Drug-Induced Autoimmune Hepatitis: An Unusual Adverse Event of Atorvastatin Therapy.

Drug-induced autoimmune hepatitis (AIH) is characterized by acute or chronic hepatic injury coupled with autoantibody development, hypertransaminasemia, and idiopathic AIH features on liver biopsy. Atorvastatin-induced AIH is a rare but well-documented life-threatening adverse event. We report a case of atorvastatin-induced AIH in a 57-year-old female who presented with worsening fatigue, jaundice, and deranged liver function tests. She had been prescribed atorvastatin 20 mg daily three months prior. Her clinical presentation, imaging findings, and serological testing were suggestive of drug-induced AIH. A liver biopsy confirmed a drug-induced autoimmune picture, and she was diagnosed with atorvastatin-induced AIH after ruling out all other possible causes. Her clinical presentation and liver enzymes improved after prolonged treatment with prednisone.

Performance and morphology of several soybean varieties and responses to pests and diseases in South Sulawesi.

Soybeans are a commodity that is widely grown by farmers in rainfed rice fields in South Sulawesi. One of the determining factors in increasing soybean productivity in South Sulawesi is the type of variety. The aim of this research was to determine the characteristics, morphology and response to pests and diseases in several soybean varieties planted in rainfed rice fields in South Sulawesi. This research was carried out in Allepolea Village, Maros Regency in 2022 using a Randomized Block Design with 13 treatments and 3 replications. Varieties tested as treatments include: 1) Derap-1, 2) Devon-2, 3) Deja-1, 4) Anjasmoro, 5) Dena-2, 6) Dena-1, 7) Gepak Kuning, 8) Grobogan, 9) Devon-1, 10) Dega-1, 11) Deja-2, 12) Demas-1, and 13) Detap-1. The results showed that of the 13 varieties tested, the highest height was found in Devon-2 (33.67 cm) and Detap-1 (31.67 cm) in the vegetative phase and in the generative phase in Detap-1 (75.53 cm) and Gepak Yellow (74.67 cm). The largest number of branches is in Dena-1 (3.13 branches). The highest nitrogen content was found in Devon-1 (12.64 m2 per g). The largest leaf area was Detap-1 (4.15 cm2) and Gepak Kuning (4.15 cm2). The highest number of stomata was in Dena-1 (42.80 µm) and Deja-1 (44.00 µm). The highest stomata width was found in Gepak Kuning (2.76 µm). The lowest level of leaf damage due to attacks by Valanga sp (Acrididae) occurred in Grobogan (6.89 %) and Dega-1 (7.35 %). The lowest level of pod damage due to Nezara viridula attack was in Devon-2 (3.56 %) and Dena-2 (3.64 %). The lowest level of leaf damage due to Phaedonia inclusa attack occurred in Dega-1 (4.37 %), Dena-2 (4, 12 %), and Grobogan (4.69 %). Seed damage due to Cercospora sp attack was lowest on Dena-2 (0.81 %). The highest seed yield was in Dena-2 (3.78 t ha-1) and the lowest in Anjasmoro (1.93 t ha-1) and Deja-2 (2.02 t ha-1).

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

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

Suprachoroidal injection of triamcinolone acetonide for management of resistant diabetic macular oedema.

OBJECTIVE: To estimate the effects and safety of suprachoroidal triamcinolone acetonide injections in treating patients with resistant diabetic macular oedema. METHODS: The quasi-experimental study was conducted at the Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from November 2019 to March 2020, and adult patients of either gender with uncontrolled diabetes mellitus. Central macular thickness, intraocular pressure and best corrected visual acuity were recorded at baseline, and the patients were followed up at one and three months after the suprachoroidal triamcinolone acetonide injection and post-intervention parameters were compared. Data was analysed using SPSS 20. RESULTS: There were 60 patients with a mean age of 49.25±5.6 years. Of the 70 eyes, 38(54.30%) belonged to male subjects and 32(45.70%) to female subjects. There were significant differences in terms of central macular thickness and the best corrected visual acuity at both follow-ups compared to the baseline readings (p<0.05). CONCLUSIONS: Suprachoroidal triamcinolone acetonide injection significantly reduced diabetic macular oedema.

Role of Serum Homocysteine and Outcome in Patients With Traumatic Brain Injury.

Background There have been indications of a correlation between serum homocysteine (Hcy) levels and poor patient outcomes in traumatic brain injury (TBI). Thus, we aimed to explore the role of serum Hcy in influencing the outcome post TBI. Methods A case-control study was conducted at Liaquat University of Medical and Health Sciences (LUMHS) between January 15, 2022 and July 1, 2022. All patients between the ages of 18 and 75 years who presented with TBI, irrespective of severity, were included in the study. All patients with neurological disorders and infections, including but not limited to cerebral tuberculosis, Alzheimer's disease, epilepsy, brain cancer, Parkinson's, and stroke, were excluded from the study. For comparison, healthy controls with similar demographics were enrolled in the study. All patients and controls underwent biochemical evaluation of serum Hcy and neurological assessment at presentation. In addition, all sociodemographic and clinical parameters, including the Glasgow Outcome Score (GOS), were collected in a predefined pro forma. Results A total of 175 patients were included who had experienced TBIs, along with an equal number of healthy controls. The most common etiology was road traffic accidents in 82 (46.9%) patients. The mean Glasgow Coma Score (GCS) at presentation was 5.78 ± 1.72. The mean Hcy levels were 31.4 ± 7.97 µmol/L in TBI patients and 11.12 ± 5.87 µmol/L in the control healthy patients (p=0.001). It was found that the severity of hyperhomocysteinemia (HHcy) was significantly related to the worst outcome possible, i.e., death (p=0.001). Conclusion The study concluded that patients who had suffered from a TBI had significantly higher serum Hcy levels. Furthermore, the study highlighted that the patients with the worst outcomes had more severe hyperhomocysteinemia (HHcy) than those with better outcomes. Moreover, patients with low GOS scores were more likely to have HHcy.

A Comparative Study of Luteinizing Hormone Levels in Polycystic Ovarian Syndrome With Hyperandrogenism: Metformin Versus Oral Contraceptive Pills.

Introduction The primary objective of the study was to compare the serum luteinizing hormone (LH) levels in patients with hyperandrogenism on metformin and combined oral contraceptive pills. Secondarily, the study also assessed the serum testosterone, body mass index (BMI), and the time to achieve regular menstruation were also assessed. Methods A quasi-experimental study was conducted at the Department of Medicine, Liaquat University of Medical & Health Sciences (LUMHS) between June 1, 2019 and May 30, 2020. A total of 200 women fulfilling the clinical and biochemical criteria for the polycystic ovarian syndrome (PCOS) were enrolled, 100 in each group. Considering the inclusion criteria, the patients were picked up from the gynecology outpatient department. After taking a detailed history and physical, abdominal, and pelvic examination, pelvic ultrasonography along with biochemical evaluations of serum LH and testosterone were done in selected patients. Metformin was started at an oral dose of 500 mg daily and maintained at 1500 mg for six months in group A, and oral contraceptive pills were given for a period of six months in group B. Besides body weight and hirsutism, serum LH levels, serum prolactin levels, and serum testosterone levels were performed at the start of the treatment and then repeated after three months and after six months. After six months of menstrual cyclicity, changes in serum LH levels and body weights were assessed in the two groups and the rate of conception in the Metformin group. Results A total of 200 women were enrolled and equally divided into metformin and oral contraceptive groups. Follow-up revealed that a significantly higher number of patients achieved regular menstruation in the metformin group as compared to the oral contraceptive groups (p = 0.03). In the metformin group, 72 patients achieved regular menses, while in the oral contraceptive groups, about 58 patients achieved regular menstruation. Both metformin and oral contraceptive therapy were effective in improving patient outcomes in terms of serum LH, testosterone levels, and BMI. However, metformin had considerably higher rates of improvement as compared to oral contraceptive group patients. The mean serum LH level decreased from 38 mIU/ml to 17.6 mIU/ml in the metformin group (p < 0.0001), while the mean serum LH level reduced from 37.5 mIU/ml to 27.7 mIU/ml in the oral contraceptive group (p < 0.01). The change in serum testosterone level after six months was 2.98 ± 0.75 in the metformin group (p < 0.001) and 1.50 ± 0.64 in the oral contraceptive group (p < 0.01). Conclusion We revealed that both metformin and oral contraceptives are effective in improving symptomatology in PCOS patients. However, a significantly higher number of patients achieved normal menses with metformin than with oral contraceptives. Moreover, metformin had considerably higher rates of improvements in serum LH levels and serum testosterone levels as compared to oral contraceptive group patients.

Depression and Anxiety in Patients With a History of Traumatic Brain Injury: A Case-Control Study.

Background The burden of psychiatric illness following a head injury may have implications on the disease prognosis. The present study evaluated the association of depression and anxiety with traumatic brain injury (TBI). Methods A case-control study was conducted in Karachi, Pakistan, from 2nd July 2021 and 30th January 2022, including individuals of age 18 and above of both genders, with or without a mild head trauma history, forming the case and control groups, respectively. Individuals with previous head trauma/congenital neurological dysfunction were excluded. A mental health assessment of the participants was carried out with two scales, the Generalized Anxiety Disorder-7 (GAD-7) scale and the Public Health Questionnaire-9 (PHQ-9) scale. Other parameters like age, gender, socioeconomic status, education status, and comorbidities were also documented. Results A total of 62 participants were enrolled with 31 cases and 31 controls. The majority were males aged between 18 and 39 years. About 29% of the patients with a history of mild TBI had moderate to severe depression while only 22.6% of them did not have depression or had minimal depression. We found that about 29.3% of patients with TBI had severe anxiety as compared to the only two healthy controls. The majority of the control group participants did not have anxiety. Conclusion Traumatic head injuries and their long-term side effects can predispose patients to a myriad of psychiatric comorbidities. In this study, we found definitive evidence that both anxiety and depression had a significantly higher incidence in cohorts that suffered from mild TBI. However, we recommend large-scale and multicenter studies in the future to explore these relationships more thoroughly and comprehensively.

Ultrafast single-photon detection at high repetition rates based on optical Kerr gates under focusing: erratum.

Two typos are corrected, and the linear refractive index n is removed from the expressions of the phase shift in Opt. Lett.46, 560 (2021)OPLEDP0146-959210.1364/OL.414895. The removal of n reduces the gate efficiency, but it does not affect the general findings. Here, we present the corrected equations and the corresponding new numerical results, showing that increasing the pulse energy from 1.8 nJ to 4 nJ leads to nearly the same results of Opt. Lett.46, 560 (2021)OPLEDP0146-959210.1364/OL.414895.

Ultrafast single-photon detection at high repetition rates based on optical Kerr gates under focusing.

The ultrafast detection of single photons is currently restricted by the limited time resolution (a few picoseconds) of the available single-photon detectors. Optical gates offer a faster time resolution, but so far they have been applied mostly to ensembles of emitters. Here, we demonstrate through a semi-analytical model that the ultrafast time-resolved detection of single quantum emitters can be possible using an optical Kerr shutter at gigahertz rates under focused illumination. This technique provides sub-picosecond time resolution, while keeping a gate efficiency at around 85%. These findings lay the ground for future experimental investigations on the ultrafast dynamics of single quantum emitters, with implications for quantum nanophotonics and molecular physics.

A rare case of large sphenoethmoidal osteoma

Osteoma is the most common benign tumour of the nose and paranasal sinuses. However, involvement of the sphenoid sinus by osteoma is rare. Most of the time, patients with paranasal sinus osteoma are asymptomatic. However, symptoms may present, depending on the location and extension of the tumour. We report a case of a patient with sphenoethmoidal osteoma found incidentally on imaging, with evidence of impingement onto the optic nerve at the optic canal. However, the patient was asymptomatic. He was surgically treated using the endoscopic transnasal approach.

A Rare Case of Retropharyngeal Hibernoma

Hibernoma is a slow growing, rare benign tumour, which derived from brown adipose tissue. This tumour is usually found in the area where foetal fat persists such as back, axilla, retro peritoneum and thorax. Hibernoma rarely occurs in the retro pharynx. We report a case of retropharyngeal hibernoma in a 44-year-old male. He presented with obstructive symptoms for six months and a retropharyngeal mass upon examination. His CT scan findings showed a mass in the prevertebral region from level of C2 until C5 causing narrowing of upper aero digestive tract. Histopathological examination reported as hibernoma.

Is action tremor in Parkinson's disease related to resting tremor?

OBJECTIVE: Action tremor (AT) and resting tremor (RT) have been widely cited in many studies with Parkinson's disease (PD) patients, but studies looking at the association between the two tremor types are few and show inconsistent results. This study will look at the prevalence and association of AT and RT in a large sample of idiopathic PD patients, and will put the results into context with the literature. METHODS: A retrospective chart review analysis of 332 patients with idiopathic PD was performed. Prevalence rates of particular tremor types were noted. The presence of AT was analyzed relative to the presence and severity of RT. RESULTS: Nearly all individuals with AT also had RT. The concurrence of the two tremor types was found to be highly significant by statistical analysis (P < 0.0001). The severity of RT, measured by its laterality, may also be of importance, albeit to a much smaller extent if at all. Neither presence of tremor nor type of tremor present was influenced by patient gender, age, or Hoehn and Yahr stage of PD. CONCLUSIONS: The results indicate that AT has extensive presence in PD. This and its seemingly close relationship to RT suggest that AT may be considered a variant of RT, particularly in PD patients. The degree of association between RT and AT needs to be further analyzed in PD, as well as in essential tremor (ET) and ET-PD.

Prevalence of nocturia in Parkinson's disease patients from various ethnicities.

OBJECTIVES: One of the most common non-motor symptoms in Parkinson's disease (PD) is nocturia. This paper seeks to address the prevalence of nocturia in PD and correlate it to various factors such as gender, Hoehn and Yahr (H&Y) stage, age, and ethnicities. METHODS: In particular, 332 PD patients were seen in a community movement disorders clinic and their charts were analyzed from 2005 to 2010. Within this population, more than one-third (34.9%) patients were diagnosed with nocturia. RESULTS: Age, gender, and PD stage were significant predictors of nocturia in PD. With every one-year increase in age, the odds of developing nocturia in PD increases by 3.1% while an increase in H&Y stage increases the odds of nocturia in PD by 1.645 times. Also, males had greater odds of experiencing nocturia in PD. Ethnicities alone were of no significant importance. However, after performing interaction analyses, Asian and Indian males, especially, were at significantly greater risk than other ethnicities. DISCUSSION: Future research is indeed required to understand why certain ethnicities are especially at risk. Clinicians must also be aware of the epidemiology of nocturia in PD to prevent and treat this debilitating symptom.

Predicting treatment-seeking for visual hallucinations among Parkinson's disease patients.

AIM: While much research has been conducted towards understanding the basis of visual hallucinations in Parkinson's disease, little has focused on characterizing the content and patients' emotional experience. These factors are likely very influential on a patient's decision to seek treatment, a critical aspect of any symptom from the clinical perspective. METHODS: A retrospective chart analysis was performed on Parkinson's disease patients seen in a community-based Parkinson's Disease and Movement Disorder Clinic between 2005 and 2010. RESULTS: The study consisted of 334 patients with Parkinson's disease, among whom 10.5% had visual hallucinations. Hoehn and Yahr disease stage (P = 0.001), concurrent presence of dementia (P = 0.001),and sex (P = 0.031) were significant onset predictors. The most significant determinant of treatment-seeking was emotional reaction, namely whether hallucinations were bothersome (P = 0.008). However, the specific type of content during hallucinations was sometimes more influential and contradicted emotional response. CONCLUSION: Although treatment-seeking can be predicted by how individuals feel about hallucinations, a patient's decision may not be logically consistent. We suggest that clinicians offer treatment based on patients' recollections and opinions.

Impact of progression of Parkinson's disease on drooling in various ethnic groups.

BACKGROUND/AIMS: Drooling or sialorrhea is a common non-motor symptom of Parkinson's disease (PD), and is reported by 35-75% of patients. Drooling is primarily due to impaired swallowing rather than hypersecretion of saliva. In this study, we examined the prevalence of drooling in PD and its relation to various factors such as age, stage of disease, gender and ethnicity. METHODS: A retrospective cohort chart analysis of 307 patients with idiopathic PD was conducted. These patients were seen in the Parkinson's Disease and Movement Disorders Clinic between 2005 and 2010. RESULTS: 123 (40%) patients exhibited drooling. No correlation between age and development of drooling was observed. However, gender was found to be a significant factor in developing sialorrhea. Males are twice as more likely to develop sialorrhea than females. In addition, drooling becomes more prevalent with disease progression; Hoehn and Yahr stage 4 patients being the most at risk. Ethnicity and immigration status have no relationship in developing drooling. CONCLUSIONS: Sialorrhea is seen in a significant number of PD patients. This study, to the best of our knowledge, is the most extensive clinical assessment of drooling in PD to date.

Impact of ethnicity on non-motor symptoms of Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative illness characterized by various non-motor symptoms that may contribute to disability, impaired quality of life and shortened life expectancy. The aim of present study was to determine the relative prevalence of common non-motor symptoms in various ethnic groups. A retrospective chart analysis was performed on Parkinson's disease patients where a total of 314 PD patients from six ethnic categories were examined for the occurrence of anxiety, visual hallucinations, nocturia, drooling and dementia. Our results show that anxiety in PD patients was correlated with their ethnicity classification. Interesting trends were observed with respect to nocturia and dementia symptoms and no significant differences were found between ethnic groups for visual hallucinations and drooling. Our study shows that non-motor symptoms of Parkinson's disease are prevalent across all ethnic groups, and except anxiety there may not be any impact of ethnicity on dementia, nocturia, drooling, and visual hallucinations.