Diagnosis, Management, and Prognosis of Spinal Tuberculosis: A Case Report.

Spinal tuberculosis (TB) is a condition that affects numerous people around the world. The incidence of TB prior to the pandemic was decreasing by about 1.8% per year; however, COVID-19 has complicated this incidence rate leading to an increase of 4.5% in 2020 and 2021. Spinal TB is a rare event in all TB patients. The management could be multifactorial including location, severity, and symptom, and this case demonstrates an example of issues to consider in the diagnosis and management of patients. This is a case of a patient presenting with back pain which was subsequently diagnosed as spinal TB. We will review this patient's presentation and consideration for multifactorial opinions in the literature. This literature review demonstrates that there is no one treatment option available. Providers need to tailor treatment to each individual case. This is an example of a case that illustrates that diagnosis of spinal TB is not straightforward and clinicians may have to make a judgment call and treat prophylactically to prevent a poor prognosis.

Comparative Analysis of Machine Learning and Deep Learning Algorithms for Real-Time Posture Detection to Prevent Sciatica, Kyphosis, Lordosis

People must incorporate a “work from home” strategy because of the COVID-19 outbreak. In today's pandemic situation, due to working from home, employees are working for long hours, and spending long hours is a pretty challenging task. Nowadays, irrespective of age concerns, sciatica, Kyphosis, and lordosis are becoming a significant problem even for youngsters. The longest nerve in our body is sciatica, which causes severe pain due to stress applied while sitting in the wrong posture. It gets compressed with our lower back discs, which may lead to severe radiating pain from our lower back disc to the entire right leg, and a person can't even perform his daily activities comfortably. To prevent these problems, sitting posture while working should be maintained correctly. This work mainly focuses on preventing employers, and students from sciatica, Kyphosis, and Lordosis health issues. We used all kinds of sitting postures that interact while working with a laptop, classified which posture was good, and predicted which stance led to health issues. We used Convolutional Neural Network and K-Nearest Neighbor machine learning algorithms to predict the correct sitting postures. In KNN, we followed two techniques to improve the performance: using Edge detection. The other method we used was detecting facial landmark detection and plotting their respective rotational angles. So by using this technique, we improved the accuracy and precision rate compared to the classical Edge detection. We also trained the model with CNN, which gives good results. We performed a comparative analysis to pick the best model to integrate with OpenCV to make it real-time. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Comparing Autopsy Thoracic Injury Patterns between In-Hospital CPR Patients Receiving LUCAS Device vs Manual Chest Compressions

Background: Current research comparing CPR-associated injuries between those receiving LUCAS device and manual CPR has primarily focused on patients who suffered out-of-hospital cardiac arrest. During the SARS-CoV-2 pandemic, more hospitals leveraged mechanical CPR devices to provide distant yet high quality chest compressions for in-hospital cardiac arrest (IHCA) patients. We sought to investigate autopsy thoracic injury patterns in in-hospital non-traumatic cardiac arrests, comparing traditional manual compressions with the mechanical LUCAS device compressions. Design: Autopsies were screened for a history of in-hospital cardiopulmonary resuscitation in the absence of prior traumatic injuries at a single, large quaternary care center from 1/1/2018 to 06/30/2021. 20 received LUCAS compressions and 40 received manual compressions. Student's T-Tests were used to compare means for continuous variables, while chi-squared and Fischer's exact tests were used for categorical variables. An alpha of 0.05 was chosen as the threshold for statistical significance. Results: A statistically significant decrease in the rate of sternal fractures and rate of multiple sternal fractures during mechanical CPR was found. A statistically significant increase in other soft tissue injuries, such as pleural wall or lung injuries was seen in mechanical CPR cases, while an increased rate of bilateral rib fractures was noted in manual compression cases. Conversely, no difference in the number or laterality of rib fractures were noted. There was no significant difference in age, biological sex, or rate of scoliosis or kyphosis between cohorts. Results are listed in table 1. (Table Presented) Little research has looked at the injury patterns of mechanical CPR in the IHCA patient population. These results point to a potential difference in thoracic injury patterns from manual compressions when compared to LUCAS device compressions. The statistically significant decrease in sternal fractures with mechanical compressions is noteworthy. Conversely, the increase in other soft tissue injury demands further examination. The decrease in bilateral rib fractures with LUCAS use suggests that placement of the device may play a role in the epidemiology of rib injuries, but not in the number of ribs injured. Further research should examine rib injuries in more detail, and quantify additional comorbidities in both survivors and non-survivors of cardiac arrest.

Growth hormone therapy in children with Schaaf-Yang-Syndrome

Introduction: Schaaf-Yang-Syndrome (SYS, OMIM # 615547) is caused by truncating variants of the paternal allele of the maternally imprinted, paternally expressed gene MAGEL2 in the Prader-Willi critical region 15q11–15q13. Prader-Willi syndrome (PWS) and SYS share several phenotypic features, including muscular hypotonia, developmental delay/intellectual disability, and short stature. Evidence exists that similar to PWS, Growth Hormone (GH) deficiency is also a feature of SYS. Since 2000, GH therapy has been approved by the Federal Drug Agency (FDA) for PWS, which poses the question if GH therapy is a suitable treatment for children with SYS. Objective: To assess the prevalence of GH therapy in SYS children, its effect on the clinical endpoints height and body mass index (BMI), possible side effects and parents’ perception of changes during the therapy. Methods: Twenty-eight individuals diagnosed with SYS were recruited through CP Schaaf and the closed Facebook group for SYS. Patients were sent a consent form, a clinical questionnaire, and asked for growth charts of the affected children. Feedback on muscle strength, endurance and satisfaction was measured on a 5-level Likert scale. Height and BMI Z Scores (defined as the standard deviation of average height or BMI compared to children of the same sex and age) were calculated using WHO/CDC data and the PedZ calculator. The effect size of GH therapy was assessed by calculating the change in Height and BMI Z Scoreover the first 6 months of treatment. Data was(figure presented)(figure presented)linearly interpolated if no measurement on exactly 90 and 180 days after treatment start was taken. Results: Of the 28 individuals enrolled, 14 were on GH therapy. Thirteen of the 14 patient families provided feedback for the changes during therapy. Detailed growth charts were available for 8 patients with GH therapy, as well as for 5 patients without GH therapy. GH treatment was initiated at an average age of 2.6 years (range: 5 months up to 8 years). No patient has had to discontinue or interrupt GH therapy. Parental perception of changes after the onset of treatment was unanimously positive: All families noted either an increase (7 patients) or strong increase (6 patients) in muscle strength. For endurance, feedback was exactly the same. Overall, general satisfaction with the treatment was high, with 8 families stating they were very satisfied, 3 families stating they were satisfied and 2 families being neutral. Additional reported benefits were improved cognitive and social skills (6 patients) and improved motor development (5 patients). Negative side effects included worsening of sleep apnea in one individual which did not require further treatment or intervention, and worsening of scoliosis/kyphosis in further two individuals. In both cases of scoliosis, treatment start coincided with local Covid19 restrictions, and physical therapy and new back braces were no longer accessible for both patients.After three months of GH treatment, Height Z Score of the treated group increased on average by +0.70. After six months of treatment, the average increase in Height Z Score was +0.99 (Fig. 1A and 1B). The BMI Z Score of the treated group decreased by −0.48 after three months and by −0.71 after six months of treatment, on average (Fig. 2A and 2B). We calculated Height Z Scores and BMI Z Scores of the treated and nontreated groups, which revealed average Height Z Scores of −1.1 in the treated group, and −3.5 in the non-treated group (Fig. 1C). The average BMI Z Score in the treated group was +0.47, while the average BMI Z Score in the untreated group was +0.93 (Fig. 2C). Conclusion: We present a retrospective, questionnaire-based assessment of GH treatment in individuals with SYS. Our findings suggest that GH therapy should be considered as treatment for SYS. In this cohort, it led to an increase of body height and parental reports suggested an improvement of endurance and muscle strength. Furthermore, several families also noted additional beneficial sideeffects like im roved cognition and motor development. These data pave the way for a prospective clinical trial of GH therapy for individuals with SYS.