Atlantoaxial rotary subluxation (AARS) is a rare condition that may cause persistent torticollis if not treated appropriately. AARS is associated with ligamentous abnormalities, which may result from acquired or congenital disorders. We report the case of a paediatric patient with congenital Marfan syndrome and AARS due to a minor traumatic head injury. A 9-year-old boy with a known diagnosis of Marfan syndrome (and extensive family history) encountered a traumatic head injury that presented as torticollis with a typical “cock-robin” head and neck orientation. AARS was diagnosed through a head and neck CT scan. He underwent initial conservative treatment involving a muscle relaxant (diazepam) and Miami-J collar. This was followed up with manipulation under anaesthesia (MUA) and further cervical traction, which resolved the subluxation without more invasive treatment. To the best of our knowledge, AARS associated with Marfan syndrome has been rarely reported in literature. It is postulated that the ligamentous laxity associated with Marfan syndrome would increase the patient’s predisposition to AARS and more importantly, the propensity to require more invasive treatment (internal fixation). However, our patient unexpectedly responded well to conservative management, namely MUA and cervical traction. This illustrates that despite the increased ligamentous laxity in Marfan syndrome, it is still advisable to conservatively manage AARS before deciding to perform invasive internal fixation.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S15
Abstract In this paper we provide a first physical interpretation for the Event Horizon Telescope's (EHT) 2017 observations of Sgr A*. Our main approach is to compare resolved EHT data at 230 GHz and unresolved non-EHT observations from radio to X-ray wavelengths to predictions from a library of models based on time-dependent general relativistic magnetohydrodynamics simulations, including aligned, tilted, and stellar-wind-fed simulations; radiative transfer is performed assuming both thermal and nonthermal electron distribution functions. We test the models against 11 constraints drawn from EHT 230 GHz data and observations at 86 GHz, 2.2 μ m, and in the X-ray. All models fail at least one constraint. Light-curve variability provides a particularly severe constraint, failing nearly all strongly magnetized (magnetically arrested disk (MAD)) models and a large fraction of weakly magnetized models. A number of models fail only the variability constraints. We identify a promising cluster of these models, which are MAD and have inclination i ≤ 30°. They have accretion rate (5.2–9.5) × 10 −9 M ⊙ yr −1 , bolometric luminosity (6.8–9.2) × 10 35 erg s −1 , and outflow power (1.3–4.8) × 10 38 erg s −1 . We also find that all models with i ≥ 70° fail at least two constraints, as do all models with equal ion and electron temperature; exploratory, nonthermal model sets tend to have higher 2.2 μ m flux density; and the population of cold electrons is limited by X-ray constraints due to the risk of bremsstrahlung overproduction. Finally, we discuss physical and numerical limitations of the models, highlighting the possible importance of kinetic effects and duration of the simulations.
We present the first Event Horizon Telescope (EHT) observations of Sagittarius A* (Sgr A$^*$), the Galactic center source associated with a supermassive black hole. These observations were conducted in 2017 using a global interferometric array of eight telescopes operating at a wavelength of $\lambda=1.3\,{\rm mm}$. The EHT data resolve a compact emission region with intrahour variability. A variety of imaging and modeling analyses all support an image that is dominated by a bright, thick ring with a diameter of $51.8 \pm 2.3$\,\uas (68\% credible interval). The ring has modest azimuthal brightness asymmetry and a comparatively dim interior. Using a large suite of numerical simulations, we demonstrate that the EHT images of Sgr A$^*$ are consistent with the expected appearance of a Kerr black hole with mass ${\sim}4 \times 10^6\,{\rm M}_\odot$, which is inferred to exist at this location based on previous infrared observations of individual stellar orbits as well as maser proper motion studies. Our model comparisons disfavor scenarios where the black hole is viewed at high inclination ($i > 50^\circ$), as well as non-spinning black holes and those with retrograde accretion disks. Our results provide direct evidence for the presence of a supermassive black hole at the center of the Milky Way galaxy, and for the first time we connect the predictions from dynamical measurements of stellar orbits on scales of $10^3-10^5$ gravitational radii to event horizon-scale images and variability. Furthermore, a comparison with the EHT results for the supermassive black hole M87$^*$ shows consistency with the predictions of general relativity spanning over three orders of magnitude in central mass.
Journal Article Lengthy persistence of ciguatoxin in the body Get access Thomas Y.K. Chan Thomas Y.K. Chan Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 92, Issue 6, November-December 1998, Page 662, https://doi.org/10.1016/S0035-9203(98)90803-3 Published: 01 November 1998 Article history Received: 30 June 1998 Accepted: 04 August 1998 Published: 01 November 1998
Abstract Introduction Gossypiboma is a term describing a retained surgical swab which is a serious complication following any surgical intervention. The incidence of these cases is wholly under reported, partly due to medicolegal aspects, but also due to the misnomer of diagnosis. In this case, we discuss the multifactorial deficiencies which led to a significant morbidity in a patient who had remained asymptomatic for nine years since index surgery. Case Presentation A 40-year-old woman presented to the emergency department febrile with a one week history of abdominal pain, on a background of a one year history of chronic pain. The patient’s surgical history demonstrated an ovarian fibroid excision and a subtotal hysterectomy nine and six years ago, respectively. It was later noted the chronic abdominal pain had been previously investigated with positive findings on imaging and biopsy, however, she was lost to follow up. A year later, she presented with an acute abdomen and operative findings of a large abscess cavity, containing a retained swab, with small bowel fistulation were noted. Conclusions This reiterates the importance of surgical safety checklists, and often despite this there are many factors that can eventually lead to complete alignment of the holes in the Swiss Cheese leading to unfavourable outcomes. It is imperative to remain hypervigilant during checkpoints, particularly in emergencies where the unpredictability of the operation leads to human error. Gossypiboma remains a serious cause for morbidity and mortality, thus the potential for modified safety checklists or alternative methods for surgical counts.
Post-bariatric hypoglycaemia (PBH) is typically a post-prandial hypoglycaemia occurring about 2–4 h after eating in individuals who have undergone bariatric surgery. PBH develops relatively late after surgery and often after discharge from post-surgical follow-up by bariatric teams, leading to variability in diagnosis and management in non-specialist centres. Aim The overall aim was to improve and standardise clinical practice in the diagnosis and management of PBH. The objectives were: (1) to undertake an up-to-date review of the current literature; (2) to formulate practical and evidence-based guidance regarding the diagnosis and treatment of PBH; (3) to recommend future avenues for research in this condition. Method A scoping review was undertaken after an extensive literature search. A consensus on the guidance and confidence in the recommendations was reached by the steering group authors prior to review by key stakeholders. Outcome We make pragmatic recommendations for the practical diagnosis and management of PBH, including criteria for diagnosis and recognition, as well as recommendations for research areas that should be explored. Plain English summary Post-bariatric hypoglycaemia (PBH) is a condition that commonly affects people who have undergone weight loss surgery. In this condition, people develop low blood sugar occurring about 2–4 h after meals, leading to debilitating symptoms such as hunger, sweating, anxiety, palpitations and even blackouts and fainting. PBH is becoming more common as weight loss surgery is being taken up by more people to help with their weight and to help with diabetes. The condition often develops after the patient has been discharged from follow-up after their surgery, which can lead to inconsistent diagnosis and treatment in non-specialist healthcare centres. The lack of clear information and evidence in the existing scientific literature further contributes to the variation in care. To address this problem, the Society for Endocrinology has created new guidelines to help healthcare professionals accurately diagnose and manage this condition. The guidelines were developed with input from dietitians, surgeons and doctors specialising in weight loss, and hormone specialists.
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