Residential MRI: Development of A Mobile Anywhere-Everywhere MRI Lab

Magnetic resonance imaging (MRI) enables unprecedented visualization of brain and central nervous system anatomy, microstructure, function, and physiology. However, unlike electroencephalography (EEG) or functional near infrared spectroscopy (fNIRS), which can be used within a doctor’s office, research laboratory, or at a participant’s home, MRI remains a hospital or center-based modality. The need for patients or research participants to travel to the scanner limits overall healthcare access and potentially biases research study populations. The recent introduction of low magnetic field strength, lightweight, and portable MRI systems offer the potential to extend beyond these traditional hospital and imaging center boundaries. Here we describe the development and deployment of a mobile imaging lab in a modified cargo van that incorporates a removable low field permanent magnet MRI system. The mobile lab allows, for the first time, rapid and routine ‘residential’ MRI that can be performed at home, community center, school, etc. Breaking traditional barriers of access, this mobile approach will enable imaging of patients and participants who have mobility challenges, live long distances from imaging centers, or are otherwise unable to travel to an imaging center or hospital.

Cooperation Between a Doctor and a Podiatrist to Improve the Quality of Life of Patients with Ingrown Toenails

Cooperation between doctors of various specialties and other medical specialists is the standard of care in the treatment of patients. Due to the variety of diseases and the dynamic development of medicine in general, it is difficult to be an expert in every field and know all the recommended treatments. An example of such cooperation is the joint treatment of patients with the problem of ingrown toenails. The article contains an analysis of patients who received treatment in a doctor’s office in cooperation with podiatrists. A conservative approach towards the treatment of this condition sees the patient being initially diagnosed and treated by a podiatrist and then later, if necessary, being referred to a doctor for surgical treatment. The exchange of experiences and information on patients treated by interdisciplinary teams allows doctors and podiatrists to find the best possible treatment and improve the quality of life of patients. The follow-up of patients after surgery can be performed later in podiatry offices. Owing to modern electronic communication, it is possible for a doctor to constantly monitor the patient’s condition without the need for direct visits to the doctor’s office.

Validation of Smartphone Sway Analysis for Fall Prevention

Analysis of the balance and sway of the elderly remains a field continuously studied for additional means of assessing the risks of falls. Almost 50% of falls among the elderly lead to serious injuries, and falls are the leading cause of death for the elderly. Thus, the development of a convenient method to assess the risks of falling would be beneficial in helping to diminish these risks. We recorded the sway data by using the widely acceptable force plate and simultaneously compared it to the angular orientation measured by a cell phone’s accelerometer attached to the subject. It was found that the correlation of the average path length and average velocity between the results from the force plate and the phone application were 0.83 and 0.86 respectively. Overall, the direction of the strongest correlation was in the anterior–posterior (AP) direction that is mostly associated with falls. The smart phone application was able to represent the results that were gathered by the force plate, thus opening the door to a simpler way to track sway variables in the elderly without the necessity to come to a doctor’s office.

BLOOD PRESSURE VARIATION IN CHILDREN AT 5 MINUTE INTERVAL FOR IDENTIFICATION OF WHITE COAT HYPERTENSION

White-coat hypertension is a condition when a person’s blood pressure tends to increase only when they are at the doctor's office. In children, blood pressure between the 90th and 95th percentile is labelled as pre-hypertension and above the 95thcentile it is classified as hypertension. The difference between 90th and 95th centiles for both systolic and diastolic blood pressure is only 4 mm of Hg. Methods: Children between ages 5 to 10 years admitted in the children ward of Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India from February to April 2020 included in the study. We record blood pressure by oscillometer 4 times a day, over 4 days of hospital stay and each time two readings were taken at 5 minute intervals. Results: During 4 days of hospital stay blood pressure varied widely. In addition second reading of BP were always less than the first reading BP, but second readings data also varied widely just as first readings. Conclusion: White coat’ hypertension is the phenomenon where BP is exaggerated by act of measuring BP. This is initiated by anxiety. Children are particularly susceptible and distressed by the circumstances of hospitalization, stranger anxiety and fear to painful intervention. We should take multiple readings before reach a conclusion of hypertension. Key words: Blood pressure, White-coat Hypertension, Ambulatory BP, Hypertension

MEDICAL ERROR, PERSISTENT VEGETATIVE STATE AND OVER NINETEEN LONG YEARS OF MEDICAL CARE

A medical error is a preventable adverse effect of medical care. Errors can happen in the hospital at the doctor’s office, at the pharmacy, laboratory and ward. These can also occur at home by the patient or the attendant. These errors may lead to death or major/minor injuries or can also be harmless. However these should be recorded, analysed and remedial measures implemented to reduce the risk of being committed in the future. We are reporting the medical care of our patient in persistent vegetative state over nineteen years due to medical error at our hospital resulting in brain anoxia. The key issues faced during the care were recurrent respiratory and urinary tract infections and in last one year kidney calculi leading to chronic kidney disease and its complications. There are no contractures or thrombo-embolic events and above all no bed sore over this period.

Vaccine Hesitancy in the Current Landscape of the COVID-19 Pandemic

For a procedure so commonplace in a doctor’s office, so critical to the prevention of disease, and so marred by controversy, it seemed odd that in my third year of medical school, I had yet to perform a vaccination. For that reason, I was very excited for my first rotation in family medicine. One could even say I was a little overzealous to learn about vaccines. To my credit, as someone who studied healthcare economics, there is a lot to love about the social return on investment of vaccines. Two weeks into my rotation I came across my first case of vaccine hesitancy. They were parents who had immigrated to Canada and were skeptical of vaccines. They wanted to pick and choose which vaccines their child would receive. These people are called the ‘vaccine hesitant’ and, unlike the devout ‘vaccine deniers’, they are the crucial swing states in a political battle for the health of our country. [1]

HYPERPIGMENTED AND HYPOPIGMENTED LESIONS – THROUGH THE EYES OF DERMOSCOPE.

Dermoscope is a very useful and non-invasive technique for diagnosis of pigmentary skin lesions. It helps in diagnosis of skin lesions like seborrheic keratosis , spitz nevus which may clinically simulate melanoma. It involves a complementary examination of pigmented lesions on the skin, increasing the chance of an accurate diagnosis of cutaneous melanoma. It is a relatively simple technique that can be carried out in a doctor's office, clinic, or hospital, with the use of a portable device (manual dermatoscope).In this article we are presenting the dermoscopic features of common hyper and hypopigmented skin lesions . The goal is to introduce this subject to those not yet familiar with it, in order to instigate and encourage the training and practice of this technique of growing importance for everyday usage.

Treatment of Nail Fold Hypertrophy by Combining Conservative Techniques

<b><i>Introduction:</i></b> Hypertrophy of the nail folds is a common condition. It occurs by alteration of shape, partial loss, or absence of the nail, resulting in loss of the nail fold physiological limit. This can also occur by the friction of the nail with the nail fold. Consequently, there is an increase in the volume of the lateral or distal nail fold and a decrease in the space of the nail bed and the nail plate. Management of this onychodystrophy may be conservative or surgical. <b><i>Case Presentation:</i></b> We present a case of distal nail embedding after trauma, submitted to conservative treatment. Combined techniques were required as trichloroacetic acid application, rolled cotton padding maneuver, artificial resin nail technique, and orthesis. After 14 months, good functional and aesthetic results were obtained, with correction of the anatomical shape of the nail unit. <b><i>Conclusion:</i></b> The conservative techniques for hypertrophy of the nail folds are a useful option with good functional and aesthetic results. The indication must be precise, considering the history of the patient and after discarding bone alterations by image exams. The disadvantage of the method is the long treatment time and constant visits to the doctor’s office.

It’s not just the elderly: digital illiteracy is common and deserves more attention when implementing eHealth (Preprint)

UNSTRUCTURED Imagine what the world would have looked like without Internet? You probably have spent the last year more hours behind the web cam than ever before! Our lives have changed tremendously. The increased use of technology was also seen in healthcare. The use of technology in healthcare is called E-Health. Examples of E-Health are online video consultations between doctors and their patients or monitoring of blood pressure with a Bluetooth device so that information can be sent from patients home to the doctor’s office. Many of these innovations lead to better health outcomes which is fantastic! E-Health possibilities seem to be endless and will play an increasingly important role in our health care system. There is one drawback however, in the Netherlands 2 million people are not capable of using digital technology. This also includes young people. Data from Eurostat shows that approximately 50% of the lower educated 25-54 year old citizens of western European countries lack basic digital skills. This is an important problem because this large group cannot profit from the benefits of E-Health. Eventually this will lead to health disparities of people who can’t use digital technology. The increasing use of E-Health will increase this gap and urgent action is needed. Also younger citizens need support to use eHealth. Policymakers need to find ways to either engage this group in E-Health or find alternative solutions for them so that everyone profit from optimal health care.