Factors influencing surgical outcomes in orbital trapdoor fracture

This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post-operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p = 0.02), muscle incarceration (p = 0.01), duration from injury to surgical reduction (p = 0.004), and postoperative supra-duction limitation (p = 0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.

Dural Arteriovenous Fistula within Superior Sagittal Sinus Wall with Direct Cortical Venous Drainage: A Systematic Literature Review

Dural arteriovenous fistulas (DAVFs) located within superior sagittal sinus (SSS) wall with direct cortical venous drainage are rare. They are also known as variant DAVF (vDAVF) and form a special subgroup of DAVFs. Their chance of presenting with aggressive features is high compared with transverse sigmoid sinus fistula. They drain directly into cortical veins (Borden type 3, Cognard type III and IV). A systematic English literature review of SSS vDAVF was made. Systematic literature review revealed a total of 31 published cases. These were commonly seen in male population, (24 males, 77.41%, 24/31). Average age of patients was 54 years. A total of 24 patients (77.41%, 24/31) had aggressive clinical presentations with 13 patients (41.93%, 13/31) having intracranial hemorrhages (ICH). Two patients had rebleeding (15.38%, 2/13). Middle portion of SSS was commonly involved (15 cases, 75%). A total of 25 (96.15%, 25/26) cases had patent SSS. Most of the fistulas were idiopathic (65.38%, 17/26), with trauma being a frequent etiological factor (26.92%, 7/26). Venous ectasia was seen in 19 patients (59.37%, 19/32). Middle meningeal arterial (MMA) supply was seen in all patients (100%, 26/26), with bilateral MMA supply in 21 cases (80.76%), and unilateral in 5 cases (19.23%). Twenty patients (62.50%, 20/32) received only endovascular treatment (EVT), while four patients had EVT followed by surgery (12.5%, 4/32). Transarterial route via MMA was the preferred treatment option (79.16%). Complete obliteration of fistulas was noted in all cases (100%, 30/30). No immediate complication was noted after EVT. As much as 92.30% patients showed good recovery. Thus, SSS vDAVF forms a special subgroup of DAVF, with aggressive presentation, and warrants urgent treatment. EVT is effective treatment option and can produce complete obliteration.

Formation of Isolated Radio Type II Bursts at Low Frequencies

The first appearance of radio type II burst emission at decameter-hectometer (DH) waves typically occurs in connection, and often simultaneously, with other types of radio emissions. As type II bursts are signatures of propagating shock waves that are associated with flares and coronal mass ejections (CMEs), a rich variety of radio emissions can be expected. However, sometimes DH type II bursts appear in the dynamic spectra without other or earlier radio signatures. One explanation for them could be that the flare-CME launch happens on the far side of the Sun, and the emission is observed only when the source gets high enough in the solar atmosphere. In this study we have analysed 26 radio type II bursts that started at DH waves and were well-separated (‘isolated’) from other radio emission features. These bursts were identified from all DH type II bursts observed in 1998 – 2016, and for 12 events we had observations from at least two different viewing angles with the instruments on board Wind and the Solar Terrestrial Relations Observatory (STEREO) satellites. We found that only 30% of the type II bursts had their source origin on the far side of the Sun, but also that no bursts originated from the central region of the Sun (longitudes E30 – W40). Almost all of the isolated DH type II bursts could be associated with a shock near the CME leading front, and only few were determined to be shocks near the CME flank regions. In this respect our result differs from earlier findings. Our analysis, which included inspection of various CME and radio emission characteristics, suggests that the isolated DH type II bursts could be a special subgroup within DH type II bursts, where the radio emission requires particular coronal conditions to form and to die out.

Factors Influencing Surgical Outcomes in Orbital Trapdoor Fracture

This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post- operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p=0.02), muscle incarceration (p=0.01), duration from injury to surgical reduction (p=0.004), and postoperative supra-duction limitation (p=0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.

Immunological Responses and Survival Outcome in HIV and SARS-CoV-2 Coinfected Patients

The coronavirus disease 2019 (COVID‐19) has created a worldwide crisis, raising fears and concerns regarding clinical outcomes in patients with comorbidities. Some of the highly prevalent communicable and non-communicable diseases worldwide are cardiovascular diseases, diabetes, HIV/AIDS, and hepatitis B and C, which reduce the host immune responses to concurrent acute infections. Despite over 170 million confirmed cases of COVID‐19 worldwide as of 24 June 2021, insufficient data is reporting the prognosis of HIV and SARS-CoV-2 co‐infection. This narrative review aims to present current knowledge on the impact of SARS-CoV-2 on people living with HIV/AIDS, in terms of immunological responses and clinical outcome. Although some studies have been performed and are in progress to determine the impact of SARS-CoV-2 infection on patients living with HIV/AIDS, controversies still exist whether COVID-19 severity and mortality are higher among this special subgroup or similar to the general population.

A Small Subgroup Attack on Bitcoin Address Generation

We show how a small subgroup confinement-like attack may be mounted on the Bitcoin addresses generation protocol, by inspecting a special subgroup of the group associated to point multiplication. This approach does not undermine the system security but highlights the importance of using fair random sources during the private key selection.

Is Symmetry Breaking into Special Subgroup Special?

The purpose of this paper is to show that symmetry breaking into special subgroups is not special at all, contrary to the usual wisdom. To demonstrate this explicitly, we examine the dynamical symmetry breaking pattern in four-dimensional $SU(N)$ Nambu–Jona-Lasinio-type models in which the fermion matter belongs to an irreducible representation of $SU(N)$. Potential analysis shows that for almost all cases at the potential minimum the $SU(N)$ group symmetry is broken to its special subgroups such as $SO(N)$ or ${USp}(N)$ when symmetry breaking occurs.

HEPATITIS C VIRUS (HCV)

Objectives: This study was carried out to find out the frequency of Hepatitis CVirus (HCV) infection in patients with end stage renal disease requiring Haemodialysis and theirrate of seroconversion to HCV positive during Haemodialysis in special subgroup population,the labour class of Punjab Pakistan. Study Designs: Cross-sectional descriptive study. Place &Duration: Haemodialysis Unit Nawaz Sharif Social Security Hospital, Multan Road Lahore fromJanuary 2009 through December 2012. Material and Method: A total of 92 patients, aged 15to 70 years belonging to Labour class of the Punjab were included in the study, who reportedfor Haemodialysis in our unit. All the patients were tested for the presence of HCV antibodyby rapid immunochromatographic technique (ICU devices) and also confirmed with EnzymeLinked Immunosorbant Assay (ELIZA) at the start of Haemodialysis and thereafter quarterly fortheir conversion to HCV positive state. Results: Out of 92 patients 34 (39.96%) were positivefor HCV Antibody 3 patients (3.26%) were positive for HbsAg where as 55 patients (59.78%)were negative for HbsAg or HCV Antibody. Out of 55 patients negative for HCV, 12 patientswere converted to HCV positive state within 18 months of Haemodialysis. Conclusion: A highincidence of HCV positive, 36.96 % was noted with a high seroconversion rate of 21.82 %toHCV positive. This study supports the idea that better socioeconomic status and awareness ofpreventive health aspects remains the corner stone for prevention and spread of HCV infection.