Notes

Vaccination as being a preventive measure leading to immune fitness.
Via inverse simulation of a protruding, downward, left and right movement, the ROM of the tongue was predicted. This prediction was compared to the ROM measured with a 3D camera. It was demonstrated that biomechanical models with personalized muscles bundles are better in approaching the measured ROM than a generic model. However, to achieve this result a correction factor was needed to compensate for the small magnitude of motion of the model. Future versions of these models may have the potential to improve the estimation of function loss after treatment for advanced tongue cancer.
Population ageing is a worldwide phenomenon; thanks to improvements in medical care and living standards. The Office of National Statistics in the UK predicts that the fastest growing age group in coming decades will be those over 85years. This is reflected in Trauma Audit and Research Network data, which has highlighted a shift in caseload from a majority of young males to elderly patients at UK Major Trauma Centres (MTC). This study of elderly trauma patients admitted to a UK MTC reviews the links between frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), and outcomes from trauma.

A retrospective database review of patients > 65years old admitted to our MTC was performed. We identified 1125 eligible patients of which 729 had a recorded CFS. Those without a CFS were omitted. The primary outcome measured was in-hospital mortality. Secondary measures were Injury Severity Score, length of stay, trauma team activation on arrival and discharge destination. check details Multivariate regression analyses were performed using STATA v 15.

Those of CFS 5-9 (frail) were 2.6 times more likely to die than the CFS 1-4 (pre-frail) (OR 2.65, 95% CI 1.47-4.78). The frail group was also 56% less likely to have a trauma call on admission (OR 0.44, 95% CI 0.30-0.65) and 61% less likely to be discharged to their usual place of residence (OR 0.39, 95% CI 0.28-0.55).

We advocate the use of the Clinical Frailty Scale as a screening tool for frailty in trauma patients, highlighting those at risk of increased length of stay and mortality, subsequently assisting healthcare providers with setting realistic expectations with family members.

Level III, prognostic and epidemiological.
Level III, prognostic and epidemiological.Poor obstetric outcomes are described in rheumatic diseases (RDs) such as systemic sclerosis (SSc). We assessed the effect of the disease in Indian women and compared with those in developed countries and other RDs. Women with SSc (ACR/EULAR 2013 criteria) registered at a tertiary care centre (2010-2016) were interviewed by teleconsultation. Pregnancies occurring after disease onset were compared with those occurring prior to it. Maternal complications included antepartum hemorrhage, postpartum hemorrhage, spontaneous abortion, preterm rupture of membrane, oligohydramnios, infection, prolonged labour, and foetal complications including low birth weight (LBW), intrauterine death (IUD), preterm delivery, and neonatal infection. Results were expressed as median (Interquartile range). Of 200 SSc, 75 patients aged 31 (22-38) years and disease duration 41 (32-50) months were interviewed. Diffuse cutaneous SSc was the most common (42.56%). 127 conceptions before the onset of SSc were compared with 15 after. Among post-diagnosis, 9 (60%) were live births, 3 (20%) spontaneous abortions 1 (6.7%) induced abortion, 2 (13.3%) IUD. Of the live births, 4 (26.7%) were preterm and 3 (20%) were LBW. Pregnancies after disease onset had a higher rate of maternal (OR - 4.9) and foetal (OR - 9.9) complications compared to pregnancies before SSc. Compared to the Italian cohort, Indian SSc patients had a higher abortion rate (OR - 5.8), frequent lower section ceaserean section (OR - 9.4) and lower live births (OR - 0.05). More frequent caesarean deliveries (OR - 93), preterm deliveries (OR - 20) when compared with lupus and favourable maternal outcomes (OR - 0.15), higher preterm deliveries (OR - 9.6) in comparison with Takayasu arteritis were noted. SSc incurs a higher risk of poor maternal as well as the foetal outcome.Kawasaki disease (KD) is a medium vessel vasculitis that predominantly affects children below 5. Diagnosis of KD is based on the presence of characteristic clinical manifestations as there are no definite diagnostic laboratory investigations for the diagnosis of this disease. Presence of atypical clinical features such as myositis often pose diagnostic challenge for the treating physicians. Presence of myositis and severe muscular weakness in KD is distinctly unusual and may lead to delays in diagnosis and administration of definite therapy. We report a 10-year-old boy who presented with fever, rash and proximal muscle and pharyngeal weakness. A clinical possibility of toxic shock syndrome or juvenile dermatomyositis was initially considered. However, he continued to have fever and developed periungual peeling of skin in fingers. Hence, a possibility of KD with myositis was considered. He showed prompt response to intravenous immunoglobulin and methylprednisolone. We also provide a review of similarly reported cases of KD myositis. It is important for clinicians to be aware of this atypical clinical presentation to avoid delays in diagnosis and treatment of KD.Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disease caused by a reduction in mesenteric blood supply without vascular occlusion. Early diagnosis of NOMI is often difficult because there are no specific findings suggesting NOMI. Here, we report a rare case of a very elderly patient with mild NOMI caused by dehydration due to short-term reduced oral intake and associated with syncope. A 90-year-old man was admitted to our hospital with syncope and melena. The syncope was thought to be caused by orthostatic hypotension due to dehydration owing to reduced oral intake for approximately 24 h. Abdominal computed tomography (CT) revealed marked bowel wall thickening with mesenteric stranding in the ileum and ascending colon, dilated small intestine with thinned bowel wall, collapsed superior mesenteric vein, hemorrhagic ascites, and absence of obvious vascular occlusion in the mesenteric vessels. Abdominal symptoms, laboratory abnormalities, and CT findings improved gradually with the correction of dehydration.
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