RESUMEN
Megaprosthesis is used to restore the form and function of massive skeletal defects, but it is accompanied by risks of failure, mainly due to perimegaprosthetic infection (PMI). In practice, the diagnosis of infected megaprosthesis among patients with a high index of clinical suspicion, elevated serological markers, and multiple negative or inconclusive imaging can be very challenging and poses a diagnostic conundrum to many orthopaedic surgeons. We present the case of a symptomatic 26-year-old female with large B-cell lymphoma who developed cellulitis with suspected complication of PMI 15 months post-implantation. The combination of advanced nuclear medicine imaging strategies, i.e., 99mTc-besilesomab/99mTc-sulfur colloid scintigraphy with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanning helps to characterise and delineate both infections. Invasive procedures such as joint aspiration and biopsy were avoided, and the patient was successfully treated with antibiotics. Hence, we report a case where advanced imaging modalities were decisive in the investigation of PMI.
RESUMEN
A study was undertaken to evaluate the human energy consumption of various field operations involved in lowland rice cultivation in Malaysia. Based on recorded average heart rates, fertilizing was found to be the most strenuous operation, with an average heart rate of 138 beats min(-1). There were no significant differences in the average heart rates of the subjects among the individual tasks within the first plowing, second plowing, and harvesting operations, with the average heart rates for these three tasks being 116, 106, and 106 beats min(-1), respectively. The corresponding energy expenditures were 3.90, 3.43, and 3.35 kcal min(-1). Loading the seed into the blower tank and broadcasting the seed were the most critical tasks for the seed broadcasting operation, with average heart rates of 124 and 136 beats min(-1), respectively. The highest energy expenditure of 418.38 kcal ha(-1) was observed for seed broadcasting, and the lowest energy expenditure of 127.96 kcal ha(-1) was for second plowing. The total seasonal human energy expenditure for rice cultivation was estimated to be 5810.71 kcal ha(-1), 55.7% of which was spent on pesticide spraying. Although the sample size in this study was relatively small, the results indicated that human energy expenditure per unit area (kcal ha(-1)) was positively linked to the average heart rate of the subjects and negatively linked to the field capacity. Thus, mechanization of certain tasks could decrease worker physical effort and fatigue and increase production.
Asunto(s)
Agricultura , Metabolismo Energético , Oryza , Análisis y Desempeño de Tareas , Enfermedades de los Trabajadores Agrícolas/prevención & control , Frecuencia Cardíaca , Humanos , Malasia , Salud Laboral , Proyectos PilotoRESUMEN
Typhoid fever remains a common problem in Malaysia, but for its diagnosis both blood culture and the Widal test have drawbacks. A dot enzyme immunoassay (EIA) has been developed which detects IgM and IgG antibodies to a specific 50 kDa outer membrane protein on Salmonella typhi. This study was performed among outpatients attending the university hospital in Kelantan, a state on the east coast of Peninsular Malaysia where typhoid is endemic. The dot EIA was done on 149 outpatients of all ages in whom typhoid was suspected. Of these, 60 were not analysable due to insufficient data. The other 89 were retrospectively classed as typhoid (total = 21), or not typhoid (total = 68). The criteria for diagnosis of typhoid was either, blood culture was positive, or with blood culture negative, temperature was at least 38 degrees C and Widal O and/or H titer greater than or equal to 1/160. We then compared the diagnosis with the EIA result. For the result where either IgM or IgG was positive, sensitivity was 90%, specificity 91% and negative predictive value 97%. For IgM positive, specificity was 100%. But the specificity of IgG positive alone was reduced by six false positives, which were probably due to persistence of IgG after acute infection. Other cases were found where IgG positive alone appeared in the first week of typhoid fever, probably due to rapid response in a second or subsequent infection. We also found that IgM-producing patients were significantly younger than those showing IgG alone positive.