Spinal epidural venous engorgement-Potential imaging confounder after diagnostic lumbar puncture.

Intracranial hypotension is a result of low Cerebrospinal fluid (CSF) pressure caused by either spontaneous or postoperative leakage. The classic presentation of spontaneous intracranial hypotension is acute orthostatic headache, but the diagnosis can sometimes be challenging as some patients may present with atypical initial presentations including cervical pain as well as cervical radiculopathy secondary to cervical spine venous engorgement. We described a 42-year-old female patient who presented initially with neuropathic pain symptoms as well as weakness involving both lower extremities for which she underwent diagnostic lumbar puncture with concern regarding demyelinating neuropathy. However, subsequently she developed postural headache as well as severe cervical pain which was attributed to cervical epidural venous engorgement in setting of intracranial hypotension based on cervical spine magnetic resonance imaging (MRI) findings. She was managed conservatively, and repeated cervical spine MRI 3 days later showed prominent improvement in the imaging findings. Spinal epidural venous engorgement can occur secondary to intracranial hypotension (mainly post lumbar puncture), and can present clinically with neck pain or even symptoms of radiculopathy. Since the findings can mimic more serious conditions, it is extremely important to consider this condition in the differential diagnosis of an enhancing epidural collection in the cervical spine, particularly when intracranial hypotension is suspected.

Thirty-day readmission rates, reasons, and costs for gastrointestinal angiodysplasia-related bleeding in the USA.

BACKGROUND: Patients with gastrointestinal angiodysplasia (GIA)-related bleeding are at high risk for readmissions, resulting in significant morbidity and an economic burden on the healthcare system. AIM: The aim of the study was to determine the 30-day readmission rate with reasons, predictors, and costs associated with GIA-related bleeding in the USA. METHODS: We queried the National Readmission Database to identify patients hospitalized with GIA-related bleeding in the year 2016 using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Primary outcomes included the 30-day readmission rate, and secondary outcomes were in-hospital mortality and resource utilization for index and re-hospitalizations. We also performed univariate and multivariate cox regression analysis to identify predictors of readmissions. RESULTS: A total of 25 079 index hospitalizations for GIA-related bleeding were identified in 2016. Out of these, 5047 (20.34%) patients got readmitted within the next 30 days. The most common diagnosis associated with readmissions were related to recurrent gastrointestinal bleeding. Readmissions compared to index hospitalization has significantly higher length of stay (5.38 vs. 5.11 days, P = 0.03), but mean hospitalization charges ($52 114 vs. $49 691, P = 0.11) and mean total hospitalization costs ($12 870 vs. $12 405, P = 0.16) were similar. Patients with multiple co-morbidities, length of stay >5 days, and end-stage renal disease were found to be independent predictors for 30-day readmissions. CONCLUSION: Our study shows that one in five patients hospitalized with GIA-related bleeding was readmitted within 30 days of index hospitalization, placing a heavy economic burden on the healthcare system. Further research identifying strategies to reduce readmissions in these patients is needed.

Anterior chest wall pilonidal sinus: Disease at a rare site.

Pilonidal sinus is defined as an infected tract in the skin, commonly containing a tuft of hair. The most common locations are buttocks, axillae, groin, etc., but it can also develop at rare locations. We present the case of a 24-year-old, hirsute male with recurrent infected discharging sinus on the anterior chest wall, at a tertiary care hospital in Karachi. The patient had earlier undergone incision and drainage multiple times before he finally came to us. On evaluation and exploration a sinus tract containing a tuft of hair was excised from the anterior chest wall. A pilonidal sinus can develop in any area containing hair under friction. Hence, it should be included under the differential diagnosis of any long-standing sinus over a hairy area.

Potential Treatment Options for COVID-19: A Comprehensive Review of Global Pharmacological Development Efforts.

Coronavirus disease-2019 (COVID-19), first reported in China during December of 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection later spread very rapidly around the globe with over 8,708,008 cases reported, including more than 461,715 deaths reported across at least 216 countries by June 20, 2020. It was declared as a global pandemic by the World Health Organization (WHO) on March 11, 2020. With the rapidly increasing number of positive cases and deaths, there is a dire need for effective treatment. An urgent unmet need led to the planning and opening of multiple drug development trials for treatment and vaccine development. In this article, we have compiled comprehensive data on many candidate drugs such as remdesivir, favipiravir, ribavirin, umifenovir, arbidol, lopinavir, ritonavir, baricitinib, hydroxychloroquine, nitazoxanide, azithromycin, baloxavir, oseltamivir, losartan, and tocilizumab. We have tabulated available data on various clinical trials testing various aspects of COVID-19 therapeutics.

Calcitonin Gene-Related Peptide Antagonists as a Savior in Episodic and Chronic Migraine: A Review.

Headaches due to migraine are the second leading cause of disability in the world. Migraine can be classified as episodic migraine (EM) and chronic migraine (CM). The course of the disease starts from an aura followed by 4-72 hours of bouts of throbbing, mostly unilateral headache associated with nausea, photo/phonophobia with/without neurological deficit. The pathophysiology of migraine remains debatable and many drugs are used to help control migraine attacks with little or no benefit. However, patient compliance remains a reason for over and underdosing of these medications. The calcitonin gene-related peptide (CGRP), a vasoactive peptide is known to contribute to the disease course. Much work is done on antagonizing the receptor or the molecule itself. For this purpose, genetically engineered monoclonal antibodies are being utilized for long-term reduction in morbidity and prevention of migraine headaches. The four to name are: galcanezumab, fremanezumab, eptinezumab, and erenumab. The purpose of this review is to shed light on the use of these monoclonal antibodies, completed and recruiting trials, and the role of these medications in the prevention of not only EM and CM but also in medication overuse headaches.

A Mysterious Case of an Infarcted Spleen due to Kissing Disease: A Rare Entity.

Viruses are long known to be leading causes of self-limiting infections. Infectious mononucleosis (IM) caused by the Epstein-Barr virus (EBV) is, however, no exception. The ailment is caused by a DNA virus belonging to the Herpesviridae family. As stated earlier, the infection is usually self-limited with mononucleosis-like symptoms such as fever, sore throat, lymphadenopathy (LAD), rash, headache, etc. In rare instances, it can lead to severe complications. The organ of prime importance following the infection is spleen. There are occasions where splenic injuries can lead to rupture, deeming to emergency surgical interventions. At other times, a rare entity may also be seen that constitutes an infarction within the splenic substance. We present this rare finding in a 20-year-old male patient with a left upper quadrant (LUQ) pain, cervical LAD, and sore throat who was brought to the emergency department. On physical examination, mild tenderness was observed in the LUQ with an inflamed throat and palpable cervical and occipital lymph nodes. Laboratory investigations suggested lymphocytosis with no blast cells, lactic acidosis, and mild acute kidney injury. A contrast-enhanced computed tomography scan demonstrated an enlarged spleen with wedge-shaped hypodense areas, which led to a diagnosis of splenic infarction secondary to infectious mononucleosis. Keeping in mind the symptomatology and the age of the patient, a bunch of differentials were needed to be ruled out. Out of a series of investigations done on the patient, EBV serology for IgM was positive. The patient was conservatively treated with a complete resolution of symptoms in one month. Our case adds to the literature the finding of a rare etiology of splenic infarction secondary to IM and the importance of stepwise and cost-effective investigations to avoid unnecessary workup when needed.

Type 3 Diabetes Mellitus: A Link Between Alzheimer's Disease and Type 2 Diabetes Mellitus.

Chronic diseases, as their name suggests, are progressive and can have overlapping features. Similar to this, Alzheimer's disease (AD) and diabetes mellitus (DM) fall into the category of chronic degenerative diseases. The global burden of these two ailments is manifold; hence, it seems important to view the pathophysiologic mechanisms of DM in the worsening of AD. Genetic as well as environmental factors are seen to play a role in the disease pathogenesis. Several genes, metabolic pathways, electrolytes, and dietary habits are seen to hasten brain atrophy. Lying behind this is the accumulation of amyloid precursor and tau - the misfolded proteins - within the brain substance. This mechanism is usually innate to AD itself, but the impact of insulin resistance, disturbing the homeostatic milieu, is seen as a powerful contributing factor aggravating the neuronal loss impairing an individual's memory. Since this neuronal loss is permanent, it may lead to complications as seen with AD. To reach a consensus, we conducted an electronic literature review search using different databases. This aided us in understanding the common aspects between AD and DM on genetic, molecular, cellular levels, as well as the impact of minerals and diet on the disease manifestation. We also found that despite exceptional work, additional efforts are needed to explore the relationship between the two entities. This will help physicians, researchers, and pharmaceuticals to frame remedies targeting the cause and avoid the progression of AD.

The Impact of Inflammatory Bowel Disease on Pregnancy and the Fetus: A Literature Review.

Inflammatory bowel disease (IBD) is a constellation of devastating chronic inflammatory changes in the bowel, either involving the large or small bowel or part of both. As it is widely diagnosed in the fertile age group, this disorder can present itself, very commonly, during pregnancy and thus a better understanding of the disease can be an important factor to influence the maternal and fetal well-being. Medications are what is considered the first line in the management of this disease to control the symptoms or keep the disease in remission. In addition to this, the drugs used to keep the disease in remission can also cause significant adverse effects on the patient and the new nurturing life preparing itself for the outside world. What the fetus gets from the mother will stay for life with the child. We conducted an electronic literature review search which highlights the significance and impact of sustained remission of IBD and the cautious use of various drugs during pregnancy for that purpose. In addition to the influences already mentioned, It is evident that nutritional deficiencies can also prevail with the advancing disease, something to manage as a side note as well. These deficiencies can have a definite effect on the fetus and may cause developmental malformations. In order to avoid this process, a systemic and joint approach should be curtailed. This can reduce the adverse outcomes associated with this ailment during pregnancy.

In-situ Coronary Thrombosis in Antiphospholipid Syndrome: A Case Report.

Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disorder characterized by arterial and venous thrombosis, often accompanied by elevated titers of anti-phospholipid antibodies. Cardiac involvement in APS is not uncommon. However, acute myocardial infarction (AMI) from in-situ thrombosis is a rare but important manifestation of APS. We present a rare case of AMI in a young female with APS secondary to in-situ coronary thrombosis.

Immunocapture and microplate-based activity and quantity measurement of pyruvate dehydrogenase in human peripheral blood mononuclear cells.

BACKGROUND: Pyruvate dehydrogenase (PDH) activity is altered in many human disorders. Current methods require tissue samples and yield inconsistent results. We describe a modified method for measuring PDH activity from isolated human peripheral blood mononuclear cells (PBMCs). RESULTS/METHODOLOGY: We found that PDH activity and quantity can be successfully measured in human PBMCs. Freeze-thaw cycles cannot efficiently disrupt the mitochondrial membrane. Processing time of up to 20 h does not affect PDH activity with proteinase inhibitor addition and a detergent concentration of 3.3% showed maximum yield. Sample protein concentration is correlated to PDH activity and quantity in human PBMCs from healthy subjects. CONCLUSION: Measuring PDH activity from PBMCs is a novel, easy and less invasive way to further understand the role of PDH in human disease.

Incidence and management of rupture uterus in obstructed labour.

BACKGROUND: Obstructed labour with ruptured uterus is a serious obstetrical complication with a high incidence of maternal and foetal morbidity and mortality. This study was conducted to find out the incidence of uterine rupture particularly in the patients of obstructed labour (OL), foeto-maternal outcome of such patients, and its management. METHODS: This two year descriptive study was conducted in the Department of Obstetrics and Gynaecology Unit-I, at Muhammad Medical College Hospital from 1st January 2007 to 31st December 2008, on 40 diagnosed cases of OL. Patients were admitted through Casualty or were admitted in ward. Patients with previous caesarean section and myomectomy were excluded. RESULTS: Ruptured uterus was found in 8 out of 40 patients of obstructed labour, they were relatively elder and grand-multiparous. Mean age of the patients was 36.5 years, while parity ranged between 5 and 12. Only one (12.5%) patient was primigravida with mean gestational age of 39.15 weeks. Seven (87.5%) patients had abdominal pain and tenderness, 5 (62.5%) vaginal bleeding, and 2 (25%) had shock. All cases were immediately managed with fluid replacement, blood transfusion and surgery. Six (75%) cases were diagnosed as ruptured uterus on clinical features while 2 (25%) with incomplete rupture were diagnosed on caesarean section for obstructed labour. Foetal mortality rate was high (7, 87.5%); 5 (62.5%) were fresh stillbirth and 2 (12.5%) died in nursery. Only 1 (12.5%) baby survived. There was 1 maternal death due to puerperal sepsis. CONCLUSION: The incidence of rupture uterus in obstructed labour was 20%. Immediate intervention is important factor for successful management of uterine rupture.