Unilateral developmental absence of internal carotid artery with contralateral middle cerebral artery occlusion.

PURPOSE: Developmental absence of the internal carotid artery (ICA) is a rare congenital anomaly that results from an insult to the third aortic arch or dorsal aorta during early embryogenesis. Patients are often asymptomatic and are diagnosed incidentally during imaging to investigate neurological complaints. METHODS: We report a rare finding of an absent ICA during a workup of stroke in a middle-aged patient. RESULTS: CT brain perfusion (CTP) and CT angiography (CTA) revealed the right middle cerebral artery (MCA) thrombotic stroke with the demonstration of contralateral left ICA absence. The patient showed spontaneous recovery, and no thrombolysis or neurointervention was considered. CONCLUSIONS: This article highlights the importance of screening the head CT on bone window settings in case of the non-visualization of ICA to differentiate congenital absence from a steno-occlusive disease. It also illustrates the role of Magnetic resonance imaging (MRI) and MR Angiography (MRA) in demonstrating further possible vascular anomalies, structural brain malformations, and collateral circulation.

Aberrant origin of bilateral vertebral arteries associated with bovine aortic arch.

PURPOSE: Variance of aortic arch branches are clinically significant as they are encountered in multiple endovascular treatments. The knowledge of different variants is crucial to perform successful vascular interventions. METHODS: We report a novel anatomical variant of aortic arch found on contrast-enhanced computed tomography scan during a workup of cervical lymphadenopathy. RESULTS: The CT neck revealed a bovine aortic arch with an aberrant origin of bilateral vertebral arteries from the aortic arch. The right vertebral artery arose between the bovine trunk and the left subclavian artery, while the left vertebral artery was present distal to the left subclavian artery. CONCLUSION: This article sheds light on the potential clinical significance of these various types of aortic arch branches. Knowing the exact type of variant is particularly important in patient undergoing management involving carotid and surrounding vessels.

Efficiency of Near-Infrared Technology in the Clinical Detection of Carious Lesions: A Systematic Review.

The field of dentistry has seen various technological advances regarding caries detection, some lesions still prove to be difficult to detect. A reasonably new detection method, near-infrared (NIR), has shown good results in caries detection. This systematic review aims to compare NIR with conventional methods in terms of caries detection. Online databases (PubMed, Scopus, ScienceDirect, EBSCO, and ProQuest) were used for the literature search. The search was performed from January 2015 till December-2020. A total of 770 articles were selected, of that 17 articles qualified for the final analysis as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles were assessed according to a modified Critical Appraisal Skills Programme checklist, and then synthesis of the review started. The inclusion criteria were clinical trials done in vivo on teeth with active caries of vital or nonvital teeth. This review excluded nonpeer reviewed articles, case reports, case series, opinions, abstracts, non-English written articles, studies of subjects with arrested caries, or teeth with developmental defects of tooth structure and teeth having environmental defects of tooth structure, as well as in-vitro studies. The review compared near-infrared technology with radiography, visual inspection, and laser fluorescence in terms of caries detection, sensitivity, specificity, and accuracy. The sensitivity of NIR ranged from 99.1 to 29.1%. Studies showed that NIR exhibited higher sensitivity for occlusal enamel and dentin caries. The specificity of NIR ranged from 94.1 to 20.0%. In enamel and dentinal occlusal caries, NIR demonstrated lower specificity than that of radiograph. The specificity of NIR in early proximal caries was low. Accuracy was determined in 5 out of 17 studies where the values ranged from 97.1 to 29.1%. The accuracy of NIR was the highest for dentinal occlusal caries. NIR shows promising evidence as an adjunct in caries examination due to its high sensitivity and specificity; however, more studies are required to determine its full potential in different situations.

Multifocal Nodular Fatty Sparing Mimicking Hepatic Tumors.

Hepatic steatosis is frequent; however, it may present with unusual patterns, resulting in a diagnostic dilemma. Herein, we present a case of fatty liver and multifocal nodular hepatic lesions that were found to be due to multifocal nodular fatty sparing, which mimics metastasis or primary multifocal tumors. As the differential diagnosis of such lesions can be difficult based on ultrasound alone, the knowledge of Magnetic Resonance Imaging (MRI) findings is crucial. It enables the radiologists to make the correct diagnosis and alleviate the patient from unnecessary biopsies.

The Prevalence of Uncontrolled Hypertension among Patients Taking Antihypertensive Medications and the Associated Risk Factors in North Palestine: A Cross-Sectional Study.

Background: Uncontrolled hypertension (HTN) is a challenge for public health professionals all over the world. It is the leading and most important modifiable risk factor for coronary artery disease, congestive heart failure, stroke, renal diseases, and retinopathy. The aim of the present study was to estimate the prevalence of uncontrolled HTN among Palestinian hypertensive patients on treatment. In addition, the study aimed to explore the relationship between socio-demographic and clinical factors with HTN control as well as establish a comprehensive literature review for similar studies. Methods: A cross-sectional study was conducted. 218 hypertensive patients who met the inclusion criteria were included in the study. Results: HTN is not adequately controlled in over 60% of treated patients. Factors that were linked to uncontrolled HTN and were statistically significant as per this study were diabetes (p=0.010), high BMI (p=0.009), smoking (p < 0.0001), lower educational level (p=0.002), and monotherapy (p=0.004). Conclusion: The results suggest that effective efforts on improving HTN control are strongly needed. The efforts need to target hypertensive patients who are also smokers, diabetics, having a low education level, and have a higher-than-normal BMI.

Spontaneously Ruptured Idiopathic Mesenteric Hematoma: A Case Report With Review of Literature.

Ruptured mesenteric hematoma is a rare entity that is not frequently reported in the literature. Spontaneous rupture of mesenteric hematoma has been vaguely described in a handful of cases. The majority of cases (unlike ours) had a reported etiology, like trauma, postoperative complications, connective tissue disease, and coagulopathy. To our knowledge, only two cases were reported for spontaneous rupture of idiopathic mesenteric hematoma. We, herein, present a 45-year-old male presented with abdominal pain, nausea, and vomiting associated with hypotension. His investigations, including abdominal computed tomography (CT) scan, showed a large lobulated mesenteric structure involving the small bowel mesentery, representing a mesenteric hematoma. Due to suspicion of intra-abdominal bleeding; we proceeded for exploratory laparotomy. Intraoperative findings showed a large mesenteric hematoma. The patient was stabilized after the evacuation of hematoma and no specific source of bleeding was identified. Ruptured idiopathic mesenteric hematoma is an extremely rare condition that poses a diagnostic challenge, it should be kept among deferential diagnoses, especially, in unstable patients with abdominal symptoms.

Trends and Spatial Pattern Analysis of Dengue Cases in Northeast Malaysia.

OBJECTIVES: Dengue remains hyperendemic in Malaysia despite extensive vector control activities. With dynamic changes in land use, urbanisation and population movement, periodic updates on dengue transmission patterns are crucial to ensure the implementation of effective control strategies. We sought to assess shifts in the trends and spatial patterns of dengue in Kelantan, a north-eastern state of Malaysia (5°15'N 102°0'E). METHODS: This study incorporated data from the national dengue monitoring system (eDengue system). Confirmed dengue cases registered in Kelantan with disease onset between January 1, 2016 and December 31, 2018 were included in the study. Yearly changes in dengue incidence were mapped by using ArcGIS. Hotspot analysis was performed using Getis-Ord Gi to track changes in the trends of dengue spatial clustering. RESULTS: A total of 10 645 dengue cases were recorded in Kelantan between 2016 and 2018, with an average of 10 dengue cases reported daily (standard deviation, 11.02). Areas with persistently high dengue incidence were seen mainly in the coastal region for the 3-year period. However, the hotspots shifted over time with a gradual dispersion of hotspots to their adjacent districts. CONCLUSIONS: A notable shift in the spatial patterns of dengue was observed. We were able to glimpse the shift of dengue from an urban to peri-urban disease with the possible effect of a state-wide population movement that affects dengue transmission.

Cooling potential for hot climates by utilizing thermal management of compressed air energy storage systems.

This work presents findings on utilizing the expansion stage of compressed air energy storage systems for air conditioning purposes. The proposed setup is an ancillary installation to an existing compressed air energy storage setup and is used to produce chilled water at temperatures as low as 5 °C. An experimental setup for the ancillary system has been built with appropriate telemetric devices to measure the temporal temperature variation, which consequently can be used to calculate the heat transfer and available cooling capacity. The system is compared to commercially available compression cooling air conditioners, and the potential of replacing them is promising, as one ton of conventional cooling can be replaced with a 500-L (0.5 m3) air tank at 20 bar operating for an hour. More tanks can be added to extend the operational viability of the system, which is also serving the original purpose of storing energy from grid excess or from solar photovoltaic panels. The thermal management has had the added benefit of increasing the roundtrip efficiency of the storage system from 31.4 to 35.2%, along with handling a portion of the cooling load.

A Rare Case of COVID-19 Infection Leading to Colonic Stricture: Case Report and Review of Literature.

Coronavirus disease 2019 (COVID-19) predominantly targets the respiratory tract; despite gastrointestinal (GI) symptoms that may present in many patients, colonic strictures in coronavirus disease (COVID-19) patients are extremely rare and, to our knowledge, have never been reported. We, herein, present a case of a 59-year-old lady who developed intestinal obstruction due to colonic strictures shortly after recovering from complicated COVID-19 pneumonia. Ultimately, she underwent laparoscopic subtotal colectomy with ileorectal anastomosis. After a long recovery period, she was discharged in good status. It has been more than two years since COVID-19 was declared as a pandemic by the World Health Organization. Infected individuals have highly variable clinical manifestations, yet the pathogenesis, diagnosis and ideal management of each of these complications is not well described in literature.

Landscape of childhood epilepsies - A multi-ethnic population-based study.

OBJECTIVE: To describe the clinical features of childhood epilepsy in Qatar. METHODS: A retrospective cross-sectional chart review analysis was conducted at the only tertiary pediatric hospital in Qatar in 1422 patients with epilepsy followed between November 2016 and October 2019. RESULTS: 55% (781) were males and 70% were non-Qatari. Age of epilepsy onset was in the neonatal period in 9% (114/1207 patients). In the non-neonatal cohort, mean age of onset was 4 yrs 9mos ( ± 1.4mos). Focal epilepsy was the predominant epilepsy type in 45% (594/1314 patients) versus generalized epilepsy in 37% and combined focal/generalized epilepsy in 12%. Etiology was unknown in most children (782/1363, 57%) whereas structural and genetic causes represented 23% and 11% of cases respectively. No differences in epilepsy type and etiology were found between different ethnic groups. Children with genetic or structural epilepsies had an earlier epilepsy onset compared to those with unknown etiologies. At the last follow up, only 36% of patients were seizure-free and 12% (170/1422) had a history of status epilepticus. Medically refractory epilepsy was found in 37% (527/1407) of patients, with the most common etiologies being unknown (36%) and structural (37%). Neurodevelopmental co-morbidities were present in most patients (62%), with global developmental delay (47%) and learning/school difficulties (22%) being the most prevalent. 94% of patients with somatic co-morbidities had concomitant neurodevelopmental co-morbidities. Risk factors associated with an increased risk of co-morbidities and intractable epilepsy included early age of epilepsy onset (< 2 years of age); etiology; antenatal risk factors; history of previous central nervous system infection; history of status epilepticus and a family history of consanguinity and epilepsy. SIGNIFICANCE: This large multi-ethnic population-based study confirms that the prevalence, incidence and clinical features of epilepsy in Qatar is in accordance with other epidemiologic studies and highlights risk factors for the development of co-morbidities and medically-intractable epilepsy.

Edema of the Ligamentum Teres as a Novel MRI Marker for Non-Traumatic Painful Hip Pathology: A Retrospective Observational Study.

Background The ligamentum teres has been recognized as an important stabilizer of the hip joint and can be affected by various hip pathologies. This study aims to introduce ligamentum teres edema as an MRI marker to diagnose the underlying cause of hip pathology, mainly femoral acetabular impingement (FAI) and adult developmental dysplasia of the hip (ADDH), in non-traumatic patients. Methodology Adult patients presenting with non-traumatic hip pain of variable duration and ligamentum teres edema on MRI between 2014 and 2020 were included. A high-resolution standard MRI hip protocol was used for all patients in this series. MRI and plain radiographs were assessed. Ligamentum teres edema, alpha angle, center edge angle of Wiberg, and retroversion were assessed. Results In total, 55 patients with 110 hip joints (males: 29 (52.7%), females: 26 (47.3%)) of different ethnicities were included in this study. Out of the 55 patients with ligamentum teres edema, one had only unilateral right-sided FAI, seven had only unilateral left-sided FAI, and 46 (94 hip joints) had either bilateral FAI or ADDH. Therefore, eight (14.5%) patients with unilateral FAI had the absence of the contralateral FAI or ADDH (6.5% false-positive) despite the presence of ligamentum teres edema bilaterally, and the rest of the patients with bilateral ligamentum teres edema (102 joints: 92.7% positive predictive value) had findings of either FAI or ADDH. Conclusions Ligamentum teres edema can be considered as an early MRI marker to diagnose the underlying pathology of symptomatic painful hip disorders, especially FAI.

Bilateral Primary Adrenal B-Cell Lymphoma Diagnosed by Workup for Primary Adrenal Deficiency.

Primary adrenal lymphoma (PAL) often occurs bilaterally and is a rare malignancy of old age. Workup for primary adrenal insufficiency often unmasks this underlying grave pathology. In this article, we present a case of a 73-yearold patient who presented with features of primary adrenal insufficiency and renal colic. Diagnostic abdominal imaging revealed bilateral suprarenal masses as the cause of adrenal gland destruction and the patient's symptoms. FDG PET-CT scan and histopathology confirmed the diagnosis of mature bilateral B-cell primary adrenal lymphomas. Though the patient showed an excellent initial response to the first four chemotherapy cycles, a relapse resulted in metastatic disease. This article highlights the PAL's disease course, imaging features, and management dilemma due to Chemotherapy's side effects and a higher recurrence rate. Keywords: Primary adrenal lymphoma, Primary adrenal insufficiency, R-CHOP, Role of imaging.

Horseshoe adrenal gland associated with type 1 diastematomyelia in an asymptomatic adult.

A horseshoe adrenal gland is a rare congenital anomaly found almost exclusively in neonates and infants based on autopsy studies. It is a term used to describe a solitary adrenal gland situated in the midline, posterior to the inferior vena cava and abdominal aorta. To date, in the literature, there have been very few cases documented in adults and they have also been reported to be associated with other co-existing intra-abdominal, vascular and vertebral congenital anomalies. We describe a rare case of an asymptomatic adult patient who was incidentally found to have a horseshoe adrenal gland as well as a Type 1 diastematomyelia.

Acute Appendicitis Presenting As Epigastric Pain Due to Incomplete Intestinal Malrotation.

Acute appendicitis is one of the most frequent causes of acute abdominal pain. Clinical signs, blood tests, and imaging are important to confirm the diagnosis. The classic presentation consists of periumbilical abdominal pain that migrates to the right lower quadrant, guarding, tenderness, and rebound tenderness in the region. We present the case of a 51-year-old male who presented with a one-day history of worsening supraumbilical pain. Abdominal computerized tomography (CT) scan showed intestinal malrotation in which the cecum assumed a midline supraumbilical location with CT features of acute appendicitis. This case highlights that the site of pain in acute appendicitis can be altered depending upon the anatomical location of the appendix, and relying on the pain's location can be misleading. We also suggest that patients with abdominal pain, which is not typical for acute appendicitis, should be investigated by abdominal CT if leukocytosis and inflammatory markers are raised.

Prediction of Dengue Incidence in the Northeast Malaysia Based on Weather Data Using the Generalized Additive Model.

INTRODUCTION: Dengue, a vector-borne viral illness, shows worldwide widening spatial distribution beyond its point of origination, namely, the tropical belt. The persistent hyperendemicity in Malaysia has resulted in the formation of the dengue early warning system. However, weather variables are yet to be fully utilized for prevention and control activities, particularly in east-coast peninsular Malaysia where limited studies have been conducted. We aim to provide a time-based estimate of possible dengue incidence increase following weather-related changes, thereby highlighting potential dengue outbreaks. METHOD: All serologically confirmed dengue patients in Kelantan, a northeastern state in Malaysia, registered in the eDengue system with an onset of disease from January 2016 to December 2018, were included in the study with the exclusion of duplicate entry. Using a generalized additive model, climate data collected from the Kota Bharu weather station (latitude 6°10'N, longitude 102°18'E) was analysed with dengue data. RESULT: A cyclical pattern of dengue cases was observed with annual peaks coinciding with the intermonsoon period. Our analysis reveals that maximum temperature, mean temperature, rainfall, and wind speed have a significant nonlinear effect on dengue cases in Kelantan. Our model can explain approximately 8.2% of dengue incidence variabilities. CONCLUSION: Weather variables affect nearly 10% of the dengue incidences in Northeast Malaysia, thereby making it a relevant variable to be included in a dengue early warning system. Interventions such as vector control activities targeting the intermonsoon period are recommended.

Meckel's Diverticulum Enterolith: A Rare Cause of Perforation and Small Bowel Obstruction Presenting as Acute Abdomen.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. MD enteroliths are an uncommon entity that could rarely present with complications. We, herein, present a case of a 56-year-old man who presented with severe abdominal pain. Preoperative CT showed an inflamed structure with central calcification connected to distal ileum lumen with an air pouch associated with small bowel obstruction. Upon laparotomy, a perforated MD was found with phlegmon formation. He underwent resection of the loops containing MD with end-to-end anastomosis.  This highlights the importance of radiological imaging in preoperative diagnosis of these conditions which should be kept in mind if we find a calcified lesion in an inflamed diverticulum around the midline region.

Vaccines Attitudes, Concerns, and Information Sources Reported by Parents of Young Children among North Palestinian Parents.

Parental acceptance of routine childhood immunization is critical to protecting children's health, as high vaccination-coverage rates lead to decreased rates of vaccine-preventable diseases. However, to communicate effectively with parents about vaccines and vaccine-preventable diseases, it is necessary to assess their vaccine-related attitudes and concerns continually. Recently the Palestine Ministry of Health has recorded epidemics of measles and mumps. Poor compliance with vaccination has been attributed to multiple factors including physician inadequacy advocating for vaccination and public mistrust of vaccinations. As a result, this study was conducted to describe the vaccine-related attitudes, concerns, and information sources of North Palestinian parents of young children. A cross-sectional survey was conducted involving parents visiting emergency departments and primary health care centers from different North Palestinian hospitals and centers. 480 surveys were eligible and analyzed. The surveys revealed that although parental confidence in vaccine safety is high, several vaccine-related concerns, such as pain from vaccine administration and the number of vaccines given at once, were common among parents of young children. To maintain and improve the success of childhood vaccines in preventing disease, a holistic approach is needed to address parents' concerns in an ongoing manner. Listening and responding in ways and with resources that address specific questions and concerns could help parents make more informed vaccination decisions.

The Epidemiology of Anti-Sperm Antibodies Among Couples with Unexplained Infertility in North West Bank, Palestine.

INTRODUCTION: Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered. AIM: This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization - intracytoplasmic sperm injection (IVF-ICSI). MATERIALS AND METHODS: A cross-sectional study was conducted on 42 normal infertile couples consulting Razan Medical Center for Infertility & I.V.F. in Nablus, Palestine, from December 2012 - March 2013. Serum levels of immunoglobulins G (IgG) ASA were measured in participants (males and females) using enzyme-linked immunosorbent assay (ELISA). In addition, participants also filled a questionnaire about the presence of previous varicocele repair, inguinal hernia repair, orchitis, testicular trauma and vasectomy reversal among males and severe coitus bleeding and coitus during menses or puerperium among females. Couples were also asked about previous IVF-ICSI procedures and the outcome of the procedure in terms of either they got pregnant or not. Data was analysed using SPSS software. RESULTS: The prevalence of ASA was 14.3% (6/42) among all couples, 9.5% (4/42) among males and 4.8% (2/42) among females. There was no significant relationship between previous varicocele repair, previous inguinal hernia repair, or orchitis and formation of ASA (p value =0.64, 0.56, and 0.26 respectively). Previous trauma, vasovasostomy, severe coitus bleeding and coitus during menses or puerperium were not observed in any of the study sample. ASA did not seem to affect the outcome of IVF-ICSI (p-value =0.54). CONCLUSION: Prevalence of ASA in infertile couples in the north part of Palestine is similar to that obtained worldwide. ASA formation does not relate to any of the studied risk factors and does not seem to associate with pregnancy rate after IVF-ICSI. We recommend further studies using a larger sample size and including all parts of Palestine in order to generalize the obtained results.

The influence of physico-chemical and process conditions on the physical stability of plasmid DNA complexes using response surface methodology.

Research is progressing fast to find safe and effective methods of delivering therapeutic genes to patients afflicted with a range of genetic and acquired diseases that either do not respond at all, or respond poorly, to treatment with small-molecule drugs or protein-replacement therapy. A technical barrier that remains relates to the need for scalable operations that can consistently and reproducibly make large quantities of the therapeutic gene vectors under the current Good Manufacturing Practice ('cGMP'). The present investigation focuses on these issues and introduces a new method of assessing the engineering effects of process and material factors on the colloidal properties of plasmid-DNA delivery systems based on response surface methodology (RSM) and experimental techniques. Previously, experiments have shown that several factors can reduce the physical stability of non-viral delivery systems. Specifically, it has been demonstrated that the mean size and charge of plasmid DNA condensed by cationic agents are affected by many factors, including the pH and ionic strength of the buffer, and the method of preparation. For example, the method and intensity of mixing of the DNA with condensing and conjugating agents have been shown to be important. Using RSM to analyse new experimental data in the present paper, we report on the impact of these factors and, more crucially, the effects of interaction between the factors on the colloidal properties of the DNA-vector complexes. Specifically, for plasmid DNA condensed by poly-L-lysine, interactions between ionic strength, pH and DNA concentrations play a critical role. Whether poly-L-lysine should be used as a condensing agent in the final delivery system remains to be demonstrated. However, the use of RSM combined with the scaleable experimental approach described in this paper may be applied to other delivery systems.