Café coronary syndrome – case report and medicolegal implications

Café coronary syndrome is a term used to describe a sudden collapse of healthy subjects during meals in the absence of any sign of asphyxia, respiratory distress, or neurological symptoms. Risk factors are advanced age, poor dentition, alcohol intoxication, and dementia or psychiatric disorders. One of the main problems with this syndrome is that, even when witnessed, it is often confused with myocardial infarction due to the absence of asphyxia symptoms. This leads to misdiagnosis and potential delays in patients’ treatment that can eventually have fatal outcomes. As a result of that, medico-legal litigation may arise. This paper presents a typical case of fatal café coronary syndrome misdiagnosed as a myocardial infarction. The legal authority that requested the autopsy asked about the potential professional negligence of the healthcare providers who took care of the patient. We discuss the clinical and medico-legal aspects of café coronary syndrome.

Perbaikan dan Perkuatan Fondasi Tiang Bor pada Bangunan Gedung Perkuliahan dengan Penambahan Tiang Pancang Bulat

Fondasi harus dibangun di atas tanah keras agar bangunan tetap stabil dan kokoh. Memastikan kekuatan fondasi adalah upaya dini untuk mencegah sudden collapse pada bangunan di kemudian hari. Penelitian ini dilakukan untuk mengetahui kuat dukung tanah pada ujung tiang fondasi dan mengamati sejauh apa kerusakan beton tiang bor pada bangunan yang baru masih dalam tahap pembangunan fondasi. Data penelitian diperoleh dari hasil pengujian PDA (Pile Driving Analyzer) dan PIT (Pile Integrity Test) pada fondasi bangunan jenis bored pile D80. Pada gedung yang berdekatan, yang dikerjakan dengan sistem yang sama dan menggunakan spun pile D50. Data kuat dukung ultimate hasil manometer alat uji hidraulik 175 ton untuk pile D50. Dari analisis uji PDA, diperoleh nilai kuat dukung ijin rata-rata tiang bor adalah 70,25 ton (51%). Analisis ulang terhadap kombinasi beban menghasilkan tambahan spun pile di 44 titik. Pada beton bored pile yang mengalami kerusakan, dilakukan perbaikan seperti penambahan cor pada lapisan luar (concrete-jacketing) untuk menutupi lapisan tulangan yang terekspos, dan penambahan tulangan terpisah di sisi dalam beton untuk antisipasi bila tulangan luar rusak akibat korosi.The foundation must be placed on hard rock so that the building remains stable and solid. Thus, ensuring the strength of the foundation is an early effort to prevent sudden collapse of the building in the future. This research was conducted to determine the bearing strength of the soil at the ends of the foundation piles and to observe the extent of the damage to the drill pile concrete in the new building which is still in the foundation construction stage. The research data were obtained from the results of PDA (Pile Driving Analyzer) and PIT (Pile Integrity Test) testing on the foundation of the bored pile type D80 building. The adjacent building is being worked on with the same system and using a D50 spun pile. With the ultimate bearing strength data, the results of the hydraulic tool manometer = 175 tons for D50 piles. PDA test analysis obtained the average allowable bearing strength of the drill pile is 70.25 tons (51%). The re-analysis of the load combination resulted in additional spun piles at 44 points. In the damaged bored pile concrete, namely by adding cast to the outer layer (concrete-jacketing) to cover the exposed reinforcement layer, and adding separate reinforcement on the inside of the concrete to anticipate if the outer reinforcement is damaged due to corrosion.Fondasi harus dibangun di atas tanah keras agar bangunan tetap stabil dan kokoh. Memastikan kekuatan fondasi adalah upaya dini untuk mencegah sudden collapse pada bangunan di kemudian hari. Penelitian ini dilakukan untuk mengetahui kuat dukung tanah pada ujung tiang fondasi dan mengamati sejauh apa kerusakan beton tiang bor pada bangunan yang baru masih dalam tahap pembangunan fondasi. Data penelitian diperoleh dari hasil pengujian PDA (Pile Driving Analyzer) dan PIT (Pile Integrity Test) pada fondasi bangunan jenis bored pile D80. Pada gedung yang berdekatan, yang dikerjakan dengan sistem yang sama dan menggunakan spun pile D50. Data kuat dukung ultimate hasil manometer alat uji hidraulik 175 ton untuk pile D50. Dari analisis uji PDA, diperoleh nilai kuat dukung ijin rata-rata tiang bor adalah 70,25 ton (51%). Analisis ulang terhadap kombinasi beban menghasilkan tambahan spun pile di 44 titik. Pada beton bored pile yang mengalami kerusakan, dilakukan perbaikan seperti penambahan cor pada lapisan luar (concrete-jacketing) untuk menutupi lapisan tulangan yang terekspos, dan penambahan tulangan terpisah di sisi dalam beton untuk antisipasi bila tulangan luar rusak akibat korosi.

Investigation on the Movement and Fracture Characteristics of an Extra-Thick Hard Roof during Longwall Panel Extraction in the Yima Mining Area, China

As an extra-thick hard roof is a significant contributing factor to frequently induced sudden roof collapse accidents and coal bursts, this study investigates the relationship between extra-thick hard roof movement and mining-induced stress using physical experiments and numerical simulation methods based on mining activities in a longwall panel in the Yima mining area, Henan province, China. The results suggested that the movement and failure processes of the extra-thick roof could be divided into three main periods: the undisturbed, movement stabilization, and sudden collapse periods. The roof displacement remained essentially unchanged during the undisturbed period. During the movement stabilization period, the displacement gradually increased into the upper roof. However, the extra-thick main roof remained undisturbed until the immediate roof experienced its fourth periodic caving in the physical model. Consequently, the displacement expanded rapidly into the extra-thick main roof during the sudden collapse period and the strain energy was violently released when it accumulated in the extra-thick main roof. Additionally, the mining-induced stress was characterized by a sudden decrease in the gradual increase trend when the extra-thick roof instantly collapsed. The deformation and fracture of the extra-thick roof could cause a sudden decrease in the mining-induced stress and lead to continuous and unstable subsidence pressure exerted on the mining panel and roadway. This significantly contributes to the occurrence of coal bursts.

Research Progress on Treatment of Abnormal Uterine Bleeding during Puberty with Traditional Chinese and Western Medicine

In recent years, the frequency of clinical occurrence of abnormal uterine bleeding in adolescence has gradually increased. In order to fully understand the research progress in the treatment of abnormal uterine bleeding in adolescence, various studies and clinical experience have been reviewed by consulting related literature reports. The results found that currently Western medicine mainly uses hormone drugs in clinical treatment, but there are risks such as more clinical adverse reactions and higher recurrence rate; traditional Chinese medicine (TCM) treatment has achieved satisfactory results, but the advantages of sudden collapse and hemostasis are not obvious. Combined TCM and Western medicine treatment, it can learn from each other and has become a research hotspot in recent years, which is worthy of an in-depth discussion.

Corrosion induced deterioration in prestressed concrete structures

Corrosion is less frequent in prestressed concrete than in ordinary reinforced concrete, but when it does occur, the results can be more dangerous and more costly. In prestressed concrete structures the reinforcing steel elements are subjected to high mechanical stresses, therefore corrosion of the tendons can lead to catastrophic consequences, by the failure of the steel and consequently of structure, or part of it, with a great potential for life losses, life disruption, and a huge economical impact. One of the most dangerous aspects is that the corrosion related fracture of the steel might lead to a sudden collapse of the structure with little or no warning. The intention of this project report is to collect and synthesize information on the corrosion of the prestressing tendons as a mechanism of deterioration in prestressed concrete.

Corrosion induced deterioration in prestressed concrete structures

Corrosion is less frequent in prestressed concrete than in ordinary reinforced concrete, but when it does occur, the results can be more dangerous and more costly. In prestressed concrete structures the reinforcing steel elements are subjected to high mechanical stresses, therefore corrosion of the tendons can lead to catastrophic consequences, by the failure of the steel and consequently of structure, or part of it, with a great potential for life losses, life disruption, and a huge economical impact. One of the most dangerous aspects is that the corrosion related fracture of the steel might lead to a sudden collapse of the structure with little or no warning. The intention of this project report is to collect and synthesize information on the corrosion of the prestressing tendons as a mechanism of deterioration in prestressed concrete.

KUPASAN ARTIKEL ‘MALAYSIA: THE 2020 PUTSCH FOR MALAY ISLAM SUPREMACY’

The 2018 General Election (PRU) marked a significant point in the history of Malaysian politics when the major opposition bloc Pakatan Harapan (PH) ended Barisan Nasional (BN) rule of 60 years since gaining independence in 1957. However, the PH government, led by ex-premier Tun Dr Mahathir Mohamad, only lasted 22 months. Accordingly, the sudden collapse of the PH government drew many to offer their respective analyses. James Chin (2020) wrote one of them titled ‘Malaysia: The 2020 Putsch for Malay Islam Supremacy’. He argued that, amongst the many reasons attributable to its sudden collapse, one stood out – the position of Islam and Malay supremacy in Malaysia. Since Malaysia is predominantly a Malay-Muslim country, such a profound claim warrants a thorough response. Thus, this study’s objective is to analyse and offer critiques on Chin’s work based on the three main factors, namely the concept of Malay supremacy, unreadiness of Malays to share power with non-Malays and the position of non-Malays in the top government positions. This study utilised documentary analysis to uplift the discussion to fit the social contract concept and the Federal Constitution and strike a balance between extremist and utopian ideas that best suit Malaysia’s political development reality. The study’s main findings can be narrowed down to show the actual picture of Malaysian political genesis’ uniqueness based on its own identity, which constantly rejuvenates and evolves across time and space. Keywords: General Election 2018, Pakatan Harapan, Islam, Malay supremacy, Malaysian political genesis.

Out-of-hospital resuscitation of a 3 month old boy presenting with recurrent ventricular fibrillation cardiac arrest: a case report

A 3 month old boy, with no known health conditions, suffered a sudden collapse at home. On first EMS arrival, ventricular fibrillation (VF) cardiac arrest was identified and resuscitation following UK national guidelines was initiated. He remained in cardiac arrest for over 25 min, during which he received 10 defibrillation shocks, each effective, but with VF reoccurring within a few seconds of each of the first 9. A return of spontaneous circulation (ROSC) was achieved after the 10th shock. The resuscitation was conducted fully in his home, with the early involvement of Advanced Paramedic Practitioners specialising in critical care (APP- CC). Throughout his resuscitation, there remained a strong focus on delivering quality resuscitation in situ, rather than a ‘load and go’ approach that would have resulted in very early conveyance to hospital with on-going CPR.The patient was subsequently discharged home and is making an excellent recovery. The arrest was later determined to have been caused by a primary arrhythmia as a result of a previously unidentified non-obstructive variant hypertrophic cardiomyopathy.We present data downloaded from the defibrillator used during the resuscitation that illustrates clearly the recurrent nature of his fibrillation.