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  • Bilateral Distal Humeral Fracture in a patient with Osteogenesis imperfecta During the Covid Pandemic

    Introduction: Osteogenesis imperfecta (OI) is a genetic disorder which is characterised by bone deformity, low bone mass, connective tissue manifestations and brittle bones with history of multiple fractures. Although recurrent fractures are known in patient with OI, the occurrence of bilateral simultaneous fracture of humerus is quite rare. Presenting complaint and investigations: The patient had a fall in the outdoors during a storm during the height of covid pandemic and sustained injury to both arms. Radiographs revealed comminuted fracture of left distal humerus and transverse extraarticular supracondylar fracture of right humerus. Diagnoses, therapeutics interventions, and outcomes: Although, conservative measures were advised as per the guidelines for orthopaedic surgery during the covid pandemic for most of the fractures, the decision to operate was made considering the morbid obesity and hampered mobility due to bilateral above elbow plaster.The patient underwent staged open reduction and internal fixation of both distal humerus with anatomical locking plates in a span of 2 weeks. She recovered uneventfully with a good functional range of movements and resumed her routine activities. Conclusion: The treatment for complex and unusual fractures should be individualised and should take into consideration of patient’s general condition and safety.

  • Reasons Early Career Black Special Education Teachers Quit Their Positions

    Special education policymakers and practitioners are concerned about attrition among teachers, especially those who leave early in their careers and teachers of color. To increase knowledge about attrition, I examined demographic and interview data from 10 Black teachers who quit their positions before they completed their probationary periods (1-3 years). Guided by Cox’s (1994) cultural diversity in organization model designed to capture the complex nature of diversity in organizations, I used phenomenological research methods to better understand the teachers’ experiences surrounding the decision to quit. The qualitative analyses revealed four themes: (a) inadequate mentoring, (b) role abuse, (c) cultural insensitivity, and (d) inadequate resources. I conclude with suggestions for education policies and practices at the local and federal level that special educators can employ to address these issues. This paper highlights issues of attrition within a subgroup of educators (Black special educators) that are underrepresented in the research literature.

  • Long Progression-free-survival Pancreatic Carcinosarcoma Under Gemcitabine-nabpaclitaxel First Line Chemotherapy

    Carcinosarcoma of the pancreas is a rare entity with short case series reported in the literature. Diagnosis is established by immunohistochemical examination including both carcinomatous and sarcomatous components. Prognosis is usually limited to 6-9 months life expectancy. Standard chemotherapy regimen is not well defined. We present a case of pancreatic carcinosarcoma with long-time progression-free-survival under first line chemotherapy treatment with gemcitabine-nabpaclitaxel combination. Tumor histopathological and clinical characteristics are reviewed.

  • APPROPRIATION OF PERSONALITY IN THE COMMONWEALTH CARIBBEAN

    There is the flagrant unauthorized use of people’s personality in the Commonwealth Caribbean, yet the tort of appropriation of personality is grossly underutilized in the region. The Author aimed at ascertaining the reason this situation persists in the Commonwealth Caribbean. The contribution to the introduction and development of appropriation of personality in the Commonwealth Caribbean made by the judgment of the only case on appropriation of personality in the region, Robert Nesta Marley Foundation v Dino Mitchelle Ltd was also discussed. The only other case on appropriation of personlity from the region Georgia Messam v Clive Morris and Milton Williams was also discussed. Traditionally, the development of the law in the Commonwealth Caribbean was along the lines of passing off based on United Kingdom jurisprudence. Recently the development of the tort has been along the lines of Canadian law. It is suggested that the tort should be developed along the lines of both Canadian and German jurisprudence. Resultantly, amendments to the law based on both Canadian and German laws were suggested.

  • Play therapy as a diagnostic tool in rural families in Mexico

    The role of play therapy as a research tool is examined after its use in a project directed to study family with at least one migrant member in deprived rural contexts in Mexico. Eighteen families were approached throughout home visits as part of social support services. Videos of the interaction with family members by using play therapy techniques were analyzed with the purpose to establish its advantages and limitations to collect information about the family dynamics. It was found that play therapy is an effective research tool in family studies, since this is a non-intrusive way to elicit feelings, spontaneous behaviors, and change in the family dynamics. Some of the advantages and limitations of this technique are further discussed eliciting practical guidelines for its use.

  • Feeling of Imminent Death after Long Bone Surgery

    71-year-old male patient with hypertension, obesity and personal history of prostate adenocarcinoma with blast bone metastases. Admitted after fall and pathological right pertrochanteric fracture. Programmed surgery is performed by means of endomedullary nailing on the fractured right hip and prophylactic left hip. Pre-surgical nasopharyngeal exudate for coronavirus is positive, with no apparent clinical translation. Three hours after surgery, the patient begins with dyspnea, central thoracic pain of a pleuritic nature and a feeling of imminent death. Physical examination reveals poor general condition, hypotension, diaphoresis, tachypnea and desaturation, without neurological affectation. Treatment is initiated with intensive serotherapy, oxygen therapy and analgesia. Analysis reveals troponin and normal NT-proBNP with elevated LDH and D-dimer, as well as mild metabolic acidosis. The electrocardiogram and transthoracic echocardiogram do not show any alterations. Urgent pulmonary CT-angiography targets signs compatible with fat embolism (see figure 1). The hemodynamic and respiratory instability improve progressively, not requiring admission to ICU, appearing at twelve hours bilateral axillary petechiae. Pulmonary fat embolism syndrome is rare, and can appear after fractures and long-bone surgery [1]. The classic clinical triad is hypoxemia, neurological alteration and petechiae[²], due to the presence of fatty emboli in the circulation and pulmonary parenchyma.

  • A world in the head: Brain abscess caused by Paradoxical embolism due to pulmonary arteriovenous fistula as a debut of hereditary hemorrhagic telangiectasia

    66-year-old patient with a history of alcoholism and smoking, chronic iron deficiency anemia treated with oral iron who was admitted for streptococcal brain abscess, during the etiological study we found arteriovenous shunt on echocardiography and pulmonary arteriovenous fistula, undergoing endovascular closure of the same during stay. In the physical examination, perioral teleangiectasis was observed, when meeting the Curaçao criteria, a genetic study of hereditary hemorrhagic teleangiectasia was requested, which was positive.

  • Male Sexual Assault – A Case Report of Foreign Body in the Rectum from Sexual Assault by Female Partner

    Most rectal foreign bodies (FB) are a result of insertion for sexual gratification. FB in the rectum as. result of sexual assault in males by the female partner is rare. A 32-year-ol man presented with a 6-day history of deep anal pain and lower abdominal pain, following an assault by a female partner while he was drunk. Physical examination and plain radiography confirmed a FB in the rectum. The FB was removed at exploratory laparotomy following failed attempt at trans rectal removal under spinal anaesthesia. The FB was confirmed to be a perfume canister. The patient has remained well at two months of follow up. Male sexual assault by female is not uncommon and can lead to disastrous effects. The female sexual assault on male is underreported and reported usually when there are complications. There is need to do more in-depth study to investigate the incidence of this.

  • FRONTAL BRANCH OF FACIAL NERVE AND THE TEMPORAL REGION

    Several layers of various soft tissues with interchanging characteristics exist below and above the zygomatic arch, this makes the temporal region anatomy somewhat uneasy to comprehend and recall. The frontal (or Temporal) branch of facial nerve is however the ultimate reason why it becomes important to study this area. Apart from Plastic, aesthetic and Reconstructive surgery, few other surgical specialties often need to work on this region, some of the common procedures include Coronal approaches; Zygoma fracture reduction; Temporoparietal flap elevation; Face and brow lift. There was a need for thorough review of this area from a surgeon’s perspective and to come up with as clear possible messages to be made in regard this topic. After an extensive literature search, we came up with few conclusions and three key illustrations that we strongly believe are crucial to be remembered. The rationale of following certain path of dissection in the temporal region, depending on the planned operation is explained. Eponyms used in literature for various structures have been discussed and clarified. The relationship of the frontal nerve to its surrounding fasciae within the zygomatic zone and Temporoparietal fascia is further explored. This updated review and guidelines are specifically been developed and recommended as an educational tool for in training surgical residents of concerned specialties, as well as for practicing surgeons in those areas to update their anatomy knowledge of this critical region.

  • A rare case of Rubinstein-Taybi Syndrome and gynecological malignancy

    Rubinstein-Taybi syndrome (RSTS) is a congenital syndrome most associated with mutations on chromosome 16p13.3 that can result in both benign and malignant neurologic and hematologic neoplasms of various primary origins. We present the case of a 39-year old female with RSTS who presented with severe abdominal and pelvic pain. Abdominal and pelvic imaging revealed multiple masses involving the uterus, liver and spleen concerning for malignancy. Biopsies from the endometrium and cervix confirmed this as a poorly differentiated, widely invasive squamous cell carcinoma. This represents the first case of primary squamous cell carcinoma of gynecologic origin in a patient with Rubinstein-Taybi syndrome. This case aims to raise awareness of the gynecological malignancy in patients with RSTS as well as serves as a reminder to clinicians to have a broad differential diagnosis in all patients which may help lead to early recognition of pathology.