A meta-analysis and mapping of global mpox infection among children and adolescents.

Monkeypox (mpox) is a significant health concern affecting children and adolescents globally. This systematic review and meta-analysis aims to synthesise the available evidence on the proportion of children and adolescents affected by the mpox virus. A comprehensive search was conducted in seven electronic databases (PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane) to identify the original reports on mpox cases in children and adolescents till 15 January 2023. Descriptive reports on probable or laboratory-confirmed mpox in children and adolescents (0-17 years old) were considered eligible. Studies not providing separate data for the above age group and case-control studies were excluded. The primary outcome was pooled proportion of mpox cases among children and adolescents. Proportion meta-analysis and heterogeneity between studies were determined using a restricted maximum likelihood estimator, and a random-effects model was fitted to the data. Sensitivity analysis and subgroup analysis were also conducted. A drapery plot was also provided as a complementary figure to the forest plot. The protocol was prospectively registered with PROSPERO (CRD42023392475). A total of 440 studies were identified, of which 37 were included in the review and 25 in the meta-analysis (62,701 participants with 3306 children and adolescents). The pooled proportion of children and adolescents was 0.46 (95% CI: 0.30-0.63, I2 :100%). The proportion of children and adolescents was significantly lower (p < 0.001) in the ongoing pandemic 0.04 (95% CI: 0.00-0.32) than before 2022 0.62 (95% CI: 0.49-0.74). The meta-regression showed that the higher the study's sample size, the lower the proportion of children among the mpox cases. Both overall and subgroup heterogeneity were high. Adolescents and children below 5 years are commonly affected by the ongoing pandemic. In conclusion, the high proportion of children affected by the mpox virus highlights the need for increased research and targeted interventions to prevent and control the spread of the virus in this population.

Ethical considerations during Mpox Outbreak: a scoping review.

BACKGROUND: Historically, epidemics have been accompanied by the concurrent emergence of stigma, prejudice, and xenophobia. This scoping review aimed to describe and map published research targeting ethical values concerning monkeypox (mpox). In addition, it aimed to understand the research gaps related to mpox associated stigma. METHODS: We comprehensively searched databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Ovid, and Google Scholar) to identify published literature concerning mpox ethical issues and stigma from May 6, 2022, to February 15, 2023. The key search terms used were "monkeypox", "ethics", "morals", "social stigma", "privacy", "confidentiality", "secrecy", "privilege", "egoism", and "metaethics". This scoping review followed the framework proposed by Arksey and O'Malley in 2005 and was further improved by the recommendations of Levac et al. in 2010. RESULTS: The search strategies employed in the scoping review yielded a total of 454 articles. We analyzed the sources, types, and topics of the retrieved articles/studies. The authors were able to identify 32 studies that met inclusion criteria. Six of the 32 included studies were primary research. The study revealed that the ongoing mpox outbreak is contending with a notable surge in misinformation and societal stigma. It highlights the adverse impacts of stigma and ethical concerns associated with mpox, which can negatively affect people with the disease. CONCLUSION: The study's findings underscore the imperative need to enhance public awareness; involve civil society; and promote collaboration among policymakers, medical communities, and social media platforms. These collective endeavors are crucial for mitigating stigma, averting human-to-human transmission, tackling racism, and dispelling misconceptions associated with the outbreak.

Anterior mediastinal mass in HIV patient with disseminated tuberculosis - An atypical case report.

We report an atypical case of an anterior mediastinal mass in a 36-year-old female with HIV and previous hospitalization due to left-side chest pain and breathlessness. The patient presented with a cough, expectoration, shortness of breath, chest pain, and fatigue. Laboratory tests revealed relevant findings, including low hemoglobin, low CD4 count, and a hyperechoic lesion in segment 5 of the liver. USG-guided aspiration of fluid from the mass was negative for fungal elements, but AFB culture showed acid-fast bacilli. Surgical excision of the mass was denied due to the patient's unfit status, and she died two weeks later due to pericardial effusion associated with tuberculosis and HIV. This case highlights the importance of considering tuberculosis as a potential complication in immunocompromised patients with anterior mediastinal masses.

Intralesional sclerotherapy for angiokeratoma of Fordyce: A case report.

A 46-year-old male presented with a 6-year history of progressive, purplish-red, hyperkeratotic papules on the scrotum. These lesions bled during intercourse and routine activities, causing significant distress. Clinical examination and pathological evaluation confirmed the diagnosis of angiokeratoma of Fordyce. Due to patient preference and cost-effectiveness, sclerotherapy with 3% sodium tetradecyl sulfate was chosen. Following topical anesthesia, the lesions were injected with the sclerosing agent. After two sessions spaced 2 weeks apart, complete resolution of both the smaller and larger lesions was achieved. This case report expands the therapeutic options for angiokeratoma of Fordyce and highlights the successful utilization of 3% sodium tetradecyl sulfate sclerotherapy in achieving complete clearance with minimal invasiveness and cost.

Molecular Characterization of Klebsiella pneumoniae Clinical Isolates Through Whole-Genome Sequencing: A Comprehensive Analysis of Serotypes, Sequence Types, and Antimicrobial and Virulence Genes.

Introduction Antimicrobial resistance (AMR) has become a menace, spreading among bacterial species globally. AMR is now recognized as a silent pandemic responsible for treatment failures. Therefore, an effective surveillance mechanism is warranted to understand the bacterial species isolated from human clinical specimens. The present study employed next-generation sequencing (NGS) or whole-genome sequencing (WGS) to identify the resistance and virulence genes, sequence type, and serotypes. Methods This study included 18 multidrug-resistant (MDR) Klebsiella pneumoniae (K. pneumoniae) isolates obtained from patients suffering from different infections attending the Prathima Institute of Medical Sciences, Karimnagar, India. All isolates were identified, and antimicrobial susceptibility profiles were determined through conventional microbiological techniques and confirmed by automated systems. All the isolates were investigated using NGS or WGS to identify the genes coding for resistance, such as extended-spectrum beta-lactamases (ESBLs), metallo-beta-lactamases, and virulence genes. Multilocus sequence typing (MLST) was conducted to identify the sequence types, and Kleborate analysis was performed to confirm the species, genes for AMR, and virulence and evaluate the capsular polysaccharide (KL) and cell wall/lipopolysaccharide (O) serotypes carried by the isolates. Results The mean age of the patients was 46.11±20.35 years. Among the patients included, 12 (66.66%) were males and 6 (33.33%) were females. A high percentage (>50%) of hypervirulent K. pneumoniae (hvKp) strains that had genes coding for AMR and plasmids having the potential to carry blaNDM and resistance genes were observed. Among the isolates, 16 (88.88%) revealed the presence of multiple antibiotic-resistant genes with evidence of at least one gene coding for beta-lactamase resistance. There was a high prevalence of blaSHV (17/18; 94.44%) and blaCTX-M-15 (16/18; 88.88%) AMR genes. Other AMR genes identified included blaTEM (83.33%; 15/18) and blaOXA (14/18; 77.77%). Two (11.11%) strains each showed the presence of blaNDM-1 and blaNDM-5 genes. The virulence genes identified included gapA, infB, mdh, pgi, phoE, rpoB, tonB, and ybt. The most frequent K. pneumoniae serotypes found were KL51:O1v2 (3/18, 16.66%), KL17:O1v1 (3/18, 16.66%), and KL64:O2v1 (3/18, 16.66%). KL64 (4/18; 22.22%) was the most common capsular serotype identified among the isolates. The most frequent MLST-based sequence type (ST) identified included ST-147 (5/18, 27.77%), followed by ST-231 (3/18, 16.66%) and ST-101 (2/18, 11.11%). Conclusions The molecular analysis of K. pneumoniae isolates revealed multiple AMR, plasmid, and virulence genes. Additionally, many global STs were noticed by MLST. The results noted a high prevalence of hvKp strains. Molecular characterization of bacterial strains using NGS/WGS is important to understand the epidemiology of bacterial strains and the antibiotic resistance and virulence genes they are potentially carrying. The data obtained from this study may be utilized to devise careful antibiotic-prescribing approaches and improve patient management practices.

Prevalence of fetomaternal Rhesus incompatibility at the tertiary care hospital: a cross-sectional study.

Background: Fetomaternal Rhesus incompatibility is a medical condition that affects the pregnant woman [of blood group (A, B, AB, O) and a negative Rhesus] and the foetus (of positive Rhesus). The objective of this study is to determine the prevalence and to present the clinical characteristics of fetomaternal Rhesus incompatibility in a tertiary care hospital. Methods: The authors conducted a retrospective cross-sectional study and 37 participants were recorded during the study period of 4 years. Results: A total of 11 898 pregnant women admitted to the maternity and 37 of them (women with blood groups A, B, AB or O and with a negative Rhesus) participated in our study, including a frequency of 0.31%. Thirty cases of fetomaternal Rhesus incompatibility were recorded in new-borns. 27 (73%) of the women are from the urban region and the age group between 21 and 25 is the most affected with 37.8%. Twenty-two (59.5%) of pregnant women have blood group O (and negative Rhesus) and primiparous women are the most affected with 64.9%. For the discovery of allo-immunization, 43.2% of women discovered it during the second pregnancy and 48.7% women received a single infusion of Anti-D serum during the first pregnancy. Twelve (40%) new-borns developed jaundice as a perinatal prognosis. Conclusion: Fetomaternal Rhesus incompatibility remains a major problem of maternal health because it is likely to lead to the formation of antibodies in women, which by crossing the placental barrier, they destroy red blood cells and thus cause serious complications.

Association of Tumor Necrosis Factor-Alpha (TNF-α) rs1800629 Polymorphism in Chronic Kidney Disease.

Background Chronic kidney disease (CKD) is characterized by progressive loss of kidney function. Tumor necrosis factor-alpha (TNF-α) is a cytokine implicated in inflammatory processes, including those affecting the kidneys. Although this association is not yet comprehensible, a tie-up between renal disease and markers of inflammation - interleukin-6 (IL-6), preceded by TNF-α - is eminent. However, a pause in research is evident concerning the TNF-α gene with kidney disease in the inhabitants of India. So, this study investigates the association between TNF-α rs1800629 polymorphism and CKD. Methodology A prospective case-control study was conducted in Andhra Pradesh for over three years. A total of 579 patients participated in the study. These were divided into premature, late-stage CKD, and control groups. The amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) was used, and biochemical investigations and genotyping were carried out for the study participants. Hardy-Weinberg expected frequencies (HWE) with chi-square test was used for detecting allele and genotype frequencies. The association between TNF-α (-308 G/A, rs1800629) and CKD was assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Results We found a higher prevalence of CKD among males (n = 301, 52%) compared to females (n = 278, 48%). Both male and female participants diagnosed with CKD exhibited significantly elevated blood urea and serum creatinine levels compared to the control group, indicating impaired kidney function. Furthermore, these markers were generally higher in the late-stage CKD group compared to the early-stage group, suggesting a progressive decline in kidney function as the disease worsens. The homozygous genotype GG was more prevalent in late-stage CKD patients compared to both early-stage CKD patients and controls. Further, the heterozygous genotype GA was more frequent in the early-stage CKD group compared to the late-stage group. The homozygous genotype AA also showed a higher prevalence in the early-stage CKD group compared to the late-stage group. The G/G genotype and the G allele (rs1800629) were significantly associated with susceptibility to CKD (P<0.005). Conclusions Our study reported the TNF-α rs1800629 polymorphism and CKD risk in a South Indian population. G/G genotype and the G allele (rs1800629) were significantly associated with the risk of CKD. However, further research with larger sample sizes is warranted to confirm these observations and elucidate the underlying mechanisms by which TNF-α might influence CKD risk.

Lipoid proteinosis: A rare genodermatosis with multisystemic manifestations-A case report.

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis, which is characterized by the deposition of amorphous hyaline material in various tissues, including the mucosa, visceral organs, and skin. We report a case of a 11-year-old girl born to consanguineous parents presented with multisystemic manifestations of the disorder. The patient presented with progressive skin lesions evolving from blisters to papules, distinctive beaded papules along eyelid margins, hoarseness of voice, impaired speech, hair loss, and a painful jaw swelling. Clinical examination revealed waxy skin, atrophic scars, and keratotic plaques. Histopathology report revealed amorphous hyaline eosinophilic material deposition. This case report highlights the multisystemic manifestations of LP and the importance of early diagnosis and management.

Association of MTHFD1 G1958A Polymorphism with Gestational Diabetes Mellitus.

Background The MTHFD1 G1958A polymorphism is a common variation in the gene encoding methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), an enzyme crucial for folate metabolism. This study investigated the association between the MTHFD1 G1958A polymorphism, which is involved in folate metabolism, and gestational diabetes mellitus (GDM) risk. Methods A case-control study was conducted and 304 pregnant women (152 with gestational diabetes as cases and 152 healthy pregnant as controls) participated in the study. The polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) techniques were used to determine the MTHFD1 1958G>A polymorphism genotypes. Results Analysis of genotype frequencies revealed a statistically significant difference (p-value < 0.05) between the GDM group and the control group, suggesting a potential association between this gene variant and the development of GDM. Interestingly, while allele frequencies alone did not show a significant association with GDM risk, analysis in a recessive model (both severe and mild forms) demonstrated a strong link between the homozygous AA genotype and increased susceptibility to GDM. Conclusion This study provides the first evidence linking the MTHFD1 G1958A polymorphism and GDM risk in an Indian setting. These findings warrant further investigation into the functional impact of the MTHFD1 G1958A polymorphism and its potential role in the pathogenesis of GDM.

Molecular Characterization of Escherichia coli Causing Urinary Tract Infections Through Next-Generation Sequencing: A Comprehensive Analysis of Serotypes, Sequence Types, and Antimicrobial and Virulence Genes.

Introduction An enormous increase in antimicrobial resistance (AMR) among bacteria isolated from human clinical specimens contributed to treatment failures. Increased surveillance through next-generation sequencing (NGS) or whole genome sequencing (WGS) could facilitate the study of the epidemiology of drug-resistant bacterial strains, resistance genes, and other virulence determinants they are potentially carrying. Methods This study included 30 Escherichia coli (E. coli) isolates obtained from patients suffering from urinary tract infections (UTIs) attending Prathima Institute of Medical Sciences, Karimnagar, India. All bacterial isolates were identified, and antimicrobial susceptibility patterns were determined through conventional microbiological techniques and confirmed by automated systems. All the isolates were investigated using NGS to identify genes coding for resistance, such as extended-spectrum beta-lactamases (ESBLs), metallo-beta-lactamases, and virulence genes. Multilocus sequence typing (MLST) was used to understand the prevalent strain types, and serotyping was carried out to evaluate the type of O (cell wall antigen) and H (flagellar antigen) serotypes carried by the isolates. Results The conventional antimicrobial susceptibility testing revealed that 15 (50%) isolates were resistant to imipenem (IPM), 10 (33.33%) were resistant to amikacin (AK), 13 (43.33%) were resistant to piperacillin-tazobactam (PTZ), 17 (56.66%) were resistant to cephalosporins, and 14 (46.66%) were resistant to nitrofurantoin (NIT). Among the isolates, 26 (86.66%) had revealed the presence of multiple antibiotic-resistant genes with evidence of at least one gene coding for beta-lactamase resistance. There was a high prevalence of blaCTX-M (19/30, 63.33%) genes, followed by blaTEM and blaOXA-1. The blaNDM-5 gene was found in three isolates (3/30, 10%). The virulence genes identified in the present study were iutA, sat, iss, and papC, among others. The E. coli serotype found predominantly belonged to O25:H4 (5, 16.66%), followed by O102:H6 (4, 13.33%). A total of 16 MLST variants were identified among the examined samples. Of the MLST-based sequence types (STs) identified, ST-131 (7, 23.33%) was the predominant one, followed by ST-167 (3, 10%) and ST-12 (3, 10%). Conclusions The study results demonstrated that the E. coli strains isolated from patients suffering from UTIs potentially carried antimicrobial resistance and virulence genes and belonged to different strain types based on MLST. Careful evaluation of bacterial strains using molecular analyses such as NGS could facilitate an improved understanding of bacterial antibiotic resistance and its virulence potential. This could enable physicians to choose appropriate antimicrobial agents and contribute to better patient management, thereby preventing the emergence and spread of drug-resistant bacteria.

The silent threat: investigating the incidence and clinical characteristics of pre-eclampsia and eclampsia in women from tertiary care hospitals of the Democratic Republic of Congo.

Background: Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess the incidence and characteristics of pre-eclampsia and eclampsia. Methods: From July 2021 to July 2022, the authors conducted a retrospective, cross-sectional, descriptive study in the Department of Obstetrics and Gynaecology of a tertiary care hospital in the Democratic Republic of the Congo (DR Congo). Out of 1236 total deliveries, 40 patients aged 18-35 years with pre-eclampsia and/or eclampsia with complete data in medical records were studied. Results: In the studied group, 3.23% of women (40 cases) experienced pre-eclampsia or eclampsia, with the majority (75%, 30 cases) occurring before childbirth. Among these, 62.5% (25 cases) were first-time mothers. The main complications observed in the mothers included HELLP syndrome and placental abruption, whereas their newborns frequently exhibited delayed in-utero growth. Caesarean delivery was the prevalent birthing method, and the treatments most often used for effective management were magnesium sulfate and nicardipine. Conclusion: The research highlights the common occurrence of eclampsia among patients in the DRC and stresses the critical need for prompt detection of hypertensive complications during pregnancy, aiming to reduce negative health impacts on both mothers and their children.

A Rare Case of Complete Cryptophthalmos and Suspected Fraser's Syndrome in a Female Neonate.

Cryptophthalmos is a rare congenital eye anomaly characterized by the absence of the palpebral fissure. Cryptophthalmos is often associated with Fraser's syndrome. We present a case of 3 days old female Asian neonate with complete unilateral cryptophthalmos, with the absence of a right eyelid. On inspection, there is an absence of eyelid, eyebrow and eyelashes in the right eye, collectively known as adnexal structures. The left eye was apparently normal. As per the parent's decision, surgical intervention was not pursued due to the poor visual prognosis. We advised prenatal genetic screening and testing for future pregnancies. These findings suggest the importance of genetic counseling and testing in cases of cryptophthalmos to identify potential genetic mutations and facilitate appropriate management.

Unilateral Phrenic Nerve Palsy as a Presentation of Diabetes Mellitus: A Rare Case Report.

Diabetes mellitus is one of the most debilitating diseases, diabetic neuropathy happens to be the most common and perhaps the most serious complication of diabetes mellitus, often leading to morbidity and mortality. A 60 year old female presented with disorientation, history of vomiting, shortness of breath, respiratory failure initially. Blood reports revealed that she was positive for ketone bodies with elevated HbA1c and general random blood sugar. Chest radiogram revealed atelectasis of the right lung with prominent involvement of right middle and lower lobes. High-resolution computed tomography of chest confirmed the findings and unilateral diaphragmatic paralysis due to phrenic nerve neuropathy due to undetected type 2 diabetes was diagnosed. Although phrenic nerve paralysis is a rare occurrence with diabetes, the possibility shouldn't be overlooked as a presentation of diabetes mellitus.

Active Screening for Pulmonary Tuberculosis Among Jail Inmates: A Mixed Method Study From Puducherry, South India.

BACKGROUND: Sustainable Development Goal 3 (SDG) aims to end the epidemic of TB by 2030. To achieve this goal, active screening should be initiated in the target populations. These target populations are those without access to proper healthcare like jail inmates. With pulmonary tuberculosis (PTB) being cosmopolitan in India, passive case finding alone cannot suffice to achieve the above-mentioned goal. Thus, active case finding (ACF) becomes the need of the hour. So, we aimed to conduct a mixed methods study that has a quantitative component, i.e., to actively screen the prison inmates for PTB, and a qualitative component, i.e., to know the perceptions of jail inmates towards PTB and the stigmas associated with it. METHODOLOGY: This was a mixed-method study conducted in the Central Jail, Puducherry. The quantitative component involved a facility-based cross-sectional study design and the qualitative component involved a focused group discussion (FGD). Participants were screened for PTB and diabetes mellitus (DM) and their anthropometry (weight, height, body mass index {BMI}, waist-to-hip ratio {WHR}) was noted. Presumptive cases were identified as those with symptoms of cough for more than two weeks with or without other concomitant symptoms. They were subjected to cartridge-based nucleic acid amplification test (CB-NAAT) assay. Data were entered in MS Excel 2017 and analyzed using SPSS version 16 (Armonk, NY: IBM Corp). For the qualitative exercise, purposive sampling with maximum variation technique was done to enroll a diverse subset of population for the FGD. Iterative analysis of the content was performed by the team to generate codes and themes. RESULTS: Out of all the 187 inmates screened, 10.7% were symptomatic. On CB-NAAT examination of the symptomatic inmates, none turned positive. The inmates with presumptive TB were older by age and had a higher proportion of illiteracy and existing co-morbidity (p≤0.05). While random blood sugar (RBS) levels of >140 mg/dL were recorded in 19.7% of inmates, RBS levels of >200 mg/dL considered diagnostic were noted in 5.34% of inmates. A total of 2.67% of the inmates were newly diagnosed with diabetes mellitus. The further management of the newly diagnosed inmates was taken over by the medical supervision team of the Central Jail. From the FGD, thematic manual content analysis was performed. A total of 24 codes were generated. After merging similar codes and removing duplications, the remaining 16 codes were grouped into six broad themes. Conclusions were drawn by interpretation of these themes. CONCLUSION: ACF is important as it is associated with early detection and treatment. It must be done periodically. During the FGD, we came across negative ideologies and stigmas associated with PTB among jail inmates. We used the same platform to clear those ideologies and recommend frequent health education exercises even in socially ostracized communities like jail inmates.

Irritant contact dermatitis due to povidone-iodine following a surgical intervention: An unusual case report.

The most common day-to-day antiseptic preparation used before any surgery usually involves povidone-iodine. Any irritant reaction to it can be devastating for the patient's aspect and would raise the need for a preliminary investigation prior to going through any antiseptic preparation. In literature, very few cases were reported on irritant dermatitis with povidone-iodine in Indian setting. We present a case of an 18-year-old female presented with irritant contact dermatitis due to povidone-iodine following a surgical intervention.

Estimation of Time Since Death From Potassium Levels in Vitreous Humor in Cases of Unnatural Death: A Facility-Based Cross-Sectional Study.

Background Estimation of time since death/postmortem interval (PMI) forms a crucial component for all autopsy surgeons. With the subjectivity that is prevalent with conventional morphological and physical signs of death, newer-age modalities such as chemical analysis provide better precision. The easy accessibility and the resistance to putrefaction make vitreous humor the best choice for such chemical analysis. Thus, the present study's aim is to estimate the time since death in cases of unnatural death by investigating the potassium level changes in the vitreous humor. Methodology This is a facility-based cross-sectional study conducted in the mortuary under the Department of Forensic Medicine in a public tertiary healthcare teaching hospital in South India between August and September 2022. Deceased individuals fulfilling the inclusion and exclusion criteria were recruited in the study. Vitreous samples were collected from a single eye and analyzed using an autoanalyzer for potassium values. After due derivations, postmortem intervals were calculated from potassium values, then they were compared with the PMIs estimated using physical signs and those determined using official police records. Data were entered using MS Excel 20 (Microsoft Corporation, Redmond, Washington) and analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20 (IBM Corp., Armonk, NY). Results Of the 100 deceased individuals included in the study, 68% were men, and the majority (24%) belonged to the age group of 53-62 years. A linear relationship is said to exist between vitreous potassium concentration and postmortem interval. No correlation was seen between the ambient temperature and the potassium levels of the vitreous humor. PMI confirmed by the potassium levels seconded the PMI given by the police records and physical signs (Rigor mortis) (Spearman's rho was statistically significant at the two-tailed level or at the 0.01 level with a kappa value of 0.88). Conclusion Potassium measurements in the vitreous humor to estimate the PMI are associated with improved accuracy and precision in determining the time since death. They are not affected by external factors, making them a reliable marker for the same.

Autoimmune Pancreatitis Presenting as Obstructive Jaundice Mimicking Pancreatic Cancer: A Case Report.

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis that can be misdiagnosed as pancreatic cancer due to similar clinical and radiological findings. In this case report, we present a 49-year-old male patient who presented with obstructive jaundice and was initially diagnosed with pancreatic cancer based on imaging findings. However, the lack of definitive parenchymal tissue in the biopsy raised suspicion for an alternative diagnosis, which led to further testing and ultimately the diagnosis of AIP. The use of endoscopic ultrasonography (EUS) and fine needle biopsy (FNB) helped to obtain a tissue diagnosis and rule out malignancy. The measurement of serum IgG4 levels further supported the diagnosis of AIP. The patient was treated with glucocorticoids and showed gradual improvement, ultimately recovering from AIP. This case highlights the importance of maintaining a high level of suspicion and considering AIP as a possible diagnosis when investigating cases that mimic pancreatic cancer. Early recognition and treatment with steroids can result in a favorable outcome for patients with AIP.

Assessment of soluble thrombomodulin and soluble endoglin as endothelial dysfunction biomarkers in seriously ill surgical septic patients: correlation with organ dysfunction and disease severity.

BACKGROUND: Sepsis, a complex condition characterized by dysregulated immune response and organ dysfunction, is a leading cause of mortality in ICU patients. Current diagnostic and prognostic approaches primarily rely on non-specific biomarkers and illness severity scores, despite early endothelial activation being a key feature of sepsis. This study aimed to evaluate the levels of soluble thrombomodulin and soluble endoglin in seriously ill surgical septic patients and explore their association with organ dysfunction and disease severity. METHODOLOGY: A case control study was conducted from March 2022 to November 2022, involving seriously ill septic surgical patients. Baseline clinical and laboratory data were collected within 24 h of admission to the Surgical Intensive Care Unit. This included information such as age, sex, hemodynamic parameters, blood chemistry, SOFA score, qSOFA score, and APACHE-II score. A proforma was filled out to record these details. The outcome of each patient was noted at the time of discharge. RESULTS: The study found significantly elevated levels of soluble thrombomodulin and soluble endoglin in seriously ill surgical septic patients. The RTqPCR analysis revealed a positive correlation between soluble thrombomodulin and soluble endoglin levels with the qSOFA score, as well as, there was a positive association between RTqPCR soluble thrombomodulin and the SOFA score. These findings indicate a correlation between these biomarkers and organ dysfunction and disease severity. CONCLUSION: The study concludes that elevated levels of soluble thrombomodulin and soluble endoglin can serve as endothelial biomarkers for early diagnosis and prognostication in seriously ill surgical septic patients.

An unusual case of acquired aplastic anemia following SARS-CoV-2 vaccination: A case report.

Aplastic Anemia (AA) is a condition where the body's immune system attacks and destroys the hematopoietic stem cells, leading to pancytopenia and an empty bone marrow. AA can be effectively treated using immunosuppressive therapy or hematopoietic stem-cell transplantation. The damage to stem cells in the bone marrow can be due to several causes, such as autoimmune diseases, medication like cytotoxic drugs and antibiotics, and exposure to toxins or chemicals in the environment. In this case report, we present the diagnosis and treatment of a 61-year-old man who was diagnosed with Acquired Aplastic Anemia, which could have developed following his serial immunizations with the SARS-CoV-2 COVISHIELD viral vector vaccine. The patient received immunosuppressive therapy consisting of cyclosporine, anti-thymocyte globulin, and prednisone, resulting in a significant improvement in his condition.