25-Hydroxyvitamin-D deficiency in chronic kidney disease stages III, IV, and V in South Asian population: a retrospective cohort.

Objective: Vitamin D deficiency in Chronic Kidney Disease is a known fact, but the data regarding the prevalence and extent of vitamin D deficiency in different stages of Chronic Kidney Disease is scarce. This leads to a delay in addressing this issue. We conducted this study to assess vitamin-D deficiency in different stages of Chronic Kidney Disease to improve the evidence available to Physicians and Nephrologists which can help them better address this common finding in Chronic Kidney Disease. Methods: This retrospective study from a tertiary care hospital in Karachi, Pakistan, included adult Chronic Kidney Disease patients who had their serum 25 Hydroxy vitamin D levels done. The patients were classified according to stages of Chronic Kidney Disease using Estimated Glomerular Filtration Rate values. Appropriate statistical tests were performed to find a correlation between the severity of vitamin D deficiency in different stages of Chronic Kidney Disease with a statistically significant p value of <0.05 and a 95% confidence interval. Results: In total, 148 patients were included in the study. All patients had serum 25 Hydroxy vitamin D levels less than 30 ng/ml. The severity of vitamin D deficiency was observed to increase progressively from stage 3A Chronic Kidney Disease through stage 5. Vitamin D levels in Chronic Kidney Disease stage 3 were significantly greater than in Chronic Kidney Disease stages 4 and 5 (p value < 0.001), and stage 5 patients had the lowest vitamin D levels in our study. Similar, statistically significant findings were observed for serum phosphate levels, too, with stage 5 Chronic Kidney Disease patients having a greater serum phosphate concentration than stages 3A and 3B (p value = 0.002, 0.006). Conclusion: All Chronic Kidney Disease patients in our study either had vitamin D insufficiency or deficiency. In addition, we observed a significant decrease in vitamin D levels from Chronic Kidney Disease stage 3 to stage 5. Greater serum phosphate levels were detected in stage 5 compared to stages 3A and 3B.

Angiotensin converting enzyme inhibitor associated spontaneous herniation of liver mimicking a pleural mass: A case report.

BACKGROUND: Spontaneous diaphragmatic herniation of the liver is a rare entity. It may mimic pulmonary mass especially in the absence of trauma. Cough is a common side effect of angiotensin converting enzyme (ACE) inhibitors that may cause diaphragmatic rupture due to a sudden increase in trans-diaphragmatic pressure. We present a case of ACE-inhibitor associated spontaneous herniation of the liver mimicking pleural mass. CASE SUMMARY: An 80-year-old woman presented with dry cough for 1 mo and sudden onset of cramping abdominal pain for 1 d. She denied history of trauma, prior surgeries, smoking, alcohol or illicit drug use. She has a history of diabetes and was started on an ACE inhibitor 6 mo ago for the management of hypertension. Examination was remarkable for right upper quadrant tenderness. Lab work-up was unremarkable. Chest X-ray showed a right lower lung opacity suspecting right pleural mass. Chest computed tomography scan ruled out pleural mass, however, revealed herniated right lobe of the liver (3.9 cm × 3.6 cm × 3.4 cm) into the thoracic cavity through the posterolateral diaphragmatic defect. Laparoscopic repair of the diaphragmatic defect was performed and the ACE inhibitor was stopped. Patients' symptoms had completely resolved on follow-up. CONCLUSION: ACE inhibitor-associated cough may cause diaphragmatic liver herniation mimicking pleural mass. Early diagnosis, surgical repair and addressing the triggering factors improve patients' outcomes.

Ocular manifestations in a patient with Dandy-Walker malformation: A case report.

We present a unique case of a ten-month-old boy with a protruding left globe and vitreous haemorrhaging, and later being diagnosed as a case of a dandy-walker syndrome (DWS) with buphthalmos and vitreous haemorrhage. Treatment is depending on the symptoms reported, thus close monitoring and a multidisciplinary approach are essential. We would like to recommend that even if there are no cardinal symptoms of DWS, paediatric patients with ocular signs should have Dandy walker Malformation (DWM) considered as a differential diagnosis.

Incidental Finding of Right-Sided Idiopathic Spontaneous Acquired Diaphragmatic Hernia.

Spontaneous acquired diaphragmatic hernia is a rare finding which occurs in the absence of any trauma or surgery. Here, we present the case of an 83-year-old male who presented to the outpatient department complaining of nausea, vomiting, epigastric pain and sensation of fullness, loss of appetite, and occasional episodes of constipation, with no history of trauma or surgery. Clinical examination revealed no specific cause. A clinical diagnosis of cholelithiasis was initially suspected and confirmed by an ultrasound of the abdomen. However, considering the worsening of symptoms, a computed tomography scan revealed an incidental right-sided spontaneous diaphragmatic hernia. A subsequent laparoscopic surgery for cholecystectomy and the correction of the right-sided defect in the diaphragm was performed. spontaneous acquired diaphragmatic hernia occurring secondary to a defect on the right side of the diaphragm without any history of trauma or surgery is an extraordinary and infrequent radiological finding. Considering the challenging clinical diagnosis of such hernias, clinicians should be vigilant when patients exhibit worsening symptoms of nausea, vomiting, and gastrointestinal obstruction with or without respiratory and cardiac complications. The surgical management of such hernias is effective and secure and usually requires either an abdominal or thoracic approach and a combination of both accesses in some cases.

Telesurgery and Robotics: An Improved and Efficient Era.

Telesurgery, or remote surgery, is widely known as a master-slave technology. It has achieved a milestone in surgical technology and intervention, providing widespread prospects of operating on a patient in a remote area with increased accuracy and precision. It consists of one or more arms controlled by a surgeon and a master controller in a remote area accessing all the information being transferred via a telecommunication system. This paper reviews the present advancements and their benefits and limitations in the field of telesurgery. A handful of operations have been done so far. However, due to time-lag (latency), global networking problems, legal issues and skepticism, and on top of the cost of robotic systems and their affordability have led to the concept of telerobotics and surgery to lag. However, with more information and high speed, 5G networking, which has been in a trial to reduce latency to its minimum, is beneficial. Haptic feedback technology in telesurgery and robotics is another achievement that can be improved; further, this allows the robotic arms to mimic the natural hand movements of the surgeon in the control center so that the master controller can perform surgeries with more dexterity and acuity. Due to coronavirus (COVID-19), this type of surgery approach can reduce the probability of contracting the virus, saving more lives and the future.

Zinc Micronutrient Deficiency and Its Prevalence in Malnourished Pediatric Children as Compared to Well-Nourished Children: A Nutritional Emergency.

Pediatric populations from lower-income countries may experience a higher incidence of zinc deficiency, which may cause physical and neurological dysfunctions. This case control study aims to assess different levels of zinc between malnourished and well-nourished children. Our study included 108 participants, all children less than 12 years of age. Out of the 108, 54 were malnourished children (cases), while 54 were well nourished (control group) and were screened for zinc deficiencies. Zinc deficiencies were 4 times more common in malnourished cases than in controls (OR: 3.89 95% CI: 1.1-14.9) with median value of zinc in cases being 91.69 and that of controls was 117.6. Our findings indicate significant deficiencies in malnourished children as compared to well-nourished children. Additionally, our findings support literature surveyed that suggest dietary changes alone would not be able to replenish zinc levels in children.

Trends and Treatment of Sub-Acute Sclerosing Panencephalitis: An Updated Review.

Measles infection, caused by the "Rubeola" virus is a highly contagious disease with outrageously fatal consequences. Initiating with a variety of symptoms including fever, cough, conjunctivitis, and runny nose, it can lead to more severe sequelae including sub-acute sclerosing pan-encephalitis which is a potentially fatal and serious complication of measles. The lackluster vaccination processes in underdeveloped areas of the world due to suboptimal immunization programs, scarce resources, and insufficient political constancy still leads to increased cases of measles and its complications. A variety of management programs including the use of several medications have been introduced according to the literature in order to counter this dreadful disease. In this review article, we focus on assessment of the previous literature and discussing the possible treatment modalities of this currently irremediable disease.

Antiviral and antiretroviral drug shortages amidst COVID-19: How Africa is struggling.

Antiviral drugs are of paramount importance in the accomplishment of the vision of zero new cases of COVID-19 globally, through sustainable retaliation against viral diseases. However, several challenges currently exist in Africa which include insufficient infrastructure, deteriorating health systems, and rising costs of healthcare delivery with concomitant rising inequity with regards to access to health services amid the COVID-19 pandemic. The pandemic itself has stimulated an increased use of phytotherapy in Africa as a result of essential drug shortages that have been attributed to a plethora of contributing factors such as travel restrictions, reduced per capita income as well as increased expenditure on transport. As a result, the paucity of antiviral along with antiretroviral drugs used to combat COVID-19 as well as several other endemic viral diseases in Africa has created a worrisome state. This article therefore discusses and aims to underscore the causes, effects, and implications of antiviral and antiretroviral shortages amid COVID-19 in Africa.

Evaluating Association of Maternal Nutritional Status With Neonatal Birth Weight in Term Pregnancies: A Cross-Sectional Study With Unexpected Outcomes.

Introduction Birth weight is described as the primary determinant of the chances of survival among newborns. Low birth weight (LBW) is considered to be a major public health issue, especially among developing countries where poor maternal nutritional status is identified as a cause of both long and short-term adverse consequences. In developing countries, the majority of the LBW infants are born at term but are affected by intrauterine growth restriction, which might have begun early in the pregnancy period. We conducted this study in order to determine the possible effects of the poor nutritional status of mothers on the birth weight of their newborns. However, in disparity to the previous literature, our study evaluated unpredictable results. Methods This is a cross-sectional study that was conducted at two tertiary care teaching hospitals from November 2020 to April 2021 in order to determine the possible effects of the poor nutritional status of mothers on the birth weight of their newborns. 156 women both primigravida and multigravida of ages between 15 and 50 years and those who delivered low birth weight (LBW) babies of either gender at term (37-40 weeks of gestation) were included. For all mothers who delivered LBW (<2500 g) at term, their mid-upper arm circumference (MUAC) was measured by inelastic tape. Mothers with MUAC less than 21 cm were considered malnourished. Results A total of 156 study participants were included in the study, with majority (n=112, %=71.8%) of them between the ages of 20 and 30 years. The mean age of all included participants was calculated to be 25.96±4.54 years (ranging from 18 to 38 years). Prevalence of maternal malnutrition was observed in 41 (26.3%) of the included women who delivered LBW babies, in contrast to high prevalence rates in previous literature. Conclusions In contrast to the previous literature, our study has shown that the nutritional status of mothers has no significant impact on the weight of neonates and the majority of neonates in our study were not severely low weight.

Treating Mooren's Ulcer - Squeezing Water From a Stone.

Mooren's ulcer, a rare ophthalmic disease, presents clinically as a painful, chronic, peripheral corneal ulceration of unknown etiology with some autoimmune origin evidence. It begins with an intense limbal inflammation, leaving behind an opaque cornea. If left untreated, progressive damage and corneal degeneration can lead to permanent loss of vision. Herein, we present a classic case of Mooren's ulcer in the right eye of a 60-year-old male patient with no known comorbid condition. No underlying systemic disorder being the rarity in our case, the cause remains idiopathic. The patient was previously diagnosed with having Mooren's ulcer in his left eye 10 years ago. Despite multiple topical treatments and surgical interventions, there was a complete loss of vision. He presented exaggerated manifestations, including pain, redeye, watery eye, photophobia, and the progressive decline of vision. A combination of multiple pharmacological and surgical interventions, including lateral tarsorrhaphy, amniotic membrane grafting, conjunctival flap, and scleral patch graft, was tried to ameliorate the affected eye but failed to salvage the eye permanently.