An update on the work-up and management of ankle fractures: A literature review

Our understanding of the management of ankle fractures has significantly improved in recent years. Computerized axial tomography and better biomechanical insights have renewed the underlying concepts for both diagnosis and treatment. Notwithstanding, some aspects of the management of malleolar fractures still lack consensus. This review aims to update concepts on the study and management of ankle fractures. Stability, radiological studies, computerized axial tomography, management of associated ligament injuries (deltoid ligament and syndesmosis), and posterior malleolus fractures are covered in the article. The authors’ opinions and the evidence are discussed for each question.

Research trends from computer and electronic sciences

Electronics as a technical and scientific discipline was born in 1904, based on the principles defined by John Ambrose Fleming (inventor of the diode) and André Marie Ampére (founder of electromagnetic theory), its evolution towards current electronics, has largely been possible thanks to the invention of the triode (device capable of converting alternating current into direct current) by Lee De Forest. On the other hand, computer science as born as a scientific discipline in the early 1940s, based on mathematical logic and algorithmic theory, the principles that sustain it go back to the works Gottlob Frege (father of modern mathematical logic) and Andréi Kolmogórov (founder of the theory of algorithm complexity). The complementarity between these two relevant disciplines has made possible the development of a wide diversity of technologies applied to studies in the care of health (e.g. biomechanics, computerized axial tomography and telemedicine) and to space exploration (e.g. communication mobile and GPS, robotics and nanotechnology), among others.

Seminoma in Undecended Testis Presenting as an Abdominal Mass: A Case Report

We report a case in which a 28-year-old infertile bilateral cryptorchoid man with decreased performance status presented to the department of urology with a mildly tender mass in right inguinal region. Both ultrasonography and Computerized axial tomography scan (CT Scan) suggested that the mass arose from right sided undescended testis and left sided testis was normal-sized intrabdominal. His serum á-fetoprotein and LDH were within normal range and only â-hCG was raised 3-fold. He was found azoospermic, his serum LH and FSH were increased but serum testosterone was reduced. The mass was removed by inguinal exploration and histopathology confirmed seminoma of testis. Orchidopexy was done on contralateral side one month after the first operation. A mass in the lower abdomen in a sexually active man with cryptorchoid testis strongly points towards the diagnosis of malignancy in the abdominal testis1. The clinician should aware of it and the urologist should do prompt removal of the tumor and orchidopexy in contralateral side in bilateral case irrespective of age. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.101-105

Brief Report: Rapid Clinical Recovery from Severe COVID-19 with High Dose Famotidine and High Dose Celecoxib Adjuvant Therapy

Celecoxib as adjuvant therapy has been shown in a small randomized trial for Covid-19 to prevent clinical deterioration and rapidly improve thoracic computerized axial tomography (CT-chest)1. Multiple descriptive trials of high dose famotidine (both inpatient and outpatient) have demonstrated clinical response2,3,4. We describe the rapid clinical responses after increasing the celecoxib dosage to 400mg bid with high dose famotidine 80mg qid in both a critical inpatient who on baseline required 40 liters per minute high flow nasal insufflation and an outpatient who declined admission but had critical Covid-19 biomarkers.

Unusual presentation of rare complication following endoscopic gastroplasty: case report

A 35-years-old female post-endoscopic gastroplasty presented to the emergency department complaining of epigastric abdominal pain. The abdominal examination showed epigastric and tenderness. On abdomen computerized axial tomography (CAT) scan she had small bowel obstruction with twisting of mesenteric vessel. The patient taken to the operating room for diagnostic laparoscopy and proceed, laparoscopic examination showed proximal dilatation of small intestine with collapse of distal part of jejunum, the obstruction identified, as fibrous band originating from the stomach to the proximal part of jejunum, this band caused by suture penetrating the stomach wall, which is going with the previous history of the endoscopic gastroplasty, reduction of the internal hernia done by releasing of the fibrous band, the herniated segment was healthy. Internal hernia can present with variety of complications. To the best of our knowledge from the literature review, this is the first case to be reported as internal abdominal hernia secondary to endoscopic gastroplasty.

COVID-19: Multiple Diseases Simulating Extreme High-Altitude Exposure? Oxygen Transport Physiology and Scarce Need of Ventilators; Andean Condor’s-Eye-View

The critical hypoxia in COVID-19 patients during this pandemic, has taken away many lives all around the globe. The mechanism has been poorly understood and initially, word got around that it was a SARS (Severe Acute Respiratory Syndrome) pneumonia. The atypical images in lung computerized axial tomography (CAT) scans were alarming. This immediately alerted everyone including poor countries to purchase lacking sophisticated ventilator equipment. However, in some countries, even 88% of the patients on ventilators lost their lives. New observations and pathological findings are gradually clarifying the disease. What seems evident is that it is not only one disease but several, with different responses in different countries and different altitudes. The critical hypoxia and «gasping» present in some patients are not totally understood. It was mentioned that it could be like a High-Altitude Pulmonary Edema (HAPE). Hereby, as high-altitude medicine and hypoxia physiology specialists, we compare the pathophysiology with that of high-altitude exposure in order to understand the mechanisms involved. Some differences in lung radiological images along with transmission and viral attack mechanisms are discussed. The oxygen transport triad used at high-altitude can be applied on this pathology in order to propose even the use of erythropoietin (EPO) early in the treatment. The immune system is the most important long-term survival tool, so we suggest a short-term strategy: the use of special Earth open-circuit astronaut-resembling suits with effective outside air filtering re-breathing mechanisms in order to return to work and daily activities, without contamination risk. Thereby, the curve can be flattened without quarantine and the economy could recover.