Sarcoidosis presenting as multiple osseous lesions.

Sarcoidosis is a multisystem inflammatory condition presenting with the formation of noncaseating granulomas. These granulomas can be found in nearly every organ of the body, but in 90% of cases the lungs are involved. Osseous manifestations are seen in only 3% to 13% of cases and are typically seen alongside the more common pulmonary manifestations. These lesions can be misdiagnosed as metastatic cancer so biopsy, along with clinical correlation and exclusion of other diseases, is necessary to make the diagnosis. Most patients with primary osseous sarcoidosis remain asymptomatic but routine monitoring is necessary to identify progression to lesion growth, cardiac manifestations, and respiratory involvement.

Effect of Coca-Cola on the Dissolution of Persimmon-Related Phytobezoar in a Tertiary Care Hospital.

Introduction Bezoars, masses of indigestible foreign bodies formed in the gastrointestinal tract, pose challenges in their management. Phytobezoars are particularly problematic due to their difficult diagnosis and resilience towards treatment. Recently, Coca-Cola has emerged as a potential solution due to its acidic composition and mucolytic properties. However, existing evidence is limited, highlighting the need for comprehensive studies. This research explores the efficacy of Coca-Cola in dissolving persimmon-related phytobezoars, aiming to contribute valuable insights to non-invasive treatment options. Material and methods Conducted as a descriptive case series, this study employed gastric cola lavage using non-probability purposive sampling. Patients aged 18-70 with persimmon-related phytobezoars were included. Two nasogastric tubes were inserted for cola lavage over 12 hours, utilizing three liters of cola until the disappearance of symptoms. When the bezoar disappeared, it was considered as complete success to the treatment. Results Out of 31 patients, 45.2% were male and 54.8% were female, with a mean age of 56.77 ± 9.01 years. Efficacy was noted in 54.8% of cases. Age less than 50 and no history of diabetes mellitus were associated with higher chances of treatment success (p-value ≤0.05). Conclusion Ingestion of Coca-Cola was highly effective, safe, and reliable for the dissolution of persimmon-related phytobezoars, as the frequency of efficacy was high in our study. Coca-Cola ingestion is a non-invasive and cost-effective mode of phytobezoar dissolution that should be taken as a first-line initial treatment option to attain desired outcomes.

The Impact of Calcium and Vitamin D Supplementation Prior to Thyroidectomy on Mitigating Postoperative Hypocalcemia.

Background Hypocalcemia remains the most frequent complication after thyroidectomy. It can either be transient or permanent, and patients often find it unpleasant due to its association with prolonged hospitalization. The objective of this study was to determine the role of preoperative calcium and vitamin D supplementation in preventing hypocalcemia after subtotal/total thyroidectomy. Material and methods This quasi-experimental study was conducted at the Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan, from January 2023 to July 2023. We utilized non-probability purposive sampling. Patients undergoing total thyroidectomy were recruited and followed until discharge to ascertain outcomes. They were divided into two groups: Group A received vitamin D (200,000 IU) one week preoperatively as single intramuscular dose and calcium (1 gm) orally two times daily for one week preoperatively, while Group B served as the control. Venous blood samples were taken post-surgery, on the second and seventh day and at day 30 to assess hypocalcemia. Chi-square test was employed, comparing hypocalcemia in both groups with a p-value ≤0.05 considered significant. Results One hundred thirty-two patients underwent subtotal/total thyroidectomy, with 46.2% (n = 61) being male and 53.8% (n = 71) female. The mean age of these patients was 37.12 ± 6.22 years, ranging from 20 to 50 years, and 57.6% (n = 76) were aged over 35 years. More than half (55.3%, n = 73) hailed from rural areas, while 4.7% (n = 59) resided in urban locales. Among the patients, 15.9% (n = 21) had a history of diabetes, and 24.2% (n = 32) were hypertensive. The mean body mass index (BMI) was 23.32 ± 2.41 kg/m2, with 7.6% (n = 10) classified as obese. The mean preoperative serum calcium level was 9.87 ± 1.07 mg/dL. Postoperatively, the mean serum calcium level was 8.74 ± 0.83 mg/dL. Both Group A (preoperative vitamin D and calcium supplementation) and Group B (control) demonstrated comparable baseline characteristics before undergoing thyroidectomy. The incidence of postoperative hypocalcemia was notably lower in Group A, with only 4.5% (n = 3) experiencing this complication. By contrast, 24.2% (n = 16) of patients in Group B, the control group, developed hypocalcemia (P = 0.001). Conclusion Our study supports the use of preoperative calcium and vitamin D supplementation in patients undergoing thyroidectomy to combat hypocalcemia. The treated group showed significantly lower hypocalcemia compared to the untreated group B. We recommend preoperative calcium and vitamin D supplementation for all thyroidectomy patients to reduce related morbidities and hospitalization duration.

Syracuse Hemoglobinopathy Presenting With Tophaceous Gout: A Case Report.

Background: Hemoglobinopathies are inherited disorders of hemoglobin that alter oxygen binding capacity by affecting the production of a specific subset of globin chains or their entire structure. A lesser-known subtype, Syracuse hemoglobinopathy, was first identified in 4 generations of a family in the 1970s. Gout has been reported in several forms of hemoglobinopathy, such as thalassemia and hemoglobin C disorder. Case Presentation: A 44-year-old man with a known history of Syracuse hemoglobinopathy, tobacco use disorder, and shoulder osteoarthritis presented with diffuse nodular masses on his joints along with joint pain. His laboratory tests and imaging showed elevated uric acid, urate crystals in his synovial fluid, and bony erosions. These findings were concerning for gout, which was treated with allopurinol, prednisone, and colchicine, resulting in improvement in his symptoms. Conclusions: Syracuse hemoglobinopathy, a rare disorder of high oxygen affinity hemoglobin, can present itself with findings of elevated serum uric acid and tophaceous gout. Most patients with hyperuricemia never go on to develop gout. However, having a condition that increases serum levels of uric acid should raise an astute clinician's suspicion when a patient presents with a history of hemoglobinopathy and joint pain.

Comparison of Preoperative Analgesics on the Efficacy of Inferior Alveolar Nerve Block with Patients Having Symptomatic Irreversible Pulpitis: A Double-Blinded, Randomized Controlled Trial.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of preoperative analgesics on inferior alveolar nerve blocks (IANB) during root canal treatment in patients with symptomatic irreversible pulpitis of the mandibular molars. METHODS: This study was a randomized, double-blinded, superiority trial with a parallel study design. A total of 120 subjects with symptomatic irreversible pulpitis were randomly assigned to one of four groups: group A (con- trol, Vitamin E, Evion 400 mg), group B (Diclofenac sodium, Voltral SR100 100 mg), group C (Piroxicam, Feldene 20 mg), and group D (Tramadol, Tramal 50 mg). The patients recorded preoperative pain levels, and after admin- istration of local anaesthesia intraoperative pain levels using the Heft-Parker visual analogue scale before and after the oral administration of the analgesics. Statistical analysis was performed using the Kruskal-Wallis test. RESULTS: All the analgesic groups showed a significant effect on the efficacy of the inferior alveolar nerve block in contrast to the control group (p<0.05). However, no significant difference was found between the drug groups on the effectiveness of the inferior alveolar nerve block (p>0.05). No side effects were reported in the present study. CONCLUSION: Preoperative analgesics significantly increase the effectiveness of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Therefore, preoperative analgesics should be considered to increase the effectiveness of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis on the mandibular molars. (EEJ-2023-02-033).

Association Between Fear of COVID-19 and Emotional Distress in Nurses With Mediating Role of Socio-Demographic Features.

Objectives: To determine the predictive association between fear of COVID-19 and emotional distress (depression, anxiety, and stress) in frontline and non-frontline nurses. To explore the mediating role of socio-demographic features. Methods: Correlational cross-sectional research design was implied. A total of 500 on-duty male and female, frontline and non-frontline, nurses were included from five major hospitals in Gujrat (Aziz Bhatti Shaheed Hospital, City Hospital, Doctors Hospital, Akram Hospital, and Gujrat Hospital). Fear of COVID-19 scale and the Urdu version of depression, anxiety, and stress scale - 21 (DASS-21) were used to measure variables of interest. Descriptive statistics, structural equation modeling (SEM), linear regression, and t-test were carried out using Statistical Package for Social Sciences (SPSS) 21. Result: Structural equation modeling (SEM) revealed a significant predictive link between fear of COVID-19 and depression, anxiety, and stress (goodness of model fit; NFI = 0.93, GFI = 0.914, AGFI = 0.93, CFI = 0.936, and IFI = 0.936). Furthermore, a significant mediating effect of certain demographic features was discovered by SEM (CMIN/DF = 1.11, NFI = 0.94, TLI = 0.98, GFI = 0.08, AGFI = 0.93, RMSEA = 0.029, CFI = 0.99, and IFI = 0.99). Results of linear regression analysis also revealed a momentous predictive association between fear of COVID-19 and emotional distress (R = 0.860). In comparative analysis, the results of t-test explored the statistical significant difference in fear of COVID-19 and emotional distress between frontline (mean = 25.775, 36.147 and SD = 1.75, 2.23) and non-frontline nurses (mean = 21.702, 27.353 and SD = 4.607, 10.212), with t (130) =7.111, 6.92. Conclusion: Managing the mediating effect of demographic characteristics and reducing the fear of COVID-19 can help nurses to overcome emotional distress, such as depression, anxiety, and stress. Further, this will increase the productivity among nurses.

Psychological problems in general population during covid-19 pandemic in Pakistan: role of cognitive emotion regulation.

Objectives: To explore psychological problems (Anxiety, Depression and Stress) in general population during Covid-19 pandemic. To find predictive effects of cognitive emotion regulation on psychological problems. Methodology: Convenient sampling technique was used to obtain the sample of 500 participants (Male = 239, Female = 261). Research instrument consists of four parts. First part comprised of consent form, second part was about demographic profile, third part was Depression, Anxiety and Stress scale (DASS-21) while Cognitive Emotion Regulation Questionnaire was the last part of the instrument. Results: SPSS 23.0 (Statistical Package for Social Sciences) version was used for study analysis. Descriptive statistics used to summarize the raw data. The inferential statistics such as regression, correlation and t-test were used to calculate the findings according to research objectives. Results indicated that 33%, 40% and 27% individuals were experiencing Depression, Anxiety and Stress respectively during Covid-19 pandemic. Among these participants, 48% (N = 242) were experiencing normal level of all these targeted psychological problems while remaining 52% (N = 258) respondents have mild to very severe level of all these disorders. Furthermore, findings of linear regression analysis illustrated that cognitive emotion regulation significantly predicts psychological problems [R2=.216; F = 51.223, p < .01] and 21% variation in psychological problems is due to cognitive emotion regulation. Conclusion: This study recommended that policy makers must develop and implement some necessary programmes to prevent and cure people from devastating psychological and mental health consequences of covid-19 on priority basis.

Application of Organic Fertilizers Affect the Citrus Leafminer, Phyllocnistis citrella (Lepidoptera: Gracillariidae) Infestation and Citrus Canker Disease in Nursery Plantations.

Citrus leafminer (CLM), Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae), is one of the most important insect pests of Pakistan's citrus nursery stock and caused extensive damage to young flushes. The organic compost is a widespread technique used to manage insect pests and plant diseases. Different composts (biofert, tara root and vermicompost) at 0.5 and 0.25 kg/plant concentration in comparison to NPK fertilizer at 0.4 and 0.2 g/plant were evaluated for CLM infestation and the associated citrus canker disease in nursery plantations of Citrus reticulata Blanco. Application of biofert at 0.5 kg/plant reduced the CLM infestation up to 54.5% during Fall-2016 and 39.1% during Summer-2017 in comparison to control treatment. The CLM larval density was also found lower by the application of biofert followed by vermicompost during both seasons. Both concentrations of biofert followed by vermicompost at 0.5 kg/plant resulted in remarkable protection against citrus canker disease in both flushes. The incidence of canker associated with CLM infested leaves was also studied and found lower by the application of biofert and vermicompost compared with control treatment. Conclusively, the soil amendment using biofert and vermicompost affects the CLM population and canker infection in nursery plantations. These organic fertilizers can be used in future citrus IPM programs as a tool to suppress the CLM population and citrus canker disease.

Probing cytoskeletal pre-stress and nuclear mechanics in endothelial cells with spatiotemporally controlled (de-)adhesion kinetics on micropatterned substrates.

The mechanical properties of living cells reflect their propensity to migrate and respond to external forces. Both cellular and nuclear stiffnesses are strongly influenced by the rigidity of the extracellular matrix (ECM) through reorganization of the cyto- and nucleoskeletal protein connections. Changes in this architectural continuum affect cell mechanics and underlie many pathological conditions. In this context, an accurate and combined quantification of the mechanical properties of both cells and nuclei can contribute to a better understanding of cellular (dys-)function. To address this challenge, we have established a robust method for probing cellular and nuclear deformation during spreading and detachment from micropatterned substrates. We show that (de-)adhesion kinetics of endothelial cells are modulated by substrate stiffness and rely on the actomyosin network. We combined this approach with measurements of cell stiffness by magnetic tweezers to show that relaxation dynamics can be considered as a reliable parameter of cellular pre-stress in adherent cells. During the adhesion stage, large cellular and nuclear deformations occur over a long time span (>60 min). Conversely, nuclear deformation and condensed chromatin are relaxed in a few seconds after detachment. Finally, our results show that accumulation of farnesylated prelamin leads to modifications of the nuclear viscoelastic properties, as reflected by increased nuclear relaxation times. Our method offers an original and non-intrusive way of simultaneously gauging cellular and nuclear mechanics, which can be extended to high-throughput screens of pathological conditions and potential countermeasures.

Persistence of fan-shaped keratocytes is a matrix-rigidity-dependent mechanism that requires α5ß1 integrin engagement.

Despite the importance of matrix rigidity on cell functions, many aspects of the mechanosensing process in highly migratory cells remain elusive. Here, we studied the migration of highly motile keratocytes on culture substrates with similar biochemical properties and rigidities spanning the range between soft tissues (~kPa) and stiff culture substrates (~GPa). We show that morphology, polarization and persistence of motile keratocytes are regulated by the matrix stiffness over seven orders of magnitude, without changing the cell spreading area. Increasing the matrix rigidity leads to more F-actin in the lamellipodia and to the formation of mature contractile actomyosin fibers that control the cell rear retraction. Keratocytes remain rounded and form nascent adhesions on compliant substrates, whereas large and uniformly distributed focal adhesions are formed on fan-shaped keratocytes migrating on rigid surfaces. By combining poly-L-lysine, fibronectin and vitronectin coatings with selective blocking of αvß3 or α5ß1 integrins, we show that αVß3 integrins permit the spreading of keratocytes but are not sufficient for polarization and rigidity sensing that require the engagement of α5ß1 integrins. Our study demonstrates a matrix rigidity-dependent regulation of the directional persistence in motile keratocytes and refines the role of αvß3 and α5ß1 integrins in the molecular clutch model.

Super-resolution microscopy reveals LINC complex recruitment at nuclear indentation sites.

Increasing evidences show that the actin cytoskeleton is a key parameter of the nuclear remodeling process in response to the modifications of cellular morphology. However, detailed information on the interaction between the actin cytoskeleton and the nuclear lamina was still lacking. We addressed this question by constraining endothelial cells on rectangular fibronectin-coated micropatterns and then using Structured Illumination Microscopy (SIM) to observe the interactions between actin stress fibers, nuclear lamina and LINC complexes at a super-resolution scale. Our results show that tension in apical actin stress fibers leads to deep nuclear indentations that significantly deform the nuclear lamina. Interestingly, indented nuclear zones are characterized by a local enrichment of LINC complexes, which anchor apical actin fibers to the nuclear lamina. Moreover, our findings indicate that nuclear indentations induce the formation of segregated domains of condensed chromatin. However, nuclear indentations and condensed chromatin domains are not irreversible processes and both can relax in absence of tension in apical actin stress fibers.

Micropatterning hydroxy-PAAm hydrogels and Sylgard 184 silicone elastomers with tunable elastic moduli.

This protocol describes a simple method to deposit protein micropatterns over a wide range of culture substrate stiffness (three orders of magnitude) by using two complementary polymeric substrates. In the first part, we introduce a novel polyacrylamide hydrogel, called hydroxy-polyacrylamide (PAAm), that permits to surmount the intrinsically nonadhesive properties of polyacrylamide with minimal requirements in cost or expertize. We present a protocol for tuning easily the rigidity of "soft" hydroxy-PAAm hydrogels between ~0.5 and 50 kPa and a micropatterning method to locally deposit protein micropatterns on these hydrogels. In a second part, we describe a protocol for tuning the rigidity of "stiff" silicone elastomers between ~100 and 1000 kPa and printing efficiently proteins from the extracellular matrix. Finally, we investigate the effect of the matrix rigidity on the nucleus of primary endothelial cells by tuning the rigidity of both polymeric substrates. We envision that the complementarity of these two polymeric substrates, combined with an efficient microprinting technique, can be further developed in the future as a powerful mechanobiology platform to investigate in vitro the effect of mechanotransduction cues on cellular functions, gene expression, and stem cell differentiation.