Normal Parameters Research Articles

Cephalometric Screening Assessment for Superior Airway Space Narrowing-Added Value of Three-Dimensional Imaging.

Background: Assessing the morphology of the superior airway space is a crucial diagnostic step in the treatment planning of patients with obstructive sleep apnea syndrome (OSAS) or prior to orthognathic surgery. The aim of this study is to evaluate the necessary scope of a two-dimensional cephalometric assessment and the necessity of three-dimensional imaging in the identification of superior airway space narrowing (SASN). Methods: The computed tomography studies of 100 non-obese, non-OSAS patients were evaluated and analyzed retrospectively. Multiplanar reconstructions were created and underwent cephalometric evaluation. The three-dimensional superior airway morphology was segmented and measured for the minimal cross-sectional area (Amin) and volume (V0). Patients were grouped according to Amin < 80 mm2 and V0 < 12 cm3. Cephalometric parameters (CPs) were analyzed according to Amin and V0 with an unpaired t-test, Pearson correlation, and ROC-curve analysis. Results: The CPs regarding sagittal airway space dimensions (IPAS, MPAS, SPAS) and mandibular body length (GoGn) show the strongest correlation to the three-dimensional minimal cross-sectional area (Amin). The ROC-curve analysis classifying for SASN led to an AUC of 0.86 for IPAS, 0.87 for MPAS, 0.88 for SPAS, and 0.63 for GoGn. Three-dimensional imaging may further improve the diagnostic accuracy in the identification of SASN for IPAS below 13.5 mm, MPAS below 10.2 mm, SPAS below 12.5 mm, and GoGn below 90.2 mm. Conclusions: Two-dimensional cephalometric sagittal airway space diameters and mandibular body length are useful initial screening parameters in the identification of superior airway space narrowing. Nevertheless, as the correlation of two-dimensional cephalometric parameters with three-dimensional upper airway space narrowing is varying and highly dependent on acquisition circumstances, indications for three-dimensional imaging, if possible, in the supine position to evaluate upper airway space morphology should be provided generously, especially in patients with low but normal airway space parameters in two-dimensional cephalometry.

Re-Expansion Pulmonary Edema as a Life-Threatening Complication in Massive, Long-Standing Pneumothorax: A Case Series and Literature Review.

Re-expansion pulmonary edema is a rare and potentially life-threatening complication that can occur after the rapid re-expansion of a collapsed lung due to pneumothorax or pleural effusion. It has a multifactorial pathogenesis, and risk factors for re-expansion pulmonary edema, such as chronic lung collapse, rapid re-expansion, and changes in pulmonary vascular permeability, have been identified. Clinical manifestations vary, ranging from almost asymptomatic to a rapidly fatal condition, and its incidence may be more common and less fatal than previously believed. The literature emphasizes the importance of early recognition and management to ensure favorable outcomes. However, there is ongoing debate regarding the indications for ventilatory support and the timing of non-invasive or invasive ventilation. Herein, we report a case series of three paradigmatic examples of massive re-expansion pulmonary edema occurring over a period of 10 years in our institution among a population of 815 patients with spontaneous pneumothorax. We also conducted a literature review on re-expansion pulmonary edema, with a particular focus on diagnosis and management. In each case, despite initially normal clinical parameters, severe respiratory distress developed following the insertion of a thoracic drainage tube for a massive spontaneous pneumothorax. Two patients required High-Flow Nasal Oxygen, and one was addressed to intensive management, including CPAP. In all cases, the patient's outcome was optimal.

Treatment intensity affects immune reconstitution even after childhood cancer not treated with hematopoietic stem cell transplantation.

Only a few previous studies examine immune system recovery after completed cancer treatment. The aim of this study was to analyze immune reconstitution after childhood cancer therapy in a non-hematopoietic stem cell transplantation setting. We analyzed children (N = 79) who received chemotherapy with/without irradiation for cancer diagnosed between 2014 and 2019 at Turku University Hospital, Finland. We retrospectively collected data on baseline parameters and post-treatment immunological recovery, namely neutrophil and lymphocyte counts, IgG levels, CD19, CD4 and natural killer cell counts. Immunological parameters were followed until their normalization. Treatment intensity was stratified according to the Intensity of Treatment Rating Scale (ITR-3). We analyzed the effects of treatment intensity on normalization of immunological parameters across the entire treatment range. Treatment intensity had a major effect on immune system recovery after completion of treatment. Most patients had normal immunological parameters 1-4 months post-treatment both in high- and low-intensity treatment groups, but patients classified in the high-intensity group had low parameters more often than patients in the low-intensity group. Our data suggest a fast recovery of studied immunological parameters after the majority of current pediatric oncologic treatments. Treatment for high-risk acute lymphoblastic leukemia, acute myeloid leukemia, medulloblastoma, and mature B-cell lymphoma was associated with prolonged recovery times for a substantial proportion of cases. High treatment intensity was associated with prolonged immunological recovery.

Aquaporin expression in cryopreserved human sperm: exploring the capabilities of natural deep eutectic solvents (NADES)

BACKGROUND: Aquaporins (AQPs) are essential proteins that facilitate the rapid movement of water and cryoprotective agents (CPAs) during the cryopreservation process, and ensure the cryotolerance of sperm cells. OBJECTIVE: This study evaluated the preservation of aquaporin levels in human sperm after undergoing freezing using natural deep eutectic solvents (NADES) as CPAs for cryoprotection. MATERIALS AND METHODS: From June 2021 to October 2022, 35 semen samples with normal sperm parameters were acquired from the Mehr Infertility Treatment Institute in Rasht, Iran. The samples were divided into several groups for analysis: control group (not frozen), group frozen with SpermFreeze Solution, and groups frozen with different NADESs, including ChS, ChX, ChU, ChG, GlyP, and EtP. After thawing, various aspects for each group were assessed, including the integrity and condensation of sperm chromatin, viability, motility, integrity of acrosome, and the expression of AQP1, AQP3, AQP7, AQP8, and AQP9 genes. RESULTS: The analysis of gene expression revealed that freezing with ChS and GlyP preserved the expression of the AQP1 and AQP3 genes compared to the control group. Regarding AQP7 and AQP8, significant differences were not observed in expression levels between certain NADES groups (e.g., ChS, ChU, and GlyP) and the control group. Additionally, samples frozen with specific NADESs, such as ChS, ChG, EtP, and GlyP, exhibited preserved levels of AQP9 expression when compared to the control group. CONCLUSION: These findings emphasize the importance of NADES in preserving the expression of aquaporins in cryopreserved human sperm and their important fertility parameters.

Pancreatic endometriosis a rare entity in surgery: a case report

Endometriosis is a rare entity that occurs in 2 to 10% of women of childbearing age. It may be rarer if it occurs in extrapelvic organs and extremely rarely in pancreatic tissue, and it may be confused with other causes of pancreatitis or pancreatic pathologies. In the following case we present a young woman of childbearing age who is admitted with abdominal pain. She mentions having recently had elevated pancreatic enzymes. At the time of evaluation within normal parameters, a pancreatic cyst is suspected, which is why it is She underwent surgical treatment, however, due to clinical signs, a cyst with the appearance of endometriosis was punctured, and the histopathological report confirmed pancreatic endometriosis, an entity little known in surgery, however, with a favorable outcome after surgical intervention.

Combined hysteroscopic Bigatti shaver (IBS) and resectoscope removal of a heterotopic cesarean scar pregnancy in the first trimester

To report a case of heterotopic cesarean scar pregnancy reduction using a combined hysteroscopic integrated Bigatti shaver (IBS) and resectoscope with the preservation of a normal gestational sac in the uterine cavity under simultaneous transabdominal ultrasound guidance. Video article. University-affiliated hospital. A 30-year-old woman, G5P2A2L2, with two previous cesarean deliveries and a history of fertility problems, was admitted with a heterotopic cesarean scar pregnancy at 7+2 gestational weeks. Ultrasound examination showed a dichorionic diamniotic pregnancy. The first gestational sac (1.7 × 1.7 × 0.6 cm) was located in the previous hysterotomy scars, with a thin layer of myometriummeasuring 0.2 cm in thickness and a rich blood supply. The second chorionic sac (2.8 × 2.4 × 1.8 cm) was observed at the uterine fundus. Normal cardiac activity and yolk sacs were observed in both gestational sacs. The couple strongly desired to preserve the intrauterine pregnancy. After Institutional Review Board approval was obtained, a hysteroscopic IBS combined with a bipolar resectoscope was used to remove the heterotopic cesarean scar pregnancy while preserving the intrauterine gestational sac under simultaneous transabdominal ultrasound guidance. The heterotopic cesarean scar pregnancy was completely resected using hysteroscopy, and the gestational sac in the uterine cavity was successfully preserved. Trophoblastic tissue was confirmed using histopathological examination. The patient had an unremarkable postoperative recovery. Subsequent serial ultrasonography confirmed a single ongoing pregnancy with normal growth parameters and a normal placental site. The inability of an IBS to perform coagulation can be offset by its combination with the bipolar resectoscope. Hysteroscopic IBS combined with resectoscope to remove a heterotopic cesarean scar pregnancy offers a short operation time and minimum blood loss. It could be an optimized approach for the management of heterotopic cesarean scar pregnancy in the first trimester when an intrauterine pregnancy needs to be preserved.

Three-dimensional morphometry of kidney in New Zealand rabbit using unbiased design-based stereology.

The rabbit is widely used as a laboratory animal in experimental models of kidney diseases. This species is also important from a veterinary perspective as a companion animal. Stereology has been accepted as an accurate approach to kidney morphometry. The objective of the present project was to provide normal quantitative stereological parameters for adult rabbit kidneys. The left kidneys of five adult male New Zealand rabbits were used. Isotropic sections were obtained using the orientation method. Total kidney volume was calculated by the Cavalieri principle. The volume fraction of the renal structures was estimated using the point counting system. The lengths of the proximal convoluted tubule (PCT) and distal convoluted tubule (DCT) were calculated using counting frames. The total glomerular number was accounted for using the physical/fractionator technique. The mean glomerular volume was obtained by dividing the total volume of glomeruli by their total number. The total volume of rabbit kidneys calculated was 10.39 ± 1.98 cm3. The fractional volume of the kidney cortex and medulla accounted for 57.79 ± 0.65% and 42.2 ± 0.65%, respectively. The total glomerular volume was 2.18 ± 0.32% of the whole kidney. The total number of glomeruli in the rabbit kidney was estimated as 204.68 ± 12 × 103. The mean glomerular volume measured 1.07 ± 0.12 × 106 μm3. The total length of PCT and DCT was 2.96 ± 0.29 km and 1.38 ± 0.24 km, respectively. These findings can be used as a reference in experimental nephrology research and may help to expand the knowledge of nephrology in mammals by comparing with available data on humans and other species. RESEARCH HIGHLIGHTS: Three-dimensional morphometry of adult rabbit kidney structures was analyzed using quantitative stereology. Total volume of kidney, fractional volume of cortex and medulla, length of renal tubules and number of nephrons were estimated. These three-dimensional morphometrical data can be used as a reference in experimental nephrology research and may help to expand the knowledge of nephrology in mammals.

Benefits of a prolonged-release amino acid mixture in four pregnant women with phenylketonuria.

Background: Maternal phenylketonuria (mPKU) is a pathologic condition occurring in the fetus of a mother with PKU that is caused by prolonged elevated intrauterine blood phenylalanine (Phe) levels, which can lead to congenital abnormalities and mental retardation of newborns. Management of PKU during pregnancy can be challenging as protein substitutes may exacerbate nausea, vomiting, and gastrointestinal symptoms. Aim: To report the successful management of four PKU pregnant women. Methods: The patients were administered with prolonged-release amino acid supplementation and were recommended to follow a strict diet. Blood Phe concentration, adherence to diet, and occurrence of adverse events were monitored. Results: All patients achieved safe levels of blood Phe concentration (120-360 µmol/L) since preconception and during pregnancy (mean Phe concentration values of 143.34 ± 137.59, 226.48 ± 194.57, 186.68 ± 133.67, and 187.47 ± 42.59 µmol/L). During the first trimester of pregnancy, all patients manifested gastrointestinal symptoms such as nausea, gastrointestinal reflux, and abdominal bloating, which were managed by either changing protein substitute or extending the time window between different meals and amino acid mixtures administration. The four women continued their pregnancies without experiencing further complications and delivered neonates with normal growth parameters and no malformations. Conclusion: Findings of this case series suggest that the intake of a prolonged-release amino acid mixture in granules is well tolerated by pregnant PKU patients, eventually leading to good metabolic control and fetal growth within normal ranges.

A Deep-Learning-Based Partial-Volume Correction Method for Quantitative 177Lu SPECT/CT Imaging.

With the development of new radiopharmaceutical therapies, quantitative SPECT/CT has progressively emerged as a crucial tool for dosimetry. One major obstacle of SPECT is its poor resolution, which results in blurring of the activity distribution. Especially for small objects, this so-called partial-volume effect limits the accuracy of activity quantification. Numerous methods for partial-volume correction (PVC) have been proposed, but most methods have the disadvantage of assuming a spatially invariant resolution of the imaging system, which does not hold for SPECT. Furthermore, most methods require a segmentation based on anatomic information. Methods: We introduce DL-PVC, a methodology for PVC of 177Lu SPECT/CT imaging using deep learning (DL). Training was based on a dataset of 10,000 random activity distributions placed in extended cardiac-torso body phantoms. Realistic SPECT acquisitions were created using the SIMIND Monte Carlo simulation program. SPECT reconstructions without and with resolution modeling were performed using the CASToR and STIR reconstruction software, respectively. The pairs of ground-truth activity distributions and simulated SPECT images were used for training various U-Nets. Quantitative analysis of the performance of these U-Nets was based on metrics such as the structural similarity index measure or normalized root-mean-square error, but also on volume activity accuracy, a new metric that describes the fraction of voxels in which the determined activity concentration deviates from the true activity concentration by less than a certain margin. On the basis of this analysis, the optimal parameters for normalization, input size, and network architecture were identified. Results: Our simulation-based analysis revealed that DL-PVC (0.95/7.8%/35.8% for structural similarity index measure/normalized root-mean-square error/volume activity accuracy) outperforms SPECT without PVC (0.89/10.4%/12.1%) and after iterative Yang PVC (0.94/8.6%/15.1%). Additionally, we validated DL-PVC on 177Lu SPECT/CT measurements of 3-dimensionally printed phantoms of different geometries. Although DL-PVC showed activity recovery similar to that of the iterative Yang method, no segmentation was required. In addition, DL-PVC was able to correct other image artifacts such as Gibbs ringing, making it clearly superior at the voxel level. Conclusion: In this work, we demonstrate the added value of DL-PVC for quantitative 177Lu SPECT/CT. Our analysis validates the functionality of DL-PVC and paves the way for future deployment on clinical image data.

Correlation between standard sperm parameters and sperm DNA fragmentation from 11,339 samples

Conventional semen parameters have long been considered fundamental in male fertility analyses. However, doubts have been raised regarding the clinical utility of the assessment of spermatozoa (sperm) DNA damage. In this retrospective study, we investigated the potential correlation between conventional semen parameters and semen DNA fragmentation (SDF) assessed as sperm DNA damage, in 11,339 semen samples collected between January 2019 and June 2022. We observed significant negative correlations between the DNA fragmentation index (DFI) and sperm viability (correlation coefficient [r] = −0.514) as well as progressive sperm motility (r = −0.512, p < 0.05). Samples were categorized into three groups according to DFI levels (Groups A, B, and C: ≤15%, 15 < DFI ≤30%, and >30%, respectively). Furthermore, the percentage of semen samples with normal sperm conventional parameters in Groups A, B, and C was 76.7% (4369/5697), 61.4% (2351/3827), and 39.7% (721/1815), respectively. Moreover, according to the reference values of conventional sperm parameters, the samples were divided into Groups F, G, and H with all normal, only one abnormal, and > two abnormal parameters, respectively. In addition, the proportions of samples with abnormal DFI values (>30) in Groups F, G, and H were 9.7% (721/7441), 23.1% (618/2676), and 39.0% (476/1222), respectively. Multivariate logistic regression models demonstrated that sperm vitality, progressive sperm motility, normal sperm form, total sperm count, semen volume, age, and some sperm kinematics collectively improved the area under the receiver operating characteristic curve (AUROC) to 0.861, surpassing the predictive value of a single predictor of pathologically damaged sperm DNA. Our study suggests that samples with abnormal sperm parameters may have a higher likelihood of high DNA fragmentation. Furthermore, certain semen parameters could be potential indicators of sperm DNA fragmentation, aiding sperm selection in assisted reproductive procedures.

Exploring celiac trunk parameters in median arcuate ligament syndrome: A CT study.

To assess anatomical variations in the celiac trunk (Ct) in patients with Median Arcuate Ligament Syndrome (MALS) using computed tomography (CT). The primary objectives were to investigate the celiac trunk angle (CtA), origin level, length (CtL), and their relationships with the superior mesenteric artery (SMA) in MALS patients. Additionally, the study intended to evaluate gender differences in these parameters and explore correlations between variables. Retrospectively, reports of abdominal CT scans taken between January 2018, and Sepmtember 2021, in the hospital image archive were screened vey two observers independently for MALS diagnosis. Parameters such as CtA, CtL, Ct-SMA distance, SMA angle (SMAA), and median arcuate ligament thickness (MALT) were measured. Statistical analyses were conducted using SPSS software. Among the 81 patients (25 females, 56 males), significant differences were observed in MALT between genders (p = 0.001). CtA showed a negative correlation with CtL and Ct-SMA (p < 0.001), and a positive correlation was found between CtL and Ct-SMA (p = 0.002). CtL was measured as 25mm for the all group. Origin levels of Ct and SMA were evaluated in comparison to vertebral levels. Ct-SMA distance was relatively shorter (9.19mm) compared to the literature. SMAA findings were consistent with normal population values. This study provided valuable insights into the anatomical parameters of the Ct ans SMA in MALS patients. Despite some differences compared to normal population parameters, no evidence supported the hypothesis of a superiorly placed Ct contributing to MALS.

MTHFRC 677T Gene Polymorphism and Homocysteine in North China Patients with Varicocele

To investigate the correlation between methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, homocysteine, and male infertility with varicocele in North China. One Hundred infertile males with varicocele (VC; grade II-III, VC group) and 100 healthy males with normal semen parameters and no varicocele (NC group) were recruited for PCR microarray, blood and semen testing. Compared with the CC genotype in the NC group, the TT genotype in the NC group and the CC genotype in the VC group showed no significant changes in sperm motility (P=0.191; P=0.130), sperm density (P=0.591, P=0.643), plasma homocysteine level (P=0.511; P=0.677), and seminal plasma MDA (P=0.752; P=0.451). In contrast, VC patients with the TT genotype had higher plasma homocysteine level and seminal plasma MDA levels (P &lt;0.001), lower partial pressure of oxygen in seminal pulse (PO2; P &lt;0.001) and poorer sperm quality (P &lt;0.001), as compared with the CC genotype. This suggests that MTHFR C677C&gt;T may not be a risk factor for male Varicocele in North China. However, this may affect the oxidative stress associated with homocysteine expression, which in turn affects semen parameters in VC patients. Larger studies are needed to validate our findings.

A Cross-Sectional Study of Hematological Parameters in the Geriatric Population Using Peripheral Smear Examination and a Five-Part Cell Counter.

"Healthy aging" is a major public health challenge, as the prevalence and incidence of diseases are much higher in older people. Among them, diabetes mellitus, hypertension (HTN), and cardiovascular illnesses are the most prevalent chronic ailments. A complete blood count test can give an overall picture of a patient's health status because abnormal counts might indicate the presence of many different types of disease. Using advanced hematology analyzers, a typical microscopic examination of a peripheral blood smear can yield vital information about the clinical state of the patient. The objective of the study was to investigate the hematological parameters in the elderly population in a tertiary care hospital, utilizing a five-part cell counter and a peripheral smear test. A cross-sectional study was conducted at a tertiary care institute on 188 patients aged 60 years and above attending the outpatient department for two years. The routine complete blood count and differential count were determined on the Siemens Advia 2120 analyzer. All the data were collected and entered into the data sheets. Appropriate statistical analysis was carried out to interpret the results. HTN, diabetes mellitus, cardiovascular disease (CVD), and generalized weakness were the most common conditions affecting our senior group. Decreased Hb was positively correlated with widespread weakness. Total leukocyte count (TLC) was found to be more prevalent in people with CVD and HTN. A sizable share of the elderly population who had diabetes mellitus and CVD showed an elevated red cell distribution width (RDW) percentage. The results indicated a significant deviation from normal hematological parameters, which were associated with various health issues. These parametric associations can be used as risk indicators, which can help healthcare professionals ensure the good health of the geriatric population.

Clinical Application of Reticulocyte Maturity Indices in Early Diagnosis of Iron Deficiency Anemia in the First Trimester of Pregnancy

Background: Iron deficiency anemia (IDA) is a prevalent global health issue, particularly affecting pregnant females due to increased iron demands during pregnancy. In Pakistan, IDA remains a significant concern, posing challenges to maternal and child health. Early detection and management of iron deficiency are crucial for improving pregnancy outcomes.&#x0D; Objective: This study aims to investigate the iron status and associated hematological parameters among pregnant females during the first trimester in Islamabad, Pakistan.&#x0D; Methodology : This cross-sectional study, conducted in collaboration with the Pakistan Atomic Energy Commission (PAEC) and the Pakistan Institute of Medical Sciences (PIMS), aimed to investigate the iron status among first-trimester pregnant females in Islamabad, Pakistan.Laboratory investigations encompassed hemoglobin and serum ferritin assays, reticulocyte counts, and other red blood cell parameters. Participants were categorized into distinct iron status groups based on these evaluations. Utilizing SPSS version 25, statistical analysis followed ethical protocols, striving to uncover discrepancies in hematological parameters across the various iron status groups.&#x0D; Results : Among 340 first-trimester pregnant women, three iron status groups were identified. Group 1 (n = 102) had low ferritin despite normal Hb, with elevated immature reticulocytes. Group 2 (n = 150) showed normal iron parameters, while Group 3 (n = 88) had high reticulocyte counts. Group 2 exhibited superior erythrocyte indices and higher ferritin levels than Groups 1 and 3. Group 3 displayed the poorest indices and elevated immature reticulocytes. These findings highlight variations in iron status and reticulocyte maturation among pregnant women.&#x0D; Conclusion: This study underscores the high prevalence of iron deficiency anemia among first-trimester pregnant females in Islamabad, Pakistan. Variations in red blood cell parameters and serum ferritin levels highlight the importance of early iron status assessment for optimizing maternal and foetal health outcomes.

Chronic stridor in a toddler after ingestion of a discharged button battery: a case report

BackgroundButton battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions.Case presentationWe present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child’s physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient’s history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily.ConclusionThis case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.

Comparison of the Haematological Parameters of Indigenous and Exotic ‎Dogs in Maiduguri, Nigeria

Health status of dogs may be assessed with haematological parameters, but adaptation to environmental stress can lead to adjustment of these normal parameters. This study was designed to compare the haematological parameters of indigenous and exotic dogs in Maiduguri during the hot dry season. Forty apparently healthy indigenous (n = 20) and exotic(n = 20) dogs of both sexes and aged from 3-48 months were used. Blood sample (5 ml) was collected from the cephalic vein of each dog in EDTA bottles. Parameters were determined using microhaematocrit method for packed cell volume (PCV), haemocytometery for red blood cell (RBC) count and total white blood cell (TWBC) count, cyanmethemoglobin method for haemoglobin concentration (Hb), and examination of stained blood smear for relative differential white blood cell (WBC) count. Mean corpuscular volume (MCV) and haemoglobin concentration (MCHC), and absolute differential WBC counts were calculated. The TWBC and neutrophil counts were significantly (p &lt; 0.05) higher in indigenousthan exotic dogs. Exotic females had significantly (p &lt; 0.05) lower MCHC and neutrophil count than indigenous females and all males. Age significantly (p &lt; 0.05) affected MCV, but the highest value was recorded in young exotic dogs. Adult indigenous dogs had significantly (p &lt; 0.05) higher neutrophil count than young indigenous and all exotic dogs. Monocyte count was significantly (p &lt; 0.05) higher in young than adult exotic and all indigenous dogs. However, haematologicalvalueswere within standard reference intervals for dogs.

Genotype-phenotype correlation in CLCN4-related developmental and epileptic encephalopathy.

CLCN4-related disorder is a rare X-linked neurodevelopmental condition with a pathogenic mechanism yet to be elucidated. CLCN4 encodes the vesicular 2Cl-/H+ exchanger ClC-4, and CLCN4 pathogenic variants frequently result in altered ClC-4 transport activity. The precise cellular and molecular function of ClC-4 remains unknown; however, together with ClC-3, ClC-4 is thought to have a role in the ion homeostasis of endosomes and intracellular trafficking. We reviewed our research database for patients with CLCN4 variants and epilepsy, and performed thorough phenotyping. We examined the functional properties of the variants in mammalian cells using patch-clamp electrophysiology, protein biochemistry, and confocal fluorescence microscopy. Three male patients with developmental and epileptic encephalopathy were identified, with differing phenotypes. Patients #1 and #2 had normal growth parameters and normal-appearing brains on MRI, while patient #3 had microcephaly, microsomia, complete agenesis of the corpus callosum and cerebellar and brainstem hypoplasia. The p.(Gly342Arg) variant of patient #1 significantly impaired ClC-4's heterodimerization capability with ClC-3 and suppressed anion currents. The p.(Ile549Leu) variant of patient #2 and p.(Asp89Asn) variant of patient #3 both shift the voltage dependency of transport activation by 20 mV to more hyperpolarizing potentials, relative to the wild-type, with p.(Asp89Asn) favouring higher transport activity. We concluded that p.(Gly342Arg) carried by patient #1 and the p.(Ile549Leu) expressed by patient #2 impair ClC-4 transport function, while the p.(Asp89Asn) variant results in a gain-of-transport function; all three variants result in epilepsy and global developmental impairment, but with differences in epilepsy presentation, growth parameters, and presence or absence of brain malformations.

Assessment of Efficacy and Safety of Dr.Ortho Capsules in Managing Musculoskeletal Disorders: A Phase IV Post-Marketing Surveillance Study

Objectives: This study aimed to evaluate the potential efficacy and safety of Dr. Ortho capsules in managing various musculoskeletal conditions, including knee pain, joint stiffness, arthritis, bulky shoulders, joint inflammation, acute sports injuries, strains, and sprains. Methods: The study was a single centric, open-label, non-randomized, post-marketing surveillance study involving 120 subjects. Subjects were selected based on inclusion and exclusion criteria. The study assessed changes in pain intensity and disability levels after the administration of Dr. Ortho capsules, employing the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively. Additionally, safety was evaluated through physical examinations, vital sign monitoring, and laboratory safety parameters. Results: The study revealed significant reductions in pain intensity and disability levels among the participants. Pain intensity, as measured by VAS, decreased significantly (p&lt; 0.0001) from a mean score of 4.84 at baseline (day 1) to 0.38 at the end of the study (day 30). Disability levels, indicated by ODI, significantly improved (p&lt;0.0001) from a mean score of 14.73% at baseline to 1.88% at the end of the study. There were no reported adverse events during the study, and all safety parameters remained within normal ranges. Conclusion: The findings of the study suggest that Dr. Ortho capsules may offer effective relief for individuals with musculoskeletal conditions, reducing pain intensity and improving functional abilities. The absence of adverse events and the maintenance of normal safety parameters indicate the safety of Dr. Ortho capsules for human consumption.

Liquor for breakfast, fighting against alcohol consumption

IntroductionThe harmful consumption of alcohol is known for how tortuous its management can be in mental health, encouraging introspection of it as a serious problem is perhaps the main key to starting to battle against its damaging influence on the development of a functional and full life.ObjectivesTo describe a clinical case showing an unpredictible complication in an alcohol detoxification process.Methods54-year-old man, native of Cádiz, widowed for half a decade, without children. He resides with his parents in the family home. Currently unemployed for approximately a year. He has previously worked in the IT sector. As a notable somatic history, we found long-established arterial hypertension and a total hip replacement. He has been under irregular follow-up with a mental health team for anxiety-depressive symptoms in the context of grief. He goes to the emergency service brought by his family to begin the detoxification process in the hospital setting. He acknowledges ethanol consumption since he was widowed, which began when he awakes; quantities that ranged between one or up to three bottles of distilled liquor per day, generally consumption is in the home environment. A little less than a year ago, he began to isolate himself in his room and abandon his self-care, eating increasingly insufficient food intake, refusing to receive professional care to quit the habit, mainly because he did not recognize it as disruptive.The patient was admitted to hospital with symptoms suggestive of withdrawal, making it extremely difficult to control blood pressure levels. On the third day of admission to the acute care unit, fever peaks, blood pressure levels well below normal parameters, and compromised level of consciousness began to be evident.ResultsBlood tests were performed that, together with the clinical picture, suggested imminent septic shock, so critical care was contacted for transfer and stabilization. A germ of probable urinary etiology sensitive to a broad spectrum of antibiotics was isolated in blood cultures, and the medication of the detoxification process was progressively optimized. Once clinical stability was achieved at all levels, an inpatient cessation resource was managed, which the patient accepted and considered suitable for his complete recovery.ConclusionsA holistic approach to the alcoholic patient is important, since serious problems of an organic nature often arise. This is why a multidisciplinary intervention is necessary, as well as a holistic approach to care, involving both classic pharmacology and assiduous long-term psychotherapeutic intervention.Disclosure of InterestNone Declared

A case of steroid induced psychosis in a patient with mediastinal lymphoma

IntroductionCorticosteroids are a key part of many cancer treatment regimens and neuropsychiatric side effects have long been recognised. Steroid-induced psychosis is a disorder classified under substance or medication-induced psychosis in the Diagnostic and Statistical Manual of Mental Disorder, 5th edition. Management strategies include treatment with antipsychotic medication and reducing corticosteroid dosage.ObjectivesTo describe the case of steroid induced psychosis in a patient with mediastinal lymphoma and provide a concise literature review.MethodsClinical case report and brief literature review.Results27-year-old male with a diagnosis of Stage IV Primary Mediastinal Lymphoma according to the Ann Arbor classification was admitted to the Haematology ward for chemotherapy treatment (R-DA EPOCH). Two days after admission the patient developed acute psychotic symptoms consisting of thought block, kinaesthetic hallucinations, and delusions. Prior to admission, the patient had been on corticosteroid treatment for two months (up to 8mg/day of dexamethasone), with a significant dose increase (up to 200mg/day of prednisone) at the beginning of chemotherapy treatment two days prior to symptom development. The patient had no personal or family history of mental health issues, no substance misuse and had not received any psychopharmacological treatment prior to admission.Medical evaluations including a cranial CT scan, an MRI, EEG, blood tests and lumber puncture were all within normal parameters, discounting organic or metastatic causes for the symptoms.Considering a potential episode of steroid-induced psychosis, the patient was started on olanzapine at a dosage of 10mg per day. The patient exhibited a positive response, with symptoms alleviating within 24 hours of the initial dose. In terms of corticosteroid therapy, haematologists adjusted the prednisone regimen to 100mg per day, and due to the encouraging progress, the olanzapine dosage was subsequently reduced to 5mg per day.ConclusionsThis case underscores the importance of considering the possibility of steroid induced psychosis as a differential diagnosis specially in patients on high dose steroids presenting with psychotic symptoms. A multidisciplinary approach is crucial to ensure optimum treatment and care.Disclosure of InterestNone Declared