Recent Articles

We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.

Methemoglobinemia is a rare disease classification related with congenital or acquired (usually iatrogenic) hemoglobin oxygenation disorder. Despite the fact that number of potentially methemoglobin forming agents is very long, methemoglobinemia is still a case-report of patients admitting to the Emergency Departments. The patient was brought after consuming resin hardener for suicidal purposes from the Center of lower reference to the hospital Emergency Department with suspected burns of the gastrointestinal tract. The patient presented cyanosis, dyspnoea and brown-colored urine on admission.

Giant cell tumor of bone (GCTB) is a primary bone tumor, locally aggressive. For many, a GCTB is considered a tumor with an unpredictable behavior, particularly regarding recurrences, pulmonary implants, and the possibility of primary malignancy. In terms of risk of recurrence, it is known that it is associated with the type of treatment used initially for the GCTB. The greater the number or recurrences, the greater the risk of pulmonary implants, and the greater the risk of malignant degeneration. Therefore, much of the prognosis of this tumor could be related to the type of initial treatment. Hence the importance of the treatment theme. This review includes a comparison between the various modalities for treatment in GCTB, considering the advantages and disadvantages of each one. Existing GCTB treatments are not 100% safe and effective at the same time. and this is the reason why the search for other treatment modalities should continue to offer a better oncologic and functional outcome to patients. In the end of this review, based on research work, we also mention other possible therapeutic options that could be explored and used in the future for GCT treatment.

Sarcoidosis and tuberculosis are chronic granulomatous diseases with predominant pulmonary involvement. Simultaneous occurrence of sarcoidosis and tuberculosis is a rarely encountered clinical entity. We present two Sri Lankan males with coexisting bacteriologically confirmed tuberculosis and histologically diagnosed sarcoidosis. Careful and timely commencement of anti-tuberculous treatment followed by steroids treatment for sarcoidosis lead to improvement of both conditions. These cases are reported to describe the dilemmas in diagnosis and management of this underrecognized clinical entity.

The aetiological diagnosis in an infant with hypotonia is a challenging task for a clinician due to variable and long list of differentials [1]. It could be due to an insult within the central nervous system (CNS) or less commonly result from a peripheral defect at neuro-muscular level and other miscellaneous causes (rickets, hypothyroidism) [2]. Most commonly it is a central hypotonia where the muscular weakness is absent or not profound. In Indian scenario, it is mostly idiopathic central hypotonia, followed by HIE (cerebral palsy) [2]. In cases of cerebral palsy, neuro-imaging reveals the severity of affliction. The peripheral aetiologies like congenital myopathies, congenital myasthenia, infantile botulism etc. are rather rare occurrences. Infants with congenital muscular dystrophy have muscular dystrophy, central neural affliction and involvement of multiple systems (skeletal, cardiovascular, respiratory, ocular etc.). It is a rare disease with studies in Italian population showing point prevalence of 0.563 per 100,000 total population [3]. Unlike HIE, the affliction in CMD is multi-system and it is an inherited disease with variable penetration, the distinction between the two is important to a clinician for the management. CMDs generally have early fatal outcome. So, early diagnosis is important for prognostication, supportive treatment and genetic counselling. The neuro-imaging findings of CMD clearly stand out from the rest aetiologies and can guide a clinician to go in early , for an invasive test like muscle biopsy which is the gold standard diagnostic test .

In order to improve the feasibility and accuracy of the roadbed settlement prediction model, the factor analysis method is combined with the BP neural network method, and an improved BP neural network roadbed settlement prediction model is proposed. Select example data to test the improved BP neural network roadbed settlement prediction model. The test results: The relative average error of the 10 sets of training samples’ predicted and actual roadbed settlements was 4.287%, and the roads of five predicted samples The relative error of subgrade settlement is 1.79%, 1.93%, 6.62%, 7.19%, 4.05%, all less than 10%, which proves that the improved BP neural network prediction model has good prediction accuracy.

This paper focuses on a solution to the finance restrictions that obstacle the development of railways section in Sudan. Sudan is a big country with an area estimated at more than 1,800,000 km2. It owns variety of natural and other resources. The transportation system in Sudan specially railways suffers a lot of restrictions that affect its contribution to the national economy. Sudan railways is one of the longest railways in Africa with about 5,000 km. Railways were the earliest mechanical means of transport to be introduced in Sudan. The construction of the first railway line started in the last decade of the Nineteen century. Railways have been playing a significant role in transportation for long time. However, railways in Sudan lack passengers’ trains recently. Moreover, the capacity of freight trains is enough to meet just 10% of needed capacity. Also, most of the rails are very old and exceeded their expire date; and as the result a lot of derailments had been occurred. Also, most of the rail on the western lines are not suited to all of the diesels. Moreover, most sleepers are creosoted wood which differ from that used in the neighboring countries that use steel or concrete. And to overcome all these issues, there is a huge need of finance. However, lacking of finance is one of the main restrictions that face the development of railways section in Sudan. And, in spite of that, the Build Operate-Transport (BOT) approach could be the best option to deal with the current situation that faces railways section in Sudan. Build-Operate-Transport Approach (BOT) is a well-known method of initiating, financing and managing public capital projects by private section for specific period of time and then transfer them to the public owners. The idea of the approach is to give the private…

Do as I say, not as I do is a common phrase that applies to the case of Notre Dame’s president as he began the Fall 2020 semester chastising students for gathering in large groups off campus leading to the spread of COVID-19 while he, just a month later, gathered unmasked in the U.S. White House Rose Garden to celebrate the nomination of a Notre Dame alum to the Supreme Court. This study draws upon image restoration strategies in crisis response literature to examine Notre Dame and its president’s public response to both the two-week move to remote education in Fall 2020 following COVID-19 outbreak among its students and the unmasked attendance to an event that resulted in Notre Dame’s president testing positive for COVID-19. Overall, evasion of responsibility and corrective action typified the university’s response to students’ behaviors that led to public health risk, but mortification along with contradictory messages evading responsibility typified the individual response of the university’s president that led to public health risk. Of interest to the case is the lack of religious appeal intertwined in the image restoration strategies used in the president’s apology yet the use of religious appeal in the university’s accusations against student public health behavior. Given that Notre Dame is a religiously affiliated university and the president is clergy, the inconsistent use of religious appeal may undermine the image restoration rhetoric of the president.

Objectives: This study aimed at evaluating the reliability of respiratory rate obtained by a non-contact technology with respect to a medically validated monitor among preterm babies. Design: This observational study compared the respiratory rates from raybaby’s non-contact technology and FDA approved Earlysense unit for the same instants of time through 760 hours of monitoring. 18 preterm babies in the NICU of a paediatric specialty hospital in India were considered for the study. The raybaby device was installed in front of the incubator and the contact-free FDA approved device was placed below the mattress of the incubator. The Respiratory Rate monitored was displayed on the device’s monitoring screen. Respiratory rates from both devices were compared to calculate the agreement between the values. Correlation, Accuracy, Hit Percentage and Fit Curves for the non-contact technology of raybaby with respect to the clinically certified device. Results: With 760 hours of monitoring, 37404 breathing instances were analysed. This yielded an accuracy of 98%. 95% of the data points fell within the +/- 5 units error range which is usually followed by medical devices. Conclusions: Raybaby uses a non-contact technology for monitoring Respiratory Rate. The average breathing rate observed was 33 to 43 breaths per minute, which falls within the breathing range of 30-60 breaths per minute. From the 37404 data points analysed, raybaby® establishes further proof for the breathing range and trend found in babies. The accuracy of non-contact technology for respiratory monitoring establishes great potential for making health monitoring less intrusive and efficient for use. This renders the technology as a hopeful tool for respiratory monitoring to deploy at observation units during the pandemic.

Introduction: Cardiovascular disease (CVD) remains the single leading cause of death around the globe. The Transtheoretical model (TTM) is a successful framework for guiding behaviour change programmes for several health behaviours, yet there are limited reviews on how TTM has been used to facilitate behaviour change associated with reduced CVD. Therefore, the aims of this systematic review are to determine (i) how TTM has been used in promoting physical activity, fruit and vegetable consumption, and smoking cessation and (ii) gaps in knowledge in the use of stage-based model to improve physical activity, intake of fruit and vegetables, and smoking cessation. Materials and Methods: The approach to this systematic review was informed by current recommendations known as Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Results: Constructs of TTM were used in the design of studies, facilitation of health behaviour change, monitoring of change in the movement of the participants across the change continuum, and evaluation of the effectiveness of health behaviour programmes. TTM was incorporated with other models, including Health Belief Model (HBM), social-ecological model, and social cognitive theory to facilitate behaviour change. There were limited studies that used all the four constructs of TTM to promote health behaviour change. Conclusion: TTM is a promising tool for designing, facilitating, monitoring, and evaluating behaviour change associated with reduced cardiovascular disease (CVD). TTM may be incorporated with other models, including HBM, social-ecological model, and social cognitive theory to facilitate behaviour change.