Acute spinal cord infarction syndrome unusually mimicking Transverse myelitis: A case report

Anterior Spinal Cord Infarction (ASCI) syndrome typically results from ischemia that affects the anterior spinal artery territory characterized by history of sudden onset flaccid paraplegia or quadriplegia depending on the level of the lesion. We describe a 57-years-old woman with sudden onset flaccid weakness of the lower limbs and numbness of the feet of two days duration, preceded by a day history of fever and several episodes of vomiting. Examination initially revealed bilateral hypotonia, hyporeflexia and dense paraplegia, with preservation of dorsal column sensations (fine touch/2-point discrimination, position and vibration sensation). Twenty-four hours thereafter a repeat examination showed hyper-reflexia and extensor plantar response with spastic paraplegia. Thoracic spine Magnetic Resonance Imaging (MRI) revealed thinning of the spinal cord extending from T1 to T9 levels with associated widening of the thecal sac suggestive of anterior spinal cord infarction with no other signal changes seen within the substance.

COMPARTMENT SYNDROME AFTER ISOLATED CLOSED FIBULA FRACTURE- A CASE SERIES

Compartment syndrome in lower extremity has been commonly associated with fractures of the tibial plateau, tibia shaft, and tibial plafond. Three patients were included in our study with history of a motor vehicle accident. All of them sustained a closed bular shaft fracture and had fullness in anterior/lateral compartments of leg but no pain with passive or active range of motion of ankle on initial presentation. Repeat examination demonstrated tense compartments of leg with severe pain during ankle range of motion. 2 out of 3 patients were on anticoagulant therapy. They were taken to operating room for four-compartment fasciotomies. On postoperative day 3 debridement & primary closure was done. Post-operative course in hospital was uneventful. No post compartment syndrome sequelae were seen in 2 months follow up. In conclusion, compartment syndrome in isolated closed bula fracture is a rare possibility.

Pregnancy in a didelphic uterus: a case report of an unusual phenomenon and review of literature

Mullerian anomalies are defects in the embryological development of the urogenital systems as these organs begin to form at about the 5 and 6th week of intrauterine life. Uterine didelphys is one of the Mullerian or paramesonephric duct anomalies occurring as a result of duplication of the uterine canal with two cervical canals and a single vagina. The incidence uterine didelphys has been quoted as 1 in 2000 women. This case report elucidates the presentation of a multiparous lady with uterine didelphys who has a had a previous successful pregnancy in of the uterine canals but presented in the second pregnancy with a missed miscarriage at 12 weeks gestational age. She also has a single right kidney. These were all diagnosed on ultrasound scan. She had an initial unsuccessful surgical management of miscarriage with uterine perforation of one of the uterine cavities, hysteroscopy and diagnostic laparoscopy and subsequently had a repeat examination under anaesthesia and second attempt at evacuation of retained products or a laparoscopy plus hysterotomy. This was particularly challenging as the cervix was flushed with the vaginal vault making delineating and dilatation of the cervical OS difficult hence sustaining a perforation of the left uterine cavity. The second attempt of surgical management was successful, and she was subsequently discharged. This is one of the few case reports in literature and will further add credence to the body of knowledge of a different aspect to the presentation and management of cases of Mullerian anomalies.

Prospective associations between ECG abnormalities and death or myocardial infarction in a cohort of 980 employed, middle-aged Swedish men

Background In 1993, 1000 randomly selected employed Swedish men aged 45–50 years were invited to a nurse-led health examination with a survey on life style, fasting lab tests, and a 12-lead ECG. A repeat examination was offered in 1998. The ECGs were classified according to the Minnesota Code. Upon ethical approval, endpoints in terms of MI and death over 25 years were collected from Swedish national registers with the purpose of analyzing the independent association of ECG abnormalities as risk factors for myocardial infarction and death. Results Seventy-nine of 977 participants had at least one ECG abnormality 1993 or 1998. One hundred participants had a first MI over the 25 years. Odds ratio for having an MI in the group that had one or more ECG abnormality compared with the group with two normal ECGs was estimated to 3.16. 95%CI (1.74; 5.73), p value 0.0001. One hundred fifty-seven participants had died before 2019. For death, similarly no statistically significant difference was shown, OR 1.52, 95%CI (0.83; 2.76). Conclusions Our study suggests that presence of ST- and R-wave changes is associated with an independent 3–4-fold increased risk of MI after 25 years follow-up, but not of death. A 12-lead resting ECG should be included in any MI risk calculation on an individual level.

A STUDY DONE IN PHASE 1 MBBS STUDENTS TO EVALUATE THE EFFECTIVENESS OF REMEDIAL INTERVENTION IN UNDERPERFORMING STUDENTS OF BIOCHEMISTRY.

Background: Remedial intervention or re teaching and repeat examination of the difficult chapters in Biochemistry can be one way to overcome weak performance by the phase 1 students in Biochemistry. The under performances by the medical students especially in Biochemistry may be because of inadequate guidance or lack of interest in a pre-clinical subject. Methodology: The present study was a Quasi experimental study conducted among the under performers in biochemistry. In the second sessional examination results in Biochemistry, those students who got less than 50% marks and who were willing to participate in the study were enrolled for remedial intervention. After a pretest, the participants were divided into small groups. Later on, 4 core biochemistry topics were discussed as small group discussion for 20 minutes with these participants. Four separate topics were covered using the same methodology which was followed by a post test. The pretest and posttest scores were analysed statistically. Results: In the present study a total of 54 students of first year MBBS (2018 batch) participated. The mean and standard deviation of the pre-test and post-test score was analysed statistically. P value was statistically significant. Conclusion: In the present study the performance of the students after remedial intervention was good. So introduction of remedial intervention for re- teaching as part of medical curriculum by adjusting the teaching hours will help the medical students to handle their performance. The present study proves that targeted remedial intervention to the underperforming medical students after assessing their deficiencies can substantially improve their academic performance. Also we can conclude from the study the importance of early remedial intervention to these students. The success of remedial intervention can be augmented if the sessions are small group discussions.

THU0645-HPR ULTRASOUND EDUCATION FOR RHEUMATOLOGIST IN RUSSIA: REALITIES AND WHAT IS NEEDED TO IMPROVE.

Background:Musculoskeletal ultrasonography (MSUS) is a valuable imaging modality for the practicing rheumatologist. In everyday practice, physical examination is limited by its sensitivity and subjectivity of assessment. MSUS is inexpensive, available, and allows repeat examination as soon as necessary. Thus, MSUS has become the “third eye” of the rheumatologist, in that it allows more detailed examination of muscles, bones, and joints, just as the stethoscope provides further details about the respiratory and cardiovascular systems. Most ultrasound examinations in Russia, including abdominal and vascular sonography, echocardiography, are conducted by trained physician - radiologist, called “ultrasonography specialists”. Nevertheless, it is very difficult to perform MSUS, mainly because standardized ultrasound protocols fore same region are different for various diseases and often do not provide physicians with the information they need, and also may been mistake. The conduct of MSUS by rheumatologists themselves is limited to the need for 4-month radiology (ultrasound) certification. However, the number of rheumatologists conducting MSUS themselves is increasing. Training week small group courses are provided by VA Nasonova Research Institute of Rheumatology for the practicing rheumatologist and other physicians.Objectives:We analyzed the training and awareness of the rheumatologists and radiologists in MSUS, as well as their commitment for participation in our courses.Methods:We studied a one and a half-year period, from June 2018 to December 2019. During this time, 57 applications were submitted to participate in the courses. All participants who arrived were tested before starting the course. Test included 40 general questions about MSUS. Test results as well as commitment to training were analyzed in two groups: rheumatologists and radiologists. Nonparametric statistics were used for data processing.Results:Among 57 applications submitted for the courses, 26 were from rheumatologists and 31 from radiologists, but the courses were attended by 13 rheumatologists and 26 radiologists (68%). Thus, commitment was reliably higher in radiologists (84%) than in rheumatologists (50%). Fisher’s methods show high statistically significance (Χ2= 7,51, p = 0,006). Although the test focused on ultrasound, it was surprise for us that the median percentage of correct answers was higher in rheumatologists - 64 (54; 80)%, than radiologists (“ultrasonography specialists”) 48 (40; 62)%. Difference also were significantly (p = 0,04).Conclusion:Thus, despite better preparedness of rheumatologist, motivation to study MSUS prevails among radiologists. It is necessary to actively introduce MSUS into general rheumatologic educational programs in order to motivate rheumatologists to study MSUS. Changes in professional standard will also encourage wide use of MSUS by rheumatologists.Disclosure of Interests:None declared

Radioulnar Ischaemic Necrosis in a Dog with Concurrent Osteomyelitis and Bone Sequestration

An 11-month-old intact female Golden Retriever presented for a 3- to 4-week history of right thoracic limb lameness. Computed tomography of the limb showed a sequestrum with a periosteal and endosteal reaction at the level of the nutrient foramen of the radius. Septic osteomyelitis was suspected based on cytology. Repeat examination and imaging revealed improvement in the lesion and resolution of the lameness. This lesion is similar to reports of radioulnar ischaemic necrosis, but is the first report with concurrent osteomyelitis and sequestration.

Complications of X-ray endovascular treatment of the May–Thurner syndrome

The article describes a clinical case of treatment of complications of the May–Thurner syndrome. Asymmetry of blood flow in the iliac veins and signs of their narrowing were observed. Phlebography showed special characteristics of pelvic vessels, trajectory of the surgery was planned. Stenting of the left iliac vein is considered the optimal treatment for such patients if the pressure in it is above 5 mmHg compared to the inferior vena cava. Specialized venous self-expanding stents are an efficient choice for stenting. Access can be performed through the popliteal vein on the unilateral side and / or the femoral or humeral artery, jugular or subclavian access can be used depending on the patient’s anatomy and the size of the delivery device. The female patient underwent coil embolization of varicocele of the lower pelvic veins. At repeat examination after 3 months, pelvic pain was minimal, no pain during sex, no varicocele in the groin and lower extremities. Contrastenhanced spiral computed tomography with 3D reconstruction of the pelvic veins didn’t show any signs of pelvic congestion syndrome.

Diet-induced oxalate nephropathy

Oxalate nephropathy is a rare condition and may be overlooked due to lack of recognition and understanding of triggers. An 81-year-old man was sent to nephrologist because of significantly increased creatinine (1.5–1.9 mg/dL) noted for 3 months. He had well-controlled diabetes but no history of kidney disease. He had no chronic diarrhoea or intestinal surgery. He was a health-minded individual who had read extensively about benefit of antioxidants. Initial work-up was unrevealing. Within a few weeks after first visit, he developed acute symptomatic worsening kidney injury with nausea, vomiting and creatinine up to 6.8 mg/dL. Repeat examination of the urine sediment revealed casts containing calcium oxalate crystals. A deeper dietary history revealed widespread oxalate precursor consumption. A kidney biopsy confirmed oxalate nephropathy. Restriction of oxalate consumption combined with adequate hydration, oral calcium acetate resulted in partial renal recovery without need for haemodialysis.

Effect of Repeat Examination on Family Medicine NBME Subject Scores

Introduction: National Board of Medical Examiners (NBME) subject examinations are used by many schools to assess student clinical knowledge. Studies indicate that mean scores on NBME examinations improve as the clinical year progresses. Literature review revealed no studies investigating changes in individual student scores when end-of-block examinations were repeated at the end of the clinical year. This study investigated NBME family medicine subject examination score changes for students who opted to repeat the examination at the end of the academic year. Methods: In 2014, students on a 4-week family medicine block clerkship took the NBME subject examination at the end of their clerkship block and were offered the opportunity to repeat this examination at the end of that clinical year; 25 of 80 students voluntarily repeated the examination. Paired t-tests were used to compare performance outcomes between the exam means at the end of the clerkship blocks to the means on the exam administration at the end of the academic year. Results: Results showed a statistically significant improvement in scores between the first and second examination administration. Examinations given immediately after the students’ clinical experience yielded scaled scores ranging from 60 to 80 compared to the national mean of 71.9. Examinations given at the end of the clinical year yielded scaled scores ranging from 57 to 90 (t[24]=-2.66, P=0.0006). Conclusion: Repeating the NBME subject examination at the end of the year led to slightly increased scores, suggesting that time spent during clerkships influences examination performance.