A New Application of the Bioarchaeology of Care Approach: A Case Study from the Metal Period, Philippines

Abstract

A case of disability in the Metal Period of the Philippines, likely requiring healthcare from others, is presented to explore aspects of group dynamics in this period of antiquity. B243, a middle-aged male excavated from the Napa site in the central Philippines, suffered severe trauma to the right leg resulting in considerable restrictions to mobility and self-maintenance of survival related behaviours such as food provision and hygiene. It is likely that B243 required assistance from others to survive for some period of time prior to eventual death. The bioarchaeology of care method was applied to assess the types of healthcare that B243 likely required, and to consider potential social and biological impacts to both B243 and his community. Provision of healthcare practice in this case suggests that B243's community had access to health-related resources, knowledge on the treatment of his injuries and underlying values in the group for sustaining human life in the case of injury and disability.

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Towards a best practice for the use of active non-contact surface scanning to record human skeletal remains from archaeological contexts

Abstract

Active surface scanners emit light or a laser stripe to record the exterior surface of an object or landscape, providing results in three dimensions. The use of active surface scanners to record anthropological and archaeological contexts has increased within the last few years, creating a number of sub-contexts within these disciplines, and allowing a further development of certain applications, such as quantitative analysis, the use of replicas in education and museums, and the creation of digital databases archived in institutions. However with guidance, this paper aims to assess the advantages and disadvantages of active surface scanning and the potential for research with regards to the recording and analysis of human skeletal remains. The key advantages and uses identified include: quantitative digitisation, geometric morphometric studies, conservation, preservation, documentation, and reconstruction. However, surface scanning also has some limitations, including: cost, technological expertise, the need for a power source, computing requirements, and data size. Overall, the application of active surface scanning technology to archaeological skeletal remains will provide a vital digital archive that will serve to preserve the integrity of this fragile and finite resource for future generations. This is particularly important within the current developer-funded environment in which many skeletal collections, including those yielding unique or unusual pathological or morphological features, are re-buried, with only very limited time for analysis.

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Traumatic aneurysm of the cortical middle cerebral artery

Description

A right-handed man aged 79 years presented with increasing confusion following a mechanical fall with head strike 2 weeks prior. CT demonstrated a left frontoparietal convexity subacute subdural haematoma (SDH) measuring 3 mm in depth and with 5 mm of midline shift to the right (figure 1). There was no skull fracture. Initial examination revealed no localising neurological deficit and he was admitted for observation. On day 3, the patient developed intermittent episodes of right-sided weakness and expressive dysphasia. Contrast MRI showed expansion of the SDH to 10 mm in thickness, and also demonstrated a 9 mm vividly enhancing focus within the haematoma overlying the frontal lobe (figure 2). The lesion enhanced on the arterial and venous phases of contrast CT (figure 3). Digital subtraction angiography demonstrated the lesion to be a 6 mm sidewall aneurysm of the cortical middle cerebral artery (MCA) (figure...

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Intraoral ulcer due to non-invasive positive pressure ventilation: an overlooked complication

Description

A male patient aged 81 years reported with dyspnoea and loss of consciousness, at our emergency department. His respiratory rate was 30 breaths/min, and his level of consciousness determined using the Glasgow Coma Scale was eye (1), verbal (1) and motor (4). Despite oxygen administration via a bag valve mask, his percutaneous oxygen saturation level was measured as only 81%. Physical examination revealed weak vesicular sound on auscultation, suggesting he had severe emphysema. Arterial blood gas analysis after continuous bag valve mask ventilation revealed pH 7.014, undetectably high pCO₂ and pO₂ of 89 tor. The patient was admitted with the diagnosis with acute exacerbation of chronic obstructive pulmonary disease (COPD). Insufficient spontaneous breathing required installation of mask-type non-invasive positive pressure ventilation (NIPPV: FiO₂, 0.35, IPAP, 10 cm H₂O, EPAP, 3 cm H₂O). After continuous NIPPV support for 8 days, an intraoral ulcer was detected on the patient's lower lip (figure 1)....

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Stress cardiomyopathy in a patient with hypertrophic cardiomyopathy and myocardial bridging

Stress cardiomyopathy is an acquired cardiomyopathy of unknown aetiology. It usually occurs in women over the age of 70 who have experienced physical or emotional stress. It is most commonly characterised by a transient, left ventricular systolic dysfunction in the apical portion and hyperkinesia in the basal segments, without obstructive coronary artery disease. Its association with obstructive hypertrophic cardiomyopathy and myocardial bridging is rare. Herein, we present such a case.

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Penetrating mitral annular abscess ruptured into the left atrium: a rare cause of mitral regurgitation

Description

A man aged 27 years from Bangladesh was referred to our centre for evaluation of fever of unknown origin of 3 months duration. There was a history of progressively increasing dyspnoea of NYHA functional class II for 25 days. He had received antibiotic therapy for a week prior to his presentation to us. Physical examination revealed muffled first heart sound with loud pulmonary component of second heart sound. A grade IV/VI (Levine grade) pan systolic murmur was heard over the apex, radiating to the left axillae. There were no clinical stigmata of infective endocarditis. Blood cultures were sterile. ECG showed sinus rhythm with left atrial enlargement and chest X-ray was suggestive of moderate cardiomegaly (cardiothoracic ratio 65%). Transthoracic echocardiogram (TTE) (figures 1 and 2 and video 1) revealed features of severe mitral regurgitation, with a ruptured abscess cavity (yellow arrow) involving the posterior...

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Septic arthritis of the pubic symphysis

Description

A seamstress aged 57 years presented with fever and pubic pain radiating to the hips. She had recently been treated for Staphylococcus aureus bacteraemia of unclear source. MRI revealed gadolinium enhancement of the pubic symphysis (PS). Small fluid collections consistent with infection were present in the PS and right obturator externus muscle (figures 1 and 2), but when aspiration was attempted, its size had reduced and was deemed undrainable. Blood cultures were sterile, and transoesophageal echocardiography was negative for valvular vegetations. The patient completed 8 weeks of intravenous vancomycin for septic arthritis of PS and obturator pyomyositis, with clinical and radiological resolution. She is well after 3 years of follow-up.

Figure 1

Coronal T2-weighted magnetic resonance image showing signal intensification in the pubic symphysis and right obturator externus muscle with interconnected fluid collections and hypointense peripheral rim.

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