Successfully managed alcoholic ketoacidosis with sepsis leading to multiple organ dysfunction syndrome: a case report.

We present the case of a 28-year-old male with a history of alcohol dependency and smoking, who presented with chest pain, shortness of breath, and altered sensorium. He exhibited severe metabolic acidosis, hypoglycemia, low platelet count, and acute kidney injury. Alcoholic ketoacidosis was suspected due to ketonuria, metabolic acidosis, and ketonemia, compounded by electrolyte abnormalities and radiographic findings of pneumonia.

Asymmetric Synthesis of Benzofuranones with a C3 Quaternary Center via an Addition/Cyclization Cascade Using Noncovalent N-Heterocyclic Carbene Catalysis.

An asymmetric addition/cyclization cascade of amidoesters and iminoquinones is developed using noncovalent N-heterocyclic carbene (NHC) catalysis. The process enables access to various functionalized benzofuranones with an all-carbon quaternary stereocenter with high yields and ee values. The reaction displays a broad substrate scope. Via product modifications, enantioenriched synthesis of biologically relevant spirocyclic lactones and lactams is achieved. Substrate activation via noncovalent interaction with NHC is suggested for the process.

Surgical Morbidity of Laparoscopic Hysterectomy versus Abdominal Hysterectomy: A Retrospective Overview.

Objectives: Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. The need for reliable training and its assessment is becoming increasingly important with the course of time. Materials and Methods: A retrospective comparative study was done in a tertiary care center where all patients undergoing hysterectomy by laparoscopic and abdominal route were included in the study. Objectives: Our study aims to compare the operative and postoperative complications of laparoscopic hysterectomy with abdominal hysterectomy. The study was conducted from June 2016 to October 2022. Results: The mean operative time for uteri size lesser than 12 weeks was found significant in the total laparoscopic hysterectomy (TLH) group (75 ± 25 min) to total abdominal hysterectomy (TAH) (117 ± 28 min, P < 0.001). The mean blood loss in the TLH group was significant (110 ± 30 ml vs. 160 ± 116 ml, P < 0.002). The mean hospital stay was significantly shorter in TLH (4 ± 2.4 days vs. 7 ± 2.41 days, P < 0.002). The operative and postoperative complications observed were 3.1% in the TLH group and 11.7% in the TAH group. Conclusion: TLH when performed efficiently has proved to be a preferable route over other conventional hysterectomies.

A Case Report on Endometriosis: "A Tip of Iceberg" Disease Identified and Managed Better With Imaging.

Endometriosis has been more common in recent decades as a result of improved diagnosis supported by enhanced clinical concepts and greater imaging tools. A multidisciplinary care strategy that extends beyond the cellular level is required for this complicated pathophysiological condition to enable patients to live disease-free lives. This case study features a young woman who was diagnosed with endometriosis and was anxious about future fertility. The condition eventually led to a series of events that defined the intricacy of the sickness involved and the accompanying complications that were better detected, and so, therapy was comparatively simplified by imaging, which helped manage the ailment and its issues. The related complications are well established; however, with the impending use of 3D imaging technology, the disease, its extent, and associated complications can be managed in a well-planned manner.

Cryptomenorrhea Due to Imperforate Hymen Leading to a Massive Hematocolpos.

Herein, we present a case of cryptomenorrhea due to imperforate hymen where approximately 3400 ml of retained menstrual blood was drained in a 16-year-old girl who presented with primary amenorrhea, cyclical abdominal pain, mass abdomen and acute pain abdomen for 15 days. Magnetic resonance imaging revealed hematocolpos due to imperforate hymen with grossly distended vagina measuring 28.6 × 9.9 × 11.3 cm. Surgical drainage of hematocolpos was done by performing hymenotomy with a cruciate-shaped incision. The post-operative period was uneventful and patient was discharged the next day in stable condition. To our knowledge, this is the first case of hematocolpos reported in literature where more than 3 liters of retained menstrual blood was drained.

Employer safety obligations, safety climate, and safety behaviors in the ready-made garment context in Bangladesh.

PURPOSE: The impact of employer safety obligations on safety climate and safety outcomes has become an important area of research in organizational and safety sciences. Evidence shows that employer safety obligations positively impact safety outcomes, including safety climate and safety behaviors. However, these relationships have not been thoroughly explored within the garment settings. This study is one of the first known studies to examine the relationships between employer safety obligations, safety climate, and safety behavior outcomes in a sample of garment employees. METHODS: Two-wave time-lagged data were collected from 347 garment employees and their supervisors in Bangladesh. Hierarchical regression analysis was applied to examine hypothesized relationships using AMOS a SPSS. RESULTS: Employer safety obligations positively influenced safety climate perceptions among garment employees. Safety climate perceptions are positively and significantly associated with safety behaviors, including safety compliance behaviors, prosocial safety behaviors, and proactive safety behaviors. Moreover, the safety climate mediates the influence of employer safety obligations on safety behaviors. CONCLUSIONS: These findings provide important evidence of the relationships between employer safety obligations, safety climate, and safety behaviors in the garment industry of Bangladesh. PRACTICAL APPLICATIONS: Ultimately, these findings guide the government, garment manufacturers, and managers to bolster garment employees' safety outcomes.

A Large Mullerian Cyst With Pressure Symptoms: A Case Report.

Mullerian cysts are of embryological origin and are usually found incidentally during delivery or a routine gynecological examination. They remain asymptomatic unless they become large enough to cause heaviness or pressure on the surrounding structures. Here, we present the case of a large 8 × 5 cm vaginal cyst that presented with bladder and bowel pressure symptoms. Complete vaginal cyst excision through the vaginal route was done to prevent its recurrence. The histopathology report showed ciliated columnar mucinous epithelium and confirmed the vaginal cyst as a cyst of Mullerian origin.

Are English-language online patient education materials related to breast cancer risk assessment understandable, readable, and actionable?

PURPOSE: To evaluate the readability, understandability, and actionability of online patient education materials (OPEM) related to breast cancer risk assessment. MATERIAL AND METHODS: We queried seven English-language search terms related to breast cancer risk assessment: breast cancer high-risk, breast cancer risk factors, breast cancer family history, BRCA, breast cancer risk assessment, Tyrer-Cuzick, and Gail model. Websites were categorized as: academic/hospital-based, commercial, government, non-profit or academic based on the organization hosting the site. Grade-level readability of qualifying websites and categories was determined using readability metrics and generalized estimating equations based on written content only. Readability scores were compared to the recommended parameters set by the American Medical Association (AMA). Understandability and actionability of OPEM related to breast cancer high-risk were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and compared to criteria set at ≥70%. Descriptive statistics and inter-rater reliability analysis were utilized. RESULTS: 343 websites were identified, of which 162 met study inclusion criteria. The average grade readability score was 12.1 across all websites (range 10.8-13.4). No website met the AMA recommendation. Commercial websites demonstrated the highest overall average readability of 13.1. Of the 26 websites related to the search term breast cancer high-risk, the average understandability and actionability scores were 62% and 34% respectively, both below criteria. CONCLUSIONS: OPEM on breast cancer risk assessment available to the general public do not meet criteria for readability, understandability, or actionability. To ensure patient comprehension of medical information online, future information should be published in simpler, more appropriate terms.

A Multimetric Evaluation of Online Patient Educational Materials for Breast Implant-associated Anaplastic Large Cell Lymphoma.

OBJECTIVE: To assess understandability, actionability, and readability of online patient educational materials (OPEM) related to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). METHODS: Search volumes for query terms related to BIA-ALCL including "breast implant associated lymphoma," "breast implant associated anaplastic large cell lymphoma," and "BIA-ALCL" were analyzed in one-week increments and normalized to total Google search volume. The same terms were then queried using an online search engine to identify commonly accessed OPEM on this topic. Understandability and actionability of OPEM were evaluated using the Patient Education Materials Assessment Tool. Grade-level readability was determined using generalized estimating equations, with observations nested within readability metrics from each website. All interval estimates were calculated for 95% confidence. RESULTS: Overall, 24 websites were identified based on search parameters. Of these websites, 11 (45.8%) met criteria for understandability, and 1 (4.2%) met criteria for actionability. Overall, readability ranged from 10.2 to 17.3 for all websites with an average grade level readability of 12.4; 0 websites were written at or below a sixth-grade reading level. Government websites had the highest average grade reading level at 14.0, followed by commercial websites at 13.2, nonprofit websites at 12.0, and then academic/hospital-based websites at 11.5. CONCLUSION: The quality of available OPEM on BIA-ALCL is limited. Future development of OPEM should be designed with the goal of improving both comprehension and actionability to help reduce patient anxiety and unnecessary clinical appointments related to this disease.