OBJECTIVE: To propose a Rapid Upper Limb Assessment for Pianists (RULA-p) for postural assessment, which will allow pianists to identify awkward postures (if any) during piano playing, thus, achieving healthful playing for injury prevention.
METHOD: This study modified (i) the muscle use score; and (ii) the force/load score, from the existing RULA as a rapid assessment for pianists' posture.
RESULTS: We proposed the modified RULA for pianists (RULA-p) in the worksheet format.
CONCLUSION: Overall, this study is intended to further expand the existing literature on the early prevention of pianists' PRMDs.
MATERIALS AND METHODS: We searched across multiple databases (PubMed, Google Scholar, ScienceDirect, Academia.edu, ResearchGate and Semantic Scholar) and suitable articles from 1993 to 2022 were systematically chosen according to PRISMA guideline. The analysis was performed on the maternal characteristics, signs and symptoms of the uterine torsion, management, complications and outcomes of both the mothers and infants. All case reports or case series reporting uterine torsion in pregnancy from English language journals were included without restriction on the geographical origin.
RESULTS: A total of 149 cases from 146 publications and one from our centre were included for analysis. Most of the cases were seen in the third trimester and presented with acute abdominal symptoms and signs. It presented a challenge in diagnosis and had a myriad of complications to the mothers and infants. The maternal mortality is 2.0% while the perinatal mortality stands at 38.2%.
CONCLUSION: Uterine torsion in pregnancy is a rarely encountered but serious condition with no specific precipitating factor or diagnostic criteria. It can occur at any gestation, has a wide range of non-specific clinical presentations, and carries a significant risk to the mother and child.
METHODS: A total of 138 patients aged between 18 and 65 years old with the American Society of Anesthesiologists (ASA) I or II status, who required general anaesthesia and had no contraindication towards the use of P-LMA™, were recruited. They were randomly positioned into three anatomical landmarks, which were umbilicus, lowest rib margin, and xiphoid. P-LMA™ was inserted following muscle paralysis, and the first successful placement was evaluated using positional and performance tests. Duration, ease of P-LMA™ insertion, and airway complications were compared.
RESULTS: Demographic and airway features were comparable among all groups. The P-LMA™ placement success rate improved when the table height was positioned at the lowest rib margin (p=0.002). All three positions were comparable in terms of duration, ease of insertion, and airway morbidities.
CONCLUSION: The lowest rib margin anatomical landmark can be used as a guide in achieving the optimal operating table height for successful P-LMA™ placement.
METHODS: A cross-sectional study involving patients with coronavirus disease 2019 self-perceived as asymptomatic was conducted. Assessments included the subjective Malaysian Smell and Taste Questionnaire and the culturally adapted Malaysian version of the objective Sniffin' Sticks Identification smell test.
RESULTS: In 81 participants (mean age of 31.59 ± 12.04 years), with mean time from diagnosis to smell test of 7.47 ± 3.79 days, subjective assessment showed that 80.2 per cent were asymptomatic (questionnaire score of 6) and 19 per cent had mild symptoms (questionnaire score of 7 and 8). The mean objective smell test score was 10.89 ± 2.11. The prevalence of olfactory impairment was 76.6 per cent among patients with coronavirus disease 2019 self-perceived as asymptomatic. There was no association between the questionnaire and the smell test scores (p = 0.25). There was a correlation between the smell test score and the duration from diagnosis to smell test (p = 0.04).
CONCLUSION: The objective assessment demonstrated that coronavirus disease 2019 patients who perceived themselves as asymptomatic showed olfactory impairment.
CASE PRESENTATION: A healthy 23-year-old Asian man presented with sudden onset of diplopia followed by left-sided facial asymmetry for 3 days. Assessment of extraocular movement revealed left conjugate horizontal gaze palsy. On right gaze, there was limited left eye adduction and horizontal nystagmus of the right eye. These findings were consistent with a left-sided one-and-a-half syndrome. Prism cover test revealed left esotropia of 30 prism diopters. Cranial nerve examination showed left lower motor neuron facial nerve palsy, while other neurological examination was normal. Magnetic resonance imaging brain showed multifocal T2 fluid attenuated inversion recovery hyperintense lesions, involving bilateral periventricular, juxtacortical, and infratentorial regions. A focal gadolinium contrast-enhanced lesion with open ring sign on T1 sequence was seen at the left frontal juxtacortical region. Multiple sclerosis was diagnosed on the basis of the clinical and radiological evidence, which fulfilled the 2017 McDonald criteria. Positive oligoclonal bands in cerebrospinal fluid analysis further confirmed our diagnosis. He had a complete resolution of symptoms 1 month after a course of pulsed corticosteroid therapy, and was subsequently placed on maintenance therapy with interferon beta-1a.
CONCLUSION: This case illustrates eight-and-a-half syndrome as the first presentation of a diffuse central nervous system pathology. A wide range of differential diagnoses needs to be considered in such a presentation as based on the patient's demographics and risk factors.