Pituitary Macroadenoma: A Comprehensive Case Study of Surgical Intervention and Postoperative Management.

This case report presents a comprehensive analysis of a 48-year-old woman diagnosed with pituitary macroadenoma, detailing the clinical presentation, surgical intervention, and postoperative management. The patient exhibited a complex array of symptoms, including persistent headaches, insomnia, and anemia, with a history of trauma and blood transfusion. Magnetic Resonance Imaging (MRI) confirmed the presence of a large, lobulated pituitary macroadenoma, prompting a trans-nasal trans-sphenoidal endoscopic excision. The surgical procedure was successful, but postoperative complications, revealed by a CT scan, included hyperdense lesions and mixed-density collections. Incorporating antibiotics, analgesics, antacids, and anti-emetics, vigilant postoperative care addressed these complications. This case underscores the challenges and successes in managing pituitary macroadenomas, highlighting the importance of individualized care, multidisciplinary collaboration, and ongoing research for optimizing patient outcomes. The insights gained from this case contribute to the evolving understanding and refinement of strategies for addressing these complex tumors.

A rare case of heme oxygenase deficiency: A case report and literature review.

Heme oxygenase deficiency, a rare condition disrupting heme metabolism, has only nine reported cases. We present a 3-year-old boy with dysmorphic facies, asplenia, and normal bilirubin levels despite ongoing hemolysis. Blood transfusions sustained hemoglobin while IV steroids managed inflammation.

Effectiveness of statins in people living with HIV: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: People living with HIV (PLWH) receiving statin therapy have shown improved lipid profiles. However, they are not free from side effects, thereby requiring strict monitoring of the therapy. The meta-analysis aims to analyze the effect of statins in PLWH and critically appraise the effectiveness of statin therapy in PLWH. METHODS: PubMed, Scopus, and Web of Science servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The meta-analysis of pooled effect estimates is produced using Revman software. RESULTS: A total of 12 RCTs with 8716 participants were included in the analysis. Analysis of the overall effect estimates found that statins resulted in a mean reduction of 41.15 mg/dl (MD = -41.15; 95% CI: -44.19, -38.11; p < 0.00001), 34.99 mg/dl (MD = -34.99; 95% CI: -34.99; 95% CI: -41.16, -28.82; p < 0.00001), and 7.36 mg/dl (MD = -7.36; 95% CI = -48.35, -33.62; p < 0.00001) in total cholesterol, low-density lipoprotein, and triglyceride levels, respectively. It is revealed that statins are associated with a significant increase in the discontinuation rate of treatment compared to placebo treatment (RR: 1.90; 95% CI: 1.36-2.65; p = 0.0002). CONCLUSION: When considered collectively, statin therapy's advantages appear to exceed its occasional predictable side effects like liver or muscle toxicity. REGISTRATION: PROSPERO registration ID: CRD42023469521.

Safety of Proton Pump Inhibitors in Pediatric Population: A Systematic Review.

Objective. Commonly recommended drugs for adults and children include proton pump inhibitors (PPIs), proven effective for treating peptic diseases like stomach ulcers, GERD, and Helicobacter pylori infections in children over 1-year-old. Yet, prolonged PPI use carries higher risks of adverse reactions, prompting this study's analysis. Methods. We have performed a systematic review of 30 articles, which include a total of 762 505 pediatric patients. Results. Adverse effects were encountered in 6.98% of the population. The 5 most common adverse effects were respiratory tract complications, gastrointestinal complications, urinary tract infections, asthma, and ENT infections. Conclusion. Hence, PPIs should be prescribed only when necessary, and physicians should prioritize patient education when considering their use.

Nalbuphine's Hemodynamic Impact in Ear, Nose, and Throat (ENT) Surgeries: A Comprehensive Review.

Nalbuphine, a semi-synthetic opioid, has gained attention for its analgesic properties, but its specific impact on hemodynamics in ear, nose, and throat (ENT) surgeries remains a subject of exploration. This comprehensive review aims to systematically analyze existing literature to understand the nuanced hemodynamic effects of nalbuphine during ENT procedures. Nalbuphine demonstrates promise as an analgesic agent in ENT surgeries with generally stable hemodynamic profiles. However, the variability in study designs and outcomes necessitates a cautious interpretation. The review underscores the need for standardized protocols and further research to elucidate patient-specific considerations, ensuring optimal utilization of nalbuphine in enhancing overall perioperative care for ENT patients.

Pseudotumor - Cysticercosis of the Flexor Digitorum Profundus Mimicking Volkmanns Contracture.

Introduction: Cysticercosis leads to a cyst formation known to occur due to the Taenia solium parasite. Patients normally present with seeding and formation of the cysts in the central nervous system (CNS) as neurocysticercosis (NCC). Intramuscular cysts are rare presentations and are mostly incidental findings in NCC patients. We present a rare case of a rapidly progressing isolated cysticercosis of the flexor digitorum profundus (FDP) muscle leading to a pseudotumor and presenting with pseudo-Volkmanns contracture and a positive Volkmanns sign. Case Report: A 26-year-old right-hand dominant vegetarian female presented with a 3-month-old progressive swelling on her right forearm with no antecedent trauma history. A positive Volkmann's sign was present. Radiographs were normal, and ultrasonography showed a cysticercus cyst in the FDP muscle belly with a multiseptated abscess around the tendons of the middle, ring, and little fingers at the musculotendinous junction. Bones and nerves were spared. After ruling out CNS involvement and providing oral antiparasitic cover, she underwent a successful surgical exploration with cyst excision, debridement, and freeing of the involved tendons. Immediately post-operatively, she was able to completely extend the three involved fingers without flexion at the wrist joint (resolving Volkmann's sign). She reported significant improvements in the functions of daily life. She was protected with a splint for 2 weeks. There was no recurrence, and the swelling subsided. Histo-pathology reports depicted cysts with visible scolices. Conclusion: It is important to consider the possibility of 'Myoparasitism' in atraumatic cases showing contractures. Clinching the right diagnosis is essential and best done with a multidisciplinary approach with ultrasonography, magnetic resonance imaging, electromyography, and nerve conduction velocity studies. It is essential to rule out life-threatening NCC beforehand and offer prophylaxis. Surgical exploration is generally indicated to regain normal function and free the involved structures.

Using Artificial Intelligence to Stratify Normal versus Abnormal Chest X-rays: External Validation of a Deep Learning Algorithm at East Kent Hospitals University NHS Foundation Trust.

Background: The chest radiograph (CXR) is the most frequently performed radiological examination worldwide. The increasing volume of CXRs performed in hospitals causes reporting backlogs and increased waiting times for patients, potentially compromising timely clinical intervention and patient safety. Implementing computer-aided detection (CAD) artificial intelligence (AI) algorithms capable of accurate and rapid CXR reporting could help address such limitations. A novel use for AI reporting is the classification of CXRs as 'abnormal' or 'normal'. This classification could help optimize resource allocation and aid radiologists in managing their time efficiently. Methods: qXR is a CE-marked computer-aided detection (CAD) software trained on over 4.4 million CXRs. In this retrospective cross-sectional pre-deployment study, we evaluated the performance of qXR in stratifying normal and abnormal CXRs. We analyzed 1040 CXRs from various referral sources, including general practices (GP), Accident and Emergency (A&E) departments, and inpatient (IP) and outpatient (OP) settings at East Kent Hospitals University NHS Foundation Trust. The ground truth for the CXRs was established by assessing the agreement between two senior radiologists. Results: The CAD software had a sensitivity of 99.7% and a specificity of 67.4%. The sub-group analysis showed no statistically significant difference in performance across healthcare settings, age, gender, and X-ray manufacturer. Conclusions: The study showed that qXR can accurately stratify CXRs as normal versus abnormal, potentially reducing reporting backlogs and resulting in early patient intervention, which may result in better patient outcomes.

The mortality, modes of infection, diagnostic tests, and treatments of Marburg virus disease: A systematic review.

Background and Aims: Marburg virus (MARV) has regularly affected people since 1967 causing multiple outbreaks. There are presently no authorized therapies for the fatal Marburg virus disease (MVD), which poses an imminent risk to global public health. The MVD has so far claimed the lives of numerous people, with an increased number of cases being seen throughout the African continent. Hence, a review was carried out to analyze the geographical distribution of MVD, mortality, routes of transmission, and diagnostic and treatment modalities. Methods: PubMed, Scopus, Web of Science, Google Scholar, and ProMED servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed. Results: A total of 11 studies (7 case reports and 4 case series) were included in the final analysis, and 21 cases of MVD were analyzed. The most frequent symptoms were fever (66.67%), vomiting (57.14%), headache (52.38%), diarrhea (52.38%), and pain (47.62%). The most commonly used diagnostic test was RT-PCR (42.11%). Contact transmission (50%) and zoonotic transmission (37.5%) were the most prevalent routes of transmission. Antibiotics (61.5%) were the first line of treatment. The most common complications were hemorrhage (60%) and coagulopathies (33.3%). The mortality rate was 57.1%. Conclusion: To avoid disastrous consequences, it is essential to reiterate the necessity of early diagnosis and treatment of MVD.

Quality assessment of polymer materials for human model eye development.

PURPOSE: We developed model eyes using six polymer materials to determine which materials were most appropriate in simulating real human sclera and extraocular muscle (EOM). METHODS: Five three-dimensional (3-D) printed polymers (FlexFill, PolyFlex, PCTPE, Soft PLA, and NinjaFlex) and one silicone material were systematically tested by board-certified ophthalmologists and senior ophthalmology residents. Material testing included scleral passes with 6-0 Vicryl sutures through each eye model. Participants completed a survey designed to collect demographic data, subjective assessment of each material's accuracy in simulating real human sclera and EOM, and a ranking for each polymer material to identify which would be most suitable for an ophthalmic surgery training tool. The Wilcoxon signed-rank test was conducted to determine if there was a statistically significant difference in the distribution of ranks between the polymer materials. RESULTS: The distribution of ranks for silicone material's "sclera" and "EOM" components were statistically significantly higher than that of all other polymer materials (all p < 0.05). Silicone material received the highest rank for both "sclera" and "EOM" components. Survey results indicated that the silicone material effectively simulated real human tissue. CONCLUSION: Silicone model eyes performed better than 3-D printed polymers as an educational tool for incorporation into a microsurgical training curriculum. Silicone models provide a low-cost teaching tool that allows for independent practice of microsurgical techniques without requiring a wet-laboratory facility.

Does Intra-operative Fluoroscopy Significantly Improve Component Position in a Primary Total Hip Arthroplasty? Our Experience in a Tertiary Care Hospital.

Background: Optimal component placement, equalization of leg lengths, and recreation of offset are important surgical objectives during total hip arthroplasty (THA). Historically, many surgeons have aimed for the Lewinnek's " safe zone," which is defined as 30°-50° of abduction and 5°-25° of anteversion. Methods for optimizing cup position include anatomic landmarks, room landmarks, acetabular cup coverage, and ischial or pubis palpation. Malposition of the acetabular component after total hip arthroplasty (THA) is related to dislocation of the prosthetic femoral head, increased polyethylene liner wear, and limited range of motion. The orientation of the acetabular component comprises inclination and anteversion. Although the inclination of the acetabular component can be easily measured on plain radiographs, the calculation of the anteversion is difficult. This study evaluates the effect of intra-operative fluoroscopy on component position, mainly anteversion and inclination of the acetabular cup, during a total hip arthroplasty. Methods: 106 hips undergoing total hip arthroplasty were assessed, and the decision to use fluoroscopy assistance was randomized based on a simple randomization technique. A total of 48 patients were operated on with fluoroscopy assistance and 58 patients without fluoroscopy assistance. All patients were evaluated postoperatively for version of component on anteroposterior radiographs of the hip using the method of Liaw et al. and for inclination of component on anteroposterior radiographs using the method of Woo and Morrey. Results: The mean version for the non-fluoroscopy (NF) group was 15.62° and the mean inclination was 44.22°, with 15.5% (9 out of 58) of the patients who did not fit into Lewinnek's safe zone for version and 25.9% (15 out of 58) of the patients who were outliers for inclination of the acetabular cup position. The mean version for the fluoroscopy group (F) was 11.80° and the mean inclination was 47.05°, with 0% (0 out of 48) of the patients who did not fit into Lewinnek's safe zone for version and 12.5% (6 out of 48) of the patients who were outliers for inclination of the acetabular cup position. Conclusion: While the mean version and inclination of the acetabular component were comparable for both groups, outliers for version and inclination were far more common in the group of patients who underwent surgery without intra-operative fluoroscopic assistance. Therefore, intra-operative fluoroscopy imaging confirms appropriate inclination (abduction) and version of acetabular cup position according to Lewinnek's safe zone and prevents undesirable component position during a total hip arthroplasty while adding a maximum of 5 min to the operative time.

Learning robotic navigation from experience: principles, methods and recent results.

Navigation is one of the most heavily studied problems in robotics and is conventionally approached as a geometric mapping and planning problem. However, real-world navigation presents a complex set of physical challenges that defies simple geometric abstractions. Machine learning offers a promising way to go beyond geometry and conventional planning, allowing for navigational systems that make decisions based on actual prior experience. Such systems can reason about traversability in ways that go beyond geometry, accounting for the physical outcomes of their actions and exploiting patterns in real-world environments. They can also improve as more data is collected, potentially providing a powerful network effect. In this article, we present a general toolkit for experiential learning of robotic navigation skills that unifies several recent approaches, describe the underlying design principles, summarize experimental results from several of our recent papers, and discuss open problems and directions for future work. This article is part of the theme issue 'New approaches to 3D vision'.

Altered subgenomic RNA abundance provides unique insight into SARS-CoV-2 B.1.1.7/Alpha variant infections.

B.1.1.7 lineage SARS-CoV-2 is more transmissible, leads to greater clinical severity, and results in modest reductions in antibody neutralization. Subgenomic RNA (sgRNA) is produced by discontinuous transcription of the SARS-CoV-2 genome. Applying our tool (periscope) to ARTIC Network Oxford Nanopore Technologies genomic sequencing data from 4400 SARS-CoV-2 positive clinical samples, we show that normalised sgRNA is significantly increased in B.1.1.7 (alpha) infections (n = 879). This increase is seen over the previous dominant lineage in the UK, B.1.177 (n = 943), which is independent of genomic reads, E cycle threshold and days since symptom onset at sampling. A noncanonical sgRNA which could represent ORF9b is found in 98.4% of B.1.1.7 SARS-CoV-2 infections compared with only 13.8% of other lineages, with a 16-fold increase in median sgRNA abundance. We demonstrate that ORF9b protein levels are increased 6-fold in B.1.1.7 compared to a B lineage virus in vitro. We hypothesise that increased ORF9b in B.1.1.7 is a direct consequence of a triple nucleotide mutation in nucleocapsid (28280:GAT > CAT, D3L) creating a transcription regulatory-like sequence complementary to a region 3' of the genomic leader. These findings provide a unique insight into the biology of B.1.1.7 and support monitoring of sgRNA profiles to evaluate emerging potential variants of concern.

The Impact of Neocolonialism on India's COVID-19 Response.

In this paper, we analyze the impact of COVID-19 in India and the nation's shortcomings in responding appropriately to the pandemic. We discuss how international vaccine inequities, rooted in neocolonialism, and the WHO's broad recommendation of Global North pandemic responses (i.e., lockdowns, nonspecific social distancing) blunted the effectiveness of India's COVID-19 response and instead heightened classism, economic turmoil, and unnecessary infection and death from the virus.

Flow-Through Atmospheric Pressure-Atomic Layer Deposition Reactor for Thin-Film Deposition in Capillary Columns.

We demonstrate the development of a new atmospheric pressure-atomic layer deposition(AP-ALD) system to coat the inner walls of capillary columns for gas chromatography (GC). Unlike traditional ALD, this reactor operates at near-atmospheric pressure and addresses the challenges of depositing thin films inside capillaries, which include long pump down times, deposition in high-aspect-ratio materials, and temperature control. We show ALD of alumina in 5 and 12 m capillaries (0.53 mm ID) via sequential half reactions of trimethylaluminum and water. Our system yields pinhole-free, uniform thin films. It includes small witness chambers for witness silicon shards before and after the capillary. An engineering flow/transport analysis of the device is provided. Our ALD alumina thin films are characterized by spectroscopic ellipsometry (SE), X-ray photoelectron spectroscopy, transmission electron microscopy (TEM), and energy-dispersive X-ray spectroscopy. Alumina film growth achieved is 1.4-1.5 Å/cycle, which is consistent with previously reported results. Film thickness measurements by SE on witness shards of silicon and by TEM at both ends of the capillary are in good agreement. A capillary column coated with alumina is used to separate different gases by GC, although the retention times of gases are essentially the same as with an untreated fused silica capillary. This successful deposition of ALD alumina in long capillaries opens the door for other possible ALD coatings, including hybrid organic-inorganic coatings, using the 450+ ALD precursors available today.

Characterising within-hospitalSARS-CoV-2 transmission events using epidemiological and viral genomic data across two pandemic waves.

Hospital outbreaks of COVID19 result in considerable mortality and disruption to healthcare services and yet little is known about transmission within this setting. We characterise within hospital transmission by combining viral genomic and epidemiological data using Bayesian modelling amongst 2181 patients and healthcare workers from a large UK NHS Trust. Transmission events were compared between Wave 1 (1st March to 25th J'uly 2020) and Wave 2 (30th November 2020 to 24th January 2021). We show that staff-to-staff transmissions reduced from 31.6% to 12.9% of all infections. Patient-to-patient transmissions increased from 27.1% to 52.1%. 40%-50% of hospital-onset patient cases resulted in onward transmission compared to 4% of community-acquired cases. Control measures introduced during the pandemic likely reduced transmissions between healthcare workers but were insufficient to prevent increasing numbers of patient-to-patient transmissions. As hospital-acquired cases drive most onward transmission, earlier identification of nosocomial cases will be required to break hospital transmission chains.

Surgical Repair of Traumatic Rupture of Tibialis Posterior Tendon in 32-Year-Old Male.

Introduction: This article reports a case of surgical repair of traumatic rupture of tibialis posterior (TP) tendon in a young healthy male after alleged history of grinder (heavy machine) injury over the foot, with the help of a suture anchor and running whip stitch followed by immobilization in a below knee slab postoperatively. The acute rupture of the TP tendon (TPT), compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. Case Report: A 32-year-old healthy male presented to the outpatient clinic with a history of pain and swelling in the right foot for 10 months after alleged history of sustaining a grinder (heavy machine) injury to the medial aspect of the right foot 10 months ago. Anteroposterior and oblique radiographs of the right foot suggestive of no skeletal pathology and patient was managed conservatively with analgesic, anti-inflammatory, and compression bandaging. A magnetic resource imaging of the right foot was advised after no relief of symptoms and was suggestive of high-grade tear of the distal tibialis posterior tendon from the level of medial malleolus to its insertion. Surgical repair of the TPT was planned with a suture anchor placed in the navicular bone. The procedure was carried out under spinal anesthesia and there were no complications in the intraoperative or post-operative period. Patient was given a below knee slab with the foot in inversion postoperatively which was revised into a below knee cast with foot in inversion. Six-week post-operative follow-up, cast was removed and physiotherapy was started for the patient that included Active Ankle ROM and Gait Training, patient had a Modified Olerud and Molander Score of 45/100. Six-month post-operative follow-up, patient was relieved of chronic pain and was able walk and stand on his toes without pain and showed significant improvement in gait with Modified Olerud and Molander Score 90/100. Conclusion: The TPT is the main dynamic stabilizer of the medial longitudinal arch of the foot. With appropriate surgical technique, adequate post-operative immobilization followed by physiotherapy surgical repair of the TPT helped alleviate the chronic pain experienced by the patient during weight bearing activities.

Comparison of demographic, clinical, spirometry, and radiological parameters between smoking and non-smoking COPD patients in rural Gujarat, India.

CONTEXT: A total of 20% of Chronic Obstructive Pulmonary Disease(COPD) patients are non-smokers due to preventable causes, such as biomass fuel exposure, post tuberculous sequelae, occupational exposure, air pollution, persistent chronic asthma, and genetic predisposition. AIMS: To compare smokers and non-smokers with COPD. SETTINGS AND DESIGN: An observational study was conducted at a tertiary care hospital on 60 patients diagnosed with COPD, (GOLD criteria), who were divided into smoker and non-smoker groups. SUBJECTS AND METHODS: Demographic data, clinical profile, smoking history, and radiological data were collected and compared. Exclusion criteria were individuals having active pulmonary tuberculosis and reversible air flow limitations. STATISTICAL ANALYSIS USED: Using STATA 14.2, quantitative and qualitative data were presented using descriptive statistics. RESULTS: A total of 100% of smokers were male, whereas 70% of non-smokers were female. Compared to non-smokers (16.67%), smokers (26.6%) presented with higher grade of dyspnea. A statistically significant difference was seen with more smokers diagnosed as severe (40%) and very severe (30%) COPD compared to non-smokers with mild (16.67%) and moderate (46.67%) COPD (P < 0.012), Post bronchodilator FEV1 among smokers (42.63) compared to non-smokers (56.63) (P < 0.01) and decrease in FEV1 as the grade of dyspnea increased (P < 0.002). Compared to 36.67% in non-smokers, 70% smokers showed emphysematous x-rays. CONCLUSIONS: In our study we found majority of non-smokers to be female, and smokers had a higher grade of dyspnea, more severe COPD, lower post bronchodilator FEV1, and more emphysematous changes on x-rays.

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells.

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity.