletal class III malocclusion with anterior and posterior crossbite can be challenging. This case report describes a case of skeletal class III malocclusion complicated with an anterior, and unilateral posterior crossbite, and severe crowding which was managed satisfactorily with a fixed orthodontic appliance. The proper clinical examination, diagnosis, problem list, and formulation of the treatment plan are of utmost importance for the proper management of the case. The diagnosis can be done through proper history, clinical examination, an orthopantomogram, and a lateral cephalogram. The patient's grin was transformed from a non-consonant to a consonant smile, and the profile was transformed from slightly concave to straight.

Readmission for Morbidities among Postpartum Women in a Tertiary Hospital of Kathmandu

Background: Postpartum period is a critical stage where the majority of the maternal mortality occurs. Major obstetric morbidities during this period include postpartum haemorrhage, puerperal pyrexia, and sepsis, and pregnancy induced hypertension. The objective of this study was to find out the morbidities in postpartum women readmitted following discharge from the hospital after delivery. Methods: It was conducted as a hospital-based descriptive study at Paropakar Maternity and Women’s Hospital (PMWH), Thapathali, Kathmandu. Ethical clearance was obtained from Institutional Review Board (IRB) of National Academy of Medical Sciences (NAMS). The total population enumeration technique was used to collect the data for a period of three months. A Standard Performa containing socio demographic characteristics, causes of readmission, complications during pregnancy, time interval of readmission and outcome of readmission was prepared which include relevant points according to the objective of the study. Data analysis was done using the Statistical Package for Social Sciences 16. Descriptive statistics (frequency, percent, mean, standard deviation and range) were used to analyse the data. Results: The incidence of postpartum readmission was 1.0% of total deliveries with 58 women being readmitted. More than two-fifth (29, 43.9%) were readmitted due to abdominal and perineal wound infections followed by urinary tract infections (8, 12.1%). Hypertension, puerperal pyrexia, secondary postpartum haemorrhage were other conditions requiring readmission in postpartum period. Conclusion: The study concluded that the women were readmitted during their postpartum period for multiple causes, wound infection being the most common. The quality of postnatal care including proper examination before discharge is necessary to ensure reduction in the readmission rate.