The use of Vaccinia Immune Globulin in the Treatment of Severe Mpox. Virus Infection in Human Immunodeficiency Virus/AIDS.

We report a case of progressive, severe mpox virus (MPXV) infection in a patient with AIDS despite a standard course of tecovirimat. He significantly improved after administration of vaccinia immune globulin intravenous (VIGIV) highlighting its use as an adjunct for severe disease in immunocompromised hosts.

A Rare Case of Reverse Takotsubo Cardiomyopathy in a 28-Year-Old Female in Peripartum Period.

Reverse Takotsubo cardiomyopathy is a rare variant of Takotsubo cardiomyopathy in which ballooning occurs at the base of the heart rather than the apex, which is hyperkinetic. Takotsubo cardiomyopathy is usually considered in postmenopausal women, but a growing number of cases of the reverse variant are emerging in peripartum women. We present a case of peripartum reverse Takotsubo cardiomyopathy in a 23-year-old G1P0 female at 38 weeks gestation, induced by preeclampsia with severe features. An echocardiogram performed in the immediate post-cesarean period demonstrated a severely reduced ejection fraction of 25%, which was improved to 43% over the next 48 hours with diuresis. Therefore, it is imperative to differentiate Takotsubo cardiomyopathy occurring in the peripartum period from peripartum cardiomyopathy, which has a similar clinical presentation, to diagnose this condition and improve patient outcomes.

Frequency of median nerve tightness and its association with upper limb functions among smartphone users of a public sector university, Karachi.

OBJECTIVE: To determine median nerve tightness in smartphone users, and to compare the upper limb functions between those with and without median nerve tightness. Methods: The cross-sectional, observational study was conducted at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from March 2020 to January 2021, and comprised subjects of either gender aged 20-40 years who had been using smartphone for >1 year. Body mass index was calculated. The participants were evaluated using upper extremity functional index-15. A hand-held dynamometer was used to assess handgrip strength, and a pinch meter assessed the pinch strength. Manual upper limb tension test 1 was used for median nerve tightness. Frequencies and percentages were drawn for all categorical variables. Data was analysed using SPSS 22. RESULTS: Of the 277 subjects, 198(71.5%) were females. The largest group 176(63.5%) was aged 21-25 years. The mean upper limb functional index was 84.24±15.09. Also, 113(40.8%) subjects were positive for left-side median nerve tightness and 122(44%) were positive on the right side. There was no significant association between median nerve tightness and upper extremity function (p>0.05). The association, however, was significant with the duration of mobile usage in years (p<0.05). Conclusion: Prolonged overuse of smartphone may lead to symptoms of median nerve tightness, but it was not found to have an effect on upper limb function, handgrip and pinch strength.

Terminal digit preference and the accuracy of breast cancer diameter reporting based on Benford's law.

Background: Breast cancer is the most frequent cancer in women all over the world, and it is one of the leading causes of cancer-related deaths in women. A pathologist's partiality for the last digit of a patient's name can lead to errors in the measurement of malignancies. This means that, rather than recording the exact measurement of a tumor, a pathologist might round it off to his preferred terminal digit. Methods: It is a retrospective cross-sectional study in which data on primary tumor resection for 1000 breast cancer patients was obtained from KRL Hospital's patient directory from November 2016 to December 2020. The tumors were measured in cm to one decimal point along their longest dimension. Ki-67 markers were used to categorize the tumors into nine categories. Terminal digit preference was evaluated using Benford's law. Results: The recording of the Ki-67 index revealed evidence of pentameric preference. The numbers three, five, and six appeared more frequently in the histogram of the Ki-67 index distribution measured in percentage. The frequency of nine dropped dramatically. However, the influence of tumor size terminal digits on Ki-67 staining scores (low proliferative vs high proliferative) assessed using the Mann-Whitney U Test demonstrated that tumor size terminal digits had no significant effect on Ki-67 staining scores (p = 0.114). Conclusion: The Ki-67 index shows evidence of pentameric preference for digits three, five, and six. The frequency of nine has dropped dramatically. The influence of tumor size on terminal digits on staining scores (low proliferative vs. high proliferative) was assessed using the Mann-Whitney U Test.

Comparative Study of Externalized Ureteral Catheter Versus Double-J Stent on Percutaneous Nephrolithotomy: A Randomized Controlled Trial.

BACKGROUND: External ureteral catheter (EUC) and double-J stent are both commonly used to drain upper urinary tract in percutaneous nephrolithotomy (PCNL). We compared the outcomes of using EUC versus double-J stent in performing PCNL in patients with renal stones in our settings in order to identify a better technique for the management of renal stones in terms of postoperative stent-related symptoms. METHODS: This randomized controlled trial was conducted at the Department of Urology, PAEC General Hospital, Islamabad, from January 2020 to December 2020. A total of 80 patients of either gender between ages 18 and 70 years planned for PCNL were enrolled and randomized into group I (double-J stent) and group II (EUC). Outcomes of the procedure were compared in both groups. RESULTS: There were 62.5% of patients in group I who demonstrated stent-related symptoms compared to 22.5% in group II (p=0.001). No statistically significant difference was noted in other outcome variables like urinary leak (10% vs. 20%, p=0.210), post-procedure fever (25% vs. 22.5%, p=0.793), mean analgesia requirement (60.8 mg vs. 58.5 mg, p=0.685), and mean length of hospital stay (3.9 days vs. 4.2 days, p=0.330). CONCLUSION: Stent-related symptoms were demonstrated by a significantly lesser number of patients who underwent PCNL with EUC when compared with patients who underwent PCNL with double-J stent. For other outcome variables (urinary leak, post-procedure fever, mean analgesia requirement, and mean length of hospital stay ), no significant difference was noted among both the groups.

Nail Polish Remover Induced Methemoglobinemia: An Uncommon Occurrence.

Methemoglobinemia, defined as hemoglobin's impaired oxygen-carrying capacity due to oxidation from the ferrous (Fe2+) state to the ferric (Fe3+) state, has many well-documented etiologies. One example of an uncommon cause of acquired methemoglobinemia is the ingestion of nail polish remover, which can contain methemoglobin generators such as nitroethane, N,N-dimethyl-p-toluidine, and isobutyl nitrite. We present a case of methemoglobinemia in an 81-year-old male following accidental ingestion of isobutyl nitrite-containing nail polish remover, commonly used as a recreational inhalant. Furthermore, we review potentially toxic substances found in commercially available nail products. This case was designed to identify and efficiently treat a rather uncommon cause of methemoglobinemia induced in this case by a common household item, nail polish remover.

A Case of Postpartum Pulmonary Edema Induced by Oxytocin.

Postpartum dyspnea can be due to many causes, such as pulmonary embolism, amniotic fluid embolism, peripartum cardiomyopathy, but less frequently due to acute pulmonary edema. The incidence of acute pulmonary edema during pregnancy and in the postpartum period has been estimated to be around 0.08%. About half of the cases are attributed to tocolytic therapy. Herein, we present a case of a young woman presenting with acute hypoxia after induction of labor with oxytocin and found to have acute pulmonary edema. This case aims to illustrate and add to a growing body of literature regarding oxytocin-induced acute pulmonary edema and highlights the importance of recognizing the rare complication of oxytocin and necessary interventions to avoid complications. Oxytocin-induced pulmonary edema is a relatively uncommon condition, but physicians should have a high index of suspicion to initiate timely intervention and to avoid fetal complications.