CASE REPORT

Abstract A healthy, 35-year old, male patient reported with left-sided facial trauma and ipsilateral lower extremity injury following a road traffic accident. Two weeks later, he developed hyperesthesia, pain and loss of vision in the left eye. Ophthalmic evaluation revealed cornea haziness, a dilated and fixed pupil and tonometry revealed an intra-ocular pressure of 60mm Hg. Thus, secondary glaucoma was diagnosed. Without delay anti-edema measures consisting of mannitol, a carbonic anhydrase inhibitor (acetazolamide) and β-adrenergic antagonistic eye-drops (timolol) were instituted. Results: Within 24 hours, the intra-ocular pressure reduced to 28mm of Hg and his vision gradually improved. The patient thereafter was put on topical anti-glaucoma medication and topical steroids for two weeks following which the IOP returned to normalcy; no inflammatory signs were noted and his medications were gradually tapered. Conclusion: Health care professionals need to be aware of the possible occurrence of such emergencies in cases of facial trauma, especially those presenting with head injury. Because head injury can similarly present with unilateral head ache, vomiting and photophobia, such symptoms have to be differentiated from those observed in secondary glaucoma, clinically. This consequently would eliminate diagnostic ambiguity. Since glaucoma is a sight-threatening emergency, extreme vigilance for such signs and symptoms is deemed necessary for immediate referral and management. Keywords: Secondary glaucoma, facial trauma, orbital injuries Case report A healthy, 35-year old, male patient reported with left-sided facial trauma and ipsilateral lower extremity injury following a road traffic accident; the patient was conscious and oriented with no history of any other neurological deficit. Local examination revealed multiple, left-sided, facial lacerations with ipsilateral circumorbital edema/ ecchymosis and sub-conjunctival hemorrhage. Palpation elicited left infra-orbital tenderness; however, ophthalmic evaluation revealed no impairment in visual acquity, ocular motility and pupillary responses (direct and consensual). CT of face revealed an undisplaced left infra-orbital rim fracture and anterior (maxillary) sinus wall communition for which wound debridement and primary closure was done. MRI of left knee joint revealed an inter-condylar fracture of tibia for which open reduction and internal fixation of the fracture was done. An orbital chart was maintained over the next 72 hours to assess visual acuity and pupillary responses. After 2 weeks, the patient developed hyperesthesia, pain and sudden loss of vision in the left eye. Immediate ophthalmic evaluation revealed a hazy cornea; the pupil was fixed and dilated; and tonometry revealed an intra-ocular pressure of 60mm Hg. Ophthalmoscopy of the fundus revealed a deep anterior chamber with multiple sphincteral and choroidal tears involving the macula. In view of these findings, a condition of secondary glaucoma was diagnosed. Anti-edema measures consisting of mannitol, a carbonic anhydrase inhibito

Coherent States and Modified de Broglie-Bohm Complex Quantum Trajectories

This paper examines the nature of classical correspondence in the case of coherent states at the level of quantum trajectories. We first show that for a harmonic oscillator, the coherent state complex quantum trajectories and the complex classical trajectories are identical to each other. This congruence in the complex plane, not restricted to high quantum numbers alone, illustrates that the harmonic oscillator in a coherent state executes classical motion. The quantum trajectories are those conceived in a modified de Broglie-Bohm scheme and we note that identical classical and quantum trajectories for coherent states are obtained only in the present approach. The study is extended to Gazeau-Klauder and SUSY quantum mechanics-based coherent states of a particle in an infinite potential well and that in a symmetric Poschl-Teller (PT) potential by solving for the trajectories numerically. For the coherent state of the infinite potential well, almost identical classical and quantum trajectories are obtained whereas for the PT potential, though classical trajectories are not regained, a periodic motion results as t --> \infty.Comment: More example

A roadmap to develop dementia research capacity and capability in Pakistan: a model for low- and middle-income countries

Objective To produce a strategic roadmap for supporting the development of dementia research in Pakistan. Background While global research strategies for dementia research already exist, none is tailored to the specific needs and challenges of low- and middle-income countries (LMIC) like Pakistan. Methods We undertook an iterative consensus process with lay and professional experts to develop a Theory of Change-based strategy for dementia research in Pakistan. This included Expert Reference Groups (ERGs), strategic planning techniques, a “research question” priority survey, and consultations with Key Opinion Leaders. Results We agreed on ten principles to guide dementia research in Pakistan, emphasizing pragmatic, resource sparing, real-world approaches to support people with dementia, both locally and internationally. Goals included capacity/capability building. Priority research topics included raising awareness and understanding of dementia, and improving quality of life. Conclusion This roadmap may be a model for other LMIC health ecosystems with emerging dementia research cultures

Crohn's disease activity index and Vienna classification - Is it worthwhile to calculate before surgery?

Background: Crohn's disease (CD) patients with increased disease activity may reveal an increased risk for perioperative complications. The `Crohn's disease activity index' (CDAI) and the `Vienna classification' (VC) were developed for standardized disease activity estimations. The significance of these scores to predict extent, type and early outcome of surgery in CD patients was analyzed. Methods: In 179 surgically treated CD patients, the CDAI and VC were assessed from a prospective database. Relations of the scores with CD risk factors, type, number, location and complications of surgery were analyzed. Results: VC behavior and location subtypes were associated with distinct types of surgery (i.e. `strictureplasty' in `stricturing disease', `colon surgery' in `colon involvement'), but not with surgery type and extent or outcome. Surgery extent (i.e. with 5 vs. 3 `surgical sites' 425 +/- 25 vs. 223.3 +/- 25) and complications (357.1 +/- 36.9 (with) vs. 244.4 +/- 13 (without)) were associated with elevated CDAI levels; however, nicotine abuse remained the only significant risk factor for perioperative complications after multiple logistic regression. Conclusion: The significance of VC or CDAI for predicting the extent of surgery or complications is limited. None of the tested variables except preoperative nicotine abuse influenced the likelihood for perioperative complications. Copyright (c) 2006 S. Karger AG, Base

Two-Dimensional Helioseismic Power, Phase, and Coherence Spectra of {\it Solar Dynamics Observatory} Photospheric and Chromospheric Observables

While the {\it Helioseismic and Magnetic Imager} (HMI) onboard the {\it Solar Dynamics Observatory} (SDO) provides Doppler velocity [$V$], continuum intensity [$I_C$], and line-depth [$Ld$] observations, each of which is sensitive to the five-minute acoustic spectrum, the {\it Atmospheric Imaging Array} (AIA) also observes at wavelengths -- specifically the 1600 and 1700 Angstrom bands -- that are partly formed in the upper photosphere and have good sensitivity to acoustic modes. In this article we consider the characteristics of the spatio--temporal Fourier spectra in AIA and HMI observables for a 15-degree region around NOAA Active Region 11072. We map the spatio--temporal-power distribution for the different observables and the HMI Line Core [$I_L$], or Continuum minus Line Depth, and the phase and coherence functions for selected observable pairs, as a function of position and frequency. Five-minute oscillation power in all observables is suppressed in the sunspot and also in plage areas. Above the acoustic cut-off frequency, the behaviour is more complicated: power in HMI $I_C$ is still suppressed in the presence of surface magnetic fields, while power in HMI $I_L$ and the AIA bands is suppressed in areas of surface field but enhanced in an extended area around the active region, and power in HMI $V$ is enhanced in a narrow zone around strong-field concentrations and suppressed in a wider surrounding area. The relative phase of the observables, and their cross-coherence functions, are also altered around the active region. These effects may help us to understand the interaction of waves and magnetic fields in the different layers of the photosphere, and will need to be taken into account in multi-wavelength local helioseismic analysis of active regions.Comment: 18 pages, 15 figures, to be published in Solar Physic

Inhibiting ACK1-mediated phosphorylation of C-terminal Src kinase counteracts prostate cancer immune checkpoint blockade resistance

Solid tumours are highly refractory to immune checkpoint blockade (ICB) therapies due to the functional impairment of effector T cells and their inefficient trafficking to tumours. T-cell activation is negatively regulated by C-terminal Src kinase (CSK); however, the exact mechanism remains unknown. Here we show that the conserved oncogenic tyrosine kinase Activated CDC42 kinase 1 (ACK1) is able to phosphorylate CSK at Tyrosine 18 (pY18), which enhances CSK function, constraining T-cell activation. Mice deficient in the Tnk2 gene encoding Ack1, are characterized by diminished CSK Y18-phosphorylation and spontaneous activation of CD

Ack1 Mediated AKT/PKB Tyrosine 176 Phosphorylation Regulates Its Activation

The AKT/PKB kinase is a key signaling component of one of the most frequently activated pathways in cancer and is a major target of cancer drug development. Most studies have focused on its activation by Receptor Tyrosine Kinase (RTK) mediated Phosphatidylinositol-3-OH kinase (PI3K) activation or loss of Phosphatase and Tensin homolog (PTEN). We have uncovered that growth factors binding to RTKs lead to activation of a non-receptor tyrosine kinase, Ack1 (also known as ACK or TNK2), which directly phosphorylates AKT at an evolutionarily conserved tyrosine 176 in the kinase domain. Tyr176-phosphorylated AKT localizes to the plasma membrane and promotes Thr308/Ser473-phosphorylation leading to AKT activation. Mice expressing activated Ack1 specifically in the prostate exhibit AKT Tyr176-phosphorylation and develop murine prostatic intraepithelial neoplasia (mPINs). Further, expression levels of Tyr176-phosphorylated-AKT and Tyr284-phosphorylated-Ack1 were positively correlated with the severity of disease progression, and inversely correlated with the survival of breast cancer patients. Thus, RTK/Ack1/AKT pathway provides a novel target for drug discovery

Association Between Periodontitis and Impaired Fasting Glucose and Diabetes

OBJECTIVEMany studies have reported that periodontal disease is associated with diabetes, but its relation with impaired fasting glucose (IFG) has been understudied. This study investigated the relationship between chronic periodontitis, IFG, and diabetes in the U.S. population.RESEARCH DESIGN AND METHODSParticipants in the National Health and Nutrition Examination Survey III, aged ≥20 years, who received periodontal examinations and provided blood samples (n = 12,254) were grouped into quintiles of mean clinical attachment loss (CAL) and pocket depth, with the lowest category being the reference. Plasma fasting glucose was categorized into three groups (normal, <100 mg/dL; IFG, ≥100 but <126 mg/dL; and diabetic, ≥126 mg/dL). Sociodemographic factors and other potential risk factors were obtained by interview or examination. SAS 9.1 was used for statistical analysis accounting for the complex weighted sampling.RESULTSParticipants in the top quintile category of CAL had higher prevalence odds of IFG (odds ratio [OR] 1.55 [95% CI 1.16–2.07]) and diabetes (4.77 [2.69–8.46]) after adjustment for related confounders, compared with those in the bottom quintile. The highest quintile of pocket depth was positively associated with IFG (1.39 [1.00–1.92]) and diabetes (1.63 [1.10–2.42]) compared with the lowest quintile. ORs for CAL increased from the lowest to the highest quintile (P value test for trend <0.01) for all outcomes. The ORs for pocket depth also tended to rise across quintiles.CONCLUSIONSChronic periodontitis measured by CAL and pocket depth was positively associated in a linear relation with IFG and diabetes in U.S. adults