G6PD Deficiency and Priapism: Is There a Link Between the Two Entities?

Glucose 6 phosphate dehydrogenase (G6PD) is called the house keeping enzyme essential for all cells survival. G6PD deficiency is best studied for its role in hemolysis as this enzyme is the only source of nicotinamide adenine dinucleotide phosphate (NADPH) in red blood cells (RBCs) and is the cells defense against reactive oxygen species. We present one of the rare complications of G6PD deficiency in this case where all other causes of priapism were ruled out.

Stem Cell Therapies: A Way to Promising Cures.

Stem cells carry the remarkable ability to differentiate into different cell types while retaining the capability to self-replicate and maintain the characteristics of their parent cells, referred to as potency. Stem cells have been studied extensively to better understand human development and organogenesis. Because of advances in stem cell-based therapies, regenerative medicine has seen significant growth. Ophthalmic conditions, some of which are leading causes of blindness worldwide, are being treated with stem cell therapies. Great results have also been obtained in the treatment of oral and maxillofacial defects. Stem-cell-based therapies have great potential in the treatment of chronic medical conditions like diabetes and cardiomyopathy. The unique property of stem cells to migrate towards cancer cells makes them excellent vectors for the transportation of bioactive agents or for targeting cancer cells, both primary and metastatic. While these therapeutic strategies are extremely promising, they are not without limitations. Failure to completely eradicate the tumor and tumor relapse are some of those concerns. Stem cells share some characteristics with cancer stem cells, raising concerns for increasing the risk of cancer occurrence. Ethical concerns due to the fetal origin of stem cells and cost are other major obstacles in the large-scale implementation of such therapies.

Mining version history to predict the class instability.

While most of the existing class stability assessors just rely on structural information retrieved from a desired source code snapshot. However, class stability is intrinsically characterized by the evolution of a number of dependencies and change propagation factors which aid to promote the ripple effect. Identification of classes prone to ripple effect (instable classes) through mining the version history of change propagation factors can aid developers to reduce the efforts needed to maintain and evolve the system. We propose Historical Information for Class Stability Prediction (HICSP), an approach to exploit change history information to predict the instable classes based on its correlation with change propagation factors. Subsequently, we performed two empirical studies. In the first study, we evaluate the HICSP on the version history of 10 open source projects. Subsequently, in the second replicated study, we evaluate the effectiveness of HICSP by tuning the parameters of its stability assessors. We observed the 4 to 16 percent improvement in term of F-measure value to predict the instable classes through HICSP as compared to existing class stability assessors. The promising results indicate that HICSP is able to identify instable classes and can aid developers in their decision making.

A Rare Case of Early Onset Multiple Myeloma in a 20-Year-Old Female With Factor X Inhibitor.

Multiple myeloma is plasma cell neoplasm affecting persons over the age 60. Less than 2% of the cases occur below the age 40. In this case report we discuss a young 20-year-old female presenting with 90% plasma cells on bone marrow biopsy and presence of factor X inhibitor.

A Great Mimicker in Thoracic Spine: Spinal Double Expressor Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is one of the most common causes of non-Hodgkin's lymphoma (NHL). Some of these DLBCLs can have genetic mutations as well as protein overexpression. The genes involved are MYC, BCL-2 and BCL-6. These are very aggressive and do not respond well to standard chemotherapy regiment. Lymphomas usually show classic signs and symptoms but rarely can present with little or no symptoms or even mimic other disease processes. Here we will present a case where a spinal lymphoma mimicked a hematoma and the patient developed signs and symptoms only after mechanical fall and hitting his back.

Diabetic retinopathy detection and classification using hybrid feature set.

Complicated stages of diabetes are the major cause of Diabetic Retinopathy (DR) and no symptoms appear at the initial stage of DR. At the early stage diagnosis of DR, screening and treatment may reduce vision harm. In this work, an automated technique is applied for detection and classification of DR. A local contrast enhancement method is used on grayscale images to enhance the region of interest. An adaptive threshold method with mathematical morphology is used for the accurate lesions region segmentation. After that, the geometrical and statistical features are fused for better classification. The proposed method is validated on DIARETDB1, E-ophtha, Messidor, and local data sets with different metrics such as area under the curve (AUC) and accuracy (ACC).

Reel Syndrome: An Atypical Cause for Inappropriate Shocks in a Patient with Automated Implantable Cardioverter Defibrillator (AICD).

A 71-year-old woman, with the past medical history of heart failure with reduced ejection fraction (EF) and automated implantable cardioverter defibrillator (AICD) placement (for low EF 5-10%) in 2015, presented in February 2017 with the complaint of AICD shocks following an episode of vomiting. She denied any chest pain, abdominal pain, shortness of breath, palpitation, or dizziness. Electrocardiogram (EKG) on admission showed ectopic atrial rhythm with premature ventricular contractions in bigeminies, anterior fascicular block, and left axis deviation. On examination of the cardiovascular system, there was a normal S1 heart sound with a loud A2. There was no jugular venous distention on the neck or pitting edema on the legs. Laboratory studies showed no elevation of cardiac enzymes. Evaluation with chest x-ray showed the right ventricular lead had migrated to the right atrium and the defibrillator generator was flipped with leads coiled around it in transverse axis. AICD interrogation was performed which revealed inappropriate shocks were due to atrial fibrillation with rapid ventricular rate and loss of capture of the right ventricular lead. The diagnosis of Reel syndrome was made, and an electrophysiologist was consulted for replacement of the AICD. Reel syndrome is a variant of Twiddler's syndrome, which is a rare complication of pacemaker implantation. It manifests with the rotation of generator on transverse axis with leads coiling around it. Twiddler's syndrome, on the other hand, is the rotation of the generator on its long axis, which causes damage to the leads by twisting. Reel syndrome is usually observed within months from the placement of the generator compared to Twiddler, which takes years to occur. Twiddler and Reel's syndromes have similar contributing factors, such as female gender, obesity, large pocket, old age, dementia, and deep brain stimulation. Our patient only had two risk factors, namely, the sex and age. We propose that every patient with a pacemaker malfunction and AICD shocks should have a posterior-anterior (PA) chest x-ray and a lateral chest x-ray in addition to AICD interrogation. Twiddler's syndrome is effortlessly observed because of the twisting of dual leads compared to Reel syndrome, which is not straightforward because of the lack tortuosity of the leads.

A Case Series of Two Patients Presenting With Pericardial Effusion as First Manifestation of Non-Small Cell Lung Cancer With BRAF Mutation and Expression Of PD-L1.

Lung cancer is the number one cause of cancer-related deaths in the United States. Involvement of pericardium occurs once cancer has progressed to stage IV which can cause massive effusion in the pericardial sac. This can lead to cardiac tamponade which can be fatal very quickly if untreated. The following is a two patient case series in which both patients presented with large pericardial effusion. The first patient sought medical attention due to new onset palpitations and was found to have hemorrhagic pericardial effusion and pulmonary embolism (PE). The second patient presented with shortness of breath. Investigations revealed that she had pericardial and pleural effusions along with multiple metastases throughout the body. Both patients ended up with a diagnosis of non-small cell lung cancer (NSCLC) with BRAF mutation. One patient had V600E mutation; other patient had a variant p.D594N mutation. Both patients also had expression of PD-L1.