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Journal of the American Veterinary... Oct 2019An 11-month-old sexually intact male red kangaroo () was examined because of bilateral radial and ulnar fractures.
CASE DESCRIPTION
An 11-month-old sexually intact male red kangaroo () was examined because of bilateral radial and ulnar fractures.
CLINICAL FINDINGS
Radiography of the forelimbs revealed bilateral, short oblique fractures in the proximal to mid diaphyses of the radii and ulnae. Fractures were overriding and moderately displaced. Wider than expected gaps were evident in the humeroulnar and humeroradial joints bilaterally. Although several physes remained open, no proximal radial physis was radiographically evident.
TREATMENT AND OUTCOME
Dual bone fixation was performed bilaterally, and dynamic luxation of the left radial head was identified and stabilized intraoperatively. Although satisfactory function of both forelimbs was evident at 8 weeks and 26 months after surgery, a persistent gait abnormality affecting the right forelimb was noted. Twenty-six months after surgery, radiography revealed bilateral proximal radial physes and resolution of the abnormally wide gaps in the humeroradial and humeroulnar joints. Despite dual bone fixation, synostoses formed bilaterally and may have contributed to the persistent lameness in the kangaroo's right forelimb.
CLINICAL RELEVANCE
Veterinarians treating kangaroos should be aware of difficulties in determining skeletal maturity and planning fracture stabilization because of potential differences in skeletal growth and fracture healing, compared with other species. We described critical issues observed in the treatment and outcome of the kangaroo of the present report and provided lessons learned as well as potential explanations of these issues to facilitate future treatment of kangaroos with forelimb fractures.
Topics: Animals; Forelimb; Fracture Fixation, Internal; Joint Dislocations; Macropodidae; Male; Radius; Radius Fractures; Treatment Outcome; Ulna Fractures
PubMed: 31573862
DOI: 10.2460/javma.255.8.942 -
Journal of the American Veterinary... Nov 20216-month-old and 7-month-old spayed female domestic shorthair cats were referred because of complications associated with inadvertent bilateral ureteral ligation and...
Bilateral renal descensus and intravesicular ureteroneocystostomy for treatment of bilateral ureteral ligation and transection that occurred during ovariohysterectomy in two cats.
CASE DESCRIPTION
6-month-old and 7-month-old spayed female domestic shorthair cats were referred because of complications associated with inadvertent bilateral ureteral ligation and transection during ovariohysterectomy.
CLINICAL FINDINGS
Both cats had a 1- to 2-day history of lethargy, inappetence, and vomiting. Initial exam findings included lethargy, signs of abdominal pain, anuria, and dehydration. Clinicopathologic testing revealed azotemia and hyperkalemia. Abdominal ultrasonography revealed peritoneal effusion and bilateral pyelectasia in both cats and retroperitoneal effusion in one. Fluid analysis in both cats supported a diagnosis of uroabdomen.
TREATMENT AND OUTCOME
Exploratory celiotomy was performed in both cats, and bilateral ureteral ligation and transection was confirmed. Bilateral renal descensus and ureteroneocystostomy with an intravesicular mucosal apposition technique was successfully performed in both cats. Clinicopathologic evaluation performed 1 day after surgery in one cat and 5 days after surgery in the other revealed complete resolution of azotemia. Ultrasonographic examination of the urogenital tract performed approximately 4 months after surgery in the first cat and 1 month after surgery in the second cat revealed complete resolution of renal pelvic dilation bilaterally.
CLINICAL RELEVANCE
Bilateral intravesicular ureteroneocystostomy in conjunction with bilateral renal descensus was used successfully to treat bilateral ureteral transection that occurred in 2 cats during routine ovariohysterectomy. Limited treatment options currently exist for this serious complication, and euthanasia is often considered. This technique, which relies on the use of the natural surrounding tissues for successful treatment, can offer a potential treatment option to correct this uncommon but devastating complication.
Topics: Animals; Cat Diseases; Cats; Female; Hysterectomy; Kidney; Ureter; Ureteral Obstruction
PubMed: 34780350
DOI: 10.2460/javma.20.10.0596 -
Cureus Aug 2021Subacute-onset muscle weakness can result from channelopathies, inflammatory myopathies, thyroid dysfunction, hypoparathyroidism, vitamin D deficiency, and...
Subacute-onset muscle weakness can result from channelopathies, inflammatory myopathies, thyroid dysfunction, hypoparathyroidism, vitamin D deficiency, and dyselectrolytemias like hypokalemia, hypocalcemia, and hypomagnesemia. We report a curious and extremely rare case of a 29-year-old woman with hyperemesis gravidarum presenting with disabling muscle weakness involving her lower limbs and trunk, and concurrent features of tetany. Following voluminous vomiting over the last two months, she presented with history of weakness of her lower limbs of 14 days duration, resulting in difficulty in her getting out of bed or walking unassisted. On examination, she was hypotensive (80/60 mmHg) and tachycardic (110 bpm), with flaccid weakness of her lower limbs (proximal weakness more than distal weakness - power of 1/5 at the hips bilaterally, and 3/5 at the knees and ankles bilaterally) and diminished deep tendon reflexes. She also had positive Trousseau's sign and Chvostek's sign. Interestingly, she also had thinned-out bluish sclerae, a high-arched palate, short stature, and bilateral conductive hearing loss. Laboratory evaluation revealed anemia, hyponatremia, hypokalemia, hypomagnesemia, hypochloremia, hypophosphatemia, and low vitamin D levels. Electrocardiogram showed prolonged QT interval. Her thyroid function test and parathyroid levels were normal. With parenteral replenishment of the electrolytes and vitamin D, her power improved and she was discharged on oral supplements. Thus, this case report demonstrates the importance of aggressive, early, and adequate management of hyperemesis gravidarum to prevent dyselectrolytemia-associated paraparesis.
PubMed: 34522495
DOI: 10.7759/cureus.17014 -
Journal of the West African College of... 2022Bilateral inguinal hernias are relatively rare in females compared to men. The management outcome of bilateral nylon darn, a method predominantly used in sub-Saharan...
BACKGROUND
Bilateral inguinal hernias are relatively rare in females compared to men. The management outcome of bilateral nylon darn, a method predominantly used in sub-Saharan Africa for same time repairs in complicated or elective hernia surgeries is largely unknown.
AIMS AND OBJECTIVES
Our aim is to report a rare case of same time bilateral inguinal hernia obstruction and review the outcome of bilateral nylon darn posterior wall repairs after herniotomy.
DESIGN OF THE STUDY
This was a retrospective analysis of bilaterally operated inguinal hernia female patients data that was retrieved for the past 6-year period. Settings: All complete records of female patients who had same time bilateral inguinal hernia repairs at the Margaret Marquart Catholic Hospital (district hospital), for the period January 2015 to December 2020 were included in the study.
MATERIALS AND METHODS
Patient biodata, clinical notes on diagnosis, surgical management, postoperative care, and complications were extracted from hospital records and analysed.
RESULTS
A total of 14 patients aged between 40 and 87 years which represented 1.85% of the total hernia repairs were female with same time bilateral inguinal hernia repairs. Seven (50%) patients presented at the emergency with hernias detected over a year. Surgical site infection and pains after surgery were the predominant complications and occurred more common after emergency repairs.
CONCLUSION
Emergency bilateral inguinal hernia repairs were three times associated with surgical site infection compared to elective repairs.
PubMed: 36213812
DOI: 10.4103/jwas.jwas_10_21 -
EvoDevo Feb 2022CYCLOIDEA (CYC)-like transcription factors pattern floral symmetry in most angiosperms. In core eudicots, two duplications led to three clades of CYC-like genes: CYC1,...
BACKGROUND
CYCLOIDEA (CYC)-like transcription factors pattern floral symmetry in most angiosperms. In core eudicots, two duplications led to three clades of CYC-like genes: CYC1, CYC2, and CYC3, with orthologs of the CYC2 clade restricting expression dorsally in bilaterally symmetrical flowers. Limited data from CYC3 suggest that they also play a role in flower symmetry in some asterids. We examine the evolution of these genes in Campanulaceae, a group that contains broad transitions between radial and bilateral floral symmetry and 180° resupination (turning upside-down by twisting pedicle).
RESULTS
We identify here all three paralogous CYC-like clades across Campanulaceae. Similar to other core eudicots, we show that CamCYC2 duplicated near the time of the divergence of the bilaterally symmetrical and resupinate Lobelioideae. However, in non-resupinate, bilaterally symmetrical Cyphioideae, CamCYC2 appears to have been lost and CamCYC3 duplicated, suggesting a novel genetic basis for bilateral symmetry in Cyphioideae. We additionally, utilized qRT-PCR to examine the correlation between CYC-like gene expression and shifts in flower morphology in four species of Lobelioideae. As expected, CamCYC2 gene expression was dorsoventrally restricted in bilateral symmetrical flowers. However, because Lobelioideae have resupinate flowers, both CamCYC2A and CamCYC2B are highly expressed in the finally positioned ventral petal lobes, corresponding to the adaxial side of the flower relative to meristem orientation.
CONCLUSIONS
Our sequences across Campanulaceae of all three of these paralogous groups suggests that radially symmetrical Campanuloideae duplicated CYC1, Lobelioideae duplicated CYC2 and lost CYC3 early in their divergence, and that Cyphioideae lost CYC2 and duplicated CYC3. This suggests a dynamic pattern of duplication and loss of major floral patterning genes in this group and highlights the first case of a loss of CYC2 in a bilaterally symmetrical group. We illustrate here that CYC expression is conserved along the dorsoventral axis of the flower even as it turns upside-down, suggesting that at least late CYC expression is not regulated by extrinsic factors such as gravity. We additionally show that while the pattern of dorsoventral expression of each paralog remains the same, CamCYC2A is more dominant in species with shorter relative finally positioned dorsal lobes, and CamCYC2B is more dominant in species with long dorsal lobes.
PubMed: 35125117
DOI: 10.1186/s13227-021-00189-8 -
Human Resources For Health May 2023Development partners and global health initiatives are important actors in financing health systems in many countries. Despite the importance of the health workforce to... (Review)
Review
Development partners and global health initiatives are important actors in financing health systems in many countries. Despite the importance of the health workforce to the attainment of global health targets, the contribution of global health initiatives to health workforce strengthening is unclear. A 2020 milestone in the Global Strategy on Human Resources for Health is that "all bilateral and multilateral agencies have participated in efforts to strengthen health workforce assessments and information exchange in countries." This milestone exists to encourage strategic investments in the health workforce that are evidence-based and incorporate a health labour market approach as an indication of policy comprehensiveness. To assess progress against this milestone, we reviewed the activities of 23 organizations (11 multilaterals and 12 bilaterals) which provide financial and technical assistance to countries for human resources for health, by mapping grey and peer-reviewed literature published between 2016 and 2021. The Global Strategy states that health workforce assessment involves a "deliberate strategy and accountability mechanisms on how specific programming contributes to health workforce capacity-building efforts" and avoids health labour market distortions. Health workforce investments are widely recognized as essential for the achievement of global health goals, and some partners identify health workforce as a key strategic focus in their policy and strategy documents. However, most do not identify it as a key focus, and few have a published specific policy or strategy to guide health workforce investments. Several partners include optional health workforce indicators in their monitoring and evaluation processes and/or require an impact assessment for issues such as the environment and gender equality. Very few, however, have embedded efforts in their governance mechanisms to strengthen health workforce assessments. On the other hand, most have participated in health workforce information exchange activities, including strengthening information systems and health labour market analyses. Although there is evidence of participation in efforts to strengthen health workforce assessments and (especially) information exchange, the achievement of this milestone of the Global Strategy requires more structured policies for the monitoring and evaluation of health workforce investments to optimize the value of these investments and contribute towards global and national health goals.
Topics: Humans; Health Workforce; Global Health; Workforce; Capacity Building; Laboratory Personnel
PubMed: 37226173
DOI: 10.1186/s12960-023-00825-5 -
Journal of Ayub Medical College,... 2021Becker's nevus is a main epidermal hypermelanotic condition that usually presents in adolescence, though childhood cases are seen less commonly. Congenital cases have...
Becker's nevus is a main epidermal hypermelanotic condition that usually presents in adolescence, though childhood cases are seen less commonly. Congenital cases have been rarely reported. Nevus is usually unilateral having increased pigmentation and is characterized by hypertrichosis. It usually presents as a patch on back, proximal upper extremities, arms and upper trunk. Becker's Nevus presenting as bilateral asymmetrical patch is rare. A case of 23 year's old male with bilateral hyperpigmentad patch over the back has been reported. The histological exams established the clinical hypothesis of Becker's Nevus.
Topics: Back; Humans; Hyperpigmentation; Male; Nevus; Skin Neoplasms; Young Adult
PubMed: 34137561
DOI: No ID Found -
Cureus Dec 2021Vogt-Koyanagi-Harada disease is a vision-threatening autoimmune disease mediated by adaptive immune responses via T helper (Th) 1 and Th17 cell activation. The...
Vogt-Koyanagi-Harada disease is a vision-threatening autoimmune disease mediated by adaptive immune responses via T helper (Th) 1 and Th17 cell activation. The disease often starts with a flu-like illness followed by eye pain, headache, and dizziness later evolving into vision loss bilaterally. Other symptoms may include vitiligo and hearing loss. Diagnostic criteria include exclusion of other eye diseases, no history of recent penetrating eye trauma or surgery, bilateral ocular involvement with evidence of diffuse choroiditis, auditory and neurological findings (tinnitus and meningismus), and skin findings including depigmentation or alopecia. Retinal examination reveals bilateral uveitis with choroidal thickening (which may be seen as a sub-retinal fluid collection or serous retinal detachment). Treatment includes corticosteroid therapy with the addition of biological and immunosuppressive medications as needed to suppress the disease activity and ensure symptomatic improvement.
PubMed: 35003972
DOI: 10.7759/cureus.20138 -
Clinics in Orthopedic Surgery Sep 2019The purpose of this study was to compare outcomes of patients who underwent bilateral total shoulder arthroplasties (TSAs) for osteoarthritis (OA) versus bilateral... (Comparative Study)
Comparative Study
BACKGROUND
The purpose of this study was to compare outcomes of patients who underwent bilateral total shoulder arthroplasties (TSAs) for osteoarthritis (OA) versus bilateral reverse shoulder arthroplasties (RSAs) for cuff tear arthropathy (CTA).
METHODS
Inclusion criteria were patients who underwent bilateral TSAs for OA or bilateral RSAs for CTA with at least 2 years of follow-up. Twenty-six TSA patients (52 shoulders) were matched 2 to 1 with 13 RSA patients (26 shoulders) by sex, age at first surgery, and time between surgeries. Outcomes measured were shoulder range of motion (ROM), complications, and patient-reported scores.
RESULTS
Preoperatively, TSA patients had significantly better forward elevation (FE) of both shoulders than RSA patients (dominant side [Dom]: 103° ± 32° vs. 81° ± 31°, = 0.047; nondominant side [non-Dom]: 111° ± 28° vs. 70° ± 42°, = 0.005) without significant differences in external (ER) or internal rotation (IR). Postoperatively, TSA patients had significantly better FE (Dom and non-Dom: 156° ± 12°, 156° ± 14° vs. 134° ± 24°, 137° ± 23°; = 0.006, = 0.019) and ER (42° ± 11°, 43° ± 10° vs. 24° ± 12°, 25° ± 10°; < 0.001, < 0.001) bilaterally and IR of their dominant arm (L1 vs. L4, = 0.045). TSA patients had significantly better activities of daily living external and internal rotations (ADLEIR) scores (Dom and non-Dom: 35.3 ± 1.0, 35.5 ± 0.9 vs. 32.1 ± 2.4, 32.5 ± 2.2; = 0.001, = 0.001), American Shoulder and Elbow Surgeons scores (94.2 ± 8.4, 94.2 ± 8.2 vs. 84.7 ± 10.0, 84.5 ± 8.0; = 0.015, = 0.004), and Single Assessment Numerical Evaluation (SANE) scores (93.5 ± 7.6, 93.8 ± 11.8 vs. 80.5 ± 14.2, 82.3 ± 13.1; = 0.014, = 0.025), with no significant difference in visual analog scale pain scores (0.4 ± 1.0, 0.3 ± 1.0 vs. 0.7 ± 1.3, 0.8 ± 1.2) bilaterally.
CONCLUSIONS
Overall, patients with bilateral TSAs and RSAs exhibited improved ROM and patient-reported outcomes. Those with bilateral TSAs had better functional outcomes than those with bilateral RSAs.
Topics: Aged; Arthroplasty, Replacement, Shoulder; Humans; Osteoarthritis; Recovery of Function; Rotator Cuff Injuries; Shoulder Joint; Treatment Outcome
PubMed: 31475053
DOI: 10.4055/cios.2019.11.3.316 -
Neuro-ophthalmology (Aeolus Press) 2020Prepapillary vascular loops are rare congenital vascular abnormalities of the retinal vasculature. This mostly benign condition can sometimes cause complications such as...
Prepapillary vascular loops are rare congenital vascular abnormalities of the retinal vasculature. This mostly benign condition can sometimes cause complications such as branch retinal artery occlusion and vitreous haemorrhage. Disc collaterals, neovascularisation of the optic disc, idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome and Wyburn Mason syndrome should be kept in mind for the vascular differential diagnosis. In addition, when the loops present bilaterally and settle into the region adjacent to the optic disc border, they can be misdiagnosed as papilloedema. The diagnosis is usually made clinically by careful fundus examination. Optical coherence tomography and fundus fluorescein angiography might serve as ancillary tools for the diagnosis. In this report, we present a 52-year-old male with bilateral prepapillary arterial loops referred to our clinic with a preliminary diagnosis of papilloedema.
PubMed: 33012926
DOI: 10.1080/01658107.2019.1680704