An unexpected cause of palmar paraesthesia in a soldier : a case report

Athletes presenting with neurological symptoms merit thorough assessments that in most cases will include investigations with one or more imaging modality. Imaging is especially useful in atypical presentations of neurological pathology (both acute and chronic) as was the instance in the presented case report. The case of a 22-year-old male soldier is presented who presented with a two week history of paraesthesia involving his right hand. After being assessed by the military medical officer, a presumptive diagnosis of cervical radiculopathy was made and appropriate treatment was prescribed. Symptoms persisted despite treatment and following an inconclusive cervical X-Ray, a magnetic resonance scan was booked that confirmed the diagnosis of multiple sclerosis. The patient was admitted to hospital and started on intravenous methylprednisolone and beta-interferon therapy with resolution of his symptoms. This case highlights the usefulness of imaging in confirming diagnosis, especially in atypical presentations of pathology afflicting the neurological system. Atypical symptoms, lack of response to standard therapy and inconclusive initial radiological investigations, should prompt the physician to carry out further detailed imaging modalities. The choice of the latter will need to reflect the working differential diagnoses. With reference to the presented case, imaging plays a role not only in diagnosis but also in assessing response to treatment and disease progression.peer-reviewe

Fibular stress fracture in a female cross-country runner : a case report

Stress fractures are probably the most feared class of injuries amongst endurance athletes, especially runners, since they require lengthy rehabilitation periods and temporary but drastic modifications of their training regime. A detailed literature review is presented with the aim of highlighting the importance of athlete education as well as pre-participation screening in female athletes for one or more components of the triad.peer-reviewe

An e-Commerce framework for wearable devices

The main drawback of pervasive computing is the lack of infrastructure on which ubiquitous applications should be deployed on. The deployment of the resources required by pervasive computing require expensive hardware. These considerable disadvantages led to the area of wearable computing. In this poster we briefly describe our work in the area of wearable computing, were we apply some major concepts of ubiquitous commerce to achieve a generic e-commerce framework that can be used by any wearable device.peer-reviewe

Audit on testosterone therapy in adult males with testosterone deficiency

Introduction: Hypogonadism is estimated to affect between 2.1 and 12.8% of the adult male population. Method: A review of 235 patients suffering from hypogonadism was undertaken. Local standards of care were compare to the Endocrine Society Clinical Practice Guideline of 2010 (ESCG). Results: Patients complained of 0, 1-4, 5-8 symptoms suggestive of hypogonadism in 17%, 67% and 16% respectively. 76.5% of the patients had repeatedly low testosterone. 20% suffered from primary hypogonadism. 77% suffered from secondary hypogonadism secondary. Karyotype was obtained in 35% and 5% of the patients suffering from primary and secondary hypogonadism respectively. Patients suffering from secondary hypogonadism had serum TSH (94%), prolactin (92%), cortisol (91%), GH levels (89%) and iron studies (43%) analysed. 77% of patients suffering from secondary hypogonadism had an MRI of the pituitary, with an abnormality reported in 53% of the patients. Prior to starting treatment 7% of the patients were assessed for prostate nodules and PSA was taken in 39% of the patients. Only 33% of the patients had bone mineral density (BMD) taken prior to starting testosterone treatment. Patients were reviewed 3-6 months (35%) and then annually (88%) after treatment was initiated. Conclusion: The study identifies the need for documentation of signs and symptoms. Testosterone levels should be repeated prior to starting treatment. It also highlights the need for karyotyping in patients with primary hypogonadism as well as the need to measure BMD and PSA before and after prescribing testosterone. Patients need review at 3-6months after initiation of testosterone supplementations.peer-reviewe

Towards optimized profile descents at Malta International Airport through revised approach procedures

The work presented in this paper was conducted as part of the CLEAN-FLIGHT project which is financed by the Malta Council for Science and Technology through the National Research and Innovation Programme 2011 (Grant Agreement R&I-2011-021).Traditionally, aircraft descend from cruise level towards the aerodrome in a stepped manner as directed by Air Traffic Control to ensure safe separation between aircraft, particularly in the terminal area. A descent methodology that is now being preferred is that of optimised profile descents (OPD). In OPDs, the aircraft descends from the top-of-descent (TOD) point towards the aerodrome following a smooth, continuous descent profile that is optimal from an operational perspective of choice, until it intersects the final approach glide path such as that of the Instrument Landing System (ILS). OPDs are advantageous because they consume less fuel and generate fewer emissions than their stepped counterparts. This paper presents a proposal of new approach procedures for use in the approaches to Malta International Airport (MIA) that will facilitate the introduction of OPDs. With around 28,000 aircraft movements per annum at MIA, this can be achieved by giving Air Traffic Control Officers (ATCOs) a selection of approach procedures on which to direct in-trail inbound and outbound aircraft without imposing altitude constraints. The discussion includes a study of current procedures, a statistical analysis of historical radar plots, the presentation of the proposed approaches, and a forecast of the potential gains in terms of fuel burn and emissions expected through fast-time simulation.peer-reviewe

Humidity distribution in high-occupancy indoor micro-climates

The general consensus among academics is that the spatio-temporal humidity distribution is more or less uniform in an indoor space. This has, for the large part, not yet been proven by an academic study; subsequently, this paper aims to demonstrate that this is not always true. The paper makes use of a validated transient CFD model, which uses the Low Reynolds Number k-ϵ turbulence model. The model simulates people in a room at a constant skin temperature and emitting a constant source of humidity using source terms in the species equation. The model is eventually used to predict the implications of having a high source of humidity, in the form of occupancy, on the micro-climate’s spatio-temporal humidity distribution. The results for the high-occupancy case show that different locations experience various amounts of humid air, with a 31% difference between the lowest and highest locations. The amount of water vapor in each person’s proximity is deemed to be highly dependent on the flow of the inlet jet, with the people farthest from the jet having an overall less mass of water vapor in their proximity over the two-hour experimental period. This paper has concluded that there are, in fact, cases where the humidity non-uniformity inside an interior environment becomes substantial in situations of high occupancy. The results of this paper may be useful to improve the design of HVAC systems.peer-reviewe

A quasi-real-time ground-based trajectory optimization tool for greener operations

This paper describes the methodology adopted in designing a quasi-real-time ground-based trajectory optimization tool for use by air traffic control officers. The tool is primarily intended for the optimization of aircraft trajectories during the climb and descent phases in which the user can define the trajectory in four dimensions. The optimized trajectories would then contribute to a reduction in fuel burn and emissions. The designed tool takes into account different aircraft types and sub-types through BADA performance and engine coefficients. A simple case study for an approach in Malta International Airport has also been presented to illustrate the use of the tool.peer-reviewe

Combination interventions to prevent HCV transmission among people who inject drugs: modelling the impact of antiviral treatment, needle and syringe programs, and opiate substitution therapy

BackgroundInterventions such as opiate substitution therapy (OST) and high-coverage needle and syringe programs (HCNSP) cannot substantially reduce hepatitis C virus (HCV) prevalence among people who inject drugs (PWID). HCV antiviral treatment may prevent onward transmission. We project the impact of combining OST, HCNSP, and antiviral treatment on HCV prevalence/incidence among PWID.MethodsAn HCV transmission model among PWID was used to project the combinations of OST, HCNSP, and antiviral treatment required to achieve different prevalence and incidence reductions within 10 years for 3 chronic prevalence scenarios and the impact of HCV treatment if only delivered through OST programs. Multivariate and univariate sensitivity analyses were performed.ResultsLarge reductions (>45%) in HCV chronic prevalence over 10 years require HCV antiviral treatment. Scaling up OST and HCNSP substantially reduces the treatment rate required to achieve specific HCV prevalence reductions. If OST and HCNSP coverage were increased to 40% each (no coverage at baseline), then annually treating 10, 23, or 42 per 1000 PWID over 10 years would halve prevalence for 20%, 40%, or 60% baseline chronic HCV prevalences, respectively. Approximately 30% fewer treatments are necessary with new direct-acting antivirals. If coverage of OST and HCNSP is 50% at baseline, similar prevalence reductions require higher treatment rates for the same OST and HCNSP coverage.ConclusionsCombining antiviral treatment with OST with HCNSP is critical for achieving substantial reductions (>50%) in HCV chronic prevalence over 10 years. Empirical studies are required on how best to scale up antiviral treatment and combine treatment with other interventions

Mapping preictal and ictal haemodynamic networks using video-electroencephalography and functional imaging

Ictal patterns on scalp-electroencephalography are often visible only after propagation, therefore rendering localization of the seizure onset zone challenging. We hypothesized that mapping haemodynamic changes before and during seizures using simultaneous video-electroencephalography and functional imaging will improve the localization of the seizure onset zone. Fifty-five patients with ≥2 refractory focal seizures/day, and who had undergone long-term video-electroencephalography monitoring were included in the study. ‘Preictal' (30 s immediately preceding the electrographic seizure onset) and ictal phases, ‘ictal-onset'; ‘ictalestablished' and ‘late ictal', were defined based on the evolution of the electrographic pattern and clinical semiology. The functional imaging data were analysed using statistical parametric mapping to map ictal phase-related haemodynamic changes consistent across seizures. The resulting haemodynamic maps were overlaid on co-registered anatomical scans, and the spatial concordance with the presumed and invasively defined seizure onset zone was determined. Twenty patients had typical seizures during functional imaging. Seizures were identified on video-electroencephalography in 15 of 20, on electroencephalography alone in two and on video alone in three patients. All patients showed significant ictal-related haemodynamic changes. In the six cases that underwent invasive evaluation, the ictal-onset phase-related maps had a degree of concordance with the presumed seizure onset zone for all patients. The most statistically significant haemodynamic cluster within the presumed seizure onset zone was between 1.1 and 3.5 cm from the invasively defined seizure onset zone, which was resected in two of three patients undergoing surgery (Class I post-surgical outcome) and was not resected in one patient (Class III post-surgical outcome). In the remaining 14 cases, the ictal-onset phase-related maps had a degree of concordance with the presumed seizure onset zone in six of eight patients with structural-lesions and five of six non-lesional patients. The most statistically significant haemodynamic cluster was localizable at sub-lobar level within the presumed seizure onset zone in six patients. The degree of concordance of haemodynamic maps was significantly better (P < 0.05) for the ictal-onset phase [entirely concordant/concordant plus (13/20; 65%) + some concordance (4/20; 20%) = 17/20; 85%] than ictal-established [entirely concordant/concordant plus (5/13; 38%) + some concordance (4/13; 31%) = 9/13; 69%] and late ictal [concordant plus (1/9; 11%) + some concordance (4/9; 44%) = 5/9; 55%] phases. Ictal propagation-related haemodynamic changes were also seen in symptomatogenic areas (9/20; 45%) and the default mode network (13/20; 65%). A common pattern of preictal changes was seen in 15 patients, starting between 98 and 14 s before electrographic seizure onset, and the maps had a degree of concordance with the presumed seizure onset zone in 10 patients. In conclusion, preictal and ictal haemodynamic changes in refractory focal seizures can non-invasively localize seizure onset at sub-lobar/gyral level when ictal scalp-electroencephalography is not helpfu

A proposal for revised approaches and procedures to Malta International Airport

Malta International Airport (ICAO code LMML) has four runways organized in T-format. The longer two are usually used by commercial aircraft since they are equipped with an Intrument Landing System and are facing local prevailing winds. The shorter two are mainly used for general aviation and for commercial airport adopting visual flight rules. Conventional procedures to and from the airfield are published in the Aeronautical Information Package, and include Standard Instrument Departures, instrument T-bar approach charts and other visual charts. However, no Standard Terminal Arrival Routes to connect inbound fixes to initial approach fixes or equivalent waypoints are available. This paper describes in detail the methodologies adopted in designing revised SIDs, STARs and associated procedures aimed at introducing optimal approaches and departures from LMML for the reduction of greenhouse gases in Maltese airspace. The resulting procedures for runway 13, which is the most heavily used runway by commercial aircraft, are presented, analyzed and discussed.peer-reviewe