Exploring the Oral Manifestations and Hazards to Dental Professionals During the COVID-19 Pandemic: A Scoping Review.

The novel coronavirus (COVID-19) has inundated the whole world by causing severe acute respiratory syndrome in humans, thus posing serious public health concerns. The oral and olfactory systems are significantly impacted by the COVID-19 condition, in addition to the respiratory and digestive systems. Oral symptoms of COVID-19 can be caused by a loss in oral hygiene, immune system suppression, a decline in general health, and candidiasis due to prolonged antibiotic use. Because many aerosols and droplets are produced during various dental operations, dental professionals and dentists are at a significant risk of contracting the COVID-19 infection. Few precautionary measures include performing a pre-appointment health screening for all patients, performing aerosol-producing procedures in a designated space or operatory, using proper personal protective equipment and disinfecting the operatory between patients, and limiting the number of dental procedures at one time. Against this background, the purposes of this article are to explore the oral presentations of COVID-19 infection and to emphasize the hazards to dental professionals during COVID-19 pandemic. Additionally, few preventive measures are also highlighted.

Smart transactive energy based approach for planning and scheduling in multi-looped microgrid distribution network across planning horizon.

In this paper, an innovative transactive energy approach is proposed as viable option for coordinated distribution system planning across a certain horizon. The proposed approach is evaluated across a multi-looped (meshed) test system and is implemented with load growth having prosumers participating in the electrical market in transactive energy system aiming at evaluation on techno-economic basis. Apart from prosumer sensitivity analysis, evaluations have been carried across reducing total production cost of energy, reduction in per unit price, active power losses. Whereas improving voltage profile, cost of scheduling and consumer per kWh purchase and sales in comparison with traditional counterpart. The proposed framework includes optimization algorithm aiming at sources scheduling and IEEE 69 system for validation. The algorithm minimizes cost, maximizes energy efficiency, increases renewable energy mix and reduces consumers cost of energy purchase. Reduction of 51.44 % in cost of energy is achieved, whereas loss reduction of 12.6% is achieved. The comparison of IEEE 69-bus base case with the 10 %, 15% and 20% transactive energy applied with simulations to evaluate performance parameters that will directly benefit both prosumers and utility alike in-terms of low bills and further reduction of stress on the grid amid load growth across multiple years.

Analysis of Gender Dimorphism and Assessment of Racial Variation Through Odontometric Technique: A Cross-Sectional Study.

BACKGROUND: When conducting a forensic investigation, one of the most important steps is establishing the biological profile of a victim who cannot be positively recognized or is just a skeleton. It has been shown that, among the other clinical indicators, the diameters of dental crowns are a good and dependable source for determining gender in a particular population sample. However, the literature is sparse regarding their assessment as a viable marker for the determination of a particular race. In addition, the need for population-specific data has also been advocated while determining gender dimorphism based on tooth size. AIM AND OBJECTIVES: To study the bisexual variation in the permanent dentition of individuals from three different sets of populations: Arabian, South Asian, and East Asian. The other objective is to explore the role of this odontometric analysis in predicting the racial identity of the subjects belonging to the aforementioned population. METHODOLOGY: The research was conducted at the College of Dentistry, AlJouf University in Sakaka. Measurements of mesiodistal and buccolingual (BL) distances were taken using a digital vernier caliper on a total of 75 pairs of research models or casts. Statistical tests were run on the information gathered. RESULTS: Of the 75 casts, 38 (50.7%) were of male and 37 (49.3%) were of female. Our analysis showed between genders, a significant difference in maxillary central incisor (P = 0.001), first premolar (P = 0.01), and first molar (P = 0.02) while for a mandibular arch, a significant difference was noted for incisors (P = 0.002) with greater tooth dimension in male than in the female. Concerning the BL dimensions, only the mandibular canine showed a significant difference between males and females (P = 0.001). Comparisons of the crown dimensions between population groups showed that the Arabian population consistently exhibits larger tooth dimensions than the other two populations in both arches. CONCLUSION: A few crown dimensions can be used as an adjunctive tool for the identification of the gender and race of an individual.

Drug Utilization Evaluation and Impact of Pharmacist Interventions on Optimization of Piperacillin/Tazobactam Use: A Retrospective Analysis and Prospective Audit.

(1) Background: Piperacillin/tazobactam is a broad-spectrum antimicrobial encompassing most Gram-positive and Gram-negative aerobic and anaerobic bacteria. The inappropriate use of such broad-spectrum antibiotics is an important contributor to the rising rates of antimicrobial drug resistance worldwide. Drug utilization evaluation studies and pharmacists' interventions are vital to assess, develop, and promote the rational use of antibiotics. This drug utilization study aimed to evaluate the current utilization practice of piperacillin/tazobactam in a hospital setting and assess the impact of pharmacist intervention in improving its appropriate use. (2) Methodology: In this study, we used a retrospective cohort and a prospective cohort, a cross-sectional, observational method. It included a retrospective (Cycle A/pre-intervention-CycA) phase followed by an educational interventional phase conducted by the pharmacists. During the 2 months of educational intervention, pharmacists used several methods, including workshops, lectures, oral presentations, and the development and reinforcement of clinical pathways to promote the judicious use of piperacillin/tazobactam. This was followed by a prospective (Cycle B/post-intervention-CycB) phase to improve piperacillin/tazobactam usage appropriateness. The appropriateness criteria for this drug utilization evaluation were established based on antimicrobial guidelines, the published literature, the institutional antibiogram, consultation from the antimicrobial stewardship committee, and the product monograph (Tazocin). The appropriateness of CycA and CycB patients was compared using the measurable elements, including indication and dose based on renal function, timely order for cultures, de-escalation, and use of extended infusion protocol. (3) Results: The study population comprised 100 patients in both CycA and CycB. The mean age of the patients was 66.28 ± 16.15 and 67.35 ± 17.98, and the ratios of men to women were found to be 49:51 and 61:39 in CycA and CycB, respectively. It was observed that inappropriate usage was high in CycA patients, and the appropriateness was improved in CycB patients. A total of 31% of inappropriate empirical broad-spectrum use was found in CycA, and it was reduced to 12% in CycB patients. The transition of appropriateness was observed in all measurable criteria, which includes the optimized dose according to the renal function (CycA = 49% to CycB = 94%), timely bacterial culture orders (CycA = 47% to CycB = 74%), prompt de-escalation (CycA = 31% to CycB = 53%), and adherence to extended infusion institutional guidelines (CycA = 34% to CycB = 86%). (4) Conclusions: The study highlighted important aspects of inappropriate piperacillin/tazobactam use. This can be considerably improved by proper education and timely interventions based on the pharmacists' vigilant approach. The study results emphasized the need for surveillance of piperacillin/tazobactam usage by conducting similar drug utilization evaluations and practice to improve quality and safety in healthcare organizations globally.

Pleomorphic Fibroma Presenting as a Nodular Lesion in the Left Shoulder: A Case Report.

Pleomorphic fibroma is an uncommon benign cutaneous tumor that often presents as a single asymptomatic skin-colored lesion with indefinite clinical diagnostic features. Here, we report a case of a 47-year-old female diagnosed with pleomorphic fibroma of the skin in the left shoulder and discuss the importance of immunohistochemistry and special features in histopathology to distinguish some of the differentials.

Confluent and Reticulated Papillomatosis Successfully Treated with Topical Vitamin A Derivative.

Confluent and reticulated papillomatosis (CARP) is a rare dermatosis that typically develops in adolescents and young adults. Clinical characteristics include hyperkeratotic papules that coalesce centrally with a reticulated pattern peripherally on the central and upper trunk, neck, and axilla. Its etiology is not precisely known, and disordered keratinization has been postulated as one of the etiologies. Treatment options of the disease include systemic (such as antibiotics, antifungals, and retinoids) and topical treatments (such as lactic acid, antifungals, retinoids, salicylic acid, urea, tacrolimus, and vitamin D analogs). We report a case of a 17-year-old boy, otherwise healthy, presented with a new onset of asymptomatic, persistent, and slowly progressing brownish skin lesions over the trunk for 6 months. The diagnosis was revised to CARP based on clinical and histopathological examination. Treatment with topical tretinoin 0.025% cream once daily was begun. There was complete resolution of his lesions at the end of 8 weeks of therapy. There has been no relapse at 2 months follow-up. The effectiveness of tretinoin in this patient supports the theory that CARP is a keratinization disorder. Initiating treatment with topical tretinoin when no limitations for its use would be reasonable as it can provide a safer alternative to systemic therapy.

Practices of Cancer Screening for Average-Risk Cancer Patients Among Primary Healthcare Center Physicians in Al-Qassim Region, Saudi Arabia.

OBJECTIVE: Cancer screening programs exist in Saudi Arabia for some types of cancers. However, data on primary healthcare center (PHC) physicians' practices in referring patients for screening tests or procedures remain unclear. METHODOLOGY: A cross-sectional study was conducted with a self-reported survey that included 141 PHC physicians affiliated with the Ministry of Health in the Al-Qassim region of Saudi Arabia. The primary outcome was the practice of recommending to average-risk patients screening tests for different types of cancers including breast, colorectal, cervical, prostate, and lung, and testing if sociodemographic, specialty, job level, years of experience, a family history of cancer, and patients encountered per day affect their decisions. Secondary outcomes were the barriers perceived by physicians to recommending a screening test. p-value <0.05 was considered significant. RESULTS: The study included 141 respondents, of which 60.3% were males, and the mean age of the entire population was 35.7 ± 8.3 years. The rate of recommending cancer screening varied by the type of cancer, with screening for colorectal cancer being the most prominent (64.5%), followed by breast cancer (51.8%). Fear of finding cancer, poor patient compliance, and difficulty in scheduling the test were the most common patient, physician, and system-related barriers as perceived by PHC physicians. Male physicians were less likely to recommend patients for breast (0.10, 95%CI 0.04-0.23, p < 0.001) and cervical (0.26, 95%CI 0.08-0.78, p = 0.017) cancer screening. However, they were 3.74 times more likely to recommend prostate cancer screening (95%CI 1.20-11.68, p = 0.023) and 5.79 times more likely to request lung cancer screening (95%CI 1.27-26.39, p = 0.023).  Level of education, specialty, and being a senior physician were factors associated with cervical cancer screening. Physicians who work in non-general practice specialties were more likely to recommend cervical cancer screening than those who work in general practice (95%CI 0.04-0.48, p = 0.002). Senior physicians such as registrars/senior registrars and consultants were more likely to request or recommend a patient for breast cancer screening (2.85, 95%CI 1.11-7.35) and cervical cancer screening (6.35, 95%CI 2.10-019.19). CONCLUSION: Screenings for colorectal and breast cancer were the commonly recommended screening tests. Patients' fear of finding cancer, poor patient compliance, and delays or difficulty in scheduling the procedures were the commonly identified barriers as perceived by physicians that influenced physician decisions in referring patients for cancer screening. Our findings suggest that cancer screening rates may be improved by educating individuals on the benefit of early detection of cancers and providing assurance for them with regard to the availability of effective treatments. More research is needed on ways to overcome the obstacles physicians encounter and the outcomes of these measures with regard to improved screening practices.

Diaminoalkanes functionalized graphene oxide as corrosion inhibitors against carbon steel corrosion in simulated oil/gas well acidizing environment.

Experimental weight loss and electrochemical measurements were used at ambient and high temperatures to evaluate the corrosion inhibition efficacies of diaminodecane functionalized graphene oxide (DAD-GO) and diaminododecane functionalized graphene oxide (DADD-GO) against carbon steel corrosion in 15.0 %HCl, mimicking an acidizing environment in an oil/gas well. The GO was made from waste graphite and then grafted with the diaminoalkanes (DAD & DADD). The GO and functionalized GOs were described using FTIR, Raman, TEM, and TGA. Concentration and temperature effects on the inhibitors'performance were also looked into. The inhibition efficiency increased with concentration at room temperature, reaching a maximum of 84 % for DAD-GO and 78 % for DADD-GO at a concentration of 5 ppm for both. At the temperatures studied, the inhibitors performed well at extremely low concentrations; however, as the temperature rises, the inhibitor's performance decreases. According to the PDP measurement, the inhibitors function primarily as mixed-type inhibitors. The Langmuir adsorption theory was found to be followed by thestudied compound. AFM, SEM, EDX, and FTIR characterization of the steel surfaces revealed that the functionalized GOs molecules adsorbed on the steel to create a protective layer that insulated the steel from aggressiveacid assault after the immersion time (24 h) in the inhibited solutions. DFT calculations were utilized to determine the relative stability of functionalized GOs toGOand to learn more about the inhibitor molecules' interactions with the steel surface. The DFT calculations corroborated the experimental findings. This study is important in tackling two significant environmental concerns: corrosion and waste management because GO is manufactured from waste graphite.

Periotome versus piezotome as an aid for atraumatic extraction: a randomized controlled trial.

Objectives: A single-blinded randomized controlled trial was designed to compare and evaluate the effectiveness of the periotome and piezotome as aids for atraumatic extraction and its sequalae. Materials and Methods: The study sample comprised 48 teeth, equally allotted to the piezotome or periotome groups by random allocation, in participants aged 19-62 years. All samples in both groups had either complete tooth structure or intact roots without crowns and had mobility ≤grade II. Clinical parameters of operative duration, presence or absence of gingival laceration, reported operative and postoperative pain, and intake of analgesics following extraction were recorded. IBM SPSS software package version 22 was used for data entry and analysis. Results: The mean operation time was significantly (P≤0.05) longer in the piezotome group than in the periotome group. However, fewer gingival lacerations were observed with use of a piezotome than with a periotome, although no significant difference was observed. The piezotome group reported significantly (P≤0.05) higher visual analog scale (VAS) pain scores during the procedure and non-significantly higher scores thereafter until the third postoperative day. In the piezotome group, the dosage of analgesic was higher, although the periotome group had a higher percentage of participants who used analgesics postoperatively; however, these differences were not statistically significant. Conclusion: The present clinical trial favors the use of periotome over piezotome for atraumatic extraction due to shorter operating time, lower postoperative VAS pain scores, and lower dosage of analgesics despite the superior ability of the piezotome to prevent gingival laceration.

Role of Dentist: COVID19 and Mucormycosis.

Dental practice has evolved over time and has adapted to the challenges that it has faced. The risk of infection spread via droplet and airborne routes poses a significant risk to the dentist who works close to patients. The risk of cross-infection between dental health-care personnel and patients can be very high due to the peculiar arrangements of dental settings. Dental clinics should have air purification systems with high volume excavators and negative pressure rooms for COVID-19 screening. Mucormycosis is a fungal disease that mostly occurs in immunocompromised individuals and those with uncontrolled diabetes. Dental extraction can trigger the occurrence. Increased occurrence of mucormycosis is seen in COVID-affected patients. This article gives a review on the dentistry-related transmission of COVID 19, the relation of COVID and mucormycosis.

Quantum Interference-Controlled Conductance Enhancement in Stacked Graphene-like Dimers.

Stacking interactions are of significant importance in the fields of chemistry, biology, and material optoelectronics because they determine the efficiency of charge transfer between molecules and their quantum states. Previous studies have proven that when two monomers are π-stacked in series to form a dimer, the electrical conductance of the dimer is significantly lower than that of the monomer. Here, we present a strong opposite case that when two anthanthrene monomers are π-stacked to form a dimer in a scanning tunneling microscopic break junction, the conductance increases by as much as 25 in comparison with a monomer, which originates from a room-temperature quantum interference. Remarkably, both theory and experiment consistently reveal that this effect can be reversed by changing the connectivity of external electrodes to the monomer core. These results demonstrate that synthetic control of connectivity to molecular cores can be combined with stacking interactions between their π systems to modify and optimize charge transfer between molecules, opening up a wide variety of potential applications ranging from organic optoelectronics and photovoltaics to nanoelectronics and single-molecule electronics.

Emergency Medicine Personnel's Preparation, Performance and Perception of Their Night Shifts: A Cross-Sectional Study from Saudi Arabia.

PURPOSE: This study aimed to investigate the perceptions and habits of different emergency department (ED) workers (nurses, residents, and attending physicians) and their pre- or post-shift routines. The study also examined the effect of night shifts on personal life, social life, and health. PATIENTS AND METHODS: An anonymous, online, cross-sectional, multiple-choice, self-rating (5-point Likert scale) survey was administered to the participants. All analyses were performed using the SPSS version 22.0. Ethical approval was obtained from the Institutional Review Board (IRB) of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. RESULTS: Thirty-three nurses, 51 residents, and 39 attending physicians participated in the survey (response rates of 21%, 100%, and 100%, respectively). A significant difference was noted in the need to use physical sleeping aids between the three groups (P < 0.003), with more nurses using humidifiers as a sleeping aid (21.2%) than residents or attending physicians. However, there was no difference in the use of pharmacological aids between the three groups. All groups utilized coffee as the preferred stimulant, especially residents (76.5%, P <0.032). Nurses and attending physicians wake up 2 hours before their shift, while residents prefer 3 hours (P <0.001). Attending physicians reported the highest accident rates post-night shifts of 17.9% (P < 0.001). Residents reported satisfaction while working night shifts and were least in agreement with night shifts reducing life span. Attending physicians were more in agreement with the increasing risk of drug/alcohol misuse and the incidence of depression in relation to night shifts. CONCLUSION: Participants shared many commonalities, yet residents were less likely to use sleeping aids and enjoy night shifts more than the other groups. All groups consumed coffee for stimulation. Attending physicians reported the highest accident rates post night shifts.

Hydroquinone Decorated with Alkyne, Quaternary Ammonium, and Hydrophobic Motifs to Mitigate Corrosion of X-60 Mild Steel in 15†wt.% HCl.

1-(6-Bromohexyloxy)-4-propargyloxybenzene upon quaternization with 3-dimethylamino-1-propanol and N,N-dimethyldodecylamine produced two new inhibitor molecules: N-[6-(4-Propargyloxyphenoxy)hexyl]-N,N-dimethyl-N-(3-hydroxypropyl)ammonium bromide (PHAB) and N-[6-(4-Propargyloxyphenoxy)hexyl]-N,N-dimethyl-N-dodecylammonium bromide (PDAB), respectively, in excellent yields. The inhibitor molecules were characterized by elemental analysis, Fourier transform infrared spectroscopy, 1 H NMR, and 13 C NMR spectroscopy. The inhibitors were evaluated for X-60 mild steel corrosion in 15 wt.% HCl using different electrochemical and gravimetric techniques. The potentiodynamic polarization confirms both the inhibitors as mixed-type corrosion inhibitors. A low concentration (15 ppm) of PDAB has demonstrated excellent corrosion inhibition efficiencies of 97%, 98%, and 86% at 25 °C, 50 °C, and 70 °C, respectively, for 24 h exposure time. SEM and EDX spectra reveal that the adsorptions of corrosion inhibitors on X-60 mild steel create a protective film that serves as a barrier to mitigate the corrosion process. The X-ray photoelectron spectroscopy confirmed the chemical interaction between the corrosion inhibitors and mild steel, which was predicted by the Langmuir adsorption model. Assembly of inhibitive motifs of the alkyne, π-electron-rich aromatic, quaternary ammonium and C12 alkyl chain hydrophobe in PDAB has augmented its inhibiting action.

Diagnostic Reliability of Ultrasound Compared to Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography in the Detection of Obstructive Jaundice: A Retrospective Medical Records Review.

Background Challenges in the diagnosis of obstructive jaundice include locating the level of obstruction, knowing the cause of obstruction, and differentiating between benign and malignant causes. Imaging plays a significant role in detecting the causes of obstruction. Radiologists aim to diagnose biliary obstruction, its level, extent, and probable causes to determine the appropriate treatment for each case.  Methods Our study is a retrospective medical record review study. It included 150 patients who had ultrasound (US) diagnosis of biliary obstruction and underwent magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) in King Fahad Specialist Hospital, Buraidah. The patients' medical records have been reviewed to measure the sensitivity and specificity of US, MRCP, and ERCP.  Results Statistical analysis of the data showed that the sensitivity of US in detecting the most common cause of biliary obstruction, common bile duct (CBD) stone, was 26.6%, while the specificity was 100%. Comparing this sensitivity of US in detecting CBD stones to that of MRCP and ERCP, we obtained the following: US, 26.6%; MRCP, 62.9%; and ERCP, 62.4%. Although US was the least sensitive for detecting CBD stones, its specificity in this detection was 100%, while MRCP was 63.6%, and ERCP was 55.2%. Conclusion  US is the best initial step for the diagnosis of biliary obstruction. However, MRCP and ERCP are more sensitive in detecting CBD stones compared to US. Also, compared to US, they have shown higher percentages in all aspects of detection: level, cause, and extent of biliary obstruction.

Dasatinib-Induced Hypopigmentation in Pediatric Patient with Chronic Myeloid Leukemia: A Case Report and Review of the Literature.

Dasatinib is an oral second-generation multitarget tyrosine-kinase inhibitor (TKI) that is efficacious in treating imatinib-resistant chronic myeloid leukemia (CML) or intolerant cases. Noncutaneous adverse effects with dasatinib are well known in the literature, most commonly cytopenias and fluid retention, while pigmentary abnormalities have rarely been reported. We report the case of a 12-year-old male known case of CML, who presented to dermatology clinic approximately 2 years after initiating dasatinib treatment, with new-onset hypopigmentation of his upper limb, upper chest, and both knees of six months' duration.

Illumination-direction multiplexing Fourier ptychographic microscopy using hemispherical digital condensers.

Simulations were conducted to explore a broader collection of possible illumination patterns realizable using a white-light-emitting hemispherical digital condenser. Several simple, but practical, illumination patterns were selected and used in experiments where a sample was illuminated simultaneously from different directions. The illumination-direction multiplexing (IDM) Fourier ptychographic microscopy (FPM) method was successfully used for imaging and phase recovery. This study suggests that IDM-FPM can be used for imaging photonic crystals with subwavelength periods using traditional microscope condensers with variable numerical aperture.

Biotin-thiamine-responsive basal ganglia disease: catastrophic consequences of delay in diagnosis and treatment.

BACKGROUND: Biotin-thiamine-responsive basal ganglia disease (BTBGD) is an autosomal recessive neurometabolic disorder caused by mutations in the SLC19A3 gene. The disease is characterized by subacute encephalopathy with confusion, dysphagia, dysarthria, and seizures. METHODS: We diagnosed a family affected by BTBGD and studied them including prognosis of cases when diagnosed and treated early in the disease process. We also review the literature comprehensively and summarize all published data about this disorder. RESULTS: Since its first description, a total of 89 cases (46 females and 43 males) have been published in the literature. We studied six patients in this article in which three died before a diagnosis was established, one was diagnosed lately and is currently severely affected, and two were diagnosed early and are currently stable on treatment. The clinical phenotype of each family member was studied in details. In addition, a genetic testing was performed using whole exome sequencing and Sanger sequencing which demonstrated a previously reported homozygous mutation in exon 5 of the SLC19A3 gene c.1264A>G (p.Thr422Ala). CONCLUSION: BTBGD is a treatable condition if recognized early and managed appropriately. The recognition of this disorder is important to avoid incorrect diagnosis and mismanagement. Children presenting with unexplained encephalopathy and MRI abnormalities including bilateral signal alteration of caudate nucleus and putamen should raise the suspicion for BTBGD and be started immediately on biotin and thiamine regimen since the prognosis of the disease is affected by the timing of treatment initiation. We present a large family affected with this disorder with severe interfamilial variability and different prognosis despite having the same mutation and same environment. A clear genotype-phenotype correlation and the clinical heterogeneity remain to be elucidated. Bad prognostic factors observed in our review include early onset of the disease, missed or delayed diagnosis, systemic involvements including respiratory failure and rhabdomyolysis, and severe neurological deficit or radiological changes at the time of diagnosis and treatment initiation. We observed during our literature review that all patients who presented since birth died despite aggressive treatment. This observation may illustrate that early presentation and disease process leads to a more catastrophic outcome.

Preeclampsia: A Possible Complication of Primary Hyperparathyroidism.

Background. Primary hyperparathyroidism is rare in pregnancy. An association between primary hyperparathyroidism and preeclampsia has been reported in few cases worldwide. Case. A 28-year-old woman (gravida 2, para 0, and abortus 1) in her 27th week of gestation was hospitalized due to a high reading of blood pressure (194/115 mmHg) that was not accompanied by any symptoms or signs of preeclampsia. Incidentally, she was found to have a high adjusted calcium and serum parathyroid hormone (PTH) level during admission. Ultrasonographic examination of the neck revealed the presence of parathyroid adenoma. She was scheduled for surgical excision after receiving an intravenous hydration. Fetal ultrasonography revealed a growth restricted fetus with normal biophysical profile. On the sixth day of hospitalization, the patient complained of headache and epigastric pain, with elevated BP and proteinuria. The fetal nonstress test was "nonreassuring." Subsequently, she had an emergency cesarean delivery and surgical removal of the adenoma. The mother and her newborn were then transferred to intensive care, where their clinical course was unremarkable. The mother was discharged after 3 days, while the neonate stayed for close observation for 60 days. Conclusion. Early recognition of primary hyperparathyroidism among women with preeclampsia is important to prevent maternal and fetal morbidity and mortality.

Animal models of spontaneous intracerebral hemorrhage.

OBJECTIVES: Intracerebral hemorrhage (ICH) is a type of stroke that results in significant mortality and morbidity. Currently there is no definitive treatment for this disease. The paucity of animal models that reflect the heterogeneity of this spontaneous human disease could be the reason. METHODS: In this review, we searched the literature for animal models of spontaneous ICH and found eight relevant papers. RESULTS: Two were related to hypertension and six were related to cerebral amyloid angiopathy (CAA). One model used double transgenic mice overexpressing human renin and angiotensinogen which caused the mice to be hypertensive. Induction of ICH, however required addition of a high salt diet and nitric oxide synthase inhibition. Another mouse model of hypertension employed subcutaneous angiotensin II infusion and nitric oxide synthase inhibition plus acute injections of angiotensin to further elevate blood pressure. Five CAA models were in transgenic mice overexpressing amyloid precursor protein. One relied on the natural development of CAA in squirrel monkeys. CONCLUSIONS: While all of the spontaneous ICH models have some advantages, the disadvantages include the sporadic time of onset of ICH and variability in size and location of ICH. Since there are no known efficacious treatments for ICH, it is not known if findings in the animal models will find treatments that are effective in humans.