We report two patients, who have used Pneumostat to replace the conventional underwater seal drainage system for recurrent pneumothorax. Both patients had required repeated chest tube insertion for recurrent pneumothorax and needed a longer hospital stay. Both patients were able to be discharged with the Pneumostat device and were reviewed in outpatient clinic. Both patients had optimal clinical improvement and chest X-ray showed no residual pneumothorax.
*Ambulatory Care ; *Chest Tubes ; Drainage/*instrumentation ; Pneumothorax/*therapy

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.
Tracheostomy

We report a case of a non-pulsatile groin swelling in a 38 years old male drug addict without the typical clinical signs of an aneurysm. Ultrasound revealed a left femoral artery pseudo-aneurysm. He was surgically treated and the vessels were ligated without revascularisation.
Swelling ; groin <1> ; Aneurysm ; Drug addict ; Aspects of signs

The anatomical structures of the first, second and third instars of Chrysomya rufifacies (Macquart) were examined by light microscopy. Observations were documented on the three main characteristics; the cephalopharyngeal skeleton, anterior spiracle and posterior spiracle. The first instar larva bore cornuae of fairly pigmented delineation with slim hypostomal sclerite and distinct dental sclerite. First instar did not have obscured anterior spiracle but posterior spiracles were obscured with thin lining of opened peritreme. Intersegmental spines were evident. The second instar larva displayed a prominent anterodorsal process approaching closer to hypostomal sclerite while upper margin of the dorsal cornua was slightly pigmented. Each anterior spiracle consisted of nine to ten papillae, arranged in a single row. Peritreme of the posterior spiracle thick, opening at the end of peritreme was not wide and confined to two spiracular slits. The third instar larva showed a prominent arch of the ventral cornua with broad and bold appearance. It approached the dorsal cornua and became narrow at the incision median. The anterior spiracle consisted of a single row of nine to ten papillae while intersegmental spine could be identified with one to three dark pigmented tips. A dark pigmented and wide periterime was observed confining three short and thick spiracular slits while button was poorly pigmented. The most distinctive feature of this second and third instar larva was the slender, thorn-like tubercle with numerous spined tips on the middle line segment of the body. These findings provide identification features of C. rufifacies larvae instars.

Objective: While tuberculosis is primarily considered a pulmonary disease, it has the potential to infect almost every organ via lymphohematogenous dissemination during the initial pulmonary infection. The aim of this study was to explore the importance of demographics, clinical characteristics and the various patterns of extrapulmonary tuberculosis among Saudi and non Saudi patients presenting to King Fahd Hospital of the University, Alkhobar, in the Eastern Province of Saudi Arabia.
Methods: Prospective study of all adult patients (13 years of age and above) with tuberculosis over a period of 9 years between 1997 and 2005.
Results: A total of 390 cases of tuberculosis were diagnosed during the 9-year period. There were 221 Saudis (57%), and 169 non-Saudis (43%). Pulmonary tuberculosis (PTB) was diagnosed in 132 cases (33 %), extrapulmonary tuberculosis (EPTB) in 244 cases (63%), and both pulmonary and extrapulmonary in 14 cases (4%). The proportion of EPTB was similar among Saudi and non Saudi patients. Constitutional symptoms were more common among PTB than EPTB patients. Lymphadenopathy was the most frequent site of involvement. Of the 244 EPTB patients, 113 (45%) had lymphadenopathy and more than half were located in the cervical region. Osteoarticular tuberculosis noted in 41 patients (17%) was the second most frequent involvement. Pleural, peritoneal, miliary, genitourinary, and central nervous system tuberculosis, each accounted for 2%10% of the total number of cases of EPTB. Co-morbidities were found in 56 patients, 12% from EPTB, and 16% from PTB. Human immunodeficiency virus test results were available for 234 patients; all were found to be seronegative.
Conclusion: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. Dealing with EPTB has been hampered by the absence of a quick and accurate diagnostic tool. Because the clinical presentation of EPTB is extremely variable, a high level of suspicion is required to diagnose and treat EPTB in a timely and health-preserving manner.

A four-month cross-sectional study found five species of parasitoids parasitizing puparia of filth flies breeding at the Taman Beringin landfill in Kepong and a poultry farm in Sungai Pelek, Sepang, Selangor. Effect of monthly rainfalls towards density of flies and percentage of parasitoids emerging from collected puparia were also analyzed. Spalangia sp. was the most common, consisting of Spalangia endius Walker, S. cameroni Perkins and S. gemina Boucek. Other parasitoids collected were Pachycrepoideus vindemmiae Rondani and Exoristobia phillipinensis Ashmead. The parasitized fly hosts were Musca domestica Linn. and Chrysomya megacephala Fabricius. S. endius was the most common parasitoid attacking M. domestica at both locations. M. domestica was the most common fly found at the Sg. Pelek poultry farm whereas C. megacephala was the most numerous at the Taman Beringin landfill. During heavy rainfall month of November 2003, density of flies were high whereas the emerging parasitoids were low at both landfill and poultry farm. The present study revealed the endemic presence of parasitoids especially S. endius in both poultry farm and garbage landfill and the potential of the parasitoid species in fly control in Malaysia.

Tendon transfers for radial nerve palsy is a common operation with good results. We did a retrospective study on twenty patients with radial nerve palsy who underwent tendon transfer surgery and recovered between January 2008 and December 2012. Outcomes measured were motor power of wrist extension, finger extension, grip strength and DASH scores. There was significant improvement of motor power of wrist and finger extension between the preoperative period and three months post-operatively, between the pre operative period and six months post operatively and between three and six months postoperatively (p = 0.0005). Grip strength improved significantly as well between preoperative, three and six months postoperatively (p = 0.0005). DASH scores reflecting patient satisfaction at six months postoperatively showed only mild or moderate difficulty of function.

An entomological study was conducted in Tanjung Sepat, Selangor, Malaysia in May until September 2007 revealing five species of butterflies (all from family Nymphalidae) were attracted to pig carcasses placed in an oil palm plantation. Euploea mulciber (Cramer 1777), Hypolimnas bolina (Linnaeus 1758), Elymnias hypermnestra (Linnaeus 1763), Mycalesis mineus (Linnaeus 1758) and Ypthima baldus (Fabricius 1775) came to the carcasses at different stages of decomposition. From this study, we know that nymphalid butterflies are attracted to carcasses but their roles are most probably unimportant in post-mortem estimation.

BACKGROUND:We compare educational environments (i.e. physical, emotional and intel ectual experiences) of emergency medicine (EM) residents training in the United States of America (USA) and Saudi Arabia (SA). METHODS:A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure (PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales (autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance. RESULTS:A total of 219 surveys were returned for 260 residents across six programs (3 SA, 3 USA), with a response rate of 84％. Program-specific response rates varied from 79％–100％. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher:118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries (P=0.243); however, role autonomy (P<0.001) and teaching (P=0.005) were better in USA programs. There were no significant differences by post-graduate training year. CONCLUSION:EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.

The incorporation of technological advances in the field of clinical orthodontics to increase treatment efficiency has led to the development of customized appliances (Insignia®), archwires (Suresmile®), and the production of devices to enhance tooth movement (Acceledent®). This review presents a comprehensive study of the literature concerning these products, and analyzes the available evidence of their efficiency. To date, one pilot study has evaluated the efficiency of the Insignia® system, three retrospective studies have assessed the efficiency of the Suresmile® system, and a few Acceledent® reports have described its effect on treatment time. Critical appraisal of the reviewed papers revealed that the efficiency of the Insignia® system cannot be confirmed based on the available evidence, while the use of Suresmile® can reduce overall treatment time in simple cases. The acceleration of tooth movement by Acceledent® devices has not yet been confirmed.
Acceleration ; Methods* ; Orthodontic Appliances* ; Orthodontics ; Pilot Projects ; Retrospective Studies ; Tooth Movement ; Vibration*