EFFECT OF LIVER MOBILITY AND MOTILITY IN CASE OF NON SPECIFIC RIGHT SHOULDER PAIN WITH MILD RESTRICTION OF MOVEMENT

Background: Shoulder pain is a common musculoskeletal condition that is a recognized as a disabling problem and cane be associated with substantial economic burden. The pain and disabilities associated with shoulder pain can have a large impact on individuals and their families, communities, and healthcare system affecting daily functioning, and ability to work .It is the third most common musculoskeletal complaint presenting to physical therapy. Objective: Reducing the non specific right shoulder pain and improve the range of motion using an osteopathic approach. Methods: The study was done on two patient aiming to reduce their right shoulder pain and mild restriction of shoulder rotation movement, we use visceral manipulation technique especially liver technique using liver for investigation and treatment purpose . Results: We found reduce the pain and improve range of movement of right shoulder after 15 min with the visceral manipulation techniques the approach is done for three times a week for two month.

A ‘never miss’ diagnosis: Ptosis secondary to metastatic breast cancer diagnosed as involutional ptosis and a review of the literature

We present a case of ptosis secondary to metastatic lobular carcinoma of the breast which was initially diagnosed as involutional ptosis. A 67-year-old woman previously diagnosed with lobular carcinoma of the breast presented to our clinic with mild restriction of lateral gaze and persistent droopiness of her right eyelid (associated with decreased levator function) despite recent repair of a suspected involutional ptosis. Orbital magnetic resonance imaging revealed a mass in the right orbit which was biopsied and diagnosed as lobular carcinoma of the breast. Poor levator function is rarely present in involutional ptosis. Especially in conjunction with abnormal extraocular motility, other etiologies of acquired ptosis must be considered. This case highlights the importance of patient history and ocular examination in identifying the underlying etiology of ptosis. A review of the literature to evaluate the incidence of signs and symptoms associated with metastatic breast cancer to the orbit is included.

DETECTION OF PULMONARY FUNCTION ON ACTIVE SMOKERS WHOM REGULARY PLAY WIND INSTRUMENT “PUI-PUI”

The method used to increase the lung capacity value is to practice using a wind instrument, one of which is the traditional Makassar wind instrument, the Pui-Pui. The purpose of this study was to look at the description of the lung capacity values of pui-pui wind instrument players in Makassar City. This research was conducted at the Pulmonary Polyclinic of Wahidin Sudirohusodo General Hospital with 27 smokers using a purposive sampling technique. Examination of lung capacity is carried out using a spirometry device by converting its value based on values based on Pneumobile Indonesia. The results of this study indicate that smokers who have been "Pui-Pui" blown music artists for more than 6 years have lung function: 24 people (89%) who have normal lung impression, 2 people (7.4%) mild obstruction, and 1 person (3.7) mild restriction. The conclusion is the occurrence of lung function disorders due to smoking is minimized by the habit of playing a wind instrument "Pui-Pui", so that this can be used as a medium of prevention or treatment to improve the lung function of those who have smoking habits.

Free subgroups in k(x 1,... ,x n )(X;σ) and k(x,y)(k;σ)

Let k be a field, let {\mathfrak{A}_{1}} be the k-algebra {k[x_{1}^{\pm 1},\dots,x_{s}^{\pm 1}]} of Laurent polynomials in {x_{1},\dots,x_{s}} , and let {\mathfrak{A}_{2}} be the k-algebra {k[x,y]} of polynomials in the commutative indeterminates x and y. Let {\sigma_{1}} be the monomial k-automorphism of {\mathfrak{A}_{1}} given by {A=(a_{i,j})\in GL_{s}(\mathbb{Z})} and {\sigma_{1}(x_{i})=\prod_{j=1}^{s}x_{j}^{a_{i,j}}} , {1\leq i\leq s} , and let {\sigma_{2}\in{\mathrm{Aut}}_{k}(k[x,y])} . Let {D_{i}} , {1\leq i\leq 2} , be the ring of fractions of the skew polynomial ring {\mathfrak{A}_{i}[X;\sigma_{i}]} , and let {D_{i}^{\bullet}} be its multiplicative group. Under a mild restriction for {D_{1}} , and in general for {D_{2}} , we show that {D_{i}^{\bullet}} , {1\leq i\leq 2} , contains a free subgroup. If {i=1} and {s=2} , we show that a noncentral normal subgroup N of {D_{1}^{\bullet}} contains a free subgroup.

Respiratory Disorders and Lung Function Impairments of the Scavengers in Bantar Gebang, Bekasi

Background: The workers in the landfill have high risk of health problems. The prevalence of respiratory disorders and lung function increases in waste collection workers. There has been no data on respiratory disorders and lung function in scavengers, especially in Bantar Gebang, Bekasi. Methods: This study used a cross-sectional design to the scavengers who work and live in Ciketing Udik, Bantar Gebang, Bekasi. Conducted in January-March 2015, doing interview with questionnaires, and spirometry examination. Results: The number of samples that suitable with the inclusion criteria are 108 subjects. Respiratory disorders are 92 subjects (85.2%). The respiratory disorders consist of 73 subjects with chronic cough, 65 subjects due to shortness of breath, 57 with phlegm and 19 wheezing. Lung function impairments consist of 18 (16.7%) subjects in the form of mild obstruction 3 (2.8%) subjects, mild restriction 11 (10.2%) subjects and mixed 4 (2.8%) subjects. Results of the analysis show that there is a significant relationship between duration of working with respiratory disorders and lung function impairments. Conclusion: There is respiratory disorders and lung function impairments of the scavengers in Bantar Gebang, Bekasi. (J Respir Indo 2019; 39(2))

Analysis of Dust Concentration, NO2 Concentration, and Pulmonary Disfunction on Woman’s Sweeper in Jalan Ahmad Yani Kota Surabaya

The lung’s function status is measured by the spirometer & known through value of Forced Vital Capacity (FVC) and Forced expiratory volume in one second (FEV1). The study aims was to analyze dust and NO2 concentration in ambient and the pulmonary disfunction of woman sweeper in Jalan Ahmad Yani Kota Surabaya. This research was a descriptive with cross sectional design. The research sample was 10 persons who were working as woman’s sweeper in the Jalan Ahmad Yani Kota Surabaya. The variables were the dust and NO2 concentration, individual charactheristics such as age, workdays duration, workyears period, using of Personal Protective Equipment (masks), passive smoker, and body mass index. The study was using interview, pulmonary function test using spirometer, measurement of dust concentration using EPAM 5000, and NO2 concentration using Gravimetry. The result showed that dust concentration on the third location was 1.33 mg/m3 and NO2 concentration on the first location was 103.6 μg/m3. Both of these parameters were above the standard of Peraturan Gubernur Jawa Timur No. 10 tahun 2009. The pulmonary function test was 6 of 10 respondents had pulmonary disfunction which is mild restriction. It was recommended to wear clean mask for woman’s sweeper while working and to consider the workdays duration.

Study of pulmonary functions with DLco in acute respiratory distress syndrome/ acute lung injury syndrome

Background: The objective of this is to study the lung functions with DLco in ARDS/ALI survivors; to study and analyse the lung functions in different diseases causing ARDS/ ALI survivors and to analyse the effect of treatment strategies on lung functions with DLco in survivors.Methods: All patients who survived ARDS/ALI illness from January 2008 to July 2009 are selected and follow up for pulmonary function at discharge, 3 months and 6 months were performed post illness were recorded and compared.Results: In the study period, 37 cases were enrolled in the prospective cohort study, out of which 9(24.3%) were suffering from ALI according to American European Consensus definition. There was varied infections etiology causing ARDS/ ALI. Pulmonary function test at discharge were showing normal flow rates and volumes (94.6%), mild restriction in some cases (8.4%) as the patients included in the study does not have any past respiratory illness out of 37(100%) patients of ARDS/ALI discharged from Hospital 21(56.8%) had low DLco and 16 (43.2%) had normal DLco.Conclusions: Diffusion defect is found to be more common in the patients who had mixed infections than the patients who had single infection. There was no effect of steroids on the outcome of the patients in terms of diffusion defect.

Delayed surgical treatment of orbital trapdoor fracture in paediatric patients

BackgroundTrapdoor fracture is a special type of orbital blowout fracture. Although early surgery is recommended, there still remain some patients delayed by various reasons. In this study, we analysed the clinical characteristics of delayed paediatric patients, especially those with different levels of ocular motility restriction before surgery.MethodsThirty patients (3 to 14 years old) who underwent delayed surgery for trapdoor fractures between January 2008 and September 2016 were enrolled. Their demographics, causes of injury and delay, clinical features, imaging data and follow-up information were collected.ResultsMuscular entrapment was found in 17 patients (group A) and soft-tissue entrapment in 13 patients (group B). 12 (7 in group A) presented with severe motility restriction and 18 (10 in group A) with mild restriction before surgery. 41.7% with severe restriction recovered after surgery, compared with 83.3% with mild restriction. Four (23.7%) in group A (all with severe restriction) and six (46.2%) in group B (half with severe restriction) presented with persistent diplopia.ConclusionsLong recovery time and a high percentage of persistent diplopia are the main problems of delayed trapdoor fracture in children. A prompt surgery within 48 hours is strongly recommended in patients with muscular entrapment even if an urgent treatment is hard to achieve. So are patients with soft-tissue entrapment and significant motility restriction. In the other patients without such indications, even though some recovery might be possible in the long term, a prompt surgery right after diagnosis is still preferable regardless of the entrapped contents.

Stable FLRW solutions in generalized massive gravity

We present exact Friedmann Lemaítre Robertson Walkers (FLRW) solutions in generalized massive gravity where the mass parameters are naturally promoted to Lorentz-invariant functions of the Stückelberg fields. This new dependence relaxes the constraint that would otherwise prevent massive gravity from possessing exact FLRW solutions. It does so without the need to introduce additional degrees of freedom. We find self-accelerating cosmological solutions and show that, with a mild restriction on the region of phase space, these cosmological solutions exhibit full stability, i.e. absence of ghosts and gradient instabilities for all the tensor, vector and scalar modes, for all cosmic time. We perform the full decoupling limit analysis, including vector degrees of freedom, which can be used to confirm the existence of an active Vainshtein mechanism about these solutions.

Idiopathic Pulmonary Fibrosis: New Insights to Functional Characteristics at Diagnosis

BACKGROUND: The lung function of patients with idiopathic pulmonary fibrosis (IPF) has not been characterized in detail.OBJECTIVE: To characterize the heterogeneous physiological abnormalities that exist in patients with IPF during their initial clinical evaluation.METHODS: Lung function tests from 93 patients, performed within six months of the initial diagnosis of IPF, were obtained from a referral pulmonary function laboratory at a tertiary care hospital in Canada. A restrictive pattern was defined as total lung capacity (TLC) <95th percentile of predicted value. Patients with obstructive lung disease, lung cancer, emphysema and other restrictive lung diseases were excluded.RESULTS: On diagnosis, 73% of patients with IPF had a restrictive pattern, with a mean TLC of 72% of predicted. Mean forced vital capacity (FVC) was 71% and 44% of patients had an FVC <95th percentile. Mean diffusing capacity for carbon monoxide (DLco) was 60% and DLco/alveolar volume (VA) 92% of predicted. Increased severity of restriction – based on TLC – was associated with lower DLco(74% of predicted in mild restriction and 39% of predicted in severe restriction) and higher forced expiratory volume in 1 s (FEV1)/FVC ratio (82% of predicted in mild restriction and 90% of predicted in severe restriction) but not with age (76 years in mild restriction and 69 years in severe restriction). Regardless of severity of restriction, the average DLco/VA (≥86% of predicted) remained within normal limits.CONCLUSIONS: One in four patients with IPF had normal TLC and more than one-half had a normal FVC during initial evaluation. As the severity of the restriction increased, FEV1/FVC increased, DLcodecreased but DLco/VA remained normal.