bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Outcome in Acute Organophosphorus Poisoning With International Program On Chemical Safety Poison Severity Score (Ipcs Pss) Grading in Dhaka Medical College Hospital
Authors: Kabir Sheikh Khairul , Alam Abu Sadat Md Moinul , Alam Mohammed Syedul , Islam Mohammad Shaiful , Chowdhury Muhammad Moazzem Hossain , Paul Sujat
Published: October 2022

Organophosphorus pesticide poisoning kills around two million people each year, principally due to self poisoning in the Asia-Pacific region. This is a cross-sectional study which was conducted to assess whether patients at high risk of death in acute organophosphorus poisoning could be identified accurately using International Program on Chemical Safety Poison Severity Score (IPCS PSS) and recording clinical parameters soon after admission in Department of Medicine Dhaka Medical College Hospital (DMCH) for a period of six months after approval of the protocol. The study was carried out from March 2013 to August 2013 in the Department of Medicine, DMCH. Eighty patients with detailed information's were obtained according to predesigned protocol. Complete history was taken either from patient or accompanying attendants. Thorough clinical examination was done. Relevant investigations report was collected. All the information's were recorded and collected data were classified, edited, coded and entered into the computer for statistical analysis by using Statistical Package for Social Sciences (SPSS) version - 17. Among the 80 cases, IPCS PSS grade I presentation was more frequent which was 71.2%, followed by grade III 15.0% and grade II presentation (IPCS PSS) 13.8%. The IPCS PSS cut grade H or III was a predictor of outcome as the IPCS PSS itself and Area Under Curve (AUC) of 0.936 with sensitivity of 1.0 and specificity 0.872. In grade I, 71.3% were cured and there was no death, in grade II, 13.8% were cured and there was no death. In Grade III, 12.5% were cured and 2.5% were found death. The present study indicated that the International Program on Chemical Safety Poison Severity Score (IPCS PSS) grading was good predictor of outcome in acute organophosphorus poisoning. Patients who presents with IPCS PSS grade II and III need to be treated accordingly and monitored closely.

JCMCTA 2015 ; 26 (1) : 25-29
Pattern of Labour in Primigravidae Monitored By Partograph
Authors: Das Suchanda , Chowdhury Bidhan Roy , Begum Rokeya
Published: October 2022

This is a cross sectional observational study was done on 100 full term primigravidae admitted in Gyane & Obstetrics department of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital. The study was carried out during the period from 1st August 2004 to 30th January 2005. Their labour was assessesd by modified World Health Organisation (WHO) partograph. The main objective of the study was to assess the importance of pantographic contral of labour in preventing prolong labour and its consequences. 74% of these labour had spontaneous vaginal delivery, 4% required forceps delivery and 6% needed ventouse delivery, Caesarean section was done in 16% cases. It has found that 86% of the patients were delivered within 7 hrs and all patients were delivered within 12 hours from active phase of labour. There was no maternal and neonatal mortality because of close intranatal care. There was no perinatal mortality in this series. If any deviation from normal, intervention was done immediately. Because of use of partograph unnecessary intervention were also reduced. Patient with non engaged head in labour required more intervention. Majority of patients within alert line delivered vaginally but 100% of the patient crossing the action line required interference. Each and every labouring woman should be supervised by a partograph. But its use in our country still limited to medical college hospital and some district hospitals only. As the poor developing country where Maternal Mortality Rate (MMR) is so high, the use of partograph is essentials and must be used by paramedics/midwives/ nurses, which will guide them for referral in proper time.

JCMCTA 2015 ; 26 (1) : 30-34
Looking In to the Changing Trend of Biological Risk Factors for Gall Stone Disease in Male and Female
Authors: Begum Momtaz , Alit SM Ashraf , Suhrawardy SM
Published: October 2022

Conventional risk factors for Gall Stone Disease (GSD) are the five 'F's - Female, Fair, Fat, Forty and Fertile' but many study revealed changing trends particularly in age, multiparity and cigarette smoking particularly in Western countries. The etiology of cholelithiasis is considered to be a multi factorial, with interaction of genetic and environmental factors. Most exogenous factors are a consequence of westernization of modern societies, including a high intake of refined carbohydrates and a high prevalence of obesity, non-insulin dependent diabetes, atherosclerosis and sedentary life-style. From January 2011 to July 2014, consecutive patients who underwent Laparoscopic Cholecystectomy (LC) at Chittagong Medical College Hospital and Royal Hospital of Chittagong City were included in a prospective database targeting biological and biochemical characteristics in Male(n=256) and female (n=256). Data collected using predetermined approved case record form, including age, sex, demographic data, biochemical data before operation. The prevalence of diabetic was more among female where hypertension and dyslipidemia were more prevalent in males. Multivariate conditional logistic regression models revealed age is insignificant both in male and female (p=.088 vs. p=0.0744). Obesity is also insignificant (p=.091 in male, p=0.084 in female). Hypertension in both sexes (p= 0.02 in male,0.03 in female)diabetes mellitus in female (p=0.02) dyslipidemia particularly high serum LDL level particularly in female (p= 0.00001) is significantly related to gall stone. Metabolic factors like blood glucose level, dyslipidemia and hypertension may be closely related to the causation of gall stone disease.

JCMCTA 2015 ; 26 (1) : 41-45
Pregnancy Following Cervical Tuberculosis
Authors: Bhattacharjee Seema , Begum Rokeya
Published: October 2022

Incidence of urogenital tuberculosis is a raising concern worldwide specially in developing countries, in most cases, primary foci may not be identified either due to ignorance of the individual or her family may remain unaware about the seriousness or consequences. In this case a multiparous reproductive aged woman presented with repeated episode of post coital bleeding. Most of the attending Physician confused with hormonal disturbance and treated with hormone and others for months in outreach area. Once upon a time however she was referred to Gynae OPD and after inspection of cervix she was advised for inpatient admission for Examination Under Anaesthesia (EUA) and biopsy. Histopathology report revealed chronic granulomatous lesion of the cervix and ultimately she was diagnosed as a case of tubercular ulcer of the cervix. After successful treatment by antitubercular medication as per schedule, she was conceived and gave birth to a healthy term baby. Pregnancy following cervical Tuberculosis (TB) is a rare incidence and probably not reported in literature.
JCMCTA 2015 ; 26 (1) : 55-58
Unusual Presentation of a Tubal Pregnancy: A Case Report
Authors: Begum Shahana , Ara Sarwat , Das Suchanda , Sultan Md Tipu
Published: October 2022

Ectopic means "out of place." In a normal pregnancy, the fertilized egg implants and develops in the uterus. In most ectopic pregnancies, the egg settles in the fallopian tubes. This is why ectopic pregnancies are commonly called "tubal pregnancies." None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth. The tube is capable for only limited distention and is unable to provide secure placentation also due to unsatisfactory environment, 80% of these embryo are malformed and more than 99% of these do not progress beyond 6 weeks of pregnancy. A 25 years lady para 1+1 (Ectopic pregnancy) present as an emergency patient with history of pregnancy of 4 months with shock immediate resuscitation, intubation and laparotomy was done for high intuition towards ectopic pregnancy. It was great surprised that there was a near about 16 weeks size of foetus coming out from the ruptured tube and the tube was hugely distented about 10 cm diameter. After laparotomy the patient was recovered well. The case is reported here as a very rare entity and near miss mortality.

JCMCTA 2015 ; 26 (1) : 59-62
Management of Right Lower Posterior Edentulous Area With Bicon Implant: A Case Report
Authors: Uddin Mohammed Kamal , Afrose Rumana
Published: October 2022

Posterior edentulous area and implant supported restorations are two important aspects in dentistry. Posterior edentulous area can't be restored effectively with partial denture or conventional bridge work The replacement of missing teeth with implant borne restorations in such conditions is gaining increasing popularity day by day. This case report describes the successful management of a posterior edentulous area using Bicon implant. The result was good, which further validate the use of this technique for suitable patient management.

JCMCTA 2015 ; 26 (1) : 63-65
Gross Morphological and Histological Study On Normal Human Placenta
Authors: Naheen Towhida , Ashrafuzzaman Md , Begum Moquaddes Akhter , Barua Rama , Iqbal Mohammed
Published: October 2022

Placenta is a vital organ for maintaining pregnancy and promoting normal foetal development. It is sometimes described as the mirror of the perinatal period. Still one of the common methods of investigation of the factors endangering the foetus and newborn during the perinatal period is the examination of placenta. The present study was conducted to make a gross morphological and histological evaluation of placenta in bangladeshi population. This cross-sectional study was carried out in the department of anatomy, chittagong medical college hospital over a period of 1 year from july 2011 to june 2012. The placentae from mature children delivered through caesarean section between 37 to 40th weeks of gestation with no complications having a birth weight of more than 2.5 kg were the study population. A total of 100 such placentae were consecutively selected from the study population. The morphological study of placenta included placental volume, weight, number of cotyledons, shape, diameter, thickness, mode of insertion of umbilical cord and histological study was volume (%) of villous area of the placenta. The mean age of the mothers whose placentae were studied was 25.3 3.8 years (range: 18 36). The mean birth weight of the neonates was 3.0 0.3 kg. Majority (96%) of the placenta was rounded in shape. The mean weight and volume of the placenta was 538.538.7 g and 45141.03 ml respectively, while the mean diameter was 16.8 + 0.99 cm. The mean thickness was 17.53 3.66 mm.Over 70% of the cords were inserted at the peripheral part of the placenta. The mean number of cotyledons was 18 and the volume of villous area was 51.1%. Majority of the placentae in bangladeshi population is round with the eccentric insertion of umbilical cord. The other features like weight, diameter and thickness, the number of cotyledons and volume of villous area are almost comparable with those of a typical one.

JCMCTA 2015 ; 26 (2) : 3 - 8
Infectious and Non Communicable Diseases : Double Burden to Bangladesh
Authors: Dutta Pradip Kumar , Mahmud Asif Mujtaba , Islam Khaleda , Mazid AHM Tharakul , Dutta Sudipa
Published: October 2022

Infectious diseases pose a significant burden to bangladesh. Water borne diarrhoeal diseases and respiratory tract infections are most prevalent due to poor quality of life as well as due to poor educational status. Tuberculosis and malaria are common and leishmaniasis is endemic in some part of the country. Besides owing to epidemic shift for rapid urbanization non-communicable diseases like cancer, diabetes mellitus, ischaemic heart disease and stroke are also responsible for significant burden to bangladesh. Some of the infectious diseases has emerged and reemerged in the recent past. The zoonotic diseases like avian influenza a/h5n1, nipah virus, japanese encephalitis virus, rabies and other communicable diseases like salmonella, hepatitis e virus, rotavirus sometimes cause outbreak in certain parts. Most of these diseases are preventable. This review will discuss the super imposed burden of non-communicable disease over emerging and re-emerging infectious diseases of public health importance in bangladesh and the underlying causes of less progress to improve detection and control.

JCMCTA 2015 ; 26 (2) : 9 - 16
Effects of Chenopodium Album Linn. Plant Extracts on the Histology of Paracetamol Induced Hepatotoxicity in Rats
Authors: Ata Maliha , Jahangir Selim Md , Islam Mahbubul , Rahman Zillur , Islam Md Saiful , Hossain Mohammad Ismail , Biswas Rajat
Published: October 2022

This study was designed to evaluate the hepatoprotective effect of extract of chenopodium album linn plant on the histology of the liver of albino rats. Thirty (30) adult albino rats were divided into five (5) groups. Group 1 was the control group that received distilled water for 7 days, group 2 was the vehicle control group that received single dose of 2 ml of propylene glycol and group 3 received single dose of paracetamol (2gm/kg) group 4 recieved only extract of chenopodium album linn plant for 7 days and group 5 was pre-treated with 500 mg/kg of the ethanolic plant extract of chenopodium album for 7 days and before inducing the liver damage on the 7th day with 2gm/kg of paracetamol. On the 9th day rats were sacrificed and the liver was fixed immediately in formalin. The liver tissues was processed and stained in haematoxylin and eosin (h&e). The histological observations showed that the plant extract of chenopodium album linn prevent liver damage.

JCMCTA 2015 ; 26 (2) : 17 - 22
Prevalence of Extended Spectrum 3-Lactamases (Esbl) Producers Among Gram-Negative Bacilli In Chittagong Medical College Hospital, Chittagong
Authors: Chowdhuy Abu Hena Md Saiful Karim , Husain Md Anwar , Akter Nasima , Ahmed Shakeel , Biswas Sanjoy Kanti , Naheen Towhida
Published: October 2022

The emergence and spread of antibiotic resistance in microorganisms have rendered the management of infectious diseases difficult. Extended-Spectrum 3-Lactamases (ESBLs) producing organisms are increasing in number and causing more severe infections because of their continuous mutation and multidrug resistance property which make its treatment difficult. The present study was undertaken to detect the prevalence of the ESBLs producing bacteria in patients attending Chittagong Medical College Hospital, so as to provide a guideline in treating them & prevent unnecessary use of antibiotics. All the isolates were identified by standard procedure & isolated gram-negative bacteria initially screened by Minimum Inhibitory Concentration (MIC) ESBLs breakpoints. Then confirmed by Phenotypic Confirmatory Test (PCT). In the present study, 176(74.89%) bacterial strains were isolated from 235 samples of wound swab, pus and urine. Among the isolates, 150(85.23%) were gram-negative and 26(14.77%) were gram-positive bacteria. Isolated gram-negative bacteria were screened for suspected ESBLs producers where 142(94.67%) were found suspected ESBLs producers, of which 89(62.68%) confirmed as  
JCMCTA 2015 ; 26 (2) : 23 - 28
Post Operative Deep Vein Thrombosis: A Study of 150 Cases
Authors: Sarker Mohammad Abu Kawsar , Amin Md Abdullah Al , Nuruzzaman AKM , Bhattacharjee Avisak
Published: October 2022

Thromboembolism is a wide spectrum entity of which post operative Deep Vein Thrombosis (DVT) is a part. At present there is inadequate information available regarding the incidence of DVT in Bangladesh. The aim of this cross-sectional study was to see the incidence of post­operative DVT at BIRDEM Hospital from March to December 2008. It was performed on 150 patients who had any operation of more than one hour of duration. Among 150 patients, 102 were male and 48 were female. The incidence of DVT in male was 36.3% and in female it was 27.5%. One-fifth of the DVT patients were smokers. Thirty two patients underwent amputation of which 14 (43.7%) developed DVT. Among the DVT cases, only 3 were clinical DVT and the rest were sub-clinical. In half of the Laparotomy patients (10/20) DVT developed. About one-fourth (34/8) of the hernioplasty patients and half of the APR patients (4/8) developed DVT. The occurrence of the condition in diabetes mellitus (36.7%) and cancer (33.3%) was high. Forty percent of the obese patients developed the condition. DVT in Bangladesh is not that much rare event. Further in-depth studies are necessary to extract other relevant information in this regard.  
JCMCTA 2015 ; 26 (2) : 29 - 33
Efficacy of Tranexamic Acid in Combination With Conventional Therapy for Treatment of Pph
Authors: Hamid Ayinur Nahar , Begum Rokeya
Published: October 2022

Haemorrhage is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. About 14 million women around the world suffer from Post Partum Hemorrhage (PPH) every year. Of them, about 2% die with an average interval of 2-4 hrs from onset of bleeding. Tranexamic Acid (TXA) is the most effective of the available anti-fibrinolytics, which has been shown to be very useful in reducing blood loss and incidence of blood transfusion in different surgeries. The study was done to see the efficacy of injectable tranexamic acid in addition to conventional treatment in control of atonic PPH. In this study, women having atonic PPH following vaginal delivery were grouped into two, A & B. Group A received 2 amp inj.TXA (Tranexamic acid) i.v immediately after diagnosis of PPH and Group B received 10ml distilled water i.v. Both groups received all other necessary measures for control of PPH and outcomes were recorded in a preformed data collection sheet. All data were analyzed by computer based software Statistical Packages for Social Science (SPSS) version 15.The results showed that tranexamic acid significantly reduced the volume of blood loss in atonic PPH, 1141.23±489.91 ml in study group versus 1365.25±428.22 ml in control group.PPH control within 2 hr with medical therapies occurred more in TXA group (88.09%) than in control group (57.14%). Invasive procedures were less required in TXA group than in control group ,condom catheter in 4 pt. (9.52%) compared to 11(26.19%) in control group. Hysterectomy was done in 1 case of TXA group compared to 7 cases of control group. TXA also significantly reduced the necessity of blood transfusion in PPH, 26.19% in TXA group compared to 54.76% in control group. So one gm i.v. tranexamic acid given along with other conventional measures at the diagnosis of atonic PPH significantly reduces the amount of blood loss, requirement of blood transfusion, necessity of invasive procedures.  
JCMCTA 2015 ; 26 (2) : 34 - 39
Laparoscopic Exploration of the Common Bile Duct and T-Tube Drainage in China
Authors: Barua Subrata , Kaiser ABM , Chowdhury Sumon Rahman , Bhuyian Md Nur Hossain , Chao Gao , Cheng Peng , Jun Niu
Published: October 2022

Biliary stones that are seen in the Asian population are very different from those seen in the west. It is frequent to see multiple, large, and impacted stones and a hugely dilated Common Bile Duct (CBD). Many of these patients have been managed by open cholecystectomy, even after the advent of Laparoscopic Cholecystectomy (LC) because these large stones pose significant challenges for extraction by endoscopic retrograde cholangio-pancreatography. This study represents an experience of managing intra and extra hepatic bile ducts using a laparoscopic approach. A retrospective data analysis was done during the period of November 2010-April 2015 and correspondingly 85 patients with documented intra and extra hepatic biliary stones were treated laparoscopically at Qilu Hospital under Shandong University, School of Medicine. There were 23 men and 62 women patients with age ranging from 23 to 76 years. The mean diameter of the CBD was 12mm. The number of stones extracted varied from 1 to 35 and the size of the extracted stones from 0.3X0.3X0.3 to 4X3.5X3.5 mm. The average duration of surgery was 170 min. There were 7 conversions to open procedures and 24 patients (29%) had nonfatal postoperative complications. Four patients had retained stones (4.7%). Though patients presented with multiple and impacted CBD stones, laparoscopy presents a unique approach for a minimally invasive procedure with its benefits in the form of laparoscopic intra and extra hepatic bile ducts exploration.  

JCMCTA 2015 ; 26 (2) : 53 - 61
The Prevalence of Pulp Stones in Bangladeshi Adults
Authors: Uddin Mohammed Kamal , Moula Sayed Morshed
Published: October 2022

Pulp Stones (PS) are discrete calcified masses found in the dental pulp. The purposes of this study were to calculate the prevalence of pulp stones in Bangladeshi adult’s undergone endodontic treatment and to report any observed associations between occurrence of pulp stones and sex, tooth type, dental arch, side and dental status. From 131 Bangladeshi adult patients, comprising 58 males and 73 females aged between 12-60 years, 148 teeth were examined under 2x magnifications on periapical radiographs pre-operatively, carefully removed roof of the pulp chamber, examined with magnified intraoral camera, and tried for orifices patency with narrow instrument. Directly observed stones, or any obstruction to negotiation to canal orifice, color change & any tactile sense of having stone like material in the pulp chamber treated as positive sign. Loose stones are then removed with curve probe like instruments; tight stones are loosen using narrow long fissure bur peripheral to stones. Pulp stones thus collected were scored as found or not found, and associations with sex, tooth type, dental arch, side and dental status noted. Pulp stones were found in 31 (23.66 percent) of the subjects and 31 (20.95 per cent) of the teeth treated. Occurrences were rare in premolars and cuspid (Almost zero percent) but significantly higher in molars (24.80 percent). If third molars were left out of analysis, pulp stones were more common in first molars than in second molars and in maxillary first molars than in mandibular first molars. Unrestored and intact molars displayed higher prevalence of pulp stones than carious and or restored molars. This study result will provide the readers significant clues about the pulp stones during canal negotiation. Pulp stones may also provide useful forensic information when examining dental records to identify deceased persons.  

JCMCTA 2015 ; 26 (2) : 62 - 66
Diagnosis and Management of Choledochal Cyst in Adult : An Experience in a Tertiary Level Hospital in China
Authors: Kaiser ABM , Barua Subrata , Biswas Siddartha , Nahar Nur , Mohammad Noor , Ara Shamim , Wei Niu , Liang Benjia , Niu Jun
Published: October 2022

The cystic dilatation of the biliary tract is a rare disease and uncertain origin. It is recognized more frequently in children; however, its incidence comes increasing in adults, representing 20% of the cases. The aims of this study to demonstrate our experience with choledochal cyst and to evaluate morbimortality rates, discuss the aetiopathogenesis, presentation, management, and outcome with review of the literature. A retrospective study and review of the records of all the patients above 15 years, who underwent therapeutic intervention of choledochal cyst in Qillu Hospital of Jinan, China, was carried out. Ten cases of choledochal cyst were found, 8 female, with mean age 31 years. These included 8 cases of Todani type I and one case each of type II and type III. The predominant symptoms were abdominal pain and jaundice. Abdominal mass and past history of cholangitis and pancreatitis were seen in 2 patients. Investigations included ultrasound in 8 patients, CT in 7, ERCP in 3, and MRCP in 5. Surgical intervention included complete excision of the cyst with hepaticojejunostomy and cholecystectomy (Type I) excision of the diverticulum (Type II) and ERCP sphincterotomy (Type III). Malignancy was not seen in any patients. The long-term postoperative complications included cholangitis in two patients. Biliary tract cystic dilatation is a rare disease. However, its incidence is increasing in the adult population; so, it must be thought as differential diagnosis when facing obstructive jaundice.  

JCMCTA 2015 ; 26 (2) : 67 - 72
Subcutaneous Emphysema Associated With Asthma Exacerbation
Authors: Alam Didarul , Islam Shanjana , Chowdhury Bidhan Roy , Chowdhury Shahed Ahmad , Roy Tarun Kumar
Published: October 2022

A 4 year 4 months girl presented with marked respiratory distress, puffiness of the face and neck. She was dyspneic with a respiratory rate 53 breaths/min, subcutaneous swelling and crepitus was felt over the neck, shoulder and chest. Chest examination revealed bilateral polyphonic rhonchi and the chest radiograph showed areas of lucency over the neck and both the anterior and posterior chest walls. A diagnosis of moderate exacerbation of asthma complicated with subcutaneous emphysema was made and the patient was managed conservatively with nebulized salbutamol, steroids, oxygen and antibiotic. She made a remarkable improvement and has remained in a stable clinical condition.  

JCMCTA 2015 ; 26 (2) : 73 - 76
Bilateral Optic Neuritis: A Rare Manifestation Of Acute Disseminated Encephalomyelitis
Authors: Hassanuzzaman Md , Azam Akramul
Published: October 2022

Bilateral Optic Neuritis (ON) is an alarming feature for the patient and not commonly faced by clinicians. Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating disease that commonly underdiagnosed due to features sharing that of stroke. But progressive clinical course, behavioral change, features of bilateral Upper Motor Neuron (UMN) lesion, convulsion, bilateral optic neuritis (Sometimes unilateral) can help clinician to think quickly that ADEM could be a possibility. Among its clinical presentation optic neuritis is least common (6%) whereas behavioral change is universal (100%). Acute disseminated encephalomyelitis is suspected in this adult male patient because of progressive painful visual impairment, urinary retention, limb weakness which were associated with behavioral change. After clinical evaluation and relevant investigations he was diagnosed as a case of ADEM, & treated with intravenous methylprednisolone followed by oral prednisolone. During follow up (After 9 weeks) his symptoms and signs improved about 80% whereas MRI lesions regressed about 50%.  

JCMCTA 2015 ; 26 (2) : 77 - 78
CMCTA Diary Vol. 26(2)
Authors: Cheif Editor In
Published: October 2022

Abstract not available

JCMCTA 2015 ; 26 (2) : 79 - 80
EXTRACEREBELLAR SIGNS OF SPINOCEREBELLAR ATAXIA TYPE 5
Authors: Trufanov Y.O.
Published: October 2022

Background: The vast majority of studies and reviews state that spinocerebellar ataxia type 5 (SCA5) is exclusively manifested by pure ataxia. We found scant information on extracerebellar manifestations of SCA5.
Objective: The purpose of our review was to find any information about extracerebellar signs of spinocerebellar ataxia type 5.
Methods: PubMed and Google Scholar resources were used to write the review article.
Results: Ranum L.P., et al. (1994), and Bürk K., et al. (2004) described writer’s cramp dystonia, facial myokymia, limited lateral gaze, brisk reflexes, and impaired vibration sense in patients with SCA5 [1, 2].
Maschke M., et al. (2005) noticed the possible presence of hyperreflexia, incontinence, tingling and cramps, diplopia, horizontal and vertical ophthalmoparesis in patients with SCA5 [3].
Spagnoli C., et al. (2020) documented infantile-onset SCA5 with optic atrophy and peripheral neuropathy, and bilateral cataracts as associated findings [4].
Stevanin G., et al. (1999) had shown that facial myokymia and decreased vibration sense are frequent and reflect lesions of other structures than the cerebellum or its pathways [5].
We did not find any article describing parkinsonism in patients with SCA5.
Conclusion: Extracerebellar manifestations of SCA5 are rare, but at the same time they can occur and are described in the literature.
DIABETIC POLYNEUROPATHY: FOCUS ON CLINIC AND DIAGNOSTICS
Authors: Dubуnetska V.M.
Published: October 2022

The objective of our research was to describe various clinical manifestations of diabetic polyneuropathy, modern diagnostic methods to increase the level of awareness of neurologists, endocrinologists and general practitioners of family medicine. Materials and methods. Specialized medical literature, medical databases PubMed and Medscape were analyzed. Discussion. In the genesis of the acute sensory neuropathy take part sharply pronounced fluctuations of glycemia, in connection with which they can be united into a single pathogenetic whole. A rare lesion of the peripheral nervous system in diabetes is “Bruns-Garland syndrome”. In all patients at the stage of clinically asymptomatic neuropathy, on electroneuromyography are showed the signs of sensory axonal polyneuropathy, mainly of the lower extremities. Reduced heart rate variability is the earliest indicator of cardiac autonomic neuropathy.
ORTHOSTATIC HYPOTENSION AS A NON-MOTOR SYMPTOM OF PARKINSON’S DISEASE
Authors: Ovchynnykova A.S. , Trufanov Y.O.
Published: October 2022

The objective of our research was to raise awareness of neurologists about orthostatic hypotension (OH) in Parkinson’s disease (PD) and to explore the current approach to the problem. Materials and methods. This work was performed by searching for current information on OH in PD, reflecting the pathophysiology, classification, symptoms, diagnosis, and treatment. PubMed and Google Scholar resources were used to write the review. Results. An important task in the management of patients with PD is diagnostic and treatment of OH due to the negative impact of the syndrome on somatic, psychological and cognitive status. According to recent data, the prevalence of OH among PD patients is 30-50% [1] with no association with the stage of the disease [2]. OH in PD is neurogenic (NOH); it results from neurodegenerative damage to the central and peripheral structures of the sympathetic nervous system, which leads to reduced postganglionic release of epinephrine [3]. It is often asymptomatic, as a result of compensatory tolerance mechanisms [1]. In about of 50% of patients [4], OH is associated with supine hypertension [2] and may have a connection with REM-sleep disorders [5]. Classification features of OH include: onset period under orthostatic stress, the relationship of OH to different parts of the cardiac cycle, mechanism of pathophysiology, clinical course, presence of symptoms and clinical severity [20, 31, 32]. OH symptoms usually occur during orthostatic stress. They include dizziness, blurred vision, cognitive slowing, syncope, coat-hanger pain, difficulty breathing, leg buckling or leg weakness, general weakness and fatigue [1, 5, 17, 18]. Bedside orthostatic test with blood pressure measurement at the 1st, 3rd and 5th minutes of standing and ambulatory blood pressure monitoring (ABPM) are used for diagnosis [6]. The treatment strategy is to evaluate the medications taken by the patient and obligatory inclusion of non-pharmacological treatment. Pharmacological treatment for supine hypertension and OH is only given if necessary [1, 2]. Conclusions. OH is a widespread non-motor symptom of PD [1], which should be timely diagnosed and treated because of the negative impact on quality of life with increased risk of death and injuries due to falls [31, 32, 33]. The relationship between OH and other non-motor symptoms of PD should be further explored, and optimal therapeutic strategies for different functional classes and a combination of non-pharmacological and pharmacological treatments for OH should be found as well.
Spacecraft Maximum Allowable Concentrations for Hydrogen Fluoride
Authors: Lam Chiu-Wing , Ryder Valerie E.
Published: October 2022

BACKGROUND: Spacecraft maximum allowable concentrations (SMACs) provide guidance on allowable chemical exposures for nominal and emergency situations aboard spacecraft. SMACs are set to mitigate or preclude potential crew health effects and performance degradation. Hydrogen fluoride
(HF) gas is highly irritating. Inhaled HF produces irritation primarily in the upper respiratory tract. HF is not routinely present in spacecraft atmospheres. However, it can be produced in spacecraft due to overheating or combustion events involving materials containing fluorinated organics.METHODS:
Toxicological data relevant to SMAC development were collected from electronic databases using principles of systematic review, and from previous assessments and reviews of HF.RESULTS: The human inhalation data of Lund (short-term) and Largent (subchronic) showed that HF at approximately
3 ppm caused very mild respiratory irritation. NASA HF SMACs are based on these findings.DISCUSSION: The 1-h and 24-h SMACs are set at 3 ppm, a value consistent with NASA short-term SMAC criteria where crew may experience mild irritation. The 7-d, 30-d, 180-d, and 1000-d SMACs are
set at 0.3 ppm to protect against any long-term crew health or performance effects that could be produced from HF exposures.Lam C-W, Ryder VE. Spacecraft maximum allowable concentrations for hydrogen fluoride. Aerosp Med Hum Perform. 2022; 93(10):746–748.
Cardiac Rupture Due to a Fall from Height: The ‘Water Hammer’ Effect
Authors: Sharma Manav Dutt , Gupta Neha , Rajkumar Tanuja , Sharma Aarti
Published: October 2022

BACKGROUND: Cardiac injury in trauma patients can be secondary to either blunt or penetrating trauma and is a significant cause of death. The commonest etiological factors for blunt cardiac injury include motor vehicle collisions, falls, and crush or blast injuries. The incidence
of blunt cardiac injury following falls is reported to be between 5 and 50%.CASE REPORT: A combat pilot lost his life in an aircraft accident. Although he had ejected successfully just before the aircraft caught fire and his parachute had deployed fully, it was engulfed in the ball
of fire rising up from the burning aircraft wreckage, causing the parachute to burn up. As a result, the pilot had a free fall from an estimated height of 70–80 ft (21–24 m). Autopsy revealed a ruptured right atrium and endocardial tears at the right atrioventricular junction.
The left side of the heart and the coronary arteries were unscathed. The histopathological finding showed evidence that the cardiac injuries sustained were antemortem. The cause of death was ascertained to be due to cardiac rupture, leading to hemorrhagic shock.DISCUSSION: Cardiac
rupture in this case appears to be a case of the ‘water hammer’ effect, the right atrium being the commonest site of blunt cardiac rupture. It is possible that the individual landed on his feet after his parachute got burnt in the ball of fire and the violent compression of the
lower limb and abdominal veins, caused by the sudden hyperflexion of the lower limbs over the abdomen, caused the cardiac rupture in this case.CONCLUSION: The possibility of blunt cardiac trauma should always be kept in mind while dealing with survivors of ejection at low levels.Sharma
MD, Gupta N, Rajkumar T, Sharma A. Cardiac rupture due to a fall from height: the ‘water hammer’ effect. Aerosp Med Hum Perform. 2022; 93(10):755–757.
Performance Influence Mechanism of Individuals’ Spatial Ability in Teleoperation
Authors: Pan Dan , Liu Dandan , Tian Zhiqiang , Zhang Yijing
Published: October 2022

BACKGROUND: Teleoperation enables performing tasks in hazardous or inaccessible environments. The relationship between spatial ability and teleoperation performance has been extensively studied; however, relatively few studies have considered examples wherein the specific influence
mechanism between the two is examined. This study aims to explore how individuals’ spatial ability affects teleoperation performance.METHODS: Forty subjects completed teleoperated expedition and escape tasks in a virtual unfamiliar environment according to the assigned requirements.
After each expedition task, subjects’ mental model about the unfamiliar environment was evaluated. The escape task performance was measured in terms of path length, completion time, and the number of collisions. The impact of spatial ability on escape task performance wherein mental
model as a mediator was examined. The Bootstrapping method was used to examine the hypothesis regarding the mediating role of mental model in the influence of spatial ability on teleoperation performance.RESULTS: Subjects with higher spatial ability exhibited significantly better
mental models and had fewer collisions. In addition, subjects with better mental models had significantly shorter path lengths and spent marginally less time on escape. In general, the mental model appeared important for path length and completion time, but not collisions.CONCLUSIONS:
The combined results of the two tasks preliminarily proved that spatial ability affected path length of the escape task through the mental model after the exploration task. The findings are expected to aid in astronaut selection and teleoperation training for space station missions.Pan
D, Liu D, Tian Z, Zhang Y. Performance influence mechanism of individuals’ spatial ability in teleoperation. Aerosp Med Hum Perform. 2022; 93(10):717–724.
Spatial Volume Necessary to Perform Open Appendectomy in a Spacecraft
Authors: Kamine Tovy H. , Siu Margaret , Kramer Kristina , Kelly Edward , Alouidor Reginald , Fernandez Gladys , Levin Dana
Published: October 2022

BACKGROUND: With the increase in crewed commercial spaceflight and expeditions to the Moon and Mars, the risk of critical surgical problems and need for procedures increases. Appendicitis and appendectomy are the most common surgical pathology and procedure performed, respectively.
The habitable volume of current spacecraft ranges from 4 m3 (Soyuz) to 425 m3 (International Space Station). We investigated the minimum volume required to perform an appendectomy and compared that to habitable spacecraft volumes.METHODS: The axes of a simulated
operating room were marked and cameras placed to capture movements. An expert surgeon, chief surgical resident, junior surgical resident, and a nonsurgeon physician each performed a Focused Assessment with Sonography for Trauma and an appendectomy on a simulated patient. Dimensions and volume
needed were collected and compared using unpaired t-tests.RESULTS: Mean volume (± SD) needed was 3.83 m3 ± 0.47 m3 for standing and 3.68 m3 ± 0.49 m3 for kneeling (P = 0.638). Minimal volume needed was
3.20 m3 for standing and 3.26 m3 for kneeling. Minimal theoretical volume was 2.99 m3 for standing and 2.87 m3 for kneeling.DISCUSSION: The unencumbered volume needed for an appendectomy is between 2.87 m3 and 4.3 m3.
It may be technically feasible to perform an open appendectomy inside the smallest of currently operating spacecraft, at 4 m3 (Soyuz-MS). Space vessels operating without rapid evacuation to Earth will need to consider this volume for potential surgical emergencies. Additional investigation
on microgravity and standardization of procedures for novices must be completed.Kamine TH, Siu M, Kramer K, Kelly E, Alouidor R, Fernandez G, Levin D. Spatial volume necessary to perform open appendectomy in a spacecraft. Aerosp Med Hum Perform. 2022; 93(10):760–763.
Return to Flying After Catheter Ablation of Arrhythmic Disorders in Military Aircrew
Authors: Guettler Norbert , Nicol Edward , Sammito Stefan
Published: October 2022

INTRODUCTION: Catheter ablation is a widely used and effective treatment option for many tachyarrhythmic disorders. This study analyzes all ablation cases in German military aircrew over a 17-yr period. Recurrence of different arrhythmias and ablation complications were analyzed
with an aim of refining specific recommendations for aircrew employment.METHODS: All cases of catheter ablations in pilots and nonpilot aircrew examined at the German Air Force Centre of Aerospace Medicine from 2004 to 2020 were analyzed for sex, age, concomitant diseases, ablated
arrhythmias, complications, recurrences, time elapsed from ablation to reablation, number of ablations, and aeromedical disposition, including restrictions in case of a return to flying duties.RESULTS: There were 36 aircrew who underwent catheter ablation; 7 were ablated for 2 or
more different arrhythmias; 10 underwent more than one ablation. Ablated arrhythmias included atrioventricular (AV) nodal re-entrant tachycardias, accessory pathways, focal atrial tachycardias, typical and atypical atrial flutter, atrial fibrillation, and premature atrial and ventricular complexes.
Recurrence rates differed between the arrhythmias and were lowest in AV re-entrant tachycardias. Complication rates were low.CONCLUSION: In this aircrew cohort, nearly all aircrew were able to return to flying duties following ablation, albeit some with restrictions. Restrictions
depended on the underlying arrhythmia, the ablation procedure, and the symptoms prior to ablation. A basic understanding of different arrhythmias, ablation techniques, and long-term success rates is essential for the AME and for the responsible licensing authority. Close cooperation with an
electrophysiologist is necessary prior to and after ablation to ensure optimal management of aircrew with arrythmias.Guettler N, Nicol E, Sammito S. Return to flying after catheter ablation of arrhythmic disorders in military aircrew. Aerosp Med Hum Perform. 2022; 93(10):725–733.
COVID-19 Pandemic Effects on the Well-Being of Professional Pilots
Authors: Stratton Emily , Haddon Robert , Murad M. Hassan , Petterson Tanya , Nelson Mitchell , T. Cowl Clayton
Published: October 2022

OBJECTIVE: The aim was to evaluate the well-being of professional pilots using a survey that included the World Health Organization (WHO)-5 Well-Being Index.METHODS: An electronic survey was sent to pilots between June 17–August 2, 2021. Pilots self-categorized
as: airline transport pilot (ATP), commercial pilot, or both. Chi-squared and Fisher’s exact tests were used to evaluate differences between variables. Logistic regression was used to estimate the odds of impaired well-being.RESULTS: A total of 639 individuals returned the
survey. The majority of respondents were ATPs and a majority identified as male. The average well-being score was 68.0 out of 100 possible, with 22% of respondents meeting the threshold definition of impaired well-being. The odds of having impaired well-being were not dependent on gender.
In unadjusted analysis, the odds of impaired well-being were higher for those flying as commercial pilots as compared to airline transport pilots/both. Age was also strongly associated with impaired well-being, with younger pilots having greater odds of impaired well-being as compared to older
pilots. Only a little over half of the surveyed pilots agreed or strongly agreed that pilot risk of occupational exposure to COVID-19 was appropriately controlled.CONCLUSION: This survey suggests an important connection between pilot age and impaired well-being scores during the
COVID-19 pandemic. Future studies targeting the well-being of younger pilots will be of interest. Additionally, measures to reduce occupational risk of COVID-19 exposure may be helpful in view of the substantial fraction of pilots expressing concern regarding that risk.Stratton E, Haddon
R, Murad MH, Petterson T, Nelson M, Cowl CT. COVID-19 pandemic effects on the well-being of professional pilots. Aerosp Med Hum Perform. 2022; 93(10):734–738.
Subjective Effects of Modafinil in Military Fighter Pilots During Deployment
Authors: Wingelaar-Jagt Yara Q. , Wingelaar Thijs T. , Riedel Wim J. , Ramaekers Johannes G.
Published: October 2022

INTRODUCTION: Fatigue has negative effects on flight safety, especially in military aviation, where missions are often performed under challenging conditions. Modafinil is a relatively new pharmaceutical able to counter the symptoms of fatigue, but efficacy has not yet been studied
in operational military aviation. This study aims to establish effectiveness and safety of modafinil in military operations.METHODS: This field study was conducted during deployment in the Middle East by the Royal Netherlands Air Force fighter pilots. Prior to use operationally,
pilots had to complete a 24-h ground test in which modafinil was administered during a nonflying period using a questionnaire to screen for duty-relevant side effects. If no side effects were reported, operational usage was allowed. In addition to registration of modafinil’s effects,
relevant data prior to and after administration were recorded, including caffeine consumption and sleep afterwards.RESULTS: Of the 75 pilots who completed ground testing, only one experienced duty-relevant side effects. Modafinil was used in 192 operational flights, mostly during
night-time. In 128 (67%) of the flights, modafinil was used preventively, in 64 (33%) because of fatigue. In 182 (95%) of the flights, positive effects of modafinil were reported, with a maximum effect 2–3 h after administration. There was no statistical correlation between modafinil’s
beneficial effects and prior administration of caffeine or sleep medication, nor was sleep afterwards negatively affected.DISCUSSION: This study indicates modafinil is a suitable pharmaceutical countermeasure to minimize the effects of fatigue during real-life fighter operations,
without signs of negative impact on flight safety or sleep quality afterwards.Wingelaar-Jagt YQ, Wingelaar TT, Riedel WJ, Ramaekers JG. Subjective effects of modafinil in military fighter pilots during deployment. Aerosp Med Hum Perform. 2022; 93(10):739–745.
The Evaluation of Traumatic Brain Injury: A Call to Action
Authors: Hastings John
Published: October 2022

INTRODUCTION: The flying status of commercial pilots with traumatic brain injury should not be based solely upon physical examination and imaging. Weaknesses exist in all neurocognitive assessment as the relationship of results to real-world performance, in this case piloting
an airplane, can be best described as moderate. There is the possibility that a pilot’s ability to fly safely might be better evaluated by check rides with an instructor pilot in flight and in simulators. Research in this area is needed.Hastings J. The evaluation of traumatic
brain injury: a call to action. Aerosp Med Hum Perform. 2022; 93(10):758–759.