Granulomatous Amyloid Angiopathy in a Patient With Persistent Headache.

Cerebral amyloid angiopathy (CAA) is a type of cerebrovascular disorder characterized by the accumulation of amyloid beta peptide within the walls of small to medium-sized blood vessels in the brain and leptomeninges. This can cause a variety of symptoms, depending on the location and extent of the deposits. Common presentations of amyloid angiopathy include cognitive decline, memory loss, headaches, vision changes, stroke-like symptoms, and seizures. In some cases, there may be no noticeable symptoms. A 78-year-old female was admitted for ongoing evaluation of a persistent headache after her primary care physician (PCP) ordered outpatient magnetic resonance imaging (MRI) that showed findings concerning metastatic tumors versus infectious processes. She underwent a right temporal lobe biopsy, which confirmed the diagnosis of granulomatous amyloid angiopathy.

Solvent based fractional biosynthesis, phytochemical analysis, and biological activity of silver nanoparticles obtained from the extract of Salvia moorcroftiana.

Multi-drug resistant bacteria sometimes known as "superbugs" developed through overuse and misuse of antibiotics are determined to be sensitive to small concentrations of silver nanoparticles. Various methods and sources are under investigation for the safe and efficient synthesis of silver nanoparticles having effective antibacterial activity even at low concentrations. We used a medicinal plant named Salvia moorcroftiana to extract phytochemicals with antibacterial, antioxidant, and reducing properties. Three types of solvents; from polar to nonpolar, i.e., water, dimethyl sulfoxide (DMSO), and hexane, were used to extract the plant as a whole and as well as in fractions. The biosynthesized silver nanoparticles in all extracts (except hexane-based extract) were spherical, smaller than 20 nm, polydispersed (PDI ranging between 0.2 and 0.5), and stable with repulsive force of action (average zeta value = -18.55±1.17). The tested bacterial strains i.e., Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis were found to be sensitive to even small concentrations of Ag-NPs, especially P. aeruginosa. The antibacterial effect of these Ag-NPs was associated with their ability to generate reactive oxygen species. DMSO (in fraction) could efficiently extract antibacterial phytochemicals and showed activity against MDR bacteria (inhibition zone = 11-12 mm). Thus, the antibacterial activity of fractionated DMSO extract was comparable to that of Ag-NPs because it contained phytochemicals having solid antibacterial potential. Furthermore, Ag-NPs synthesized from this extract owned superior antibacterial activity. However, whole aqueous extract-based Ag-NPs MIC was least (7-32 µg/mL) as compared to others.

Acute liver failure secondary to the use of unmonitored drugs and herbal supplements: an underreported and serious issue.

Acute liver failure (ALF) is a potentially fatal illness marked by the abrupt development of jaundice, coagulopathy, and hepatic encephalopathy (HE) in persons having no previous history of hepatic disease. It is a relatively uncommon illness, having an incidence of 1 to 8 per million people. Hepatitis A, B, and E viruses have been documented as the most prevalent etiologies of acute liver failure in Pakistan and other developing nations. However, ALF may also occur secondary to toxicity caused by the unmonitored overdosing and toxicity of traditional medicines, herbal supplements, and alcohol. Similarly, in some instances, the etiology remains unknown. Herbal products, alternative, and complementary therapies are frequently practiced across the globe for treating various illnesses. In recent times, their use has gained much popularity. Indications and the use of these supplementary drugs vary significantly. The majority of these products have not gained approval from Food and Drug Administration (FDA). Unfortunately, the incidence of documented adverse effects linked to the usage of herbal products has increased recently, but still, these events are underreported, and the condition is known as drug-induced liver injury (DILI) and herb-induced liver injury (HILI). The estimated total herbal retail sales increased from $4230 million in 2000 to $6032 million in 2013, representing a total of 42 and 3.3% per annum increase. To reduce the occurrence of HILI and DILI, physicians in general practice settings should inquire about patients' understanding of potential toxicity with the consumption of hepatotoxic and herbal medicines.

Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems.

Objective This study was conducted to assess the outcome in patients with hydrocephalus who underwent ventriculoperitoneal (VP) shunt surgery. Methods This retrospective study was conducted at the neurosurgery department of a tertiary care hospital. The time frame was three years and five months from January 2017 to May 2020 with a follow-up of six months. Results This study included 1030 patients, out of whom 64.2% were male and 35.8% were female. While the majority of the patients were more than 11 years of age (466), age did not have any significant impact on the outcome of the ventriculoperitoneal shunt surgery. The most common cause of hydrocephalus was congenital (47.6%). A good outcome was seen in 63.4%, mortality was 10.6%, and complications were identified for 25.8%. The underlying pathology had a significant impact on the outcome in our study (p-value < 0.05) where the congenital cause of hydrocephalus showed a better outcome than any other cause. Conclusion Ventriculoperitoneal shunt is a good way to manage hydrocephalus, but there is always a high risk of complications.

Improving the efficiency of dye-sensitized solar cells based on rare-earth metal modified bismuth ferrites.

This study reports light energy harvesting characteristics of bismuth ferrite (BiFeO3) and BiFO3 doped with rare-earth metals such as neodymium (Nd), praseodymium (Pr), and gadolinium (Gd) dye solutions that were prepared by using the co-precipitation method. The structural, morphological, and optical properties of synthesized materials were studied, confirming that 5-50 nm sized synthesized particles have a well-developed and non-uniform grain size due to their amorphous nature. Moreover, the peaks of photoelectron emission for bare and doped BiFeO3 were observed in the visible region at around 490 nm, while the emission intensity of bare BiFeO3 was noticed to be lower than that of doped materials. Photoanodes were prepared with the paste of the synthesized sample and then assembled to make a solar cell. The natural and synthetic dye solutions of Mentha, Actinidia deliciosa, and green malachite, respectively, were prepared in which the photoanodes were immersed to analyze the photoconversion efficiency of the assembled dye-synthesized solar cells. The power conversion efficiency of fabricated DSSCs, which was confirmed from the I-V curve, is in the range from 0.84 to 2.15%. This study confirms that mint (Mentha) dye and Nd-doped BiFeO3 materials were found to be the most efficient sensitizer and photoanode materials among all the sensitizers and photoanodes tested.

Cytotoxicity Study of Gold Nanoparticle Synthesis Using Aloe vera, Honey, and Gymnema sylvestre Leaf Extract.

Gold nanoparticles (AuNPs) have gained importance in the field of biomedical research and diagnostics due to their unique physicochemical properties. This study aimed to synthesize AuNPs using Aloe vera extract, honey, and Gymnema sylvestre leaf extract. Physicochemical parameters for the optimal synthesis of AuNPs were determined using 0.5, 1, 2, and 3 mM of gold salt at varying temperatures from 20 to 50 °C. X-ray diffraction was used to evaluate the crystal structure of AuNPs, which came out to be a face-centered cubic structure. Scanning electron microscopy and energy-dispersive X-ray spectroscopy analysis confirmed the size and shape of AuNPs between 20 and 50 nm from the Aloe vera, honey, and Gymnema sylvestre, as well as large-sized nanocubes in the case of honey, with 21-34 wt % of gold content. Furthermore, Fourier transform infrared spectroscopy confirmed the presence of a broadband of amine (N-H) and alcohol groups (O-H) on the surface of the synthesized AuNPs that prevents them from agglomeration and provides stability. Broad and weak bands of aliphatic ether (C-O), alkane (C-H), and other functional groups were also found on these AuNPs. DPPH antioxidant activity assay showed a high free radical scavenging potential. The most suited source was selected for further conjugation with three anticancer drugs including 4-hydroxy Tamoxifen, HIF1 alpha inhibitor, and the soluble Guanylyl Cyclase Inhibitor 1 H-[1,2,4] oxadiazolo [4,3-alpha]quinoxalin-1-one (ODQ). Evidence of the pegylated drug conjugation with AuNPs was reinforced by ultraviolet/visible spectroscopy. These drug-conjugated nanoparticles were further checked on MCF7 and MDA-MB-231 cells for their cytotoxicity. These AuNP-conjugated drugs can be a good candidate for breast cancer treatment that will lead toward safe, economical, biocompatible, and targeted drug delivery systems.

Radiological Association Between Multiple Sclerosis Lesions and Serum Vitamin D Levels.

INTRODUCTION: The primary aim of this study was to determine a plausible association between the radiological location of multiple sclerosis (MS) lesions and serum 25-hydroxyvitamin D (vitamin D) levels at the time of diagnosis. MS is a common immune-mediated neurological condition mainly affecting the central nervous system. Although the association of vitamin D levels is well established, there have not been many studies to propose a connection between the location of the lesions based on serum vitamin D levels. In this study, we determine the association between serum 25-hydroxyvitamin D and the radiological distribution of lesions in patients with MS. METHODS: Twenty patients with a confirmed diagnosis of MS involving new T2-weighted and gadolinium-enhancing T1-weighted lesions in the entire central nervous system (brain and spinal cord) with serum 25-hydroxyvitamin D levels at the time of diagnosis were included in a case group. As a reference, 20 patients with a confirmed diagnosis of MS with isolated new T2-weighted and gadolinium-enhancing T1-weighted lesions (either supratentorial, infratentorial, or spinal cord) with serum 25-hydroxyvitamin D levels at the time of diagnosis were included in the control group. RESULTS: The mean serum 25-hydroxyvitamin D level was significantly low in the case group compared to the control group (36.2 ± 17.2 vs 62.6 ± 21.0; p-value <0.0001). CONCLUSION: There is a plausible inverse relationship between serum vitamin D and the MS lesions involving the entire central nervous system (brain and spinal cord). This evidence may enable clinicians to forecast disease load based on serum vitamin D levels.

Alcohol Use Disorder Admissions During the COVID-19 Pandemic: Findings From a Tertiary Community Hospital.

OBJECTIVES: The first case of Coronavirus disease-19 (COVID-19) in the United States was confirmed by the Centers for Disease Control (CDC) in January 2020. The presence of COVID-19 and the subsequent spread of this disease led to stress, anxiety, grief, and worry. We aimed to study the rate of hospital admission for alcohol use disorder (AUD) before and during the COVID-19 pandemic in a tertiary community hospital in Michigan. METHODS: Two subsets of hospital data were collected for comparison between hospitalized patients before and during the pandemic in a tertiary community hospital. Logistic regression was used to identify the odds ratio of AUD admission rates among all patients in 2020 compared with 2019 while controlling for covariates. RESULTS: Our data showed a statistically significant increase in AUD patients in 2020 compared to 2019 (3.26% versus 2.50%, adjusted OR=1.44 with P=0.002). In addition, females had significantly lower chances of admission for AUD compared with males (OR=0.22 with P<0.001) and African Americans had significantly lower chances of admission for AUD compared to Whites (OR=0.44 with P <0.001). Divorced patients had a higher probability of admission for AUD compared to married patients (OR=2.62 with P<0.001). CONCLUSION: Our study found a significantly higher rate of AUD admissions in 2020 during the COVID-19 Pandemic compared to 2019. Gender, race, age, and marital status are significant risk factors related to AUD admissions.

The Prediction of Outcomes in Patients Admitted With Traumatic Brain Injury Using the Rotterdam Score.

OBJECTIVE: The objective was to use the Rotterdam score, which is based on a CT scan, to assess the outcomes of traumatic brain injury patients. MATERIAL AND METHODS: This research, which included 319 head trauma patients, was carried out at the neurosurgery department of a tertiary care hospital between June 2019 and December 2020. The Rotterdam score was calculated for each patient on the basis of the first CT scan after the head injury. The Glasgow Outcome Score was used to assess the results three months following the injury. RESULTS: In our research, there were 270 male patients (84.6%) and 49 female patients (15.4%). The mean age was 37.4 ± 15.4 years and road traffic accidents were observed in 275 people (86.2%). Severe traumatic brain injury (TBI) was seen in 123 patients (38.6%). The most common Rotterdam score was 2 in 86 (27.0%) patients, while it was score 3 in 72 (22.6%), score 4 in 59 (18.5%), score 5 in 41 (12.9%), score 1 in 31 (9.7%) and score 6 in 29 (9.1%). The mortality rate was 33.5% in our patients and good recovery was seen in 150 (47.0%) patients. CONCLUSION: The Rotterdam score is a useful tool to evaluate and predict outcomes in head trauma patients.

Synthesis and Characterization of Polyvinyl Chloride Matrix Composites with Modified Scrap Iron for Advanced Electronic, Photonic, and Optical Systems.

In this study, Fe2O3 powder was synthesized using the co-precipitation method from scrap iron, which was then treated with varying concentrations of copper. Afterwards, the modified Fe2O3 was reinforced in the PVC matrix by using the solution-casting method to synthesize PVC composite films, which were subjected to a UV-visible spectrophotometer, a Fourier transform infrared spectrophotometer, an X-ray diffractometer, and a thermal gravimetric analyzer to evaluate the optical, chemical, structural, and thermal properties. FTIR analysis reveals the formation of the composite through vibrational bands pertaining to both components present, whereas no significant changes in the XRD patterns of PVC were observed after the doping of modified iron oxide, which reveals the compatibility of fillers with the PVC matrix. The optical properties of the copper-doped iron oxide-PVC composites, including absorbance, refractive index, urbach energy, and optical as well as electrical conductivity are measured, and show an increase in optical activity when compared to the pure PVC compound. Moreover, the increased thermal stability of the synthesized composite was also observed and compared with conventional compounds, which, in accordance with all the other mentioned properties, makes the copper-dopped iron oxide-PVC composite an effective material for electronic, photonic, and optical device applications.

Stimulation of Erythrocyte Membrane Blebbing by Bifenthrin Induced Oxidative Stress.

Background: Bifenthrin is an insecticide and anti-estrogenic compound primarily used to control residential pests by depolarizing sodium gated voltage channels in the nervous system. Eryptosis, the suicidal death of erythrocytes, featured by PS exposure, membrane blebbing and cell shrinkage. Anemia is an outcome of uncontrolled eryptosis. Research Design: In this study, erythrocytes were treated with different concentrations (.5-1-1.5 µM) of bifenthrin over a period of 48 hours. In order to investigate the oxidative stress induced by bifenthrin, catalase, superoxide dismutase, and glutathione peroxidase activities were investigated. Results: Obtained data indicated the decrease in the enzymes (superoxide dismutase, glutathione peroxidase, and catalase) activities in bifenthrin treated cells at 1 µM concentration. In addition, measurement of cell size and confirmation of the role of calcium in the stimulation of the eryptotic activity of bifenthrin were performed. A significant increase in mean cell volume was found in the presence of bifenthrin and a decrease in mean cell volume in the presence of calcium channel blocker was observed. Similarly, there was also a significant increase in the percentage of hemolysis indicating the necrotic activity of bifenthrin. Conclusions: It is concluded that the indicated doses of bifenthrin triggered oxidative stress which may lead to early cell death by eryptosis and hemolysis.

Induction of Erythrocyte Membrane Blebbing by Methotrexate-Induced Oxidative Stress.

Methotrexate (MTX) is a common chemotherapeutical agent and folate antagonist with reported apoptotic activity in nucleated cells. The presented research work was planned to investigate the eryptotic effects of methotrexate after the exposure of erythrocytes to therapeutical doses (10-15 µM) of methotrexate. Eryptosis and the role of calcium in the stimulation of membrane blebbing were evaluated through the determination of mean cell volume. Oxidative stress induced by methotrexate (10-15 µM) was determined by antioxidative enzyme activities. Cytotoxic activity against human erythrocytes was examined through hemolysis assay. Exposure of erythrocytes to methotrexate results in significant reduction of superoxide dismutase, catalase, and superoxide dismutase activities at 10 and 15 µM in comparison to the untreated cells. Erythrocytes mean cell volume (MCV) was increased after 48 hours exposure of erythrocytes to methotrexate (10 µM). Significantly increased hemolysis percentage was observed at 10 µM after 48 hours incubation of erythrocytes with methotrexate. The results of the study suggested that the therapeutical doses (10-15 µM) of methotrexate may lead to increase in eryptotic and hemolytic activity of erythrocytes through free radical generation and subsequent calcium entry.

A Case of Subclavian Artery Thrombosis.

Subclavian artery thrombosis is a rare cause of upper limb ischemia resulting from occlusion of the upper extremity blood supply. Symptomatic presentation is quite rare and therefore remains underdiagnosed by physicians. Possible catastrophic clinical consequences necessitate prompt rectification of the underlying disease and risk factors. Treatment modalities are often selected depending on the severity of clinical presentation. Herein, we present a case of a 52-year-old man who presented to the outpatient department with a one-month history of pain and blackish discoloration of the right-hand digits, palm, and wrist. His social history also revealed a chronic 30-year history of smoking. At the time of consultation, his past medical history was insignificant for chronic medical disease and hospitalizations. However, inpatient investigations diagnosed him with diabetes. Physical examination revealed a bad odor emanating from the devitalized affected right hand. Neurological examination was significant for the loss of pain sensation in the right hand. Furthermore, the right radial and brachial pulses were also absent (grade 0). Right upper extremity angiography revealed the occlusion of the right subclavian artery and right brachial artery. Above elbow amputation was advised and performed based on angiogram scans and physical examination findings. We report a case of subclavian artery thrombosis in an undiagnosed diabetic with a chronic history of smoking. Our report details the common etiology, clinical presentation, and management options feasible for this clinical entity. Furthermore, it reiterates the importance of counseling patients to attend annual healthcare doctor visits.

An Unusual Case of Klebsiella pneumoniae Endocarditis.

Klebsiella pneumoniae notoriously causes life-threatening community-acquired or hospital-acquired pneumonia. In the United States, community-acquired pneumonia is a relatively common diagnosis. However, community-acquired pneumonia due to Klebsiella pneumoniae is fairly uncommon. Delayed antibiotic administration can result in bacteremia, septicemia and other systemic complications. Infective endocarditis arising as a complication of community-acquired Klebsiella pneumoniae infection has rarely been reported. Our patient is an 88-year-old diabetic female, who was admitted to our intensive care unit due to a high-grade fever, worsening dyspnea and hypotension. Chest x-ray and blood culture were conclusive for pneumonia due to Klebsiella pneumoniae. Importantly, the species was only susceptible to colistin. Furthermore, an echocardiogram revealed mobile vegetations of the non-coronary cusp of the aortic valve. Treatment with colistin resulted in clinical improvement and an uneventful discharge from the hospital. Follow up echocardiography was scheduled upon discharge to monitor the resolution of cardiac vegetations.

Pulmonary capillary hemangiomatosis: a lesson learned.

Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.

Pulmonary capillary hemangiomatosis: a lesson learned

Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.

Frightening" Resistant Clostridial Myonecrosis: A Case Report.

Clostridial myonecrosis is a diffuse necrotizing infection of deep soft tissues. It is known for its acute, rapid progression, poor prognosis, and high mortality. We report a case of traumatic clostridial myonecrosis, a 17-year-old, previously healthy female reported to our department with the complaint of pain in her left arm a week after she suffered a fall from her chair on to her left arm. Due to the injury sustained in the incident, under suspicion of a forearm fracture, a cast was applied to her left arm at a local polyclinic. However, after a few days, she reported unbearable pain, which led to the removal of the cast, and that is when diffuse crepitations due to gaseous accumulation were noted in her entire left upper limb. A week later, X-ray studies failed to reveal any fracture or abnormality. The patient was started on broadspectrum antibiotic coverage with intravenous (IV) benzylpenicillin, rifampicin, and clindamycin for a considerable period of time, but there was no improvement in her condition and the infection continued to spread into adjacent soft tissues, requiring intervention with hyperbaric oxygen therapy.

Perception of Preparedness of Health Care Professionals in Case of a Nuclear, Chemical, Biological Attack/Emergency in a Tertiary Care Hospital.

Background With the growth of global terrorism and rapid advancements in the field of science, the threat of a nuclear, biological, and chemical (NBC) attack remains imminent. This study assesses perceptions of preparedness of health care professionals in case of an NBC attack/incident in a tertiary care hospital. Patients and methods We conducted a descriptive, cross-sectional study of 200 health care workers (including nurses and doctors) in a tertiary care hospital, from October 2018 through December 2018. Participants answered 17 yes/no questions and five 5-point Likert scale questions. We analyzed the data using chi-square tests and one-way analysis of variance. Results Most participants (73.6%) reported availability to an isolation facility, and a majority of participants (72%) reported they had access to ventilators. Approximately 60% of participants reported they had access to beds, and 44.6% reported access to a laundry facility. Most participants (65.3%) knew of an employee assistance program while 31.1% did not know about such a program at their institution. More than 50% of the respondents think they can deal with an emergency involving an NBC attack while 60% of the respondents did not think that their institution would be able to protect them in the event of an NBC attack/incident. Overall, the participants were not adequately prepared for a mass scale NBC incident. The level of preparation was linked to the number of courses and training programs completed by the participants, with postgraduate medical personnel having the maximum level of preparedness, followed by medical graduates and nursing personnel. Conclusion Given the inadequate level of preparedness for an NBC incident as indicated by our findings, drills and seminars on large-scale emergencies such as an NBC attack should be included in the curriculum of undergraduate medical and nursing students in order to impart them the necessary training and confidence in dealing with an NBC incident.