The Epidemiology and Clinical Presentation of Pancreatic Divisum: A Case Series of 57 Case Reports.

OBJECTIVES: Pancreatic divisum (PD) is the second most common congenital abnormality of the pancreatic duct, which affects 2% to 3% of the population. Most of the population remains asymptomatic, but in people who present with symptoms, it can be a cause of anguish and should be recognized. The main goal of this article was to provide a comprehensive picture of clinical and epidemiological methods of diagnosis and treatment of PD. METHODS: A total of 57 PD case reports were considered in this descriptive analysis with 51 case reports and case series published within the last 25 years. The search strategies include systemic searches using scholarly search engines such as Medscape, Scopus, Cochrane, and PubMed. RESULTS: The 57 cases we studied have an average age of presentation of 42 years, with female sex (58%) predominance. Common presenting symptoms were abdominal pain (87.72%) and radiation to the back (21.6%). Eighty-one percent of the case studies reported pancreatitis, and 63.2% had recurrent pancreatitis. At presentation, laboratory values demonstrated increased amylase, lipase, and liver enzymes. PD was diagnosed using magnetic resonance cholangiopancreatography (28.1%), endoscopic retrograde cholangiopancreatography (57.9%), endoscopic ultrasound (7%), or computed tomography (5.3%) scan of the abdomen. Of significance, biliary duct dilation was found in 70.6% of patients diagnosed as having PD. Incidental masses were found in 66.7% of the patients. The most successful treatment was sphincterotomy with or without stents (47.6%), followed by pancreatoduodenectomy (19%) and pancreaticojejunostomy (10%). CONCLUSIONS: Physicians managing pancreatitis should add PD to their differential diagnoses because it will help improve patient outcomes and avoid unfavorable consequences.

The cardio-oncology continuum: Bridging the gap between cancer and cardiovascular care.

Cancer and cardiovascular disease are two of the leading causes of death worldwide. Although cancer has historically been viewed as a condition characterized by abnormal cell growth and proliferation, it is now recognized that cancer can lead to a variety of cardiovascular diseases. This is due to the direct impact of cancer on the heart and blood vessels, which can cause myocarditis, pericarditis, and vasculitis. Additionally, cancer patients frequently experience systemic effects such as oxidative stress, inflammation, and metabolic dysregulation, which can contribute to the development of cardiovascular risk factors such as hypertension, dyslipidemia, and insulin resistance. It is important to closely monitor patients with cancer, especially those undergoing chemotherapy or radiation therapy, for cardiovascular risk factors and promptly address them. This article aims to explore the clinical implications of the underlying mechanisms connecting cancer and cardiovascular diseases. Our analysis highlights the need for improved cooperation between oncologists and cardiologists, and specialized treatment for cancer survivors.

Lab testing overload: a comprehensive analysis of overutilization in hospital-based settings.

Overuse of laboratory tests has been a growing problem in the inpatient hospital setting for years, which adds to the rising cost of care. Various factors come into play, such as clinical routines, lack of cost transparency, and the convenience of electronic health record-based ordering. The financial ramifications of the overuse are significant, as lab costs drive most medical decisions. Eliminating unnecessary testing with clinical decision support and best practices is associated with marked cost savings, improved outcomes, and decreased patient distress. The excessive use of laboratory tests highly affects patients, resulting in hospital-induced anemia, low patient satisfaction, and poor outcomes. Tackling lab overuse requires a multifaceted approach that includes education, technology, and policy changes. In the era of precision healthcare, optimizing test utilization can reduce costs, decrease waste, and improve patient care.

Cardiovascular Challenges Beyond Earth: Investigating the Impact of Space Travel on Astronauts' Cardiovascular Health.

In the coming decades, as humanity aims to establish a presence on Mars, there is a growing significance in comprehending, monitoring, and controlling the diverse health challenges arising from space exploration. The extended exposure to microgravity during space missions leads to various physical alterations in astronauts, such as shifts in bodily fluids, reduced plasma volume, loss of bone density, muscle wasting, and cardiovascular deconditioning. These changes can ultimately lead to orthostatic intolerance, underscoring the increasing importance of addressing these health risks. Astronauts are exposed to cosmic radiation consisting of high-energy particles from various sources, including solar cosmic rays and galactic cosmic rays. These radiations can impact the electrical signals in the heart, potentially causing irregular heart rhythms. Understanding the risks to the heart and blood circulation brought on by exposure to space radiation and the overall stress of spaceflight is essential and this article reviews the cardiovascular effects of space travel on astronauts.

Age-Related Orthostatic Hypotension: A Comprehensive Analysis of Prevalence, Mechanisms, and Management in the Geriatric Population.

Geriatric patients frequently encounter orthostatic hypotension (OH), a multifaceted condition characterized by a significant drop in blood pressure upon assuming an upright position. As the elderly population is particularly susceptible to OH, our review endeavors to comprehensively explore the complex nature of this condition and various factors contributing to its development. We investigate the impact of comorbidities, polypharmacy, age-related physiological changes, and autonomic dysfunction in the pathogenesis of OH. Geriatric patients with OH are faced with an elevated risk of falls, syncope, a decline in their overall quality of life, and hence increased mortality. These implications require careful consideration, necessitating a thorough examination of therapeutic strategies. We evaluate various pharmaceutical and nonpharmacological therapies, delving into the effectiveness and safety of each approach in managing OH within geriatric populations. We explore the role of pharmacotherapy in alleviating symptoms and mitigating OH-related complications, as well as the potential benefits of volume expansion techniques to augment blood volume and stabilize blood pressure. We place particular emphasis on the significance of lifestyle changes and nonpharmacological interventions in enhancing OH management among the elderly. These interventions encompass dietary modifications, regular physical activity, and postural training, all tailored to the unique needs of the individual patient. To optimize outcomes and ensure patient safety, we underscore the importance of individualized treatment plans that take into account the geriatric patient's overall health status, existing comorbidities, and potential interactions with other medications. This review aims to improve clinical practice and patient outcomes by advocating for early detection, properly tailored management, and targeted interventions to address OH in the elderly population. By raising awareness of OH's prevalence and complexities among healthcare professionals, we hope to foster a comprehensive understanding of OH and contribute to the overall wellness and quality of life of this vulnerable demographic.

A comprehensive analysis of different types of clinical rounds in hospital medicine.

Table rounds and bedside rounds are two methods healthcare professionals employ during clinical rounds for patient care and medical education. Bedside rounds involve direct patient engagement and physical examination, thus significantly impacting patient outcomes, such as improving communication and patient satisfaction. Table rounds occur in a conference room without the patient present and involve discussing patient data, which is more effective in fostering structured medical education. Both bedside and table rounds have pros and cons, and healthcare professionals should consider the specific requirements of their patients and medical trainees when deciding which approach to use. This research utilized a comprehensive search to identify relevant resources, such as university website links, as well as a PubMed search using relevant keywords such as 'bedside rounding,' 'table rounding,' and 'patient satisfaction.' Relevance, publication date, and study design were the basis for inclusion criteria. This study compared the effectiveness of these two methods based on physician communication, medical education, patient care, and patient satisfaction.

Optical photothermal infrared spectroscopy and discrete wavenumber imaging for high content screening of single cells.

Major drawbacks of direct mid-infrared spectroscopic imaging of single cells in an aqueous buffer are strong water absorption, low resolution typically above 10 µm, and Mie scattering effects. This study demonstrates how an indirect detection principle can overcome these drawbacks using the optical photothermal infrared (O-PTIR) technique for high-resolution discrete wavenumber imaging and fingerprint spectroscopy of cultivated cells as a model system in a simple liquid sample chamber. The O-PTIR spectra of six leukemia- and cancer-derived cell lines showed main IR bands near 1648, 1547, 1447, 1400, 1220, and 1088 cm-1. Five spectra of approximately 260 single cells per cell type were averaged, the O-PTIR data set was divided into leukemia-derived cells (THP-1, HL 60, Jurkat, and Raji) and cancer cells (HeLa and HepaRG), and partial least squares linear discriminant analysis (PLS-LDA) was applied in the spectral range 800-1800 cm-1 to train three classification models. A leukemia versus cancer cell model showed an accuracy of 90.0%, the HeLa versus HepaRG cell model had an accuracy of 95.4%, and the model for the distinction of leukemia cells had an accuracy of 75.4%. IR bands in linear discriminants (LDs) of the models were correlated with second derivative spectra that resolved more than 25 subbands. The IR and second derivative spectra of proteins, DNA, RNA and lipids were collected as references to confirm band assignments. O-PTIR images of single cells at a 200 nm step size were acquired at 1086, 1548, and 1746 cm-1 to visualize the nucleic acid, protein, and lipid distribution, respectively. Variations in subcellular features and in the lipid-to-protein and nucleic acid-to-protein ratios were identified that were consistent with biomolecular information in LDs. In conclusion, O-PTIR can provide high-quality spectra and images with submicron resolution of single cells in aqueous buffers that offer prospects in high-content screening applications.

Investigating biochemical and structural changes of glycated collagen using multimodal multiphoton imaging, Raman spectroscopy, and atomic force microscopy.

Advanced glycation end products (AGEs) form extracellular crosslinking with collagenous proteins, which contributes to the development of diabetic complications. In this study, AGEs-related pentosidine (PENT) crosslinks-induced structural and biochemical changes are studied using multimodal multiphoton imaging, Raman spectroscopy and atomic force microscopy (AFM). Decellularized equine pericardium (EP) was glycated with four ribose concentrations ranging between 5 and 200 mM and monitored for up to 30 days. Two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) microscopic imaging probed elastin and collagen fibers, respectively. The glycated EP showed a decrease in the SHG intensities associated with loss of non-centrosymmetry of collagen and an increase of TPEF intensities associated with PENT crosslinks upon glycation. TPEF signals from elastin fibers were unaffected. A three-dimensional reconstruction with SHG + TPEF z-stack images visualized the distribution of collagen and elastin within the EP volume matrix. In addition, Raman spectroscopy (RS) detected changes in collagen-related bands and discriminated glycated from untreated EP. Furthermore, AFM scans showed that the roughness increases and the D-unit structure of fibers remained unchanged during glycation. The PENT crosslinked-induced changes are discussed in the context of previous studies of glutaraldehyde- and genipin-induced crosslinking and collagenase-induced digestion of collagen. We conclude that TPEF, SHG, RS, and AFM are effective, label-free, and non-destructive methods to investigate glycated tissues, differentiate crosslinking processes, and characterize general collagen-associated and disease-related changes, in particular by their RS fingerprints.

Asymptomatic Hyperuricemia as an Independent Risk Factor for Myocardial Infarction in Adult Population: A Four-Year Follow-Up Study.

Introduction A condition in which uric acid levels are elevated but there are no accompanying symptoms is known as asymptomatic hyperuricemia. As a result of the disparity in opinions and findings between the studies, the guidelines regarding whether or not asymptomatic hyperuricemia should be treated are unclear. Material and methods Between the months of January 2017 and June 2022, this research was carried out in the community in collaboration with the internal medicine unit and the public health unit of Liaquat University of Medical and Health Sciences. After obtaining informed consent from each participant, the researchers enrolled 1,500 patients in the study who had uric acid levels that were greater than 7.0 mg/dL. These patients ranged in age from 40 to 70 years old and were of either gender. As a control group, 1,500 patients were recruited who did not have abnormally high levels of uric acid. Patients were monitored for a total of 48 months or until the occurrence of a major cardiovascular event (MACCE) or death from all causes, whichever occurred first. Death, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke were the four categories that made up the primary outcome, also known as MACCEs. Results In the hyperuricemic group, the incidence of myocardial infarction that did not result in death was significantly higher than in the non-hyperuricemic group (1.6% vs. 0.7%; p-value, 0.04). However, the result was not significant for deaths from all causes, deaths from cardiovascular disease, or strokes that did not result in death. Conclusion Asymptomatic hyperuricemia is a potential threat to one's health that can lead to cardiovascular diseases and may go undiagnosed in some cases. It is important to remember that hyperuricemia can lead to delirious complications, so efforts should be made to perform routine monitoring and management of the condition.

Effect of Phosphodiesterase-5 (PDE-5) Inhibitors on Clinical Outcomes in Patients With Pulmonary Hypertension: A Meta-Analysis of Randomized Control Trials.

We intended to summarize the most recent research pertaining to the use of phosphodiesterase-5 (PDE5) inhibitors in pulmonary hypertension in light of recent developments in the knowledge of the pathophysiological mechanisms and treatments for pulmonary hypertension, with major contributions in the area in the last decade. The aim of this meta-analysis is to determine the efficacy of PDE5 inhibitors for pulmonary hypertension in adults. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to carry out this meta-analysis. Online database searching to identify eligible trials was performed in MEDLINE, EMBASE, and the Cochrane Library by two authors independently. Outcomes assessed in the current meta-analysis included change in the cardiac index from baseline in liters per minute per square meter (L/min/m2), mean peripheral arterial pressure (PAP) in mm Hg, mortality, hospitalization, and six-minute walking distance (6MWD) in meters (m). Overall, 17 articles met the inclusion criteria and were included in the current meta-analysis. PDE5 inhibitors significantly improve cardiac index (mean difference: 0.18, 95% CI: 0.04, 0.32, p-value: 0.01), mean PAP (mean difference: -5.61, 95% CI: -7.60, -3.62, p-value: 0.01), and 6MWD (mean difference: 26.26, 95% CI: 16.95, 35.57, p-value: 0.001) as compared to the patients in the control group. No significant difference was found in terms of risk of mortality (risk ratio (RR): 0.51, 95% CI: 0.17, 1.54) and risk of hospitalization (RR: 0.59, 95% CI: 0.23, 1.55) between the two groups. The current meta-analysis concluded that PDE5 inhibitors improve 6MWD, mean PAP, and cardiac index in patients with pulmonary hypertension. However, no significant difference was reported in terms of mortality and hospitalization between the two groups.

Comparison of Efficacy and Safety of Low-Dose Versus High-Dose Dexamethasone in Hospitalized COVID-19 Patients: A Meta-Analysis.

The aim of this study is to compare the efficacy and safety of low-dose and high-dose dexamethasone in hospitalized coronavirus disease 2019 (COVID-19) patients. The current meta-analysis was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase. Outcomes assessed in the current meta-analysis included 28-day mortality, intensive care unit (ICU) admission, mechanical ventilation, length of ICU admission (days), and length of hospital stay (days). For safety, we compared hypoglycemia and the incidence of infection between the high-dose dexamethasone group and the low-dose dexamethasone group. A total of four studies fulfilled the inclusion criteria and were included in this meta-analysis. No significant difference was found between the two groups in terms of ICU admission (risk ratio (RR): 0.72, 95% confidence interval (CI): 0.41-1.28, p-value: 0.27), length of stay in ICU in days (mean difference (MD): -0.05, 95%CI: -3.96-3.87, p-value: 0.98, I-square: 94%), length of hospital stay in days (MD: -0.94, 95%CI: -1.94-0.06, p-value: 0.07), need of mechanical ventilation (RR: 0.72, 95%CI: 0.36-1.48, p-value: 0.38), and 28-day mortality (RR: 0.90, 95% CI: 0.50-1.64, p-value: 0.74). The current study showed that higher doses of dexamethasone failed to enhance efficacy compared to low-dose dexamethasone. Thus, based on the findings of this meta-analysis, low-dose dexamethasone can be recommended for these patients.

Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Patients With Diabetes and Chronic Kidney Disease (CKD): A Meta-analysis of Randomized Control Trials.

The current meta-analysis aims to assess the efficacy and safety of sodium glucose cotransporter 2 (SGLT2) inhibitors in individuals with diabetes and chronic kidney disease (CKD). The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted to identify all relevant studies related to the efficacy and safety of SGLT2 inhibitors in individuals with diabetes and CKD. The search was undertaken in PubMed, EMBASE, and Cochrane Library from January 2000 to September 2022. The primary efficacy outcome assessed in the current meta-analysis included major adverse cardiovascular events (MACE). Other efficacy outcomes included all-cause mortality and change in hemoglobin A1c (HbA1c) (%). Safety outcomes included serious adverse events, acute kidney injury, hypoglycemia, and hyperkalemia. In total 11 articles met the inclusion criteria and were included in the final analysis enrolling 27520 patients (14491 in the SGLT2 inhibitors and 13029 in the placebo group). The findings of this meta-analysis have shown that the risk of MACE and all-cause mortality was significantly lower in patients receiving SGLT2 inhibitors. Additionally, Hb1AC change was also significantly greater in SGLT2 inhibitors group. In relation to safety outcomes, serious adverse events, risk of acute kidney injury, and hyperkalemia were significantly lower in the SGLT2 inhibitors group. The SGLT2 inhibitors significantly decreased the risk of major cardiovascular events and all-cause mortality in patients with CKD and diabetes. Furthermore, SGLT2 inhibitor is also effective in reducing Hb1Ac levels in patients.

Effect of Statin Therapy on Mortality and Recurrence of Intracerebral Hemorrhage in Patients With Spontaneous Intracerebral Hemorrhage.

Statins can play an essential role in the tertiary and primary prevention of cardiovascular events by reduction of cholesterol in a stroke patient. This meta-analysis aims to assess statin therapy's effect on mortality and recurrence of Intracranial Hemorrhage (ICH) in patients with spontaneous ICH. The current meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed using PubMed, EMBASE, and Cochrane Library to identify studies assessing the use of statins in patients with ICH. The primary outcome assessed in the current meta-analysis was a hemorrhagic stroke. The secondary outcomes included cardiac-related events and all-cause mortality. A total of 9 studies were included in the current meta-analysis enrolling 49027 patients, with 8094 patients on statin therapy and 40933 patients in the control group. The risk of recurrent ICH was significantly lower in patients receiving stains (RR: 0.81, 95% CI: 0.67-0.99, p-value: 0.02) compared to placebo. However, no significant differences were observed regarding all-cause mortality (RR: 0.80, 95% CI: 0.53-1.20, p-value: 0.27) and cardiovascular events (RR: 1.24, 95% CI: 0.88-1.74). In ICH patients, statins can reduce the risk of recurrent ICH in patients with a history of ICH. However, statins had no significant effect on all-cause mortality and cardiovascular events.

An Unusual Presentation of Esophageal Tuberculosis: A Case Report.

The lungs, kidneys, liver, and pancreas are just some of the organs that can be affected by tuberculosis. Tuberculosis is a disease that can affect many organs of the human body. Rarely can tuberculosis (TB) manifest itself in the digestive tract; in fact, the gastrointestinal tract ranks as the sixth most common site of extrapulmonary TB. However, involvement of the esophagus by tuberculosis is extremely uncommon. We present a case of esophageal tuberculosis in a 27-year-old man with epigastric pain and weight loss as his only symptoms. There were no complaints of odynophagia or dysphagia, nor was there any evidence of immunodeficiency. Upper gastrointestinal endoscopy found an ulcer 26 centimeters from the incisor. Histopathology and a biopsy confirmed the diagnosis of primary esophageal tuberculosis. Six months after beginning anti-TB therapy, he was confirmed to be free of tuberculosis.

Monkeypox-Associated Pericarditis: A Maiden Case.

One of the most prevalent causes of pericarditis has been identified as virus infection. However, very little is known regarding cardiac involvement as a consequence of monkeypox infection. We describe a rare case of pericarditis with mild pericardial effusion in an immunocompetent adult with a one-week history of monkeypox. To the best of our knowledge, not many case reports are available in the existing literature. This might be the among the first few cases of monkeypox associated pericarditis during the current pandemic. The use of nonsteroidal anti-inflammatory medications, and colchicine to manage pericarditis has been the cornerstone of the therapy. Within two weeks, the patient reported improvement in his symptoms and the resolution of the pericardial effusion.

Chloroquine-Induced Psychosis: A Case Report.

The use of antimalarial drugs for prophylaxis is a widespread practice while traveling to underdeveloped nations, particularly those with a high malaria prevalence. Chloroquine is still one of the most commonly recommended antimalarials, either alone or in combination with others, for prophylaxis. However, its increased use over the past few decades has been associated with many adverse effects, including headaches, dizziness, vomiting, and diarrhea, as well as neuropsychiatric symptoms such as psychosis. Here, we discuss the case of a 30-year-old Asian man who, after starting a 500-milligram (mg) prophylactic dosage of chloroquine per week, developed psychotic symptoms. This case highlights the need to use chloroquine and other antimalarials with care, especially when beginning as a prophylactic measure with the lowest suggested dosage.

Bupropion-Induced Dystonia: A Case Report.

Bupropion is one of the most commonly prescribed antidepressant medications by physicians all over the world. Because of its favorable sexual profile, it is used as an alternative to serotonin reuptake inhibitors (SSRIs). Its significance in smoking cessation is also well recognized. However, it is associated with a few side effects, such as dizziness, anxiety, tremors, nausea, and insomnia. We present the case of a 54-year-old chronic smoker who developed acute facial dystonia involving the temporomandibular joint (TMJ) after being prescribed 300 mg of bupropion. The Naranjo scale was used to assess the probability of bupropion-induced dystonia. Following the diagnosis, the drug was stopped, and the dystonia completely resolved within one week. At her follow-ups, the patient was found to have no recurrence of dystonia.

Warfarin-Induced Skin Necrosis in a 14-Year-Old Female: A Case Report.

Warfarin is a widely known oral anticoagulant used for the treatment and prevention of thromboembolic conditions. A rare, crippling, and occasionally fatal complication of warfarin is skin necrosis, resulting in significant morbidity and mortality. Due to the disease's unknown pathophysiology and rare occurrence, the treatment guidelines are not well established. We present the case of a 14-year-old female with a history of mitral stenosis and atrial fibrillation who had been on warfarin for the last two years and now develops an acute excruciating rash within three days of reinitiation of warfarin despite enoxaparin bridging and a normal blood clotting profile. After cessation of warfarin, the skin necrosis progressed to eschar formation and resolved within four weeks. To prevent further complications, early diagnosis and treatment with intravenous vitamin K, fresh frozen plasma (FFP), and aggressive wound care are essential. The prognosis may be improved by prompt diagnosis and drug cessation.

Hyperpigmentation as a Primary Symptom of Vitamin B12 Deficiency: A Case Report.

The presentation of vitamin B12 deficiency varies from being asymptomatic to affecting multiple organ systems. In addition, several systemic diseases can be associated with generalized weakness and hyperpigmentation. However, vitamin B12 deficiency rarely presents with hyperpigmentation as an initial symptom. We present a rare case of a 22-year-old college student who presented with hyperpigmentation as the only physical manifestation of early vitamin B12 deficiency. This case underlines the need to rule out vitamin B12 deficiency when clinicians encounter hyperpigmentation as a solo presentation and also emphasizes the significance of early treatment in preventing the irreversible neurological manifestations of vitamin B12 deficiency.