bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe asthma that was endotracheally intubated 16 times in 20 years
Authors:   Pulmonology Hospital “E Perón” of Granadero Baigorria. Argentina. Faculty of Medical Sciences, National University of Rosario, Argentina, Nannini Luis J
Published: October 2021

Introduction: Severe asthma is a complex airway disease characterised by multiple aggravating-factors, and frequent comorbidities. Poor asthma control does not always correspond to the severity of airflow obstruction. One cause of disproportionate breathlessness in asthma is dysfunctional breathing/hyperventilation syndrome which is increasingly recognized. Case study: This female individual arrived at our asthma centre for the first time, coming from a primary care site 20 years ago. During the past 20 years she was intubated 16 times. Airway obstruction was never assessed surrounding the acute asthma episodes. Asthma diagnosis was confirmed by spirometry many times during routine visits at the asthma centre, where she never came to our asthma centre during an acute asthma exacerbation. Despite warranting the availability of controller medication with high ICS dose plus LABA, she repeated the episodes of severe dyspnoea requiring endotracheal intubations. Results: At a routine outpatient visit to our asthma centre for claiming her asthma medication, she developed an extreme dyspnoea as it occurred so many times earlier, using accessory respiratory muscles. The modified Borg scale for dyspnoea was 9/10. Pulse oximetry showed 96% O2 saturation breathing at room air. Baseline FEV1 was 1.96 L. Dyspnoea did not improve after 30 minutes of treatment. However, the FEV1 increased 29% to 2.53 L (96% predicted). Relaxation respiratory techniques began and the extreme dyspnoea slowly disappeared. Conclusion: Hyperventilation syndrome was confirmed with a score 32 with the Nijmegen Questionnaire (normal <23). Hyperventilation syndrome could coexist with severe asthma in 47% of cases. Keywords: Asthma; Asthma primary care; Hyperventilation syndrome.
Cronkhite-Canada syndrome with hypothyroidism: Clinical, endoscopic and pathologic pitfalls
Authors:   Department of Pathology, Baylor Scott & White Medical Center, Temple, TX 76508, USA, Wang Dapeng , McPhaul Christopher ,   Department of Pathology, Baylor Scott & White Medical Center, Temple, TX 76508, USA, Rampisela Debby ,   Department of Pathology, Baylor Scott & White Medical Center, Temple, TX 76508, USA
Published: October 2021

Cronkhite-Canada Syndrome (CCS) is a rare non-hereditary protein-losing enteropathy, and characterized by ectodermal and gastrointestinal abnormalities. The etiology remains unclear, however, some studies suggest the likelihood of immune dysregulation. The diagnosis of CCS is challenging because the clinical symptoms are non-specific and the endoscopic and pathologic findings can overlap with other processes. This can potentially lead to delay in diagnosis, resulting in delayed patient management. We reported a 74-year-old male presented with initial symptoms of abdominal pain and nausea, and later with diarrhea, weight loss, hypothyroidism and multiple strokes. Gastric Antral Vascular Ectasia (GAVE) was suspected on the initial endoscopy. The diagnosis of CCS was rendered on the third biopsy. After steroid treatment, the patient’s clinical symptoms were relieved. In this paper, we discussed the clinical, endoscopic and pathologic pitfalls of CCS.
Gouty flexor tenosynovitis – Case report and review of the literature
Authors:   Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois, USA, Prescher Hannes , Teven Chad M ,   Section of Plastic and Reconstructive Surgery, Mayo Clinic Phoenix, Phoenix, Arizona, USA, Shenaq Deana ,   Division of Plastic and Reconstructive Surgery, Rush Medical College, Chicago, Illinois, USA, L Reavey Patrick ,   Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York, USA
Published: October 2021

Gout is a rare cause of tenosynovitis and is difficult to diagnose based on clinical symptoms and imaging modalities. We present a case of gouty tenosynovitis of the proximal interphalangeal joint. A 32-year old male patient presented with a swollen, painful proximal interphalangeal joint of the 3rd digit on his right hand for 2 weeks with flexion contracture. Surgical exploration of the affected joint revealed a gouty tophus with extensive infiltration of the underlying flexor tendon. A tenosynovectomy and flexor tendon release was performed to treat the flexion contracture. Pathology disclosed urate crystals deposited within the tendon. Gouty infiltration of the flexor tendons of the hand can lead to extensive damage and compromised function. A high level of clinical suspicion is required as gouty tenosynovitis is a rare presentation and can often mimic an infectious etiology. Keywords: Gout; Tenosynovitis; Flexor tendon; Hand; Tophi.
Case report of isolated gastric IgG4-related lesion and series of literature review
Authors:   Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China, Ye Xiang-Xi , Zou Tian-Hui ,   Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China, Tan Juan ,   Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China, Wang Zheng ,   Division of Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China., Chen Ying-Xuan ,   Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China, Gao Qin-Yan ,   Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China
Published: October 2021

IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease that responds to glucocorticoids, which is gradually well known in recent years. It can involve multiple organs of patients, including pancreas, bile duct, gallbladder, salivary gland, orbital tissue, lung, liver, lacrimal gland, kidney, retroperitoneal, aorta, thyroid and lymph node, [1] in which gastrointestinal involvement is relatively rare [2]. Most of the known reports of isolated gastric IgG4-related lesions were accidental found (in physical examination or other site examination), and often treated as Gastrointestinal Stromal Tumors (GIST) lead to surgically resection. In addition, Calcified Fibrous Tumor (CFT) in gastrointestinal tract often occurs with submucosa [3] is histologically similar to IgG4-RD, [4] whether it belongs to IgG4-RD is still controversial.
Idiopathic hypoparathyroidism induced fahr’s syndrome
Authors:   Department of Internal Medicine, Kettering Medical Center, Kettering, OH, USA, Stuart Ryan , Duarte Harold ,   Department of Internal Medicine, Kettering Medical Center, Kettering, OH, USA, Gilbert Zachary ,   Department of Internal Medicine, Kettering Medical Center, Kettering, OH, USA, Valencia Damian ,   Department of Cardiovascular Disease, Kettering Medical Center, Kettering, OH, USA, Linares Juan David ,   Department of Cardiovascular Disease, Kettering Medical Center, Kettering, OH, USA, Sarvepalli Satish ,   Department of Infectious Diseases, Kettering Medical Center, Kettering, OH, USA, Barker Robert ,   Department of Neurocritical Care, Kettering Medical Center, Kettering, OH, USA
Published: October 2021

Fahr’s Syndrome (FS) is a rare neurological disorder of abnormal calcium deposition. FS is most notably characterized by deterioration of motor function, neuropsychiatric impairment and seizures. These symptoms are primarily due to calcification of the basal ganglia and cerebral cortex. Although there are currently no curative therapies, treatments are available which can significantly improve quality of life, making early diagnosis and identification of etiology essential. Hypoparathyroidism with intracranial calcification is extremely rare clinically. Here we present a case of idiopathic hypoparathyroidism induced Fahr’s syndrome with classic symptomatology, imaging of examination findings and extensive cerebral calcifications. Keywords: Fahr’s Syndrome; idiopathic hypoparathyroidism.
Acute anterior myocardial infarction complicated by a large ventricular septal defect
Authors:   Department of Fu Wai Hospital Chinese Academy of Medical Sciences, Shenzhen (Shenzhen Sun yat-sun Cardiovascular Hospital), Guangdong, Shenzhen 518057, PR China, Ming Yi , Qian Cao ,   Department of Fu Wai Hospital Chinese Academy of Medical Sciences, Shenzhen (Shenzhen Sun yat-sun Cardiovascular Hospital), Guangdong, Shenzhen 518057, PR China, Qiang Liu ,   Department of Clinical Medicine, University of South China, Hunan, Hengyang 421001, PR China
Published: October 2021

Post-Infarction Ventricular Septal Defect (PIVSD) are a rare complication of Acute Myocardial Infarction (AMI). According to clinical guidelines, surgical repair of a PIVSD is the recommended acute-stage course of treatment. Nevertheless, thoracotomy is not always clinically suggested for patients with unstable hemodynamics and otherwise at high risk. Currently, percutaneous interventional closure of a PIVSD represents an alternative therapy, and an attractive option for particular patients [1,2]. Here we report a 67-year-old man was transferred to Shenzhen Sun yat-sen Cardiovascular Hospital to evaluate a PIVSD and undergo repair. Echocardiography confirmed a large Ventricular Septal Defect (VSD) and significant left-to-right shunt (Figure 1a). Few reports of the closure of a PIVSD at an acute/subacute stage have been previously published. An interventional closure treatment (Amplatzer Septal Occluder device) was successfully performed after bridging to a subacute stage through use of mechanical circulatory backup (Figure 1b).
Ultrasound-guided diagnosis of an uncommon stroke: A case of giant cell arteritis
Authors:   Neurology, San Giuseppe Hospital, Empoli, Italy, Baldini Mariella , Giannoni Sara ,   Neurology, San Giuseppe Hospital, Empoli, Italy, Cioffi Elisa ,   Internal Medicine II, San Giuseppe Hospital, Empoli, Italy, Grifoni Elisa ,   Internal Medicine II, San Giuseppe Hospital, Empoli, Italy, Bertini Elisabetta ,   Neurology, San Giuseppe Hospital, Empoli, Italy, Cosentino Eleonora ,   Internal Medicine II, San Giuseppe Hospital, Empoli, Italy, Signorini Ira ,   Internal Medicine II, San Giuseppe Hospital, Empoli, Italy, Grisanti Cinzia ,   Neurology, San Giuseppe Hospital, Empoli, Italy, Colon Serena ,   Neurology, San Giuseppe Hospital, Empoli, Italy, Stagnaro Chiara ,   Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, Segneri Antonio ,   Radiology, San Giuseppe Hospital, Empoli, Italy, Sestini Stelvio ,   Unit of Nuclear Medicine, Department of Diagnostic Imaging, S. Stefano Hospital, Prato, Italy, Guidi Leonello ,   Neurology, San Giuseppe Hospital, Empoli, Italy, Masotti Luca ,   Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
Published: October 2021

Giant Cell Arteritis (GCA) is an immune-mediated vasculitis of large- and medium-sized vessels. Stroke happens in 3% to 7% of the cases, and identifying GCA properly is important because potentially curative treatment exists. We present a case of an 83-year-old woman, in whom suspected GCA was revealed by stroke caused by Vertebral Artery (VA) inflammation. The uncommon stroke localization and the ultrasound findings suggested vasculitic etiology of lesions. 18-Fluorodeoxyglucose-Positron Emission Tomography (18-FDG-PET) confirmed inflamed VA walls. Patient was treated with oral steroids and antiplatelet therapy, with improvement of clinical and ultrasonographic status. In our patient clinical diagnosis of GCA was challenging due to limited classical symptoms. Arguments in favor of arteritis were the symmetric and bilateral involvement of the VA, the sonographic halo sign and atypical stroke localization. Abbreviations: VA: Vertebral Artery; MRI: Magnetic Resonance Imaging; 18-FDG-PET: 18-Fluorodeoxyglucose-Positron Emission Tomography; AICA: Anterior Inferior Cerebellar Artery; PICA: Posterior Inferior Cerebellar Artery; GCA: Giant Cell Arteritis.
Lung adenocarcinoma characterized by multiple thromboemboli was misdiagnosed as primary anti-phospholipid syndrome: A case report
Authors:   Department of Respiratory Medicine, Yantai Yuhuangding Hospital, Yantai 264010, China., Shan Xiaoxi , Liu Dongxing ,   Department of Emergency Medicine, Provincial Hospital affiliated to Shandong University, Jinan 250021, China, Lv Shouchen ,   Department of Radiology, Provincial Hospital affiliated to Shandong University, Jinan 250021, China, Lin Xiaoyan ,   Department of Pathology, Provincial Hospital affiliated to Shandong University, Jinan 250021, China, Liu Mingjie ,   Department of Pathology, Provincial Hospital affiliated to Shandong University, Jinan 250021, China, Yang Qingrui ,   Department of Pathology, Provincial Hospital affiliated to Shandong University, Jinan 250021, China, Zhu Ling ,   Department of Pathology, Provincial Hospital affiliated to Shandong University, Jinan 250021, China
Published: October 2021

Giant Cell Arteritis (GCA) is an immune-mediated vasculitis of large- and medium-sized vessels. Stroke happens in 3% to 7% of the cases, and identifying GCA properly is important because potentially curative treatment exists. We present a case of an 83-year-old woman, in whom suspected GCA was revealed by stroke caused by Vertebral Artery (VA) inflammation. The uncommon stroke localization and the ultrasound findings suggested vasculitic etiology of lesions. 18-Fluorodeoxyglucose-Positron Emission Tomography (18-FDG-PET) confirmed inflamed VA walls. Patient was treated with oral steroids and antiplatelet therapy, with improvement of clinical and ultrasonographic status. In our patient clinical diagnosis of GCA was challenging due to limited classical symptoms. Arguments in favor of arteritis were the symmetric and bilateral involvement of the VA, the sonographic halo sign and atypical stroke localization. Keywords: Adenocarcinoma; Antibodies; Antiphospholipid; Antiphospholipid Syndrome; Lung neoplasms; Venous thrombosis
Brigatinib treatment for primary lung lesions in non-small-cell lung cancer based on ALK gene rearrangement detected in resected brain metastases: A case report and literature review
Authors:   Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing, China., Geng Sumin
Published: October 2021

Background: Lung cancer is the main cause of brain metastasis, primary lesions in patients with brain metastases from lung cancer are most often treated with surgery, and adjuvant chemoradiotherapy and other therapeutic methods are used to control disease progression based on the characteristics of the primary lesions. Materials and methods: Here, we report a case of a patient with NSCLC who received brigatinib treatment for the primary lung lesions after the resection of brain metastases based on the ALK gene rearrangement detected in the resected brain metastases by highthroughput sequencing. Results: The result of ten months follow-up showed satisfactory curative effect. The primary lung lesions disappeared and no sign of recurrence in the brain and lung Conclusion: This method provides a new option for the treatment of primary lung lesions in patients with brain metastases from lung cancer Keywords: NSCLC; Brain metastasis; ALK gene rearrangement; Brigatinib.
A mask that masked the diagnosis!
Authors:   Endocrine Research Center Institute of Endocrinology and Metabolism, Tehran University of Medical Sciences, Tehran, Iran, Mohajeri-Tehrani Mohammad-Reza , Hatami Neda ,   Endocrinology and Metabolism Research Center, Iran University of Medical Science, Tehran, Iran
Published: October 2021

A 31-year-old woman presented with chief complaint of muscle weakness. As this complaint was the most bothersome of all, the patient forgot to mention many other problems that she had. Asking her to remove the face-mask, made us to look for other problems because the typical moon face was masked under the mask!. The other problems were recent weight gain, purple striae on the abdomen, easy bruising and skin acne. She didn’t have hypertension. By reviewing her medical data we found out she had diabetes and was taking metformin. She used to have mild exophthalmos one year ago and thought to be due to thyroid disease but thyroid function tests were normal.
Overexpression of SOX2 is associated with poor prognosis in human breast cancer
Authors:   Program in Health and Development in the Midwest Region of UFMS, Campo Grande, Belo Horizonte, Brazil., Rodrigues Raquel C , Almeida Camila P ,   Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Oliveira Milena C M ,   Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Ferreira Enio ,   Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Ribeiro Thais S ,   Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Borges Isabella T ,   Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Gomes Hipacia W ,   Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Oliveira Cleida A ,   Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Puerto Helen L Del ,   Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Martins Almir S ,   Program in Health and Development in the Midwest Region of UFMS, Campo Grande, Belo Horizonte, Brazil.
Published: October 2021

SOX2 is a transcription factor that activates or suppresses genes involved in cellular differentiation, proliferation, and apoptosis. The deregulation of gene expression programs can lead to cancer initiation, promotion, and progression. The present study investigated SOX2 immunolocalization and expression in Invasive Ductal Carcinoma (IDC), and its correlation with clinical-pathological characteristics of the tumor. Immunohistochemical expression of SOX2 was evaluated in 19 cases of IDC and correlated with clinical-pathological tumor features. To investigate the correlation of SOX2 expression in IDC with other characteristics of human breast cancer, the same samples were also stained with immunohistochemical prognostic panels (estrogen and progesterone receptors, and HER-2). SOX2 overexpression was observed in 44% of the cases. Higher SOX2 expression was correlated with the worst lymph node status (p<0.001) and with positive HER-2 immunostaining (p<0,001). The present study demonstrated the association of SOX2 and tumors with worse TNM staging, as well as its overexpression in positive HER-2 tumors. In conclusion, SOX2 was identified as a potential biomarker for poor prognosis of human breast cancer. Further studies with higher patient numbers are necessary to investigate and help clarify the mechanisms underlying this association. Keywords: SOX2; HER-2; Breast cancer; IHC; Invasive ductal carcinoma; Prognosis.
Patients with acute respiratory distress syndrome due to pandemic Coronavirus disease 2019 (COVID-19)
Authors:   Division of Nephrology, National University Health System, Singapore., Seeger Julia , Wenzel Volker ,   Medical Campus Lake Constance, Department of Anaesthesiology, Friedrichshafen, Germany., Wöhrle Jochen ,   Division of Nephrology, National University Health System, Singapore.
Published: October 2021

We report on a case study of patients with Coronavirus disease 2019 (COVID-19). Evaluation of factors predicting outcome in patients with COVID-19 are very important. Both patients developed respiratory failure complicated by acute respiratory distress syndrome. Patients were intubated and invasively ventilated, underwent prone positioning and careful ventilation according to criteria for acute respiratory distress syndrome. In addition, biomarkers were daily evaluated including C-reactive protein, d-dimer and high-sensitive troponin T. Although treatment did not differ between patients, one patient survived whereas the other one died. The patient who survived had a faster onset of invasive ventilation with prone positioning, a lower maximal level of C-reactive protein and a lower value of high-sensitive troponin T. The use of mechanical ventilation in combination with a high PEEP and an early start of prone positioning in patients with severe ARDS may be beneficial. The values of C-reactive protein and troponin T levels seems to be predictive for the clinical course. Keywords: Coronavirus disease 2019; COVID-19; Troponin; C-reactive protein; Mechanical ventilation.
A transient spinal cord ischemia reveals a silent type A aortic dissection
Authors:   Faculty of Medicine, Université Saint-Joseph, Department of Neurology, Hotel-Dieu de France Hospital, Beirut, Lebanon., Nahed Rachelle Abi , Rizk Wissam ,   Department of Neurology, Kesserwan Medical Center, Jounieh, Lebanon.
Published: October 2021

Aortic dissection is a life-threatening vascular emergency that requires a prompt diagnosis and management. Isolated spinal transient ischemic accident is an extremely rare manifestation of Aortic Dissection (AD) type A. Thus, AD should be on the top of the aetiology list, despite the isolated character of the neurological presentation. A 53-year-old man, previously healthy, presented to the emergency department for a right sided renal colic documented by a uroscan showing a right ureterovesical junction stone (Figure 1). Initial blood tests were normal. While symptomatic treatment was being administered, he presented an acute paraplegia with anaesthesia of both lower limbs in all modalities below T4. Deep tendon reflexes were absent and plantar reflex was indifferent bilaterally. His blood pressure was 200/140 mmHg. His symptoms self-resolved after 20 minutes. He denied any significant thoracic or back pain, and had no signs of limb ischemia.
MOG-related bilateral optic neuritis in a patient with cystic fibrosis
Authors:   Neurology Department, Hotel-Dieu De France, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon., Nahed Rachelle Abi , Succarieh Georges ,   Ophthalmology Department, Hotel-Dieu De France, Saint Joseph University, Beirut, Lebanon., Soueidy Amine Al ,   Ophthalmology Department, Hotel-Dieu De France, Saint Joseph University, Beirut, Lebanon., Baz Patrick ,   Ophthalmology Department, Hotel-Dieu De France, Saint Joseph University, Beirut, Lebanon., Macaron Gabrielle ,   Neurology Department, Hotel-Dieu De France, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon., Khaled Karine Abou ,   Neurology Department, Hotel-Dieu De France, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon.
Published: October 2021

Optic neuropathy secondary to Cystic Fibrosis (CF) has been described as a manifestation of chloramphenicol toxicity. Inflammatory optic neuritis and Myelin Oligodendrocyte Glycoprotein (MOG)-related disorders have not been previously described in patients with CF. We report the case of a 19-year-old woman with cystic fibrosis who presented for sub-acute onset decreased visual acuity, dyschromatopsia, and optic disk swelling in both eyes, with near-complete resolution after a course of high-dose corticosteroids. MOG-IgG were positive in the serum. MOG-related optic neuritis can occur in CF and represent a diagnostic and long-term therapeutic challenge. Keywords: Optic neuritis; MOG; cystic fibrosis.
Perioperative adolescent serotonin syndrome secondary to methadone and fentanyl administration: A case report
Authors:   Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA., Smith Bergbower Emily Anne , Cheung Enoch ,   Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA., Hong Caron ,   Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Published: October 2021

Serotonin Syndrome (SS) is a serious toxidrome associated with significant morbidity when undiagnosed or improperly managed. We report a perioperative case of serotonin syndrome in an adolescent male on fluoxetine (selective serotonin reuptake inhibitor-SSRI) therapy secondary to an intraoperative combined opioid analgesic regiment. He received low dose methadone and fentanyl for induction for a LeFort osteotomy, the presumed trigger for his perioperative SS. This study demonstrates the essential need for anesthesiologists’ vigilance regarding identifying SS, risk factors of SS and implementation of immediate and effective management. Abbreviations: GAD: Generalized Anxiety Disorder; GPCR: G-protein Coupled Receptor; IV: Intravenous; MAOI: Monoamine Oxidase Inhibitor; MDD: Major Depressive Disorder; OR: Operating Room; PACU: Post-Anesthesia Care Unit; RAE: Right Angle Endotracheal; SERT: Serotonin Transporter; SNRI: Serotonin-Norepinephrine Reuptake Inhibitor; SS: Serotonin Syndrome; SSRI: Selective Serotonin Reuptake Inhibitor.
Polycystic ovarian syndrome and pituitary macroadenoma a deadly combination with good outcome
Authors:   H.B.T. Medical College & Dr. R. N. Cooper Hospital, Juhu, Mumbai, India., Shamim Ansari Sumayya , Wani Reena Jatin ,   H.B.T. Medical College & Dr. R. N. Cooper Hospital, Juhu, Mumbai, India., Relwani Hema Prakash ,   H.B.T. Medical College & Dr. R. N. Cooper Hospital, Juhu, Mumbai, India., Doshi Kruti ,   H.B.T. Medical College & Dr. R. N. Cooper Hospital, Juhu, Mumbai, India.
Published: October 2021

We are presenting here a case of polycystic ovarian syndrome, an endocrine disorder, afflicting 5-13% females of reproductive age, causing 70-80% infertility associated with pituitary macroadenoma i.e. size >10mm& prolactin level >250 ng/mI. PCOS has a higher relationship with metabolic disturbance and hypothalamic-pituitary-ovarian axis function disorder. Prolactinoma is present in about 50% women with hyperprolactinemia and 33% present with galactorrhea. Our patient was a 22 yrs nulligravida married since 3 yrs first presenting 5 yrs back with complaints of secondary amenorrhea with galactorrhea and infertility. On evaluation she was diagnosed as PCOS and pituitary macroadenoma on MRI. We medically treated her with tab. cabergoline in consultation with endocrinologist and neurosurgeons opinion. Being a compliant patient with regular follow up she conceived twice with good outcome and breastfed her babies on medical management only. Now she has 2 children (male child of 3 yrs and 1 month). Dilemma in management options will be discussed. Summary: Inspite of having both Polycystic Ovarian Syndrome (PCOS) & Pituitary Macroadenoma, which warrant surgical management (major causes of Infertility) selected cases like ours can be managed medically successfully.
An efficient multidisciplinary approach in a pregnant patient with hereditary spastic paraparesis treated by intrathecal baclofen therapy: A case report
Authors:   Anaesthesiology CHU UCL NAMUR Site Godinne, Yvoir, Belgium., M Fostier , V Roland ,   Gynaecology-Obstetric CHRN Sambre et Meuse, Namur, Belgium., T Dereine ,   Anaesthesiology, CHRN Sambre et Meuse, Namur, Belgium., T Deltombe ,   Physical and Medicine Rehabilitation, CHU UCL NAMUR Site Godinne, Yvoir, Belgium., T Gustin ,   Neurosurgery, CHU UCL NAMUR Site Godinne, Yvoir, Belgium.
Published: October 2021

Literature regarding cases of pregnant patients with hereditary spastic paraparesis (Strumpell-Lorrain disease) and those treated by intrathecal baclofen therapy is sparse. There are currently no specific guidelines to manage pregnancy and delivery in these patients. A 42-year-old woman presented to our clinic with hereditary spastic paraparesis and was treated with intrathecal baclofen for spasticity. She conceived twice and delivered successfully by caesarean section under subarachnoid anaesthesia. The two pregnancies had favourable outcomes with no increase in spasticity and no problems encountered with the intrathecal device. In this report, we discuss the evolution of both pregnancies and the anaesthetic management for deliveries in the presence of an intrathecal catheter. Keywords: Caesarean section; case report; hereditary spastic paraparesis; intrathecal baclofen; pregnancy.
Unusual cause of gastric perforation
Authors:   Department of Internal Medicine, Regional Hospital, Jicin, Czech Republic., Cyrany Jiri , Sieber Pavel ,   Department of Surgery, Regional Hospital, Jicin, Czech Republic., Rejchrt Stanislav ,   Department of Internal Medicine - Gastroenterology, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic.
Published: October 2021

39-year-old woman was admitted to surgery department for epigastric pain, upper abdomen was tender on palpation without signs of peritoneal irritation. Abdominal plain X-ray and ultrasound showed no significant pathology, there were mild microcytic anemia and leukocytosis, serum amylase was normal, initial C-reactive protein 6 mg/l rose to 142 mg/l during 2 days. Gastroscopy revealed tiny foreign body stabbed into the anterior wall of gastric antrum with submucosal edema around (Figure 1). Sharp fragment was released from the gastric wall by a polypectomy snare and extracted with a forceps (partially pulled into the working channel to avoid esophageal injury), outside verified as plastic shard (Figure 2). CT scans showed single air bubble in the subhepatic space, thus verifying transmural perforation (Figure 3,4). Nevertheless, subsequent course was uneventful with antibiotic and proton pump inhibitor therapy. Retrospectively, patient admitted intake of beverage with ice prepared by smashing of frozen plastic bottle 2 days before hospital admission.
Drug induced bullous erythema multiforme in a 75-year-old male: A case report
Authors:   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India., R Karthik , PT Ravikumar ,   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India., Fenn Saramma Mathew ,   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India., P Durgadevi ,   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India., S Mohithan ,   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India., Gokulraj Sabitha ,   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India., A Kumar ,   Department of Oral Medicine & Radiology, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Salem, Tamilnadu, India.
Published: October 2021

A 72-year-old-male reported with a chief complaint of bleeding from the lips and soreness due to the presence of erosion and ulcers for the past 1 month (Figure 1). He also complaints of burning quality of intense pain in his mouth and difficulty to consume beverages or eat food. Patient visited a dentist in a private dental clinic and was prescribed Amoxicillin and aceclofenac for the pain, but the lesion hasn’t subsided. He had no history of deleterious habits of chewing or smoking tobacco or consumption of alcoholic beverages. His family history was noncontributory. Extraoral examination revealed no cervical lymphadenopathy. Extensor aspect of the arm revealed target eye lesion- central area of scab surrounded by a paler ring like area bordered by pigmentation (Figure 2). Flexor aspect on the skin of left forearm revealed Bull-eye lesion consisting of a central paler area bordered by popular area of pigmentation (Figure 3).
A case report of entrapped angioplasty balloon in circumflex coronary artery
Authors:   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland., Surowiec Mateusz , Kolowca Maciej ,   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland., Kosiorowska Monika ,   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland., Bąk Janusz ,   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland., Rak Marcin ,   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland., Widenka Kazimierz ,   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland., Żurek Sławomir ,   Szpital Wojewódzki N2, Oddział Kardiochirurgii, Rzeszów, Poland.
Published: October 2021

Entrapment of coronary angioplasty hardware during coronary artery interventions is rare but in most cases requires prompt treatment. This article reported a case of 65-year-old woman who underwent a percutaneous transluminal coronary angioplasty to the circumflex artery. A ruptured angioplasty balloon was entrapped in the circumflex artery with proximal end of the guidewire placed in the descending aorta. The patient underwent surgical removal of the foreign body and coronary artery bypass grafting. The case and the management are discussed. Keywords: Angioplasty; coronary artery bypass; equipment failure; angioplasty balloon.
Factor V11 deficiency: A rare cause of nasal bleeding
Authors:   Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania., Balyorugulu Georgina G , Kiritta Richard F ,   Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University of Health and Allied Sciences, Mwanza, Tanzania., Ambrose Emmanuela ,   Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Tanzania., Tebuka Erius ,   Hematology, Department of Pathology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Published: October 2021

Factor VII deficiency is a rare inherited disorder. Clinically the patient presents with bleeding tendencies. Diagnosis is made by prolonged prothrombin time, normal activated partial thromboplastin time and low functions factor VII assay or factor VII antigen. Therapy involves factor VII concentrates, recombinant factor VII, fresh frozen plasma and fibrinolytic inhibitors. We present a 6 years old boy with nose bleed for six months of whom prothrombin time was prolonged with functional factor VII assay of less than 1% confirming factor VII deficiency. He was managed with fresh frozen plasma, blood transfusion, tranexamic acid. Factor VII deficiency even though rare should be sought out in children presenting with bleeding. Keywords: Factor VII deficiency; coagulation; hemorrhage.
Chikungunya neonatal: A neglected disease
Authors:   Instituto Fernandes Figueira (IFF/ Fiocruz), Brazil., Villela Suyen Heizer , Pereira Giuliana Villela ,   Hospital Universitário Gaffrée e Guinle-UNIRIO, Brazil., Moreira Maria Elisabeth Lopes ,   Instituto Fernandes Figueira (IFF/Fiocruz), Brazil.
Published: October 2021

Chikungunya virus infection is an emerging arbovirus with a global distribution that can cause significant morbidity and also death in infected fetuses and neonates. Unfortunately, there is still lack of data about the incidence of Chikungunya in pregnant women and the consequences for their fetus. This is a case series report including clinical presentation, images and clinical assessment. Keywords: Chikungunya; neonatal; vertical transmission.
Chest tube telltale: A miraculous injury
Authors:   Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia., Mahboob Ali Mohamed Shafi Bin , Mamat Ahmad Zuhdi ,   Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Published: October 2021

A 35-years-old man with an underlying lymphoma presented with the complaint of progressive dyspnea. The left hemithorax was dull on percussion with a significant reduce air entry. Chest x-ray showed a total ‘white-out’ of the left hemithorax suggestive of pleural effusion. A medical officer inserted a left chest tube with the sharp trochar provided. After the puncture, he noticed a rapid flow of frank blood. Otherwise, patient’s vital sign was stable. An urgent CT showed the tip of the tube was a milimetres into the interventricular septum. Fortunately, the chest tube dislodged after the patient ambulated. He was monitored in the ICU and an ECHO was done which showed a normal heart function. He was referred to the interventional radiologist for pig-tail drainage. He was discharged the following week. Chest tube insertion using a sharp trochar should not be recommended as it is associated with high morbidity and mortality.
Interconnection In the Convergence Era (IP-BASED Interconnection Regulation Challenges)
Authors: Ate Abdelrahim Ahmed Mohammed , Mohamed Sohila
Published: October 2021

The IP age of networks and services is increasing very quickly. Starting from its VoIP, NGN, and IMS to today's IP services landscape, which includes fixed and mobile high-definition (HD) voice, HD video calling, unified communications (UC), video conferencing, and telepresence, cooperation, instant messaging (IM), and the rich communication suite (RCS). Convergence is one of the most significant current trends in the ICT sector. It has changed the way services are delivered and obscured the distinction between fixed and mobile services. The transition to Next-Generation Networks (NGN) is the most important next phase in the ICT sector's convergence-driven evolution. In the realms of NGN, VoIP, and IMS, there is no PSTN equivalent; instead, there are "IP islands " that locate the total value of an IP service. The next basic step is to expand the arrive of those services across a totally interconnected cross-network premise in order to maximize their overall esteem among their target audiences. The liberalization of infrastructure services depends on managing the interconnection interface between the competitive and regulated sectors. These paper outlines regulation issues raised by IP-based interconnection and examine the current practices and procedural ways that being developed to address these concerns.
Brontaea debilis (Thomson, 1896) (Diptera: Cyclorrhapha: Muscidae) as host for Spalangia drosophilae Ashmead, 1885 (Hymenoptera: Pteromalidae: Spalanginae) in Brazil
Authors: Carlos Henrique Marchiori
Published: October 2021

The flies included in the infra-order Cyclorrhapha (Muscomorpha) have medical and veterinary importance, since they may produce myiasis and act in carrying pathogens to man and animals. The experiment was carried out at the Federal University of Goiás farm in Goiânia, Goiás, Brazil. Every fortnight, ten dishes black plastic containers containing bovine feces were exposed for fifteen days in the pastures. After this period, the feces were sent to the laboratory for pupae extraction. The experiments were carried out from April 2006 to December 2007. Ninety-two pupae of Brontaea debilis (Thomson, 1896) (Diptera: Muscidae), from bovine feces, from which 31 specimens of Spalangia drosophilae Ashmead, 1887 (Hymenoptera: Pteromalidae) were emerged. The percentage of parasitism was 33.7%. Spalangia drosophilae is cited in the literature as parasitoid of the pupae of Diptera including Chloropidae, Drosophilidae, Muscidae, Sarcophagidae and Sepsidae.
Bibliographic abstract on parasitoids of the Order Strepsipterans (Insecta: Strepsiptera): A review
Authors: Carlos Henrique Marchiori
Published: October 2021

The objective of this study was to conduct a bibliographic summary of the parasitoids of the order strepsipterans. The mini review consists of a literature search on strepsipterans (Order: Strepsiptera). The research was conducted in studies related to the quantitative aspects of the Family, Genus and Species (taxonomic groups) and in conceptual aspects such as: neoteny, cryptic species, endoparasitic larva and parasitism. A literature search was conducted containing articles published from 1978 to 2021. The mini review was conducted in Goiânia, Goiás, from August to September 2021, through the Online Scientific Library (Scielo) and internet.
Body Mass Index (BMI) correlate with blood glucose level in the state of Qatar
Authors: Ghazi Daradkeh  , M. Calapano  , H. Acido  , Marwa Rustom  , C. Kajayon  , Asma Al-Muhannadi
Published: October 2021

Objectives: Development of type 2 diabetes mellites (T2DM) is highly corelated to obesity. This is a cross-sectional study conducted in the state of Qatar to investigate the association between blood sugar level and body mass index (BMI). Methods: Two-hundred and nineteen adult subjects, undiagnosed with T2DM (defined by ICD-9-CM diagnosis codes and not on anti-diabetic medications) participated in the study. Age ranged from 18-65 with a mean of 42.0 ± 9.8 years (34.0 + 8.6 among females and 44.2 ± 9.6 among males). Blood sugar, weight, height, and BMI were measured during the survey. Individuals with BMI < 18.5 kg/m2 were excluded, (Mean BMI =27.4 ±4.71). Blood sugar level of overweight: BMI 25–29.9 kg/m2 or Obese: BMI ≥30 kg/m2 compared with normal BMI (18.5–24.9 kg/m2) to assess the impact of BMI on blood sugar. Results: 219 participants included in this study, a positive association between BMI with blood sugar level and the risk of a T2DM diagnosis was noticed. Conclusions: Blood sugar level and the risk of being diagnosed with T2DM is highly dependent and corelated with BMI. The incremental association of BMI category on the risk of T2DM is stronger for people with a higher BMI relative to people with a lower BMI.
Intraspecific ecological relationships harmonious and inharmonious of parasitoids Class Insect Order Hymenoptera and a review
Authors: Carlos Henrique Marchiori
Published: October 2021

The aim of this study was to perform a bibliographic summary on the harmonic and disharmonious intraspecific ecological relationships of parasitoids (Insect: Hymenoptera). The mini review consists of bibliographical research on the parasitoids of the Hymenoptera Parasitic group. The research was conducted in studies related to quantitative aspects of the Superfamily, Family, Genus and Species (taxonomic groups) and in conceptual aspects such as: parasitism, parasitoidism, mutualism, spider parasitoids, "cockroaches karate kick parasitoid wasps to avoid becoming zombies", kicking defense by the cockroach, Wasp 'walking' a roach and ant parasitoids. A literature search was carried out containing articles published from 1982 to 2021. The mini review was carried out in Goiânia, Goiás, from August to September 2021, through the Online Scientific Library (Scielo) and internet.
Human Emotions and Fallible Judgments
Authors: Colapietro Vincent M.
Published: October 2021

The author argues that Peirce, James, and Dewey propose a version of emotional cognitivism (the position that an emotion is in effect a judgment and, as such, highly fallible). He goes on to highlight certain features of human emotions, conceived in this light, above all emotional reflexivity (the feelings we tend to have about our own feelings, e.g., the case of becoming angry at being angry in the first place or that of feeling ashamed at allowing oneself to be shamed). Given the highly fallible character of our emotional judgments, the reference to the “I,” in addition to that to the object, can hardly be overlooked. Deliberative agents are wise to confess, “I am angry,” without eliminating what James identifies as “the intensely objective reference” of such feelings as fear, anger, and rapture.
Prozessmerkmale guten Unterrichts mit Flipped Classroom
Authors: Ulbrich Heidemarie
Published: October 2021

Chancen und Herausforderungen im Homeschooling besonders in diesem digitalen Zeitalter gab es im letzten Jahr mehr als genug. Guter Unterricht wird in Zeiten von Schullockdowns im Rahmen der COVID-19-Pandemie von den Pädagog*innen mehr denn je gefordert. Die Merkmale guten Unterrichts wie etwa jene von Meyer rücken also wieder stärker in den Fokus. Unterrichts- und Lernkonzepte unter Einsatz digitaler Medien mit den passenden Unterrichtsmethoden bedürfen einer Neuorientierung durch die Pädagog*innen. Der Lehrrahmen von Bloom als Grundgerüst für weitere Unterrichtskonstrukte, sowie dessen Top-Down-Ansicht in der Unterrichtsmethode „Flipped Classroom“ sind wichtige Merkmale für einen guten Unterricht im Homeschooling.
Happy Littering
Authors: Van Duyvenbode Beatrix
Published: October 2021

Dass Raucher/innen sehr häufig ihre Zigarettenreste achtlos auf den Boden fallen lassen – also „littern“, ist ein weitverbreitetes Problem.  Das Littering von Zigarettenstummeln verunstaltet die betroffenen Areale, verursacht hohen Zeit- und Kostenaufwand für deren Reinigung und kontaminiert noch dazu Boden und Grundwasser mit zahlreichen Giften. Der vorliegende Beitrag befasst sich mit diesem Thema.

Im Sinn der Aktionsforschung wird ein Zyklus empirischer Untersuchungen zum Umweltbewusstsein und der Haltung der jugendlichen Raucher/innen gegenüber dem „Kippen-Littering“, deren eigenem Umgang mit ihren Zigarettenstummeln und deren Handlungsmotivation zu umweltgerechter Müllentsorgung bzw. zu Littering an der Berufsschule Steyr vorgestellt. Dabei wird auf theoretische Grundlagen zum Thema Littering, zu den Voraussetzungen für umweltbewusstes Handeln, den schulischen Herausforderungen und Möglichkeiten in Sachen Umweltbildung und dem Happy-Victimizer-Phänomen Bezug genommen. Letzteres erklärt Littering als Handlungsmuster, bei dem sich Personen trotz Übertritt moralischer Regeln gut fühlen. Die Ergebnisse der Befragung der Berufsschüler/innen zum „Happy Littering“ zeigen, dass die Entscheidung für oder gegen umweltbewusstes Verhalten sehr oft mit den Gefühlserwartungen, die sich der Einzelne von seiner Handlung verspricht, in Verbindung steht. Schließlich werden aufgrund der theoretischen und empirischen Erkenntnisse Perspektiven und Methoden diskutiert, welche geeignet sein könnten, Littering – im Speziellen das achtlose Wegwerfen von Zigarettenstummeln am und um das Schulareal – zu reduzieren.
Mathematische Auffälligkeiten bei Rechenstörungen
Authors: Hofbauer Nadine
Published: October 2021

Mathematische Auffälligkeiten erweisen sich während der Grundschulzeit als vielseitig und gleichermaßen als hilfreich, um Rechenstörungen frühzeitig erkennen zu können und somit die Grundlage für eine umfassende Diagnose sowie eine angemessene Förderung von betroffenen Kindern zu schaffen. Sowohl im privaten als auch im später beruflichen Bereich sorgen mathematische Lernschwierigkeiten für beeinträchtigende Herausforderungen, wobei ein frühzeitiges Erkennen die negativen Auswirkungen von Rechenstörungen minimieren kann. Der vorliegende Beitrag erläutert mathematische Auffälligkeiten bei Rechenstörungen, welche sich im schulischen Kontext zeigen. Insbesondere für Lehrpersonen werden häufig auftretende Erscheinungsformen sowie Symptome von Rechenstörungen beschrieben, welche die Beobachtungen mathematischer Lernschwierigkeiten ermöglichen und somit den Ausgangspunkt für umfassende diagnostische Maßnahmen darstellen.