Imaging Update of Congenital Hearing Loss: A Recent Insight Imaging Including 3D MRI Cisternography Prior to Cochlear Implant.

SNHL in children is an important issue. Cochlear implant is a highly technological device that is surgically inserted in the cochlea to solve this issue. To evaluate types of anomalies of the inner ear in children with sensorineural hearing loss in a tertiary care hospital and confirm that the routine MRI, MR cisternography and HRCT provides the surgeon with the imaging finding and criteria of patients candidates for CI. Patients and method: 600 patients with SNHL underwent HRCT and MRI. CT examinations were normal in 457 patients (76.2%) and 143 patients (23.8%) with inner ear anomalies. MRI examinations were normal in 440 patients (73.3%) and had inner ear anomalies in 160 patients (26.7%). 3D bFFE and 3D DRIVE was summarized. The 3D bFFE sequence was statistically significantly better than the 3D DRIVE for the demonstration of the cochlear vestibule. Superior, inferior vestibular nerves and facial nerves while 3D DRIVE is superior to 3D bFFE in the visualization of the semicircular canals. HRCT and MRI provide accurate anatomical delineation of complex inner ear structures and 3D improves pre-implant evaluation.

The effect of butyric acid and nucleotides supplementation on broiler (Gallus gallus domesticus) growth performance, immune status, intestinal histology, and serum parameters.

Background: Butyric acid and its derivatives support the immune system, lessen inflammation, and lessen oxidative stress in broilers in addition to preserving gut homeostasis and epithelial integrity. Broiler performance has also been demonstrated to rise with the addition of nucleotides to the diet. Aim: The purpose of the study was to ascertain the effects of butyric acid and nucleotides added to feed on the overall performance, immunity, oxidant/antioxidant enzyme levels, intestinal histology, and hepatic functions of broilers. Methods: Four experimental groups of thirty chickens, each were used in the present study. The groups were assigned as a control group that received normal diet without additives, butyrate (B) group received the diet supplemented with butyric acid (250 g/ton feed), nucleotides (N) group received the diet supplemented with nucleotides (200 g/ton feed), and the fourth group received the diet supplemented with a combination of butyrate and nucleotide (BN) (250 g/ton B feed, and 200 g/ton N feed, respectively). Necrotic enteritis was produced in ten birds from each group to assess the immune-modulatory effect of these supplements, antioxidant status, intestinal histology, and liver functions were measured in all experimental groups. Results: The addition of butyric acid and nucleotides to feed enhanced body weight, growth performance, hepatic functions, and antioxidant capabilities. Histological sections of the gut from challenged or unchallenged (with necrotic enteritis) groups in the BN group showed considerable improvement, as shown by strong proliferation in intestinal crypts and villus enterocytes. Conclusion: Nucleotides and butyric acid can be added to broiler feeding regimens to enhance growth and health.

Gastrointestinal Bleeding in Patients With Acute Ischemic Stroke: A Literature Review.

Stroke is an infarction of the central nervous system (brain, spinal cord, or retina) that results from a disruption in cerebral blood flow either due to ischemia or hemorrhage. Complications of acute stroke are common and include pneumonia, urinary tract infection, myocardial infarction, deep vein thrombosis, and pulmonary embolism, among several others, all of which increase the risk of poor clinical outcomes. Gastrointestinal bleeding is a well-known complication that can occur during the acute phase of stroke. In this review, we have summarized the existing data regarding the incidence, pathophysiology, risk factors, morbidity, mortality, and management strategies for gastrointestinal bleeding in patients with acute ischemic stroke.

Autoimmune Hepatitis: An Unusual Presentation.

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that occurs in a bimodal age distribution in the second and fifth-sixth decade of life. The disease is more prevalent in females and presents with variable clinical manifestations ranging from being asymptomatic to acute liver failure. AIH is often overlooked and not worked up in elderly patients who present with liver failure. This can lead to increased morbidity and mortality in elderly patients. AIH should be considered as a differential diagnosis in patients who present with elevated transaminases regardless of age or gender as early recognition and treatment leads to improved outcomes. In this article, we present a unique case of AIH in a male patient in his eighth decade of life who presented with acute liver failure without any obvious cause and had no history of autoimmune diseases.

Skin histopathological responses of Oreochromis niloticus (Nile tilapia) to transportation in water with and without salt.

Oreochromis niloticus (Nile tilapia) is a well-known economic fish species that can thrive under the right environmental circumstances. The transport of live fish, either for food or as companion animals, presents a big issue for animal welfare at the same time it is considered one of stressful conditions. Hence, the present study investigated the skin histopathological responses of O. niloticus that were attributed to stress and salt addition during transportation. Three experimental groups of O. niloticus the 1st is the control non-transported group (CG), the 2nd is transport in water without salt (PT-S) and the 3rd is transport in water containing 5gL- 1salt (PT + S), the last 2 groups were transported in 5 h transport model. Results indicate that the skin of PT-S fish showed a marked decrease in epidermal thickness, decreased number of goblet cells, and an increase in the sub-epidermal and dermal pigments with the presence of large edematous vacuoles. Fish skin from PT + S demonstrated mild hydropic swelling in epidermal cells with normal goblet (mucous) cells density, and more or less normal melanin pigment distribution in sub epidermis and on the dermis layers, however, dermis showed mild edematous spaces. Scanning microscopy of PT-S skin tissue showed few scratched white patches among normal regions that may represent a thickened surface with the decreased number of goblets cell opening, while the PT + S group showed moderate preservation of surface skin architectures with the presence of goblet (mucous) cells opening in spite of presence of slight thickened white patches. The estimated total lesion changes present in PT-S group showed a significant increase (P < 0.001) compared with the control (CG) group. On the other hand, PT + S showed significant (P < 0.001) improvement in the overall previously recorded changes compared with the PT-S group, and a non- significant change in the histological architectures compared with the control group. Our findings underlined the importance of skin and its mucous cover health during transportation. The use 5 gL- 1salt during O. niloticus transportation appears to preserve the surface skin features, and keep the goblet (mucous) cells open to the external surface, and may act as a deterrent for the release of mucus from goblet (mucous) cells in response to stress and lessen the stress of transportation.

Mangiferin (mango) attenuates AOM-induced colorectal cancer in rat's colon by augmentation of apoptotic proteins and antioxidant mechanisms.

Mangiferin (MF) is a natural C-glucosylxantone compound that has many substantial curative potentials against numerous illnesses including cancers. The present study's goal is to appraise the chemo preventive possessions of MF on azoxymethane (AOM)-mediated colonic aberrant crypt foci (ACF) in rats. Rats clustered into 5 groups, negative control (A), inoculated subcutaneously with normal saline twice and nourished on 0.5% CMC; groups B-E injected twice with 15 mg/kg azoxymethane followed by ingestion of 0.5% CMC (B, cancer control); intraperitoneal inoculation of 35 mg/kg 5-fluorouracil (C, reference rats) or nourished on 30 mg/kg (D) and 60 mg/kg (E) of MF. Results of gross morphology of colorectal specimens showed significantly lower total colonic ACF incidence in MF-treated rats than that of cancer controls. The colon tissue examination of cancer control rats showed increased ACF availability with bizarrely elongated nuclei, stratified cells, and higher depletion of the submucosal glands compared to MF-treated rats. Mangiferin treatment caused increased regulation of pro-apoptotic (increased Bax) proteins and reduced the ß-catenin) proteins expression. Moreover, rats fed on MF had significantly higher glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), and lower malondialdehyde (MDA) concentrations in their colonic tissue homogenates. Mangiferin supplementation significantly down-shifted pro-inflammatory cytokines (transforming growth factor-α and interleukine-6) and up-shifted anti-inflammatory cytokines (interleukine-10) based on serum analysis. The chemo-protective mechanistic of MF against AOM-induced ACF, shown by lower ACF values and colon tissue penetration, could be correlated with its positive modulation of apoptotic cascade, antioxidant enzymes, and inflammatory cytokines originating from AOM oxidative stress insults.

Sinomenine accelerate wound healing in rats by augmentation of antioxidant, anti-inflammatory, immunuhistochemical pathways.

Sinomenine (SN) is a well-documented unique plant alkaloid extracted from many herbal medicines. The present study evaluates the wound healing potentials of SN on dorsal neck injury in rats. A uniform cut was created on Sprague Dawley rats (24) which were arbitrarily aligned into 4 groups receiving two daily topical treatments for 14 days as follows: A, rats had gum acacia; B, rats addressed with intrasite gel; C and D, rats had 30 and 60 mg/ml of SN, respectively. The acute toxicity trial revealed the absence of any toxic signs in rats after two weeks of ingestion of 30 and 300 mg/kg of SN. SN-treated rats showed smaller wound areas and higher wound closure percentages compared to vehicle rats after 5, 10, and 15 days of skin excision. Histological evaluation of recovered wound tissues showed increased collagen deposition, fibroblast content, and decreased inflammatory cells in granulated tissues in SN-addressed rats, which were statistically different from that of gum acacia-treated rats. SN treatment caused positive augmentation of Transforming Growth Factor Beta 1 (angiogenetic factor) in wound tissues, denoting a higher conversion rate of fibroblast into myofibroblast (angiogenesis) that results in faster wound healing action. Increased antioxidant enzymes (SOD and CAT), as well as decreased MDA contents in recovered wound tissues of SN-treated rats, suggest the antioxidant potentials of SN that aid in faster wound recovery. Wound tissue homogenates showed higher hydroxyproline amino acid (collagen content) values in SN-treated rats than in vehicle rats. SN treatment suppressed the production of pro-inflammatory cytokines and increased anti-inflammatory cytokines in the serum of wounded rats. The outcomes present SN as a viable pharmaceutical agent for wound healing evidenced by its positive modulation of the antioxidant, immunohistochemically proteins, hydroxyproline, and anti-inflammatory cytokines.

Evaluation of Immunohistochemical Expression of ALK-1 in Gliomas, WHO Grade 4 and Its Correlation with IDH1-R132H Mutation Status.

BACKGROUND: Glioblastoma (GB), a grade 4 glioma is the most common primary malignant brain tumor in adults. Recently, the mutation status of isocitrate dehydrogenase (IDH) has been crucial in the treatment of GB. IDH mutant cases display a more favorable prognosis than IDH-wild type ones. The anaplastic lymphoma kinase (ALK) is expressed as a receptor tyrosine kinase in both the developing central and peripheral nervous systems. Increasing lines of evidence suggest that ALK is over-expressed in GB and represents a potential therapeutic target. OBJECTIVES: The goal of the current study was to investigate ALK-1 immunohistochemical expression in gliomas, grade 4, besides its correlation with IDH1-R132H mutation status and the clinicopathological parameters of the tumors. MATERIAL AND METHODS: Seventy cases of gliomas, grade 4 were tested for immunohistochemical expression of ALK-1 & IDH1-R132H in the tumor cells. RESULTS: ALK-1 immunoexpression was detected in 22.9% of our cases and IDH1-R132H mutation was detected in 12.9% of them. ALK-1 expression (100%) was only detected in the more aggressive IDH R132H-negative GBs. ALK-1 expression was also noted in the larger-sized tumors, more in males and patients older than the mean age.  Conclusion: Our results suggest that mutations in ALK-1 may predict a more dismal prognosis since ALK expression was only noted in IDH-R132H negative GBs known to have a considerably poorer outcome compared to IDH-R132H mutant cases. GBs with detectable ALK-protein expression could potentially experience substantial clinical advantages through the utilization of newly introduced ALK inhibitors allowing personalized treatment to a subset of patients. Hence, future studies targeting ALK in IDH wildtype Glioblastomas including clinical trials on larger scales are recommended.

Myeloperoxidase Inhibition in Heart Failure With Preserved or Mildly Reduced Ejection Fraction: SATELLITE Trial Results.

BACKGROUND: Inflammation is a key driver of heart failure with preserved left ventricular ejection fraction. AZD4831 inhibits extracellular myeloperoxidase, decreases inflammation, and improves microvascular function in preclinical disease models. METHODS AND RESULTS: In this double-blind phase 2a study (Safety and Tolerability Study of AZD4831 in Patients With Heart Failure [SATELLITE]; NCT03756285), patients with symptomatic heart failure, left ventricular ejection fraction of ≥40%, and elevated B-type natriuretic peptides were randomized 2:1 to once-daily oral AZD4831 5 mg or placebo for 90 days. We aimed to assess target engagement (primary end point: myeloperoxidase specific activity) and safety of AZD4831. Owing to coronavirus disease 2019, the study was terminated early after randomizing 41 patients (median age 74.0 years, 53.7% male). Myeloperoxidase activity was decreased by more than 50% from baseline to day 30 and day 90 in the AZD4831 group, with a placebo-adjusted decreased of 75% (95% confidence interval, 48, 88, nominal P < .001). No improvements were noted in secondary or exploratory end points, apart from a trend in Kansas City Cardiomyopathy Questionnaire overall summary score. No deaths or treatment-related serious adverse events occurred. AZD4831 treatment-related adverse events were generalized maculopapular rash, pruritus, and diarrhea (all n = 1). CONCLUSIONS: AZD4831 inhibited myeloperoxidase and was well tolerated in patients with heart failure and left ventricular ejection fraction of 40% or greater. Efficacy findings were exploratory owing to early termination, but warrant further clinical investigation of AZD4831. LAY SUMMARY: Few treatments are available for patients with the forms of heart failure known as heart failure with preserved or mildly reduced ejection fraction. Current treatments do not target inflammation, which may play an important role in this condition. We tested a new drug called AZD4831 (mitiperstat), which decreases inflammation by inhibiting the enzyme myeloperoxidase. Among the 41 patients in our clinical trial, AZD4831 had a good safety profile and inhibited myeloperoxidase by the expected amount. Results mean we can conduct further trials to see whether AZD4831 decreases the symptoms of heart failure and improves patients' ability to participate in physical exercise.

Immunohistochemical Evaluation of Perlecan (Heparan Sulphate Proteoglycan 2) Expression in Invasive Female Breast Carcinoma.

BACKGROUND: Breast cancer (BC) is the commonest type of female cancer worldwide and a leading cause of cancer-related deaths. Perlecan expression increases in aggressive breast cancers, pointing to a possible significance of this novel target therapy. Consequently, the current research investigates the immunohistochemical expression of Perlecan by tumor cells in female breast cancer and the correlation of such expression with the pathologic parameters of the tumors. METHODS: A retrospective cross-sectional investigation was carried out. Seventy-four formalin-fixed, paraffin-embedded breast carcinoma tissue samples from patients undergoing modified radical mastectomy (MRM) or conservative breast surgery (CBS) were collected from the pathology department at Kasr El Aini Hospital. The paraffin blocks were sectioned and immunostained with Perlecan, and their expression was investigated in tumor cells and evaluated according to the H-score and classified into low and high expression. The expression was statistically correlated with the clinicopathological parameters of the cases. RESULTS: Perlecan expression was low in 41 cases (55.4%) and high in 33 cases (44.6%). It showed a statistically insignificant correlation with all studied parameters, but increased Perlecan expression was directly associated with poor tumor prognostic factors including higher tumor grade, advanced T stage, N3 stage, advanced anatomic stage, high Ki-67 index, positive lymphovascular invasion and perineural invasion, luminal B molecular subtype, and HER2 over-expression. CONCLUSION: Perlecan expression measured by immunohistochemical staining is associated with aggressive characteristics in breast cancer, suggesting that Perlecan may help in cancer progression and can be investigated as a possible target therapy.

Synthesis and Antiproliferative Potential of Thiazole and 4-Thiazolidinone Containing Motifs as Dual Inhibitors of EGFR and BRAFV600E.

Thiazole and thiazolidinone recur in a wide range of biologically active compounds that reach different targets within the context of tumors and represent a promising starting point to access potential candidates for treating metastatic cancer. Therefore, searching for new lead compounds that show the highest anticancer potency with the fewest adverse effects is a major drug-discovery challenge. Because the thiazole ring is present in dasatinib, which is currently used in anticancer therapy, it is important to highlight the ring. In this study, cycloalkylidenehydrazinecarbothioamides (cyclopentyl, cyclohexyl, cyclooctyl, dihydronapthalenylidene, flurine-9-ylidene, and indolinonyl) reacted with 2-bromoacetophenone and diethylacetylenedicarboxylate to yield thiazole and 4-thiazolidinone derivatives. The structure of the products was confirmed by using infrared (IR) spectroscopy, nuclear magnetic resonance (NMR) spectroscopy, mass spectrometry, and single-crystal X-ray analyses. The antiproliferative activity of the newly synthesized compounds was evaluated. The most effective inhibitory compounds were further tested in vitro against both epidermal growth factor receptor (EGFR) and B-Raf proto-oncogene, serine/threonine kinase (BRAFV600E) targets. Additionally, molecular docking analysis examined how these molecules bind to the active sites of EGFR and BRAFV600E.

Mechanisms of anti-ulcer actions of Prangos pabularia (L.) in ethanol-induced gastric ulcer in rats.

Peptic ulcer disease is the greatest digestive disorder that has increased incidence and recurrence rates across all nations. Prangos pabularia (L.) has been well documented as a folkloric medicinal herb utilized for multiple disease conditions including gastric ulcers. Hence, the target study was investigation the gastro-protection effects of root extracts of Prangos pabularia (REPP) on ethanol-mediated stomach injury in rats. Sprague Dawley rats were clustered in 5 cages: A and B, normal and ulcer control rats pre-ingested with 1 % carboxymethyl cellulose (CMC)); C, reference rats had 20 mg/kg omeprazole; D and E, rats pre-supplemented with 250 and 500 mg/kg of REPP, respectively. After one hour, group A was given orally 1 % CMC, and groups B-E were given 100 % ethanol. The ulcer area, gastric acidity, and gastric wall mucus of all stomachs were determined. The gastric tissue homogenates were examined for antioxidant and MDA contents. Moreover, the gastric tissues were analyzed by histopathological and immunohistochemically assays. Acute toxicity results showed lack of any toxic effects or histological changes in rats exposed to 2 and 5 g/kg of REPP ingestion. The ulcer controls had extensive gastric mucosal damage with lower gastric juice and a reduced gastric pH. REPP treatment caused a significant reduction of the ethanol-induced gastric lacerations represented by an upsurge in gastric mucus and gastric wall glycoproteins (increased PAS), a decrease in the gastric acidity, leukocyte infiltration, positively modulated Bax and HSP 70 proteins, consequently lowered ulcer areas. REPP supplementation positively modulated oxidative stress (increased SOD, CAT, PGE2, and reduced MDA) and inflammatory cytokines (decreased serum TNF-α, IL-6, and increased IL-10) levels. The outcomes could be scientific evidence to back-up the folkloric use of A. Judaica as a medicinal remedy for oxidative stress-related disorders (gastric ulcer).

Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation.

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

The association between body mass index elevation and differentiation in vitamin D receptor gene expression, genetic polymorphism, and oxidative stress in adult Egyptian individuals.

Vitamin D plays a central role in maintaining calcium, phosphorus, and bone homeostasis in close interaction with the parathyroid hormone. Obesity is a significant health problem worldwide, particularly in developed nations. The current study was carried out to investigate the possible relationship between body mass index (BMI) elevation and differentiation in 25-hydroxyvitamin D (VD), vitamin D receptor (VDR) gene expression, and genetic polymorphism besides oxidative stress in adult Egyptian individuals. This was done to explore the mechanisms underlying the suggested role of the VD/VDR complex in the pathogenesis of obesity. A total of 70 subjects (30 obese, 25 overweight, and 15 normal, age: 20-50 years, without other chronic diseases) were selected. The study focused on the determination of VD, VDR gene polymorphism, VDR gene expression, alkaline phosphatase, calcium, phosphorus, glucose, lipid profile, oxidative stress including, oxidant (malondialdehyde), and anti-oxidants (reduced glutathione and superoxide dismutase). The results showed that elevation in BMI led to the percentage of the Ff 'allele' becoming predominant, while the percentage of the FF 'allele' was in the normal BMI range. Also, BMI elevation caused significant reductions in VD and VDR expression, with significant elevations in alkaline phosphatase and the levels of calcium and phosphate in serum. Also, oxidative stress increases with increasing BMI. Elevation in BMI causes a reduction in VD concentration and VDR gene expression levels. Also, the percentage of heterozygous mutant genotype Ff 'allele' is predominantly in the obese human, in contrast to normal subjects, where the percentage of homozygous wild genotype FF 'allele' is predominant. In general, the genetic expression and polymorphism of VD and VDR can be used as a genetic marker for predisposition, diagnosis, prognosis, and progression of obesity.

Different Continuous Training Intensities Improve Echocardiographic Parameters, Quality of Life, and Functional Capacity in Heart Failure Patients with Reduced Ejection Fraction.

Background: Multiple comorbidities and physiological changes play a role in a range of heart failure conditions and influence the most effective approach to exercise-based rehabilitation. This research aimed to examine and compare the outcomes of continuous training at three different intensities, focusing on left ventricular (LV) remodeling, functional capacity, and quality of life among patients with heart failure with reduced ejection fraction (HFrEF). Methods: In this randomized control trial, a total of 60 male patients (average age: 54.33 ±2.35 years) with HFrEF were randomly allocated into three groups: 1) High-intensity continuous training group (HICT), 2) Moderate-intensity continuous training group (MICT), and 3) Low-intensity continuous training group (LICT). All the training was performed on a bicycle ergometer 3 times/week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro-B-type natriuretic peptide (NT-proBNP), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walking test) were assessed before and the end of the study. Results: The HICT group demonstrated the greatest improvements in all measured variables when compared to the other two groups (P < 0.05). These findings were consistent across all measured outcomes. Conclusion: It was determined that HICT appears to yield the most favorable outcomes in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among HFrEF patients.

A Rare Case of Colon Cancer in a Young Patient With HIV Infection: Is it Time for New Colon Cancer Screening Guidelines for HIV Patients?

Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of colonic neoplasms than the general population. In these patients, tumors develop at an earlier age, are diagnosed at more advanced stages, and have a dismal prognosis. Current guidelines recommend initiating colon cancer screening in HIV patients at the age of 45 which is consistent with screening age in the general population. We present a rare case of colon cancer diagnosed in an HIV-infected patient at a young age of only 34 years. Therefore, we recommend early screening for colon cancer in HIV patients than the general population.

A Rare Case of Malignant Syndrome in Parkinson's Disease Caused by Severe Dehydration and Complicated by Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH).

Malignant syndrome (MS) in Parkinson's disease (PD) is a rare complication that occurs in patients who have a history of PD and are taking dopaminergic drugs. The syndrome is quite similar to neuroleptic malignant syndrome (NMS) in presentation and is a potentially fatal syndrome. Awareness of symptoms, early diagnosis, and the ability to differentiate it from NMS is important to prevent mortality. Clinical manifestations of MS are similar to NMS and include altered mentation, rigidity, fever, leukocytosis, and elevated serum creatine kinase (CK). However, MS is differentiated from NMS by the precipitating factors; of which, the commonest precipitating factor for MS is dopaminergic drug withdrawal or dose reduction while other less common causes include infection, dehydration, and hot weather. We present a rare case of MS in a patient with a history of PD precipitated by severe dehydration and hot weather in the absence of dopaminergic drug withdrawal. He presented with fever, severe rigidity, altered mentation, dehydration, leukocytosis, and elevated CK. He was correctly diagnosed with MS and promptly treated, preventing mortality. The triad of fever, severe rigidity, and altered sensorium in a patient with a history of PD should prompt evaluation for MS in addition to NMS to initiate appropriate treatment and prevent mortality.

Clinical evaluation of zirconia crowns cemented with two different resin cements: A retrospective study.

BACKGROUND: Self-adhesive resin cement has been used extensively with zirconia crowns. Several in vitro studies showed that adhesive resin cementation may increase zirconia crowns' retention and their fatigue resistance. OBJECTIVES: This retrospective study aimed to evaluate the clinical performance, survival and success rates and complications encountered with zirconia crowns cemented with two different self-adhesive resin cements. METHODS: A total of 112 patients who received 176 monolithic zirconia crowns were evaluated. Crowns were cemented with RelyX Unicem 2 (n = 74) and Panavia SA (n = 102) self-adhesive resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by two evaluators. Descriptive statistics, McNemar, t-test, log rank (Mantel-Cox) tests and Kaplan-Meier survival analyses were performed (a = .05). RESULTS: The 5-year survival and success rates were 100% and 96.4%, respectively. The complications encountered were recurrent caries (2.2%) and the need for endodontic treatment (0.5%). No technical complications, such as fracture or loss of retention, were observed. The type of cement and patient-related factors did not influence the survival and success rates of the crowns. CONCLUSIONS: Survival rate of zirconia crowns cemented with two different self-adhesive resin cements was 100% after 5 years.

Evaluation of Monkeypox as an Unrecognized Sexually Transmitted Disease: A Rare Case of Monkeypox Infection with HIV and Syphilis Coinfection.

Monkeypox (MPX) virus is endemic in Africa. However, since May 2022, many cases have been reported worldwide in many non-endemic regions as well. The virus usually spreads from animals to humans or from humans to humans through respiratory droplets or after contact with infected lesions. In the recent outbreak of MPX, many cases did not have any travel history to endemic areas and were reported in men who have sex with men (MSM) along with the diagnosis of other sexually transmitted diseases (STDs). However, MPX is not yet considered a sexually transmitted infection (STI), even though a relationship between MPX and other STIs may exist with a possible facilitating action on their spreading. We present a similar case of MPX infection in an MSM patient with concomitant HIV and syphilis infections and no travel history to an endemic area.