Unusual Cases Research Articles

What Is in the Myopathy Literature?

We cover intensive care unit-acquired neuromuscular disorders associated with coronavirus disease 2019. Outcomes may be worse than expected in these patients, and there is some evidence that coronavirus disease 2019 causes myopathy directly. Corticosteroid regimens in Duchenne muscular dystrophy are addressed including outcomes in pulmonary and cardiac function. A recent article notes a continued diagnostic delay in Duchenne muscular dystrophy. An interesting report of a Canary Islands cohort of patients with oculopharyngeal muscular dystrophy is discussed. Features and clinical pearls related to a series of patients with limb-girdle muscle dystrophy R12 (anoctaminopathy) and a misdiagnosis of idiopathic inflammatory myopathy are provided. The last section on autoimmune myopathy includes articles on clinical and pathologic features associated with myositis-specific antibodies and dermatomyositis, the epidemiology of immune-mediated necrotizing myopathies (IMNMs) in Olmsted County, Minnesota, and features of a German cohort of hydroxy-3-methylglutaryl coenzyme A reductase-associated IMNM. A recent article proposes the benefit of early intravenous immunoglobulin use for adults with IMNM. We also highlight a report of 2 unusual cases of antisignal recognition particle myopathy presenting with asymmetric distal weakness.

"Unconventional" Causes of Acute Kidney Injury: A Critical Nuance of Interpretation and Intervention.

Acute kidney injury (AKI) is one of the most common clinical problems encountered by physicians in day-to-day practice which is associated with increased morbidity and mortality. The incidence of AKI is increasing so the right approach for interpretation of clinical clues and investigation may be lifesaving. The study aimed to document the variety of unusual cases of AKI and suggest a case-based approach for clinical evaluation and investigations to help physicians treat such cases. This was a retrospective analysis of medical/electronic records of 10 patients who were admitted in medical wards between January 2020 and June 2021 and diagnosed to have AKI. We present the history, clinical findings, and investigations of 10 patients diagnosed with unusual causes of AKI. It is important for physicians to recognize unusual causes of AKI. A high index of suspicion and timely diagnosis and treatment interventions may bring complete recovery of renal functions in patients of AKI.

Essays in Narrative and Fictionality: Reassessing Nine Central Concepts

Essays in Narrative and Fictionality: Reassessing Nine Central Concepts

Bomb explosions fatalities in civilian area: Two unusual cases

While bomb blasts are often associated with wars and terrorism in military and terrorism-prone areas, these events are incredibly rare in other civilian areas. Consequently, forensic medicine experts are rarely exposed to such cases. Explosion injuries produce a distinctive pattern on the body that can help determine the cause of death and reconstruct the crime scene. As such, it is imperative for an autopsy surgeon to be aware of the pattern of bomb blast injuries as well as their mechanisms. In this article, we present autopsy findings of two scrape yard workers who were killed by a bomb blast while breaking scrapes that they received from an army firing range. Furthermore, we have tried to correlate autopsy findings with the circumstances of the blast.

Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center

Only a few clusters of invasive pneumococcal disease have been described globally in children, and most of these cases occurred before pneumococcal vaccination implementation. Two unusual cases of pneumococcal meningitis, occurring in the same daycare center over a 3-day period, were reported. Both cerebrospinal fluid (CSF) were sent to the National reference center for pneumococci. In addition, we decided to perform a pneumococcal carriage study on all children and staff of the daycare center to analyze the pneumococcal serotypes circulating in this DCC and to discuss an antibiotic chemoprophylaxis. CSF culture was positive for pneumococcus, and serotype 25A was identified by latex agglutination. The second case had negative CSF culture, but CSF antigen test and gene amplification results were positive for Streptococcus pneumoniae. Serotype 12F was identified by using molecular biology. The absence of correlation between these strains was confirmed by multi-locus sequence typing. In the carriage study, we included 29 children (median age 1.9 years, interquartile range 1.4–2.5) and 10 adults. Among the children, 24 carried Streptococcus pneumoniae (83%). The main serotypes isolated were 23A for 6 children and 25A for 5 children; serotypes were non-typeable for 3 children. Only 1 of 10 adults tested carried Streptococcus pneumoniae (serotype 12F). Despite this temporo-spatial pattern, the cases were unrelated and not due to carriage of a particular serotype. No specific action has been taken for the other children attending this DCC, and no other case of bacterial meningitis occurred.

The winding 12-month journey of the AstraZeneca COVID-19 vaccine since its first administration to humans

The deficiently designed and conducted initial clinical development plan and the occurrence of thrombotic thrombocytopenia cases, have marked the first 12-month journey of the AstraZeneca coronavirus disease 2019 (COVID-19) vaccine after it was first administered to humans. When it was authorized, there were no available efficacy data in the elderly. However, this age group was included in the product labelling based on immunogenicity data. The lack of safety and efficacy data in the elderly that was acknowledged in the product information, triggered most European Union (EU) countries to limit the administration of this vaccine to certain age groups. In February-March/2021, after the results of observational studies supported the vaccine effectiveness in the elderly, several countries broadened its use to this age group. When trust on the vaccine was ramping up, unusual blood clot cases were described in Europe, which led 24 countries around the world to temporarily halt its administration. These cases were first described as thrombotic thrombocytopenia in late March. In mid-April, the UK Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA) updated the product information and confirmed the positive benefit/risk ratio of the vaccine, recommending its use with no age restrictions. The World Health Organization (WHO) coincided with this approach. However, several countries decided to limit its use to certain age groups. The EMA listed thrombotic thrombocytopenia as a “very rare” adverse reaction. Although, the AstraZeneca vaccine was conceived in early 2020 to be a worldwide leader in the fight against COVID-19, its use was abandoned by the African Union, Denmark, and Israel. However, this vaccine has shown its usefulness in many settings across the world.

Detection of blood flow through artery in the presence of steno-occlusive disease post liver transplantation by modeling for theatrical and detrimental environmental changes

This research intends to expand a mathematical model for studying the non-Newtonian surge of blood through a hepatic artery in the presence of steno occlusive disease post-liver transplantation. Power law liquid demonstrates the non- Newtonian character of blood. The hemodynamic conduit of the fluid is altered by the occurrence of arterial stenosis. In our study, the difficulty is resolved by applying diagnostic methods with the assistance of marginal circumstances and consequences. The outcomes are explained graphically for unusual cases for such stenosis. The study design is based on a tensorial form and converts its solution using numerical and analytical techniques. Our study outcome suitably demonstrates that the mathematical model used corroborates with the clinical scenario of the patient with hepatic disease.

Googling for a veterinary diagnosis: A replication study using Google as a diagnostic aid.

BackgroundThe purpose of this study was to replicate in the veterinary context a BMJ study using Google to assist in diagnosis of complex cases.Hypothesis/ObjectivesTo assess percentage of diagnoses identified using Google as a diagnostic aid in veterinary medicine.AnimalsNone; 13 cases in cats and 17 in dogs published in JAVMA.MethodsCross‐sectional survey of Google results from searches using keywords generated independently by a generalist and a specialist veterinarian who reviewed the published case history and diagnostic components while blind to the diagnosis. They offered diagnoses and generated up to 5 search strategies for each case. The top 30 Google results for each search were reviewed by the generalist to inform a final Google‐aided diagnosis. Both veterinarians' initial diagnoses and the Google‐aided diagnoses were compared with the published diagnoses.ResultsGoogle searching led to 52 diagnoses out of 60 possible. Twenty‐two (42%, 95% confidence interval [95% CI] 29%‐55%) Google‐aided diagnoses matched the JAVMA diagnosis. This accuracy rate does not differ significantly from 58% (n = 15/26, 95% CI 38%‐77%) identified in the BMJ study. Google‐aided results were not statistically different from those achieved unaided by each veterinarian (33%, 95% CI 16%‐50%).Conclusions and Clinical ImportancePublished information found searching Google using keywords related to complicated or unusual cases could assist veterinarians to reinforce their initial diagnosis or consider other differential diagnoses. Search strategies using words representing either signs or the preliminary diagnoses can yield results useful to confirming a correct diagnosis.

Histomorphological Analysis of Nephrectomy Specimens

Introduction: For a range of kidney abnormalities, including both neoplastic and nonneoplastic disorders, nephrectomy is a popular surgical treatment. We conducted this study to examine the range of lesions found in the nephrectomy specimens obtained and to ascertain the distribution of these lesions by age and sex. Materials and Methods: This study was conducted in the department of pathology, from 2017 to 2022. All nephrectomy specimens received during 5 years were included. Results: The spectrum of renal lesions observed in the study included both neoplastic (43.75%) and nonneoplastic (56.25%) conditions. Nineteen patients were males (59.37%) and 13 were females (40.62%) (M: F = 1.4:1). The most common entity in the nonneoplastic category was chronic pyelonephritis (n = 9, 28.12%). In our study, we documented two unusual cases of renal replacement lipomatosis (RRL), a type of pseudotumor related to nonfunctioning kidneys. Fourteen patients underwent nephrectomy for neoplastic conditions such as Wilm's tumor and renal cell carcinoma (RCC). Conclusion: Nephrectomy for the nonneoplastic condition was performed more frequently in our series. Histopathological evaluation of nonneoplastic nephrectomy specimens must be thoroughly considered, particularly in unusual circumstances such as RRL, where a preoperative erroneous initial impression of a malignant lesion such as angiomyolipoma or liposarcoma is possible.

Climate Change: It’s Causes, Inflicted Hazards, Adopted Strategies and Opportunities in Agriculture of Nepal: A Detailed Review

The greatest threat of 21st century, climate change is being deeply studied for its adverse effects and coping strategies by almost all nations of world. Although, detailed studies in developed nations are most common, Nepal lags in its own research and studies for understanding this change. With great geographic, altitudinal, socio-economical and biological variation in Nepal, the need for study of climate change has grown mandatory since farmers are experiencing peculiar unusual cases different from past. Farmers perception and studies remark the changes in temperature, rainfall, weed dynamics, insect, pest and disease outbreak, hazardous events, duration of a season, unpredictability in weather, loss of production and productivity, food insecurity, degradation of soil physical and chemical status, biological losses and alterations. Many adaptative strategies have been put forward locally and from government level that have shown different efficacy in different environment. Simply put, local site-specific adaptive strategies must be given more importance and prioritization. Financial cringe to tackle climate change must be sorted out and available resources must be put to use by NAPA. Modifications in farm operations, time adjustment and use of modern technology in practices, crop selection, improvement and their cultivation, detailed weather forecasting, soil and water conservation practices, agroforestry, crop rotation, share cropping and off farm engagements have been highlighted. Factors that influence the rate of adoption include age, gender, education and outreach of house head, financial liquidity, size of farms and availability of resources. New opportunities and prospects though revealed, it is still to be utilized.

Mini-Review: Omental Patch Repair of Giant Perforated Peptic Ulcer

Introduction. A perforated giant peptic ulcer is an emergency that requires surgery. Closure of the perforation with an omental patch has been reported in several cases of perforated giant peptic ulcers. However, there is insufficient evidence regarding the option of preferred treatment. This review to discuss published reports of a perforated giant peptic ulcer closed with an omental patch that focused on the complications Method. The literature search was conducted through the Cochrane, PubMed, Scopus, and EBSCO data sites. The articles obtained were screened for duplication, title, abstracts, and full-text based on inclusion and exclusion criteria. Result: Two articles were included in this study for critical review. From these two articles, no complications were reported regarding the closure of giant perforated gastric ulcers with an omental patch. Conclusion: In general, closure of perforated gastric has a minimal incidence of postoperative complications. An omental patch can be used to close gastric perforation in unusual cases, such as giant perforation and septic shock, as presented in this case.

A case of agnogenic intrahepatic arterioportal fistula complicated by gastric ulcer bleeding and progressive portal thrombosis

AbstractArterioportal fistulas (APFs) are defined as vascular communications between the systemic arteries and portal circulation. APFs are classified as congenital or acquired, large or small, intrahepatic or extrahepatic, and traumatic or spontaneous. The consistent abnormal connection may result in severe presinusoidal portal hypertension, leading to gastrointestinal bleeding (GIB), ascites, elevated liver function enzymes, heart failure, diarrhea, and even pancreatitis or hematobilia in some unusual cases. Indeed, less than half reported cases have GIB, predominately caused by variceal rupture. Peptic ulcer bleeding has rarely been reported in the setting of APFs. Herein, we describe a case in which intrahepatic APF manifested as gastric ulcer bleeding, progressive portal thrombosis, and massive ascites, with these symptoms successfully relieved by endovascular treatment.

"Unusual cases of foetal death in Pitbull bitches: Foetal mummification and maceration "

"Unusual cases of foetal death in Pitbull bitches: Foetal mummification and maceration "

Effect of Jaggery on the Properties of Concrete

Abstract: Concrete is a composite material used because all imaginable design structures are made of concrete. The report emphasizes that using locally available materials such as jaggery may improve concrete features. The test was completed to test the quality properties of the concrete using Jaggery as a mixer in the creation of the concrete. These types of blends are often used as part of unusual cases such as large wharves and long piles. Four different levels of admixtures (Jaggery) were selected for testing as 0.5%, 1%, 2%, 2.5%, 3%, 3.5%, 4%, 4.5% and 5% by weight of cement by M25 grade, mix design concrete. Finally, it was thought that the performance and compressive strength of the concrete were improved when Jaggery mixtures were applied to the concrete mix. Keywords: Jaggery, Concrete, Consistency, Setting Time, Slump Value., Compaction Factor, Compression, Scanning Electron Microscopy

Review of the clinical spectrum of typical and atypical Lyme neuroborreliosis in southwest England

BackgroundLyme disease is endemic in the UK with a high incidence in southwest England. Neurological involvement occurs in approximately 5% of infected individuals. Previous reviews in southwest England have shown a consistent phenotype in most cases, however anecdotal review suggests a small number of atypical cases, with diverse presentations, which provide a diagnostic challenge, even to experienced neurologists.MethodsWe performed a retrospective, observational study of all identified cases (positive screening ELISA confirmed by immunoblot and neurological symptoms) of neuroborreliosis from six hospitals between January 2015 and December 2017. In addition, we reviewed atypical cases seen over the last decade in the regional neurosciences centre in depth.Results72 patients were included in the observational study. 83% had characteristics of Bannwarth’s syndrome (cranial neuropathy, radiculopathy and CSF pleocytosis). Unusual cases included mononeu- ritis multiplex.Central nervous system involvement was rare. We saw cases presenting with cerebrovascular events, meningitis and encephalitis. Complete resolution of symptoms was reported in 72% of patients. 28% of patients reported residual symptoms, most commonly fatigue and memory problems.ConclusionsThis is the largest UK review of neuroborreliosis. The presentation is usually typical, but atypical presentations vary and can be challenging. The majority of patients recover fully.amyrossrussell@gmail.com

Secure blockchain enabled Cyber- Physical health systems using ensemble convolution neural network classification

Breast cancer is the most widely recognized malignancy affecting women. The risk of death has been consistently associated with breast cancer. In addition, the cyber-physical system (CPS)is the processing and data transfer of physical processes. This study presents a safe, intrusive, blockchain-based data transfer using the CPS classification model in the health industry to overcome the problem. Considering the challenges in breast tumor classification, this paper accords a reasonablearrangement to examine the mammogram image to discover the detection and classification of various stages of cancer. The breast cancer detection images obtained from the mammogram were processed and experimentally evaluated for parameters such as a sensitivity of 90%, a specificity of 98%,andaclassification accuracy of 98%.The results of the ensemble convolution neural network (E-CNN) classifier, such as VGG-16 and Inception-v3, which separates ordinary and unusual cases from the applied advanced mammographic image, will be projected by comparing the two existing methods.

New insights in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms.

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare epithelial neoplasms derived from pluripotent endocrine cells along the gastrointestinal tract and pancreas. GEP-NENs are classified into well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Despite overlapping morphological features, GEP-NENs vary in molecular biology, epigenetic, clinical behavior, treatment response, and prognosis features and remain an unmet clinical challenge. In this review, we introduce recent updates on the histopathologic classification, including the tumor grading and staging system, molecular genetics, and systemic evaluation of the diagnosis and treatment of GEP-NENs at different anatomic sites, together with some insights into the diagnosis of challenging and unusual cases. We also discuss the application of novel therapeutic approaches for GEP-NENs, including peptide receptor radionuclide therapy, targeted therapy, and immunotherapy with immune checkpoint inhibitors. These findings will help improve patient care with precise diagnosis and individualized treatment of patients with GEP-NENs.

Sex in an Old Regime City: Young Workers and Intimacy in France, 1660–1789

Sex in an Old Regime City: Young Workers and Intimacy in France, 1660–1789

Successful minimal invasive treatment of massive colonic bleeding from a pseudoaneurysm in a Nigerian with end-stage kidney disease: A case report

Emergency presentation of some rare causes of massive colonic bleeding with clinical hemodynamic instability often presents challenging diagnostic and therapeutic dilemmas. This is more so in a resource-limited locality such as ours where there is a dearth of technical expertise and equipment available to handle such unusual cases. This report presents a case of massive colonic bleed from a pseudoaneurysm of a branch of the ileocolic artery which had a fistulous communication with the cecum and was successfully treated with minimally invasive interventional radiology procedure in Lagos, Nigeria.

Formula Otorrhea in Pediatric Patients With Cleft Palate.

The case series details 2 unusual cases of male newborns with cleft lip and palate (CLP) that later developed formula otorrhea. Both patients underwent bilateral myringotomies with the insertion of pressure equalizing (PE) tubes for chronic otitis media with effusion (OME). Chronic otorrhea associated with feeding occurred post-PE tube insertion and the otorrhea was later confirmed to be due to reflux of formula. Patients were treated with antibiotic ear drops, routine ear cleaning, anti-reflux medication, and reflux precautions. After definite cleft palate repair, formula otorrhea completely resolved. When patients with CLP develop chronic OME or otorrhea following PE tube placement, reflux of formula into the middle ear should be considered and treated accordingly.