A Rare Case of Malignant Syndrome in Parkinson's Disease Caused by Severe Dehydration and Complicated by Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH).

Malignant syndrome (MS) in Parkinson's disease (PD) is a rare complication that occurs in patients who have a history of PD and are taking dopaminergic drugs. The syndrome is quite similar to neuroleptic malignant syndrome (NMS) in presentation and is a potentially fatal syndrome. Awareness of symptoms, early diagnosis, and the ability to differentiate it from NMS is important to prevent mortality. Clinical manifestations of MS are similar to NMS and include altered mentation, rigidity, fever, leukocytosis, and elevated serum creatine kinase (CK). However, MS is differentiated from NMS by the precipitating factors; of which, the commonest precipitating factor for MS is dopaminergic drug withdrawal or dose reduction while other less common causes include infection, dehydration, and hot weather. We present a rare case of MS in a patient with a history of PD precipitated by severe dehydration and hot weather in the absence of dopaminergic drug withdrawal. He presented with fever, severe rigidity, altered mentation, dehydration, leukocytosis, and elevated CK. He was correctly diagnosed with MS and promptly treated, preventing mortality. The triad of fever, severe rigidity, and altered sensorium in a patient with a history of PD should prompt evaluation for MS in addition to NMS to initiate appropriate treatment and prevent mortality.

A Rare Case of Colon Cancer in a Young Patient With HIV Infection: Is it Time for New Colon Cancer Screening Guidelines for HIV Patients?

Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of colonic neoplasms than the general population. In these patients, tumors develop at an earlier age, are diagnosed at more advanced stages, and have a dismal prognosis. Current guidelines recommend initiating colon cancer screening in HIV patients at the age of 45 which is consistent with screening age in the general population. We present a rare case of colon cancer diagnosed in an HIV-infected patient at a young age of only 34 years. Therefore, we recommend early screening for colon cancer in HIV patients than the general population.

A Meta-analysis of the Severity of Acute Pancreatitis (AP) in COVID-19 Infection.

Many studies have reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affecting the gastrointestinal tract and causing gastritis, colitis, duodenitis and acute pancreatitis (AP). We conducted a meta-analysis to evaluate if SARS-CoV-2 infection (COVID-19 infection) affects the outcomes and severity of AP. We searched for articles in PubMed (MEDLINE), Cochrane Library, and clinicaltrials.gov databases and included studies comparing the outcomes of AP in patients with and without COVID-19. Our outcomes were the mean age of occurrence of AP, Charlson Comorbidity Index, incidence of idiopathic etiology of AP, severity of AP, incidence of necrotizing pancreatitis, need for intensive care unit (ICU) admission, and mortality between the two cohorts. We included five observational studies with a total population of 2,446 patients. Our results showed that in COVID-19 patients; AP had higher odds of having an idiopathic etiology (odds ratio, OR 3.14, 95% confidence interval, CI 1.36-7.27), be more severe (OR 3.26, 95% CI 1.47-7.49), had higher risk for pancreatic necrosis (OR 2.40, 95% CI 1.62-3.55), require ICU admission (OR 4.28, 95% CI 2.88-6.37) and had higher mortality (OR 5.75, 95% CI 3.62-9.14) than in patients without COVID-19 infection. Our study concluded that SARS-CoV-2 infection does increase the morbidity and mortality associated with AP and further large-scale multi-center studies are needed to confirm these results.

Plant Growth Regulators with a Balanced Supply of Nutrients Enhance the Phytoextraction Efficiency of Parthenium hysterophorus for Cadmium in Contaminated Soil.

Heavy metal contamination in soil, such as cadmium (Cd), poses a serious threat to global food security and human health. It must be managed using environmentally friendly and cost-effective technologies. Plants with high resistance to Cd stress and high biomass production could be potential candidates for the phytoremediation of Cd-contaminated soils to improve Cd phytoextraction. In this regard, the present study was carried out to determine the effect of gibberellic acid (GA3), indole acetic acid (IAA), and fertilizers (N, P, and K) on Parthenium hysterophorus growth and biomass production as well as Cd phytoextraction capabilities. A pot experiment was conducted with various combinations of PGRs and fertilizers, with treatments arranged in five replicates using a completely randomized design. After harvesting, each plant was divided into various parts such as stems, roots, and leaves, and different growth, physiological, and biochemical parameters were recorded. Results showed that under Cd stress, growth, physiological, and biochemical parameters were all significantly decreased. With the combined application of plant growth regulators (GA3 and IAA) and nutrients, Cd stress was alleviated and all parameters significantly improved. In comparison to the control treatment, the combined application of N + P + K + GA3 + IAA resulted in the highest fresh and dry biomass production of the root (12.31 and 5.11 g pot-1), shoot (19. 69 and 6.99 g pot-1), leaves (16.56 and 7.09 g pot-1), and entire plant (48.56 and 19.19 g pot-1). Similarly, the same treatment resulted in higher chlorophyll a and b and total chlorophyll contents under Cd stress, which were 2.19, 2.03, and 3.21 times higher than the control, which was Cd stress without any treatment. The combination of N + P + K + GA3 + IAA also resulted in the highest proline and phenolic contents. In the case of different enzyme activities, the combined application of N + P + K + GA3 + IAA under Cd stress led to a high increase in catalase (2.5 times), superoxide (3.5 times), and peroxidase (3.7 times) compared to the control. With the combined application of N+ P+ K + GA3 + IAA, the maximum values of BCF (8.25), BAC (2.6), and RF (5.14%) were measured for phytoextraction potential. On the basis of these findings, it is concluded that P. hysterophorus has a high potential to grow, produce the most biomass, and act as a Cd hyperaccumulator in Cd-contaminated soil.

Heart failure as a risk factor for osteoporosis and fractures.

Although heart failure (HF) and osteoporosis are common diseases, particularly in elderly populations, patients with HF have an increased risk for osteoporosis. The relationship of HF with osteoporosis is modified by gender and the severity of HF. In addition, shared risk factors, medication use, and common pathogenic mechanisms affect both HF and osteoporosis. Shared risk factors for these 2 conditions include advanced age, hypovitaminosis D, renal disease, and diabetes mellitus. Medications used to treat HF, including spironolactone, thiazide diuretics, nitric oxide donors, and aspirin, may protect against osteoporosis. In contrast, loop diuretics may make osteoporosis worse. HF and osteoporosis appear to share common pathogenic mechanisms, including activation of the renin-angiotensin-aldosterone system, increased parathyroid hormone levels, and/or oxidative/nitrosative stress. HF is a major risk factor for mortality following fractures. Thus, in HF patients, it is important to carefully assess osteoporosis and take measures to reduce the risk of osteoporotic fractures.

Severe Pulmonary Artery Hypertension in Otherwise Silent Lupus: A Unique Hybrid Treatment Approach Using Hydroxychloroquine and Sildenafil.

Pulmonary hypertension (PH) is a rare manifestation of systemic lupus erythematosus (SLE). Even more rare is pulmonary artery hypertension (PAH) presenting as the initial manifestation of SLE and may be a cause of diagnostic delay. As symptoms of PAH are very mild in the early stages, prompt diagnosis is crucial to prevent the progression of the disease. Echocardiographic evaluation involving the measurement of different right-sided heart variables in addition to estimated pulmonary artery pressure helps in reducing the false-positive rates of detection of PAH. The role of immunosuppression in addition to PAH-specific vasodilator therapy is one of the key aspects of management to minimize flares and improve hemodynamics. Equally important is the choice of a regimen best suited to minimize complications. We present a case of PAH in newly diagnosed SLE and the diagnostic and treatment challenges as a safety net hospital.

Theoretical analysis of unsteady squeezing nanofluid flow with physical properties.

Theoretical analysis of physical characteristics of unsteady, squeezing nanofluid flow is studied. The flow of nanofluid between two plates that placed parallel in a rotating system by keeping the variable physical properties: viscosity and thermal conductivity. It is analyzed by using Navier Stokes Equation, Energy Equation and Concentration equation. The prominent equations are transformed by virtue of suitable similarity transformation. Nanofluid model includes the important effects of Thermophoresis and Brownian motion. For analysis graphical results are drawn for verity parameters of our interest i.e., Injection parameter, Squeezing number, Prandtle number and Schmidt number are investigated for the Velocity field, Temperature variation and Concentration profile numerically. The findings underline that the parameter of skin friction increases when the Squeezing Reynolds number, Injection parameter and Prandtle number increases. However, it shows inverse relationship with Schmidt number and Rotation parameter. Furthermore, direct relationship of Nusselt number with injection parameter and Reynolds number is observed while its relation with Schmidt number, Rotation parameter, Brownian parameter and Thermophoretic parameter shows an opposite trend. The results are thus obtained through Parametric Continuation Method (PCM) which is further validated through BVP4c. Moreover, the results are tabulated and set forth for comparison of findings through PCM and BVP4c which shows that the obtained results correspond to each other.

Pulmonary Embolism in Acquired Hemophilia A: A Rare Complication With Factor VIII Inhibitor Bypassing Activity Therapy.

Acquired hemophilia A (AHA) is an uncommon complication caused by autoantibodies against Factor VIII. The main concern with these patients is hemorrhage, which is often treated with Factor VIII inhibitor bypassing activity (FEIBA). On rare occasions, treatment with FEIBA can result in thromboembolism, a potentially fatal complication. This unfortunate situation occurred in our patient, a 64-year-old female who was treated with FEIBA after being diagnosed with AHA. After initiating FEIBA, she developed clinical signs and symptoms of pulmonary embolism, which was ultimately responsible for her acute death. While pulmonary embolism may be a rare complication of FEIBA treatment, clinicians should be aware of its possibility, especially as the complete safety profile for this treatment is not well known.

All-Cause Mortality Outcomes of Usage of Cardiac Contractility Modulation in Patients With Dilated Cardiomyopathy Ineligible for Cardiac Re-Synchronization Therapy: An Updated Meta-Analysis of Randomized Controlled Trials.

Introduction Dilated cardiomyopathy has been associated with remarkably high mortality despite guideline-directed therapy. This study compares the all-cause mortality rate between a cardiac contractility modulation group and a standard therapy group in patients with dilated cardiomyopathy who were monitored via follow-up for 12 weeks or more. Materials and methods We conducted a systematic search of Medline (PubMed) and Cochrane Central Register of Controlled Trials for abstracts and fully published studies (from inception to October 2018). We searched for articles comparing cardiac contractility modulation device therapy with standard therapy for patients with dilated cardiomyopathy between September 1, 2018, and October 30, 2018. Only fully published randomized clinical trials comparing all-cause mortality outcomes of device therapy and standard therapy for patients with dilated cardiomyopathy were included in our meta-analysis. A total of 673 studies were identified. Studies that were systematic reviews or meta-analyses, study designs or protocols, trials on other regimens, wherein medical therapy was not compared, or wherein the primary outcome of mortality was not assessed, were excluded. Data were abstracted by two independent reviewers. A random-effect model using the Mantel-Haenszel method calculated the weighted risk ratio (RR). Statistical analyses were performed using Review Manager 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration; Copenhagen). The primary outcome of interest was a comparison of all-cause mortality between the two groups when patients were monitored via follow-up for 12 weeks or more. Results Four fully published randomized clinical trials met the inclusion criteria of our analysis. A random-effect model using the Mantel-Haenszel method calculated the weighted RR. Our analysis included a total of 930 patients. The cardiac contractility modulation therapy group showed no significant reduction in all-cause mortality compared to the standard therapy group (RR, 0.63; 95% CI, 0.29-1.35; P = .23). However, the trend was toward device therapy. Tests for statistical heterogeneity did not show any significant heterogeneity (P = .82, I2 = 0%). Conclusions Cardiac contractility modulation device therapy is not associated with significant all-cause mortality reduction in patients with dilated cardiomyopathy. Our meta-analysis underscores the need for a large randomized controlled trial on the efficacy of cardiac contractility modulation in a population with dilated cardiomyopathy who are ineligible for cardiac resynchronization therapy.

On the study of flow between unsteady squeezing rotating discs with cross diffusion effects under the influence of variable magnetic field.

The aim of this article is to provide an analytical and numerical investigation to the viscous fluid flow, heat and mass transfer under the influence of a variable magnetic field. The governing system of partial differential equations are transformed by means of similarity transformations to a system of ordinary differential equations which are solved by Homotopy Analysis Method (HAM) and BVP4c. The effects of involved physical parameters are illustrated for the velocity components, magnetic field components, heat and mass transfers. Authentification of HAM results for various involved physical parameters are supported by comparison with numerical results obtained by BVP4c. It is observed that increasing distance between discs increase pressure on lower disc and torque on upper disc. It is also observed that increase in axial component of magnetic field increase fluid's axial velocity and increase in magnetic Reynold's number decrease magnetic flux it lower disc. Heat flux from lower to upper disc is increased by increase in Dufour number.

Case Report of Spontaneous Remission of Biopsy-Proven Idiopathic Immune Complex-Mediated Membranoproliferative Glomerulonephritis.

Membranoproliferative glomerulonephritis (MPGN) is a histopathologic diagnosis causing microscopic hematuria, nephrotic range proteinuria, and chronic renal failure. Current understanding divides pathogenesis into two broad categories: immune complex mediated and complement mediated (now termed C3 glomerulopathy). The term idiopathic immune complex-mediated MPGN would apply to a patient without an identifiable source of immune complex production and no evidence of C3 glomerulopathy. Presented is a patient with idiopathic immune complex mediated MPGN and her clinical course. The patient opted for conservative therapy with losartan, carvedilol, chlorthalidone, and atorvastatin. Nephrotic range proteinuria of 8.7 g per day resolved over 5 months, with improvement of serum from 3.3 to 1.2 mg/dL. Remission continues at follow-up 21 months after biopsy. For idiopathic immune complex-mediated MPGN, resorting to empiric immunosuppression therapy may not be the best option. As this patient demonstrates, a conservative approach of blood pressure control with anti-renin-angiotensin agents, control of lipids, and watchful follow-up can be successful.

Localized nonlinear waves on quantized superfluid vortex filaments in the presence of mutual friction and a driving normal fluid flow.

We demonstrate the existence of localized structures along quantized vortex filaments in superfluid helium under the quantum form of the local induction approximation (LIA), which includes mutual friction and normal fluid effects. For small magnitude normal fluid velocities, the dynamics are dissipative under mutual friction. On the other hand, when normal fluid velocities are sufficiently large, we observe parametric amplification of the localized disturbances along quantized vortex filaments, akin to the Donnelly-Glaberson instability for regular Kelvin waves. As the waves amplify they will eventually cause breakdown of the LIA assumption (and perhaps the vortex filament itself), and we derive a characteristic time for which this breakdown occurs under our model. More complicated localized waves are shown to occur, and we study these asymptotically and through numerical simulations. Such solutions still exhibit parametric amplification for large enough normal fluid velocities, although this amplification may be less uniform than would be seen for more regular filaments such as those corresponding to helical curves. We find that large rotational velocities or large wave speeds of nonlinear waves along the filaments will result in more regular and stable structures, while small rotational velocities and wave speeds will permit far less regular dynamics.

Steady flow and heat transfer analysis of Phan-Thein-Tanner fluid in double-layer optical fiber coating analysis with Slip Conditions.

Modern optical fibers require double-layer coating on the glass fiber to provide protection from signal attenuation and mechanical damage. The most important plastic resins used in wires and optical fibers are plastic polyvinyl chloride (PVC) and low-high density polyethylene (LDPE/HDPE), nylon and Polysulfone. In this paper, double-layer optical fiber coating is performed using melt polymer satisfying PTT fluid model in a pressure type die using wet-on-wet coating process. The assumption of fully developed flow of Phan-Thien-Tanner (PTT) fluid model, two-layer liquid flows of an immiscible fluid is modeled in an annular die, where the fiber is dragged at a higher speed. The equations characterizing the flow and heat transfer phenomena are solved exactly and the effects of emerging parameters (Deborah and slip parameters, characteristic velocity, radii ratio and Brinkman numbers on the axial velocity, flow rate, thickness of coated fiber optics, and temperature distribution) are reported in graphs. It is shown that an increase in the non-Newtonian parameters increase the velocity in the absence or presence of slip parameters which coincides with related work. The comparison is done with experimental work by taking λ → 0 (non-Newtonian parameter).

Unsteady MHD Thin Film Flow of an Oldroyd-B Fluid over an Oscillating Inclined Belt.

This paper studies the unsteady magnetohydrodynamics (MHD) thin film flow of an incompressible Oldroyd-B fluid over an oscillating inclined belt making a certain angle with the horizontal. The problem is modeled in terms of non-linear partial differential equations with some physical initial and boundary conditions. This problem is solved for the exact analytic solutions using two efficient techniques namely the Optimal Homotopy Asymptotic Method (OHAM) and Homotopy Perturbation Method (HPM). Both of these solutions are presented graphically and compared. This comparison is also shown in tabular form. An excellent agreement is observed. The effects of various physical parameters on velocity have also been studied graphically.

Thin film flow in MHD third grade fluid on a vertical belt with temperature dependent viscosity.

In this work, we have carried out the influence of temperature dependent viscosity on thin film flow of a magnetohydrodynamic (MHD) third grade fluid past a vertical belt. The governing coupled non-linear differential equations with appropriate boundary conditions are solved analytically by using Adomian Decomposition Method (ADM). In order to make comparison, the governing problem has also been solved by using Optimal Homotopy Asymptotic Method (OHAM). The physical characteristics of the problem have been well discussed in graphs for several parameter of interest.

Heat transfer analysis of MHD thin film flow of an unsteady second grade fluid past a vertical oscillating belt.

This article aims to study the thin film layer flowing on a vertical oscillating belt. The flow is considered to satisfy the constitutive equation of unsteady second grade fluid. The governing equation for velocity and temperature fields with subjected initial and boundary conditions are solved by two analytical techniques namely Adomian Decomposition Method (ADM) and Optimal Homotopy Asymptotic Method (OHAM). The comparisons of ADM and OHAM solutions for velocity and temperature fields are shown numerically and graphically for both the lift and drainage problems. It is found that both these solutions are identical. In order to understand the physical behavior of the embedded parameters such as Stock number, frequency parameter, magnetic parameter, Brinkman number and Prandtl number, the analytical results are plotted graphically and discussed.