bluuebunny/crossref_metadata_2025 huggingface dataset:
Production and Application of Magnesium Alloys Castings
Authors: Klakurková Lenka , Juliš Martin , Gejdoš Pavel , Švejcar Jiří , Cileček Jarmil
Published: July 2022

In this article, the possibility of using investment casting technology to produce high-quality shaped and thin-walled castings of magnesium alloys (Mg-Al based alloy - AZ91E and Mg-Zr-based alloy WE43B) at ALUCAST s.r.o. (the Czech based precision castings foundry) is described. The paper briefly focuses on using suitable and available protective atmospheres for the safe processing of magnesium alloys, considering the current European legislation. The casting process and the best arrangement of the gating system were optimized by software simulation of the casting process using "ProCast" software by the ESI group. Microstructures and mechanical properties of magnesium alloys AZ91E and WE43B within the scope of this article were investigated by light microscopy (LM), hardness tests, and tensile tests. In addition, radiography inspections and chemical composition analyses were performed. The experiments show that good mastery of magnesium melt processing technology (including knowledge of methods for reducing reactions between melt and ceramic shell, the porosity of real castings around 0.04%, etc.) allows high quality and precise magnesium castings with high mechanical properties corresponding to castings from AZ91E and WE43B alloys produced by sand casting.
Hardening of Rail Vehicle Axles
Authors: Němeček Stanislav , Trojan Karel , Čapek Jiří , Ganev Nikolaj , Černý Ivo , Kec Jan
Published: July 2022

The development of the technology for laser hardening of the axle seats of rail vehicles aims to improve the high-cycle service life of these axles under wheel pressing and thus to increase safety in rail transport. Laser hardening can create high compressive stresses that increase the fatigue resistance of the material. The paper will present the results of this development on the EA1N material together with the documentation of the microstructure, hardness profiles and correlations with the internal residual stresses as well. These compressive stresses can play a crucial role in significantly increasing the fatigue resistance of the axles under operation.
Influence of Calcium Stearate Ca(C18H35O2)2 on the Properties of Fine-Grained Concrete
Authors: Soloviev Vadim , Shvetsova Victoria
Published: July 2022

The article presents experimental data obtained during the use of powdered calcium stearate and its suspension as bulk water repellents for fine-grained concrete. The use of powdered calcium stearate in an amount of 0.5% of the mass of cement led to an increase in air intake by 1.7 times, mobility by 8.5%, and a decrease in density by 2.5% compared to similar indicators of a concrete mixture without a water repellent. Powdered calcium stearate had no significant effect on compressive strength and flexural strength. With the introduction of CS in the form of a suspension and a powder in an amount of 0.5%, the capillary water absorption was reduced by 3 times, the water absorption by weight after the first day was 19% less than that of the samples without the additive. During the first day, water absorption for samples with a suspension of CS in an amount of 0.5% was 8.8%, for samples with CS powder - 7.6%. The highest water absorption is typical for samples without a hydrophobization and was equal to 9.3%, the lowest for samples with an CS suspension in the amount of 1.5% –4.4%. The introduction of a suspension of calcium stearate in an amount of 0.5% by weight of cement led to an increase in air entrainment by 2.1 times, a decrease in density by 4%, and a decrease in mobility by 5% compared to the samples without additive.
Role of urinary NGAL and microalbuminuria in the detection of subclinical acute kidney injury in pediatric intensive care unit and diabetic children
Authors: Ishak SallyK. I. , Aguizy Fayrouz El , Elsebaie Eman H. , Youssef Meray R. L. , Ismail Mohamed M. , Abdelraouf Fatma H. , Ghaffar Heba A. Abdel , Riad Nermine M.
Published: July 2022

Subclinical Acute Kidney Injury (AKI) describes patients who did not fulfill the classical criteria for AKI diagnosis but showed elevated levels of new biomarkers reflecting tubular injury. One of these biomarkers is Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study is to investigate the role of urinary NGAL and microalbuminuria as non-invasive biomarkers in the detection of subclinical AKI. Analysis of urinary NGAL and microalbuminuria in 91 subjects [30 pediatric intensive care unit (PICU) patients, 31 diabetic patients and 30 healthy controls] recruited from Cairo University Pediatric Hospital was done. Our study revealed that urinary NGAL was significantly higher in the PICU group followed by the diabetic group and lowest in the controls group (p=0.022). A positive correlation was found between urinary NGAL and microalbuminuria in the PICU group (Rvalue= 0.585, p-value=0.001). In diabetic group, a positive correlation was found between urinary NGAL and fasting blood glucose, 2 hours post prandial and HbA1C (R-value=0.421; pvalue= 0.021; R-value=0.426; p-value=0.019; R-value=0.438; pvalue= 0.018 respectively). Urinary NGAL may be a potential biomarker to detect subclinical AKI before actual functional renal damage leading to early intervention and reduction of mortality.
Patterns in the relationship between acute COVID-19/long COVID-19 and quality of life
Authors: Tüzün Hakan , Özbaş Cansu , Budak Burkay , Altunay Gizem , Aksakal F. N. Baran
Published: July 2022

Objective:

To determine the change in the quality of life (QoL) of patients who applied to a tertiary outpatient clinic according to their COVID-19 status.

Methods:

This cross-sectional study comprised 1 370 participants. Short form-12 (SF-12), which includes Physical Component Summary (PCS) and Mental Component Summary (MCS) domains, was used to evaluate the QoL. Different linear regression models created using PCS-12 and MCS-12 were dependent variables.

Results:

A total of 19.2% of participants had acute COVID-19, and 8.4% had long COVID-19. The most common sypmtoms were fatigue (72.6%), headache (42.5%), and joint pain (39.8%) in patients with long COVID-19. The model including all participants showed that long COVID-19 reduced the QoL in multivariate analysis for both MCS and PCS, while acute COVID-19 had no significant effect on the QoL comparing with those without COVID-19. Model that included participants with COVID-19 showed that long COVID-19 negatively affected the QoL in the multivariate model for PCS-12 and MCS-12. Variables that were significant in the multivariate model for those who had long COVID-19 were having a chronic disease and presence of ongoing symptoms. Females were disadvantaged for PCS-12 and MCS-12 in the multivariate models including all participants, and models including participants who have had COVID-19. Low educational group were disadvantaged for PCS-12 in the multivariate model including all participants. This group were also disadvantaged for PCS-12 and MCS-12 in the multivariate models including participants who had COVID-19.

Conclusions:

In studies, acute COVID-19 and long COVID-19 should be treated as separate categories. The effects of long COVID-19 should be considered when providing and planning health services. The effect of gender, and education, on QoL shows that health inequalities continue to be effective during the pandemic period.
Disseminated histoplasmosis in a 17-year-old Nigerian male patient
Authors: Ewa Atana Uket , Ekeng Bassey Ewa , Bassey Glory Ekpo , Akpah Enobong Ufot , Asemota Osamagbe Aiyudubie , Nweke Livinus Nwancho
Published: July 2022

Rationale:

Disseminated histoplasmosis is the most severe form of histoplasmosis and often associated with fatal outcomes. Both pulmonary and disseminated forms mimics tuberculosis (TB) and may be misdiagnosed.

Patient concerns:

A 17-year-old male patient compliant with anti- tuberculosis therapy with complaints of fever, cough productive of thick yellowish sputum, fast breathing, abdominal pain, swelling and jaundice. HIV status was negative.

Diagnosis:

Disseminated histoplasmosis.

Interventions:

Antimicrobials including anti-TB therapy, ceftriaxone, gentamicin, azithromycin and ciprofloxacin.

Outcomes:

He was responding to anti-TB drugs until about 4 and a half months on treatment when he fell ill. Peripheral blood film done 2 days prior to his demise revealed florid yeast like organisms in monocytes with eccentric chromatin suggestive of Histoplasma capsulatum.

Lessons:

Histoplasmosis can both mimic and coexist with TB and so a high index of suspicion is needed for its diagnosis.
Spectrum of Movement Disorder Emergencies in a Tertiary Care Center in India
Authors: Bhoyar Abhishek P. , Mahale Rohan , Kamble Nitish , Holla Vikram , Pal Pramod Kumar , Yadav Ravi
Published: July 2022

Introduction:

Movement disorders can present in emergency services in an acute severe form which can be life threatening if not recognized. The relative frequency and spectrum of movement disorder emergencies have not been studied extensively. We studied the frequency, spectrum, and outcome of patients presenting with movement disorders emergencies.

Methods:

This was a prospective, descriptive single center study. Patients presenting with acute movement disorders to the neurology emergency services of the institute during the study period from April 2019 to June 2021 were analyzed.

Results:

A total of 71 patients presented with acute movement disorders during the study period. Out of them, 65 patients had hyperkinetic and 6 patients had hypokinetic movement disorders emergencies. Fifteen patients were below the age of 18 years. Chorea (59.1%) was the most common movement disorder emergencies followed by dystonia and myoclonus in adults. Dystonia (33.3%) was the common movement disorder emergencies in children. Hyperglycemia followed by stroke was the most common etiology of acute movement disorders.

Conclusion:

This study brings out some novel findings on the movement disorders emergencies in Indian scenario. Chorea was the most common movement disorder emergencies presenting to the neurology emergency services. Early recognition and management of movement disorders emergencies help in reducing morbidity.
Bedside Reduction of Gastroschisis: A Preliminary Experience in Yaounde-Cameroon
Authors: Tambo Faustin Felicien Mouafo , Badjang Gaelle Therese , Kamga Gacelle Fossi , Sadjo Salihou Aminou , Tsala Irene Nadine Kouna , Ondobo Gervais Andze , Sosso Maurice Aurélien
Published: July 2022

Background:

Gastroschisis denotes a congenital or sporadic malformation of the anterior abdominal wall, which is rarely associated with other anomalies. The mortality in African countries is still high almost 100%.

Objective:

The aim was to determine the feasibility and safety of bedside reduction of gastroschisis and factors affecting the outcome in low-income setting.

Methodology:

This was a retrospective, descriptive and analytic study over a period of 6 years conducted in the Pediatric Surgery Service of the Yaoundé Gyneco-Obstetric and Pediatric Hospital. Only neonates with gastroschisis seen within 6 h of life without bowel necrosis and in whom bedside reduction was attempted in the neonatology unit under sedation (with 0.5 mg/kg of diazepam intra-rectally and 0.5–1 mg of atropine intravenously) were included in this study. Ethical clearance was obtained for the Ethical Committee of the Yaoundé Gyneco-Obstetric and Pediatric Hospital and a signed consent form was required from the parents of the children prior to the procedure.

Results:

Twelve neonates with a mean age of 16.8 h (0 and 24 h) and mean birth weight of 2245 g (1860–3600 g) were enrolled. The mean time to presentation at hospital was 3.5 h (2–9 h). Bedside closure was successful in 10 patients. Two patients underwent primary closure in the theatre after failure of bedside reduction due to the volume of contents of gastroschisis. Mortality rate in our study was 33.3% and the morbidity was dominated by compartment syndrome and malnutrition.

Conclusion:

Bedside reduction of gastroschisis under sedation in Yaoundé seems to be way to reduce the mortality.
An Unusual Presentation of Primary Actinomycosis Infection in Hard Palate of a 15-Year-Old Girl
Authors: Swain Santosh K.
Published: July 2022

Actinomycosis is an uncommon infection caused by filamentous Actinomyces, which forms club-shaped filaments arranged in a radiating pattern and rarely infects palate. The clinical presentations are often non-specific, so it posed a challenging situation for clinicians to get diagnosis of actinomycosis. The histopathological study is often helpful for the diagnosis of actinomycosis. The patient needs clinical follow-up for complete healing of the lesion. This case report describes a case of palatal cyst, which was diagnosed as actinomycosis on the basis of histopathological examination. Surgical excision of the cyst with debridement of the granulation tissue is mandatory for such cystic presentation of actinomycosis. This case was undergoing complete excision, followed by amoxycillin and clavulanic administration for 3 months. The bony defect was reconstructed using mucoperiosteal flap of the palate.
Effect of Yoga and Naturopathy on Health Disorders
Authors: Badave Akshata S. , Prasad Ritu , Bhogal Ranjit S. , Pathak Satish D.
Published: July 2022

RRS, a male participant, was admitted into Kaivalyadhama Yogic Hospital with complaints of obesity, hypertension, borderline diabetes mellitus, and hyperlipidemia. The health-related parameters, namely, weight, blood glucose level, lipid profile, spirometry, and chest-back-leg strength, were assessed. Pre-tests and post-tests were held before and after 30 days of yoga and naturopathic treatment intervention, including diabetes-related expert advice. His weight was reduced from 100 to 92 kg, HbA1c was reduced from 8.1% to 6.9%, and lipid profiles total ratio came down from the initial reading of 4.5 to 3.7, following the intervention. His overall lung capacity was found improved after yoga practices. The participant showed improvement in his chest-back-leg strength from 93.33 to 112.33 kg. The authors recommend diet, naturopathy, and yoga therapies, employed in this case study, for addressing the health issues mentioned in the study.
Gastric cancer: Environmental risk factors, treatment, and prevention
Authors: Woodman Alexander , Akhtar Mahmood , Al-Jamea Lamiaa , Sagher Malek , Sager Mohamed
Published: July 2022

Gastric cancer is a heterogeneous, multifactorial, aggressive disease that has been and remains one of the most common causes of cancer-related deaths and a significant public health issue worldwide. Currently, gastric cancer shows decreasing trends in its incidence and mortality in some geographic areas; however, the disease still shows a poor prognosis and remains difficult to cure. The prognosis for gastric cancer patients depends on the stage at which the gastric cancer is detected, and complete excision of the cancer is the only proven curative option. Gastric cancer prevention remains a priority. Patients at higher risk should be screened for early detection and chemoprophylaxis. Surgical resection enhanced by standardized lymphadenectomy remains the gold standard in the treatment of gastric cancer. Systemic therapy improves long-term disease-free survival compared to surgical treatment alone. Palliative chemotherapy in patients with inoperable gastric cancer prolongs survival and improves the quality of life. Demographic, ecological, environmental, cultural, and genetic variables all contribute to the heterogeneity of gastric cancer; however, environmental risk factors play an important role throughout all the stages of the disease progression, management, and surveillance. In this review, we address the role of important environmental risk factors in the onset of gastric cancer and highlight the current treatment modalities and prevention measures.
The 80th annual (virtual) conference of the American Diabetes Association: June 12–16, 2020
Authors: Suliman Mohamed , Mohammed Nagi , Suliman Sara
Published: July 2022

A large number of presentations on clinical, basic science, and genetics were discussed at the first virtual American Diabetes Association conference held in June 2020. Studies of relevance to practicing clinicians included the results of the VERTIS-CV study that confirmed the SGLT2 inhibitor ertugliflozin was similar to other drugs in the group in terms of cardiovascular safety, heart failure, and renal benefits. A symposium on heart failure also highlighted the benefits of this group of drugs for treating heart failure both in patients with and without diabetes. The new Food and Drug Administration guidance for new diabetes drugs was presented and created a lively discussion about the pros and cons of these new rules. Another lively debate on whether there is a place for sulfonylureas in the era of the modern diabetes medications reached the conclusion that there is probably still a place for these old and established drugs. On the lipid front, the safety of statins was emphasized in face of negative publicity in the social media, while the recently published REDUCE-IT study showed that tackling low-density lipoprotein cholesterol only may not be enough in the battle against increased cardiovascular risk in diabetes. Looking to the future, a weekly basal insulin may be in sight in a few years' time.
Predictors of dental general anesthesia receipt among children attending a tertiary hospital in Saudi Arabia
Authors: Abolfotouh Mostafa , Alhumaidan Ghaida , Almalki Bashaer , Alhasson Alanoud , Bushnak Ibraheem , Adlan Abdallah
Published: July 2022

Aim: Children are normally treated in a dental chair, despite that some may have their treatment done under dental general anesthesia (DGA). Factors affecting the decision on DGA include the quality and quantity of treatment needed and child's age and cooperation. This study aimed to estimate the prevalence of DGA among children with dental caries and to identify the associated factors in a tertiary care setting in Saudi Arabia. Methods: A cross-sectional study of 400 children with dental caries was conducted. Data were collected from the patients' records including demographic, behavioral, and clinical information, diagnosis using caries indexes (Decayed, Missing, Filled Teeth/decayed filled teeth [dft]), and number of DGA and its indications. Logistic regression analysis was applied to identify the predictors of DGA, and significance was considered at P ≤ 0.05. Results: The study included 400 children; 55% of them were below the age of 6 years, with a mean age of 6.4 ± 2.3 years. About one-half of children were males (51.7%) and unhealthy (48.2%). The majority were of negative behavior (70.7%) and noncomplaint to dental appointments (70.3%). More than three-fourth of children (78.5%) experienced one or more DGA. GA use was significantly associated with gender (χ2 = 4.30, P < 0.04), age (t = 12.37, P < 0.0001), health status (χ2 = 16.02, P < 0.0001), dft index (z = 11.44, P < 0.0001), child behavior (χ2 = 48.54, P < 0.0001), age at the first dental visit (t = 11.73, P < 0.0001), number of dental treatment visits (z = 11.14, P < 0.0001) and dental preventive visits (z = 7.21, P < 0.0001) before the index dental visit, and compliance with dental appointments (χ2 = 39.50, P < 0.001). However, after adjusting for confounders, using the logistic regression analysis, DGA use was predicted by unhealthy children (odds ratio [OR] = 27.35, P = 0.002), those with a negative behavior (OR = 18.28, P = 0.003), and those with higher dft index (OR = 1.68, P < 0.001). Conclusions: Noncooperation, general health status, and dental caries level (dft) were the main factors for the decision of DGA. High caries-risk children must be the target for behavioral management to minimize their need for treatment under DGA. Post-DGA appointment to guide the child back to normal dental care is recommended.
Predisposing factors and health-care utilization in liver transplant recipients with takotsubo cardiomyopathy: A national analysis
Authors: Patel Kishan , Bhatti Salman , Black Sylvester , Porter Kyle , Hanje James , Mumtaz Khalid
Published: July 2022

Aims and Objectives: Takotsubo cardiomyopathy (TCMP) is an acquired cardiomyopathy associated with physical, emotional, and surgical stress. Current literature on TCMP in liver transplant recipients (LTRs) is limited to case reports and case series. Methods: The Nationwide Readmission Database was utilized to identify all adults with an index admission for LT between 2010 and 2014 who developed TCMP. The prevalence of TCMP at the LT admission or readmission within the calendar year was examined. Predictors of development and health-care utilization of patients with and without TCMP in LTR were compared. Multivariable regression analysis was performed. Results: The prevalence of TCMP in LTRs was found to be 0.5% (141/28,067). Most of these patients developed early TCMP on the index admission for LT (n = 115; 82%). Older (57.5 ± 1.3 vs. 55.1 ± 0.3 years, P < 0.001) females (adjusted odds ratio [aOR]: 2.27; confidence interval [CI]: 1.20–4.27; P = 0.01) with ≥4 Elixhauser comorbidity (aOR: 2.36; CI: 1.15–4.83; P = 0.02) were predisposed to develop TCMP in LTRs. LT at a medium-sized center (aOR: 0.17; CI: 0.03–0.88) has a protective effect on the development of TCMP. Increased health-care utilization in the form of mechanical ventilation, hemodialysis, vasopressors, and intra-aortic balloon pumps is observed in patients with TCMP. This resulted in increased length of stay and cost in patients with TCMP. Moreover, increased mortality was seen in patients who developed TCMP within the same calendar year. Conclusion: This is the first report showing the prevalence of TCMP in LTRs to be 0.5%. Older females with increased comorbidity are predisposed to TCMP. Patients who developed TCMP necessitate a higher acuity of medical care and cause an increased health-care burden and ultimately experience an increase in mortality.
Family relations of living-related kidney donors in Tripoli, Libya
Authors: Elamouri Jamila , Fawaris Nada
Published: July 2022

Introduction: Despite efforts to increase community awareness of kidney donation and transplantation, there remains a huge gap between the number of kidneys needed and those available. Objectives: We aimed to document the types of relationship between donors and recipients of kidney transplants in a previously unexamined community. Patients and Methods: This was a descriptive retrospective study of 454 living-related kidney transplant patients registered during 2019 in the posttransplant clinic at the National Centre for Organ Transplantation, Tripoli, Libya. Demographic data and the type of relationship between recipients and donors were studied. Results: There was a male donor predominance (67.4%), with a male-to-female ratio of 2: 1. The mean age of the donors was 34.2 ± 10.27 years. The sibling constituted the majority (62.2%) of donors, with brother predominance. They were followed by off-spring donors (17.6%), with a predominance of sons and parents (12.4%), with mothers acting as donors more than fathers. Donation from spouses was relatively infrequent (3.5%). Conclusions: The study revealed that brothers are the most common donor and all donors more commonly donate to male recipients, except mothers who donate more commonly to female recipients. This may be reflective of the sociocultural factors. More social awareness is needed regarding organ donation, especially among females, to increase their contribution in donation.
Doctors' attitude and engagement in research: A survey from two emerging regions
Authors: Beshyah Salem , Ali Khawla , Mustafa Huda , Hajjaji Issam , Hafidh Khadija , Abdelmannan Dima
Published: July 2022

Background: Research is an essential component in the advancement of medicine. Evidence indicates that developing regions have low research productivity and contribution to the international literature. It is unclear if physicians' attitudes and perceptions of research could be contributory. Objectives: This study examined the attitudes to research, perceived barriers to research, and experiences of prior participation in research projects among physicians from the Middle East and Africa. Subjects and Methods: A cross-sectional electronic survey was developed based on the published literature to address these questions and was E-mailed to a large sample of practising clinicians and academics. Results: A total of 283 responses received, 61.1% were men with a mean age of 48 years. Responses originated from 23 countries. The majority were from the Middle East (79.2%), whereas 29.9% were from African countries. Over half of physicians (51.1%) held high-level speciality qualifications and were senior clinicians or academics (50.9%). Regarding engagement in research, 41.3% were interested in research but not involved at the time of the survey, 38.5% were involved but not formally employed in a research role, 12.7% had formal research roles, and 7.4% were not interested in research. Majority conducting research held lead-investigator roles (44.2%) followed by co-investigator roles in 37.9% of respondents. Most of the research work was self-initiated original research (42.6%) followed by clinical case series (35.7%). Main motivators to conduct research were contributing to the practice and improving patients' care. Main deterrents to research were lack (41.7% of respondents) and/or difficulty in acquiring research funding (50.2%), in addition to the lack of research-protected time (40.5%). Conclusions: The majority of physicians interested and/or involved in research are not formally employed in a research role. The facilitators seem to stem from personal interest and professional recognition, whereas barriers result from lack of time, support, and expertise.
The prescription practices of adrenaline auto-injector for children at risk of anaphylaxis
Authors: Elghoudi Ahmed , Stiefel Gary , Holloway Judith
Published: July 2022

Background: Guidelines on indications for adrenaline auto-injector (AAI) exist. There is no consensus on the prescription criteria of AAI. However, the European Academy of Allergy and Clinical Immunology (EAACI) and the United Kingdom (UK) resuscitation council provide guidances on prescription practices. Objectives: This study aims to investigate prescription practices of AAIs prescribed by members of four regional pediatric allergy groups (PAGs) in the UK. Materials and Methods: An online questionnaire was e-mailed to the PAGs members. Scenarios of absolute and relative indications for AAI prescriptions (as per the EAACI guidelines) were presented to clinicians to establish whether they would prescribe an AAI. Results: One hundred and seventeen responses from members of PAGs working in four different regions were received. Practices were similar in scenarios of absolute indications for AAI. Intraregional (variations within the regions) as well as interregional (variations between the regions) variations were observed. There were statistically significant interregional differences in scenarios of relative indications for AAIs. For mild reaction to peanut (PN)/tree nut (TN), AAI would be prescribed more often by doctors from Wessex clinicians (67%) than those from Midlands (31%), London (24%), and Northern (20%) (P < 0.05). Whereas for a previous mild reaction to trace of PN/TN, Northern clinicians (47%) would prescribe AAI less often than those from the Midlands (78%), Wessex (82%) and London (79%) (P < 0.05). Intraregional differences were also observed. Conclusions: There is a consensus with absolute indications for AAI prescriptions across and within regions. There are intraregional and interregional differences in prescribing practices in scenarios where there is a relative indications for an AAI. Better intra- and interregional work could improve consistency or practice across the country are explain differences in practice.
A rational approach to the evaluation and management of patients with hyperprolactinemia
Authors: Aldahmani Khaled , AlMalki Mussa , Beshyah Salem
Published: July 2022

Prolactin has multiple biological functions. Hyperprolactinemia is a common condition in clinical practice both in women and men. It has multiple etiologies and may present with variable symptoms to different health-care providers. Therefore, a rational and systematic approach is paramount when evaluating patients with hyperprolactinemia to arrive at the correct diagnosis and institute the appropriate therapy. We here review the etiology, clinical presentation, and differential diagnosis of hyperprolactinemia and present a practical plan for further evaluation and management. It is most essential to establish the diagnosis and need for the treatment of patients with micro- and macro-prolactinomas and identify when only observation may be warranted. The biological, medical, and social contexts have to be considered to make the appropriate management decisions on an individual basis.
Hematologic, biochemical, and infection biomarker abnormalities associated with COVID-19: A systematic review and meta-analysis
Authors: Abdulla Sara , Elamami Adela , Elawamy Hayam , Muhammed Aisha
Published: July 2022

Objectives: We aimed to analyze the laboratory data of coronavirus disease 2019 (COVID-19) patients for clinical help, to overcome the vulnerabilities of reverse transcription–polymerase chain reaction testing for diagnosing COVID-19, and to reduce the number of negative results when diagnosing, particularly in global regions which are recognized to have limited resources. Materials and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors performed a systematic literature review, using three databases to assess laboratory data of COVID-19-confirmed cases, and the articles that described significant laboratory irregularities were ultimately chosen. Crosschecking was performed on the references of these articles in order to identify further studies. The statistical software R version 3.6.1 was used for meta-analysis of COVID-19 studies. Results: A total of 13 relevant articles were included. They yielded a total of 2662 individuals who tested positive for COVID-19. The analysis results demonstrated that male patients comprised a more substantial proportion, accounting for 57.9% of the total. The principal laboratory findings of the COVID-19 patients indicated that they commonly had lymphocytopenia 0.943 (confidence interval [CI]: 0.857–1.03), high D-dimer 0.459 (CI: 0.237–0.6808), high procalcitonin 0.089 (CI: 0.066–0.111), high C-reactive protein 17.203 (CI: 6.520–27.886), and high lactate dehydrogenase 278.265 (CI: 238.995–317.535). Conclusions: Infection with COVID-19 is associated with significant laboratory irregularities. The increased focus must be applied to laboratory parameters to quickly identify a large number of infected patients and asymptomatic carriers, prevent virus transmission, and assure timely treatment of patients, particularly in regions characterized by limited resources.
A rare case of intra-auricular sinus presenting as recurrent perichondritis
Authors: Manoharan Kiruba , Bakshi Satvinder
Published: July 2022

Periauricular sinuses are common and are often associated with other congenital anomalies. The most common type is the preauricular sinus followed by the postauricular variant. Intrapinna sinus is extremely rare with very few cases reported in literature. We present a 15-year-old male presented with recurrent perichondritis of his left pinna. Examination revealed a sinus opening in the pinna. The sinus along with its cul de sac was excised completely. We conclude that although intra-auricular sinuses are extremely rare, they should be kept in the differential diagnosis of a patient presenting with recurrent pinna perichondritis. The treatment includes complete excision of the sinus tract along with its sac.
Urinary diversion in patients with muscle-invasive bladder cancer and severe ureteral stricture: A case report of a new surgical technique
Authors: Chiancone Francesco , Fabiano Marco , Fedelini Paolo
Published: July 2022

The use of an ileal segment has been previously described in the treatment of long-segment ureteral strictures. The aim of this study was to describe the use of a skin and muscle flap tube as an alternative procedure to perform ureterocutaneostomy in patients who are not eligible for the use of bowel segments in the urinary diversion or when the patients are at high risk of morbidity and mortality. We describe the case of a 74-year-old male patient. The technique was performed without complications and complete recovery of the patient. No anastomotic leaks and stenosis were reported at a follow-up of 36 months. The use of a skin and muscle flap tube can be a feasible and safe procedure in case of huge loss of tissue (long-segment ureteral strictures), in patients whose underwent radical cystectomy with UCS, in particular when the patients are not eligible for the use of bowel segments in the urinary diversion or when the patients are at high risk of morbidity and mortality.
Early-onset antibiotic-induced autoimmune hemolytic anemia
Authors: Kiblawi Mahmoud
Published: July 2022

Drug-induced immune hemolytic anemia (DIIHA) is a rare adverse reaction that causes secondary autoimmune hemolytic anemia in susceptible patients. Drug-induced antibodies and nonimmunological protein absorption are the known mechanisms associated with DIIHA. The two most common reported antibiotics to cause drug dependent antibodies are cephalosporin and penicillin. The author reports two rare cases of DIIHA. The first case is a middle-aged woman clinically diagnosed with community-acquired pneumonia, which develops hemolytic anemia secondary to ceftriaxone. The second case is an elderly gentleman who developed DIIHA secondary to piperacillin–tazobactam that started managing gastrostomy site infection. Both patients had hypoxemia and shortness of breath secondary to drop in hemoglobin, but the outcome was uneventful. Antibiotic-induced hemolytic anemia can develop as early as 2 days after starting the antibiotic. Therefore, early diagnosis and discontinuation of the offending agent can prevent poor prognosis.
Effect of Ramadan on glucose levels, serum lipid profile, and blood pressure among fasting and nonfasting medical students in a public university of Karachi
Authors: Khan Nazeer , Rafi Syed , Siddiqui Shameem , Shakeel Saba , Rahman Haseeb-ur , Hasan Wajiha
Published: July 2022

Objective: The objective of this study was to assess the effect of Ramadan fasting on blood pressure, fasting glucose, lipid profile, and serum proteins between non-Muslim and fasting Muslim students. Methodology: The study was conducted on undergraduate medical students of a medical university of Karachi. Participants were invited for data collection: in the last 10 days of Shaban, Ramadan, and Shawwal. Along with blood pressure, height, and weight were measured and a sample of 10 cc blood was also drawn in each visit. Blood samples were analyzed for glucose, lipid profile, and serum protein. Two samples, “t”-test and repeated measure design analysis of variance were utilized for statistical analysis. Results: Sixty Muslims and 15 non-Muslim students completed all the three visits. Seventy-five percent were females. Mean systolic blood pressure reduced significantly in Ramadan. Mean diastolic blood pressure reduced noticeably in Ramadan and Shawwal for non-Muslim students and minor changes occurred in Muslim students. Even though the fasting blood sugar increased insignificantly from Shaban to Ramadan in the total sample, but the increment among Muslim students showed a significant increase. The mean cholesterol value of Muslim students significantly increased in Ramadan but decreased in Ramadan for non-Muslim students. The mean value of low-density lipoprotein increased significantly in Ramadan for Muslim students but decreased in Ramadan for non-Muslim. The mean values of triglyceride showed a significant reduction from Shaban to Ramadan and then increased in Shawwal. Conclusion: The study revealed that the environment of Ramadan was helpful to the non-Muslim students more than the Muslim students, with respect to the biochemical parameters.
Femoral neuropathy after kidney transplantation: A literature review of case reports and case series
Authors: Rissardo Jamir , Caprara Ana
Published: July 2022

Kidney transplant (KT) surgery can increase survival probability more than any other transplant. In this context, neurological complications could occur in an important percentage of individuals because this surgery is considered one of the most common organ transplantations. One rare type of neurological complication, which can occur after KT surgery, is the femoral motor neuropathy. We aimed to evaluate the clinical epidemiological profile and pathological mechanisms of femoral motor neuropathy after KT surgery. Relevant reports in six databases were identified and reviewed by two reviewers without language restriction. Seventeen reports of 183 cases from ten countries, more one unpublished case from our institution were assessed. The mean age was 39 years (range 5–69) with male sex (62.5%) and Asiatic origin predominance. The central primary kidney disease leading to renal failure was essential hypertension. The mean time from KT surgery to the onset of femoral neuropathy was 1.78 days, and the time from the occurrence of neuropathy to recovery was 6 months. The incidence of femoral neuropathy after KT surgery was 1.85%. The current review provides four possible mechanisms related to this complication, but maybe these explanations lead to a misunderstanding of the main risk factors for the development of femoral neuropathy. Furthermore, studies with current surgical techniques should be investigated because most of the data come from the old literature. Therefore, prospective studies and reports assessing the graft-recipient ratio and management options should be done.
Centrifugal propagation of the circumpapillary lesion in a patient with atypical multiple evanescent white dot syndrome
Authors: Joo Chan Woong , Kim Yong Dae , Park Sung Pyo , Kim Yong-Kyu
Published: July 2022

A 20-year-old woman presented with central scotoma in her left eye. Whitish retinal spots were observed mainly in the region nasal to the optic disk outside the major vascular arcade. Optical coherence tomography revealed subfoveal outer retinal disruption with hyperreflective material. Retinal spots coalesced into a larger lesion and progressed peripherally. Nasal retinal spots and foveal outer retinal lesion improved spontaneously, and her vision was completely recovered. The current case suggests that sequential sublethal infection of photoreceptors possibly via blood-borne pathogens and spreading to the nearby cells may be the possible alternative mechanism of multiple evanescent white dot syndrome pathophysiology.
Blepharoptosis as a presenting sign of Hashimoto's thyroiditis in a young girl
Authors: Meena Manju , Karthikeyan Arcot S
Published: July 2022

Thyroid eye disease (TED) refers to the ocular symptoms and signs caused by an autoimmune pathology affecting the thyroid gland and the orbit. It is most commonly seen in patients with Graves' disease and rarely with Hashimoto's thyroiditis (HT). Upper eyelid retraction is the most consistent eyelid sign. Blepharoptosis in TED has been reported sparsely and is mostly associated with myasthenia gravis. Here, we report a case of blepharoptosis as a presenting sign of HT in a young girl.
Bilateral hypopyon corneal ulcers in pancreatic carcinoma
Authors: Sangaraju Suneel , Sivanandam Lokesh Koumar , Behera Geeta , Thumaty Divyabala , Babu Krishna Ramesh
Published: July 2022

A 39-year-old woman on palliative chemotherapy for pancreatic carcinoma presented with painful bilateral vision loss. On examination, she had large bilateral corneal ulcers with hypopyon, with corneal and conjunctival xerosis. She was extremely malnourished. Investigations revealed macrocytic anemia with pancytopenia and hypoproteinemia suggestive of pancreatic enzyme insufficiency (PEI). Microbiology reported Pseudomonas aeruginosa infection that was sensitive to ceftazidime. Treatment with topical ceftazidime and oral vitamin A and B12 supplementation (therapeutic doses) led to rapid resolution of the ulcers in 4 weeks. Xerophthalmia with secondary keratitis due to malnutrition from pancreatic carcinoma is hitherto unreported but can be treated successfully with timely identification.
Role of compression sutures in partial-thickness corneal tears
Authors: Puttagunta Sahiti , Nagella Sunitha , Killani Srinivas P
Published: July 2022

Ocular trauma is an important cause of unilateral vision loss worldwide. In cases of perforating corneal injuries, immediate surgical intervention is imperative to prevent endophthalmitis; however, in cases of partial-thickness corneal tears, conservative management usually suffices. However, intervention in the form of compression sutures may be required later for astigmatism that may arise.
Periorbital metastasis from breast cancer
Authors: Pliakou Evangelia , Poulli Tsielestina , Lampropoulou Dimitra Ioanna , Soupos Nikolaos , Aravantinos Gerasimos
Published: July 2022

Breast cancer (BC) is a heterogeneous disease, both molecularly and histologically. The most common histological subtype of BC is that of no special type, followed by lobular carcinoma. Metastatic tumors of the orbit are relatively infrequent, and their primary sites can be the prostate, the gastrointestinal tract, and for women, the breast. The diagnosis and management of such rare cases are very challenging due to the limited data. We present two interesting cases of women initially diagnosed with BC characterized by different histological features who developed periorbital metastases. Orbital radiotherapy was the treatment of choice, and the outcome was successful.
Parinaud's oculoglandular syndrome
Authors: Han Goh Chon , Run Ng Hui , Jalaluddin Juliana Bt
Published: July 2022

Parinaud's oculoglandular syndrome (POGS) is a rare condition characterized by unilateral granulomatous conjunctivitis and ipsilateral regional lymphadenopathy. Among all infectious agents, cat scratch disease (CSD), which is caused by Bartonella henselae, remains the commonest etiology agent of POGS. We present a case report of a 13-year-old boy who came to a tertiary center in Malaysia with left granulomatous conjunctivitis and subsequent necrotizing lesions involving left upper eyelid, left paranasal region, and left preauricular lymph nodes. With a poor initial treatment response and confusing investigation results, this interesting case describes the diagnostic dilemma in differentiating the etiological agents of POGS.
Push down technique in phacoemulsification without reversal of tarsorrhaphy
Authors: Kumar Dhivya Ashok , Selvaraj Jayapratha R , Narasimhan Smita , Agarwal Amar
Published: July 2022

Tarsorrhaphy usually reduces the palpebral aperture width and often requires reversal during cataract surgery and reformation. We present a case of phacoemulsification with intraocular lens implantation performed without reversal of tarsorrhaphy with the “push down technique” in a patient with cataract with left facial nerve palsy after surgical excision of acoustic neuroma. The phacoemulsification was performed in the small aperture by the push down technique, whereby the eyeball is manipulated by pushing down the phacoemulsification probe and the second instrument. The simple technique prevented an unnecessary additional surgical procedure and facilitated early rehabilitation.
Retinal arterial occlusion following acute bout of intense exercise
Authors: Ratra Dhanashree , Khanna Raunaq
Published: July 2022

The various health benefits of physical exercise are well known. Regular, moderate exercise is included in every cardiovascular risk prevention program, as it has a protective effect on the cardiac vasculature. But intense, supramaximal exercise might have potentially adverse effects ranging from increased risk of vascular endothelial injury to sudden cardiac arrest. Acute bout of exercise at high-enough intensity can damage the endothelial cells in the systemic blood vessels. Exercise also affects the retinal and choroidal blood flow, but studies evaluating these effects are limited. Autoregulation, perfusion pressure, endothelial injury, hemoconcentration, and other systemic factors play a complex role in this. In a rare occurrence, we report two cases of sudden occlusion of retinal circulation involving the central retinal artery in one and the ophthalmic artery in the other, following acute, intense exercise in otherwise young, healthy persons. Extensive investigations revealed no other cause for the occlusion. Vision in the affected eye remained poor.
Ophthalmia nodosa presenting as pan-uveitis and infective scleral abscess
Authors: Thundikandy Radhika , Vedhanayaki Rajesh , Anjana S , Rathinam S R
Published: July 2022

A 38-year-old gentleman presented with bilateral ocular inflammation following fall of caterpillar hair. Examination revealed caterpillar hairs embedded in the palpebral conjunctiva, corneal abrasions, and anterior chamber reaction. The hairs were removed and topical antibiotics were initiated. Later, he presented with multiple scleral abscesses, retinal exudates, and sub-tenons fluid on B scan. The scleral abscesses were drained and treated with appropriate antibiotics and oral steroids. The abscesses and retinal exudates resolved with scleral thinning. This is the first report of ophthalmia nodosum presenting with scleral abscesses and panuveitis.
Conjunctival squamous cell carcinoma as a second primary malignancy in a patient with colon adenocarcinoma
Authors: Ancona-Lezama David , Bastán-Fabián Daniel , Ortiz-Morales Gustavo
Published: July 2022

Second primary malignancies (SPM) are observed in up to 8.1% of cancer patients and are often overlooked. We present the case of a 58-year-old male with ongoing treatment for colon adenocarcinoma who was discovered to have a mass in the conjunctiva in his right eye. Other than his oncologic diagnosis, he had no other risk factors, such as a history of smoking, unusual exposure to ultraviolet radiation, fair skin, or other conditions, that could explain the lesion.
Mycotic keratitis due to rare fungal species Neoscytalidium
Authors: Mandlik Kunal , Ramakrishnan Seema , Kabra Neha , Bhattacharya Devika , Gubert Joseph
Published: July 2022

Neoscytalidium dimidiatum is a plant pathogen that rarely causes human infection. Very few cases of ocular infection have been reported. We report a case series of three patients who presented with keratitis caused by it. The culture showed effuse, white-to-grayish colonies with yellow-to-deep orange colony reverse. Chains of arthroconidia typical of Neoscytalidium were seen on staining with lactophenol cotton blue. Two patients responded to topical antifungal treatment while one needed therapeutic keratoplasty. Hence, early diagnosis and intensive antifungal treatment are essential for successful healing in mycotic keratitis caused by Neoscytalidium species.
Multimodal imaging in syphilitic retinitis with vasculitis in an immunocompetent patient
Authors: Ramdoss Jeyasooriya , Jain Anupreeti , Biswas Jyotirmay
Published: July 2022

A 47-year-old male reported a sudden diminution of vision in the left eye for 1 month. Fundus examination showed dense vitritis, retinal hemorrhages around the disc with subretinal precipitates. Peripheral examination revealed snowball opacities. Multimodal imaging indicated syphilitic retinitis with vascular leakage. A complete systemic workup was performed to support the diagnosis. Intramuscular benzathine penicillin injection along with oral corticosteroids showed an excellent response as confirmed by the multimodal imaging. Syphilitic retinitis with vasculitis is uncommon and can occur in immunocompetent patients. Multimodal imaging can be used to demonstrate the extent of involvement and to monitor treatment response.