We report a rare case of diabetes insipidus following fire burn injury. Meticulous fluid balance and the use of carbamazepine resulted in her survival.
Burns/*complications ; Carbamazepine/therapeutic use ; Diabetes Insipidus, Neurogenic/drug therapy/*etiology ; Female ; Fires ; Fluid Therapy/methods ; Humans ; Self-Injurious Behavior ; Young Adult

Neuroimaging biomarkers have potential role in the early diagnosis as well as periodic follow-up of neurodegenerative diseases such as Alzheimer’s disease (AD). Structural imaging biomarkers can be used to predict those who are at risk or in preclinical stages of AD. It could possibly be useful even in predicting the conversion of Mild Cognitive Impairment (MCI) an early stage of AD to AD. In addition there has been a lot of progress in molecular imaging in AD. This article presents a review of recent progress in selected imaging biomarkers for early diagnosis, classification, and progression, of AD. A comprehensive integrative strategy initiated early in the cognitive decline is perhaps the most effective method of controlling progression to Alzheimer’s disease.

The role of bivalent cations and choli ne in ATP-induced apoptosis via P2Z pur i noceptor was investigated in human leu ke mic lymphocytes. In vitro exposure of le ukemic lymphocytes with P2Z receptor s to 1 mmol/L ATP or 0.1 mmol/L benzoyl benzo ic ATP(BzATP) for 8 h in the prese nce of choline, 1 mmol/L Mg2+ or oth er biva lent cations, and ATP-induced DN A breaks , associated with apoptosis wer e quantif ied by TdT assay. We observed that (1) E xtracellular Mg2+ or Ca2 + stimulat ed ATP-induced DNA fragmenta tion in a do se-dependent manner, and th e compatible evidence was provided by t he inhibition of ATP-induced DNA fragme ntation in the present of EGTA or EDTA; (2) ATP-induced DNA fragmentation was completely inhibi ted by 1 mmol/L Zn2+ ;(3)ATP-induced D NA breaks were not af fected by Ba2+, Sr2+, Co2+ whe n they were substitu ted for extracellul ar Mg2+ or Ca2+ ;(4)Choline, an in hibitor of phospholipa se D(PLD) stimula ted by ATP through P2Z receptor in huma n lymphocytes, was also a partial inhib itor of ATP-induced DNA f ragmentation, and the results were confi rmed by flow cytometric analysis (FCA); (5)ATP-induc ed DNA fragmentation was com pletely obl iterated when the temperature was lower than 10℃. These results sugge st that t he endonuclease and PLD may be involved in ATP-induced apoptosis in hum an lymp hocytes via P2Z receptor.

BACKGROUND: Several different patterns of wavebreak have been described by mapping of the tissue surface during fibrillation. However, it is not clear whether these surface patterns are caused by multiple distinct mechanisms or by a single mechanism. METHODS: To determine the mechanism by which wavebreaks are generated during ventricular fibrillation, we conducted optical mapping studies and single cell transmembrane potential recording in 6 isolated swine right ventricles. RESULTS: Among 763 episodes of wavebreak (0.75 times/sec/cm2), optical maps showed 3 patterns: 80% due to a wavefront encountering the refractory waveback of another wave, 11.5% due to wavefronts passing perpendicularly each other and 8.5% due to a new (target) wave arising just beyond the refractory tail of a previous wave. Computer simulations of scroll waves in 3-D tissue showed that these surface patterns could be attributed to two fundamental mechanisms: head-to-tail interactions and filament break. CONCLUSION: We conclude that during sustained ventricular fibrillation in swine RV, surface patterns of wavebreak are produced by two fundamental mechanisms: head-to-tail interaction between waves and filament break.
Computer Simulation ; Heart Ventricles* ; Membrane Potentials ; Swine* ; Ventricular Fibrillation*

Background: Postoperative urinary retention is a commonly encountered problem after anal surgery particularly under spinal anesthesia. Bethanchol chloride, a muscarinic cholinergic receptor agonist was used to determine whether it could prevent this problem. Methods: One hundred six patients with mean age of 37+ 9 who underwent anal surgery under spinal anesthesia from January to August 2007 were included in this nonblinded randomized prospective experimental study. Forty- six patients were given bethanechol chloride 25mg/tab 1 hour post- op then another dose after 4-6 hours. Those with the urge to void but unable to do so within the hour or had hypogastric pain (VAS > 8) were immediately catheterized and the amount drain recorded. Conclusion: Although bethanechol chloride did not completely prevent the development of postoperative urinary retention, it use was associated with reduced need for the catheterization.
Human ; Adult ; BETHANECHOL ; URINARY RETENTION ; ANESTHESIA, SPINAL

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition. METHODS: This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED. RESULTS: A total of 2228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71％) more commonly presented to the ED with migraine than males. The migraine population was significantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17 SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous (IV) fluids with phenothiazine additives were commonly used. Over 20％ of patients were prescribed oral or parenteral opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used. CONCLUSION: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a significant variation from published guidelines.

Objective: To determine the association of anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR test results among patients in a tertiary government hospital in Metro Manila. Methods: Design: Cross-Sectional Study. Setting: Tertiary Government Hospital. Participants: Patients aged 18 years old and above who consulted or were admitted with COVID-19 symptoms at the Quezon City General Hospital in the Philippines from July to September 2020 answered an offline version of the American Academy of Otolaryngology-Head and Neck Surgery AAO-HNS COVID-19 Anosmia Reporting Tool prior to undergoing (COVID-19) RT-PCR testing. Results: Out of 172 participants, 63 (36.6%) presented with anosmia. Sixty (95.2%) out of 63 of those with anosmia had a positive COVID-19 RT-PCR test result. Forty-one (65%) participants reported anosmia as the first symptom while the most common associated symptoms were fever (59%), cough (50%), and rhinorrhea (31%). There was a significant association between anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR tests (X2 =33.85, df=1, p<.0001). Conclusion Anosmia was associated with a positive SARS-CoV-2 (COVID-19) RT-PCR test in more than 95% of those who reported the symptom. Anosmia should be considered as a red flag sign which should be included in the screening of persons suspected of being infected with COVID-19 to help mitigate further spread of the virus.
Anosmia ; Coronavirus ; SARS-CoV-2 ; Pandemics ; COVID-19

Human immunodeficiency virus (HIV) leads to immunosuppression by depleting CD4+ T-cells. Psoriasis, a common immune-mediated inflammatory dermatosis, can paradoxically worsen or emerge as an initial presentation of HIV. The introduction of highly active antiretroviral therapy (HAART) in psoriatic patients with HIV may trigger severe psoriasis flare-ups, often linked to immune reconstitution inflammatory syndrome (IRIS).

This case involves a 31-year-old Filipino male with recurrent, resistant psoriatic plaques. Further testing revealed latent syphilis and HIV infection. The patient completed treatment for syphilis and began HAART, but developed erythrodermic psoriasis, likely due to IRIS. After an inadequate response to acitretin, guselkumab, an IL-23 inhibitor, was administered. The patient responded well, showing significant improvement after four months of treatment without adverse effects.

This case suggests that in severely immunocompromised patients with newly diagnosed HIV, adding guselkumab to conventional HAART may be a safe and effective option for controlling erythrodermic psoriasis flares triggered by immune reconstitution. However, further research is needed to assess the long-term safety and efficacy of guselkumab in HIV-associated psoriasis.

Human ; Male ; Adult: 25-44 Yrs Old ; Guselkumab ; Hiv ; Psoriasis

Introduction: Dioctophyma renale, also known as the “giant kidney” worm is the largest nematode that infects mammals. Most commonly, it infects dogs and only a few cases of human infestation have been reported. Case Presentation: In this case, we present a 71-year-old male with a history of right flank pain, painless hematuria, obstructive urinary symptoms and occasional passage of a long red meat-like structure via urethra. Previous ultrasonography revealed a renal mass that was interpreted as renal malignancy. Patient was advised radical nephrectomy with biopsy; however, he was lost to follow up. After 8 years, he again presented with a 2-month history of right flank pain, gross hematuria, unintentional weight loss and obstructive urinary symptoms. He was admitted to our institution and laboratory findings revealed microcytic hypochromic anemia. Ultrasound showed a focal bulge in the superior wall of the urinary bladder and an enlarged right kidney with a large heterogeneous solid structure. Insertion of a foley catheter relieved the urinary obstruction and there was noted passage of a single roundworm measuring 55 cm by 0.32 cm. The specimen was sent for histopathology and microscopic examination revealed a necrotic body of a roundworm consistent with Dioctophyma renale. Case Discussion The clinical manifestations of D. renale infection are non-specific and the diagnosis can be a challenge as it commonly mimics renal malignancy and other intra-abdominal tumors. The diagnosis is often an incidental finding of the parasite on necropsy or by finding ova in the urine. The clinical findings of painless hematuria, unintentional weight loss and an ultrasound finding of renal mass usually point toward the diagnosis of renal cell carcinoma. As we present this case, it will be highlighted that such signs and symptoms, such as painless hematuria, unintentional weight loss and ultrasound finding of a renal mass, can also be found in patients with rare human parasitism from Dioctophyma renale.
Parasites ; Dioctophymatoidea ; Carcinoma ; Kidney

INTRODUCTIONThe management of recurrent traumatic patellar dislocation includes surgical realignment. There is no clear distinction whether proximal soft tissue or distal procedures produce superior results. However, distal realignment procedures are commonly associated with greater morbidity. We advocate a distal procedure only for cases which are more severe, such as the presence of patellar maltracking.

MATERIALS AND METHODSBetween January 2002 and June 2007, all patients who had a history of traumatic patellar dislocation with recurrent symptoms and failed conservative management underwent surgical realignment. Patients who had evidence of lateral patellar subluxation on computed tomography (CT) scan were offered a distal realignment procedure using the Elmslie-Trillat or Roux Goldthwaite procedure. All other patients underwent proximal soft tissue medial patellofemoral ligament (MPFL) reconstruction. Pre and postoperative functional International Knee Documentation Committee (IKDC), Lysholm and Tegner score assessments were performed for a minimum follow-up period of 6 months. The mean scores for each group were analysed using the Wilcoxon Matched-Pairs Signed-Ranks test and the Mann-Whitney U test was used to evaluate the difference between the groups.

RESULTSA total of 23 patients underwent surgery for patellar realignment. Of whom, 14 patients had a distal realignment procedure while 9 patients had a proximal procedure of MPFL reconstruction. There was greater morbidity reported with distal realignment procedures. Pre and postoperative IKDC, Lysholm and Tegner scores showed significant improvement for both treatment arms. However, there was no significant difference between the improvement scores for both groups.

CONCLUSIONPatients with significant patellar maltracking following traumatic patellar dislocation would benefit from distal realignment using the Elmslie-Trillat or Roux Goldthwaite procedure. Otherwise, a proximal soft tissue procedure involving MPFL reconstruction would be adequate. A management algorithm is proposed for clinical use.

Adolescent ; Adult ; Algorithms ; Bone Malalignment ; surgery ; Female ; Humans ; Joint Instability ; surgery ; Male ; Orthopedic Procedures ; Patellar Dislocation ; epidemiology ; physiopathology ; surgery ; Recurrence ; Treatment Outcome