Plant based synthesis of silver nanoparticles, antimicrobial efficiency, and toxicological assessment using freshwater fish (Cyprinus carpio).

Silver nanoparticles (AgNPs) are widely used and have various applications, including medicine, electronics, and textiles. However, their increasing use raises concern about their potential environmental impact, particularly on aquatic organisms, such as fish, which are the primary consumers of aquatic environments and can be exposed to AgNPs through various routes. For this purpose, the leaves of the plant species Bellis perennis were used as a reductive agent to convert silver nitrate into AgNPs, to assess its toxicity against fish. Well-dispersed and undersized AgNPs were obtained and confirmed using analytical techniques, including Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM). Moreover, the AgNPs have shown significant antibacterial activity against Aeromonas hydrophila (25.71 ± 0.63) and Vibrio harveyi (22.39 ± 0.29). In addition, the toxicity of the obtained AgNPs was assessed by exposing Cyprinus carpio to various concentrations, including 0.06, 0.1, and 0.2 mg/L. The findings revealed that the AgNPs were significantly accumulated in the intestine, followed by the gills, liver, muscles, kidney, and brain. This bioaccumulation led to histological alterations and destruction in the villi of the intestine, regeneration of liver cells, and degeneration of the gill lamella. RESEARCH HIGHLIGHTS: Plants based synthesis of AgNPs is mostly considered as eco-friendly A significant antibacterial activity was obtained The plant mediated AgNPs were found less toxic The AgNPs was profoundly accumulated and causes histological alterations.

A case report of hypokalemic periodic muscular weakness secondary to Sjögren's syndrome with distal renal tubular acidosis.

Key Clinical Message: An underlying autoimmune condition should be suspected in patients who presented with periodic muscular weakness secondary to distal RTA that leads to hypokalemia because distal RTA is commonly associated with autoimmune disorders such as Sjögren's syndrome. Abstract: A 22-year-old female presented with a sudden onset of bilateral weakness in both upper and lower limbs. The patient had a history of muscular weakness secondary to hypokalemia and dryness of the eyes for the last 3 years. Laboratory investigations revealed decreased potassium and metabolic acidosis. Further investigations confirmed distal renal tubular acidosis (RTA) and Sjögren's syndrome. A diagnosis of distal RTA secondary to Sjögren's syndrome was made. Her potassium levels were replaced, and she was discharged with oral potassium supplements, steroids, and artificial tears.

Fahr's Syndrome Secondary to Primary Hypoparathyroidism Presenting With Seizures and the Role of Steroid Therapy.

Background: Fahr's syndrome a rare neurological condition characterized by an abnormal basal ganglia calcification. The condition has both genetic and metabolic causes. Here, we describe a patient who had Fahr's syndrome and basal secondary to hypoparathyroidism, and her calcium level raised after the administration of steroid therapy. Case report: We presented a case of a 23-year-old female with seizures. Associated symptoms included headache, vertigo, disturbed sleep, and reduced appetite. Her laboratory workup revealed hypocalcemia and low parathyroid hormone level, computed tomographic (CT) scan of the brain showed diffuse calcification in the brain parenchyma. The patient was diagnosed as a case of Fahr's syndrome secondary to hypoparathyroidism. The patient was started on calcium and calcium supplementations along with anti-seizure therapy. Her calcium level raised after the initiation of oral prednisolone and she remained asymptomatic. Conclusion: Steroid could be considered as an adjunct therapy with calcium and vitamin D supplementation in patient whose Fahr's syndrome is secondary to primary hypoparathyroidism.

Seizures in activating calcium-sensing receptor antibodies positive autoimmune hypoparathyroidism and preponderance of steroids therapy: A case report.

A 55-year-old female patient presented with generalized tonic-clonic seizures. Laboratory evaluation revealed low calcium (4.9 mg/dl), low PTH (0.9 pg/ml), and positive activating CaSR antibodies. The condition was diagnosed as autoimmune hypoparathyroidism. Calcium and vitamin D supplements did not correct the patient's hypocalcemia. The addition of prednisone to vitamin supplements showed a better response and corrected the hypocalcemia. The patient remained in seizure-free for one year.

Diagnostic dilemma of celiac disease presenting with weight loss and secondary amenorrhea: A case report.

RATIONALE: Celiac disease (CD) is autoimmune enteropathy affecting the proximal small intestinal mucosa. It is caused by insensitivity to gluten, a protein predominantly presented in wheat. CD is classically associated with gastrointestinal symptoms. The non-classic clinical presentation of CD can present with other organ involvement. Non-human leukocyte antigens genes are associated with atypical forms. PATIENTS CONCERN: We reported a case of 30-year-old female who presented with progressive pallor, amenorrhea, and unexplained weight loss with generalized body weakness. Her body mass index was 20. The patient was having no other systemic manifestations. DIAGNOSIS: This paper reports a case of a female patient having CD without its typical features. Her laboratory evaluation revealed microcytic anemia. Anti-TTg IgA and Anti-TTG IgG antibodies were raised, ferritin and folate were low, and there was mild hyperbilirubinemia. However, follicle-stimulating hormone, luteinizing hormone, and serum estradiol levels were normal. She was diagnosed with a case of anemia resulting from malabsorption caused by CD. INTERVENTIONS: A management plan was devised based on a strict gluten-free diet. The patient received supplements containing folates, iron, calcium, zinc, and vitamins A, D, E, B6, and B12. OUTCOMES: After 3 months of treatment with strict gluten-free diet patient showed remarkable improvement. Her hemoglobin level raised with weight gain. Her normal menstrual cycle was restored with complete resolution of symptoms at 1 year follow-up. LESSONS: The pathogenesis of the atypical CD is multifactorial, but impaired uptake of micronutrients from the duodenum is the most likely cause, even if other common features of classical forms, such as bloating and diarrhea, are absent. Lack of awareness about atypical forms may lead to under-diagnoses of the disease. The physicians should consider the atypical presentations of CD to avoid the under-diagnoses of this multisystem disorder.