A Delayed Diagnosis of Bilateral Pediatric Trigger Thumbs: A Case Report and Literature Review.

We describe the case of a 6-year-old female who presented with tender nodules and fixed flexion of her thumbs, diagnosed as bilateral pediatric trigger thumb. Though present since infancy, her condition was not diagnosed in prior clinical visits. Pediatric trigger digit is a clinical diagnosis, often missed if the digit's range of motion is not assessed routinely. Given the duration, pain, and severity of her condition, conservative management was deferred, and she was referred for surgery. An approach to clinical management is discussed. Ultimately, further study is required to develop structured management guidelines for pediatric trigger digit.

Simultaneous molecular detection of Anaplasma marginale and Theileria annulata in cattle blood samples collected from Pakistan-Afghanistan boarder region.

Theileria annulata (T. annulata) and Anaplasma marginale (A. marginale) are among the most extensively reported tick borne pathogens and are associated with huge economic losses worldwide. A total of 298 cattle blood samples were screened to report the presence of these two pathogens. The samples were collected from apparently healthy cattle (Achai, n = 155, Jersy, n = 88 and crossbred, n = 55) in Bajaur district of Khyber Pakhtunkhwa (KPK) during June and July of 2022. A total of 31 out of 298 cattle (10.4%) were found infected with T. annulata as PCR amplified a 156 base pair fragment from Tams-1 gene of T. annulata from their blood. While 16/298 animals (5.4%) were found infected with A. marginale as they amplified a 382 base pair fragment specific for msp5 gene of this bacterium. Three animals (1%) were found co infected. Cattle susceptibility to T. annulata infection was significantly higher than A. marginale infection (P < 0.001). Phylogenetic analysis revealed that Pakistani isolates of both detected pathogen clustered together and were closely related isolates from worldwide countries. Prevalence of T. annulata varied significantly among the sampling sites (P = 0.05) while no such association was observed for A. marginale among the tested cattle. Epidemiological data analysis revealed that none of the studied risk factors was found associated either with the prevalence of T. annulata or A. marginale (P > 0.05) among enrolled cattle. In conclusion, our study has revealed a relatively higher prevalence of T. annulata than A. marginale in cattle from the Bajaur district in KPK. This information is important for improving the productivity of the livestock sector, which is one of the main sources of income in the country. It is recommended that this data be taken into account for the development and implementation of effective tick control programs, as well as for the improvement of livestock management practices to prevent and manage TBDs in Pakistan.

Gastrointestinal Eosinophilic Granulomatosis with Polyangiitis following a Clostridium difficile Infection.

Eosinophilic granulomatosis with polyangiitis (EGPA), historically named Churg-Strauss syndrome, is a rare vasculitis affecting small- and medium-sized blood vessels. The disease has a predilection for numerous organs including the lungs, sinuses, kidneys, heart, nerves, and gastrointestinal tract but is prominently associated with asthma, rhinosinusitis, and eosinophilia. Gastrointestinal involvement is common; however, a gastrointestinal manifestation as the cardinal symptom following an infection is atypical. Here, we present a case of a 61-year-old male who presented with persistent diarrhea following a toxigenic Clostridium difficile infection despite multiple antibiotic courses. Repeat testing confirmed eradication of the infection, and further evaluation with colon biopsy revealed small and medium-sized vasculitis with eosinophilic infiltration and granulomas. Treatment with prednisone and cyclophosphamide resulted in rapid improvement of his diarrhea. Gastrointestinal symptoms in EGPA are associated with worse prognosis, so prompt identification and treatment of the disease is crucial. EGPA is rarely documented in histopathological samples from the gastrointestinal tract as endoscopic biopsies are typically too superficial to sample the submucosal layer containing the affected vessels. Additionally, the link between EGPA and infections as a potential trigger has not been clearly established, but gastrointestinal EGPA manifesting after a colonic infection raises concerns that this may have been a triggering event. Ultimately, further study is needed to understand, diagnose, and treat gastrointestinal and postinfection EGPA.

Accessing Intraabdominal Abscess for Percutaneous Drainage Using a Trocar Only Technique to Maneuver Intervening Bowel.

Conventional approaches to the drainage of abscess surrounded by bowel contraindicate percutaneous drainage and often involve more invasive laparotomy. We attempt to demonstrate the use of an image-guided blunt trocar to navigate obstructive bowel and access abdominal abscess. This report presents the use of a blunt trocar to safely maneuver obstructive bowel and perform successful percutaneous drainage of intraabdominal abscess in two separate cases: one presenting a left lower quadrant diverticular abscess and the other presenting an abscess in the right lower quadrant. Thus, traversing obstructive bowel using a blunt trocar under computed tomography-guidance allows for percutaneous drainage of an intraabdominal abscess, and provides a safer and more effective alternative to more invasive procedures.

Selective Androgen Receptor Modulators: An Emerging Liver Toxin.

Selective androgen receptor modulators (SARMs) are a class of nonsteroidal drugs that are favored over anabolic androgenic steroids (AASs) for their tissue-selectivity and improved side-effect profile. These drugs have been evaluated for treatment of various diseases including muscle-wasting disorders, osteoporosis, and breast cancer. Despite lacking approval for therapeutic use, SARMs are widely used recreationally as performance enhancing drugs by bodybuilders and athletes. In recent years, cases of drug-induced liver injury (DILI) secondary to SARMs have begun to emerge, but little is known regarding their hepatotoxicity. In this review, we provide current knowledge regarding DILI from SARMs. A literature search was conducted regarding SARMs and liver injury to evaluate relevant cases and information. SARMs have been associated with a cholestatic syndrome congruent with that of DILI from AASs, and it consists of a bland cholestasis in which there is minimal bile duct injury, inflammation, or necrosis. Patients present with an insidious onset of jaundice with marked hyperbilirubinemia and mild hepatic enzyme elevations. No clear treatment exists, although patients typically show improvement with cessation of the offending SARM. Given the novelty of these drugs, further study is necessary to understand diagnosis, management, and complications of SARM-related DILI.

Varying Doses of Rare-Earth-Metal-Based Neodymium Zirconate Zinc Sulfide Nanocomposite Disrupt Blood and Serum Parameters, as well as Markers of Oxidative Stress in the Selected Organs of Albino Mice.

Despite extensive industrial use, the biocompatibility of nanocomposites has not been extensively explored. The present study was designed to report the effect of variable doses of a newly synthesized nanocomposite, Neodymium Zirconate Zinc Sulfide, on selective serum and complete blood count parameters and on the oxidative stress markers from the vital organs of albino mice. Albino mice (C57BL/6 strain, 5 weeks old) of both sexes were orally treated for 11 days, either with 10 mg (low dose) or 20 mg/mL saline/kg body weight (high dose) of Neodymium Zirconate Zinc Sulfide nanocomposite. A control group that was not treated with the nanocomposite but with saline solution was also maintained. Data analysis revealed that high-dose nanocomposite-treated male mice had significantly reduced hemoglobin concentration as compared to the control males. Female mice treated with both doses of nanocomposite had higher serum triglyceride levels than controls. High-dose-treated female mice had elevated serum cholesterol concentration compared to their saline-treated controls. Oxidative stress marker analysis from selected organs indicated that concentrations of malonaldehyde (MDA) in the kidney and liver, Superoxide dismutase (SOD) levels in the brain and catalase in the kidney of male mice treated with the nanocomposite were significantly higher than in the control group, whereas SOD in the heart, MDA in the heart and kidney and catalase levels in the kidney were significantly disrupted in female mice compared to their respective controls.

Skeletal Fluorosis: A Case of Inhalant Abuse Leading to a Diagnosis of Colon Cancer.

Skeletal fluorosis is a long-term bone disease that develops when prolonged fluoride toxicity leads to osteosclerosis and bone deformities that result in crippling pain and debility. The disease is endemic to many countries due to environmental or industrial exposures. However, rare cases in the United States have been reported from various causes including heavy toothpaste ingestion, excessive tea consumption, voriconazole use, and inhalant abuse. Here, we present a case of a 41-year-old man who presented for weight loss and severe joint pains due to bony sclerotic lesions found on X-rays. Social history revealed that he had been recreationally inhaling compressed air dusters used for cleaning electronics. Owing to concern for malignancy, he underwent an extensive work-up which led to a diagnosis of colon cancer, but positron emission tomography/computed tomography (PET/CT) and bone biopsy were unexpectedly negative for metastatic bone disease. Further characterization of his lesions by skeletal survey led to a diagnosis of skeletal fluorosis secondary to inhalant abuse. As in this patient, the disease can be difficult for clinicians to recognize as it can be mistaken for various boney diseases such as metastatic cancer. However, once there is clinical suspicion for skeletal fluorosis, various tests to help confirm the diagnosis can include serum and urine fluoride levels, skeletal survey, and bone ash fluoride concentration. Treatment of skeletal fluorosis primarily involves cessation of fluoride exposure, and recovery can take years. Ultimately, further study is required to develop recommendations and guidelines for diagnosis, management, and prognosis of the disease in the United States.