A Case of Non-cirrhotic Portal Hypertension in a Patient With Primary Myelofibrosis Disease.

Idiopathic non-cirrhotic portal hypertension can emerge due to a varied spectrum of underlying and contributory factors, presenting in the form of abdominal distention as the initial symptom encountered. Often, a patient remains asymptomatic to the underlying cause and seeks medical care for their abdominal enlargement. As the portal hypertension continues to progress, ascites begins to develop due to a history of portal vein thrombosis being sufficient to increase splanchnic blood flow in a portal hypertensive pattern. We present a rare case of ascites in a non-cirrhotic patient due to portal vein thrombus with underlying myeloproliferative disease of primary myelofibrosis.

A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis.

A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence since September 2021. One month after quitting alcohol, she experienced a sudden deterioration in bilateral extremity neuropathy, forgetfulness, difficulty writing, and severe mood swings, which continued to worsen until her presentation in July 2022. Laboratory tests, including complete blood count and electrolyte levels, were within normal ranges. A previous MRI performed during the investigation for alcoholic neuropathy a few months before she quit drinking showed no abnormalities. However, a subsequent MRI during work-up for the current acute symptoms revealed significant signal abnormalities involving the central pons, bilateral cerebral peduncles, and medullary pyramids, consistent with chronic central pontine myelinolysis (CPM) with extrapontine myelinolysis (EPM) extending into the peduncles. The patient received treatment with folate and multivitamins and was scheduled for outpatient follow-up with physical therapy for rehabilitation. This case highlights CPM as a consequence of alcohol withdrawal and emphasizes the importance of timely diagnosis and appropriate management in such patients.

A Rare Presentation of Zoledronate-Induced Systemic Inflammatory Response.

Zoledronic acid is a bisphosphonate commonly used to treat various conditions involving bone loss. While it is generally well-tolerated, the occurrence of severe inflammatory reactions is rare. We present the case of an 82-year-old female who developed a severe immune reaction, including weakness and tenderness in her upper and lower extremities, following a single dose of zoledronic acid infusion for the treatment of osteoporosis. The onset of symptoms occurred one week after the infusion and persisted, progressively worsening over time, leading to functional impairment and the need for a walker for ambulation. Laboratory studies revealed an elevated erythrocyte sedimentation rate while other autoimmune markers were within normal limits. Differential diagnosis included an adverse reaction to zoledronic acid or underlying polymyalgia rheumatica. The patient showed significant improvement with a prednisone taper, suggesting an immune-mediated response. This case highlights the importance of considering severe immune reactions as a potential side effect of zoledronic acid and emphasizes the need for further research to better understand the underlying mechanisms and optimize patient management.

A Case of Acute Liver Failure Due to Artemisinin-Derived Herbal Supplements.

A 49-year-old female presented with malaise, nausea, vomiting, and discolored urine. She was found to have an acute liver failure with labs significant for aspartate aminotransferase (AST) of 2164, alanine aminotransferase (ALT) of 2425, alkaline phosphatase (ALP) of 106, total bilirubin of 3.6, and lactate dehydrogenase (LDH) of 2269. The international normalized ratio (INR) was also elevated at 1.9. All workup for acute liver failure was negative and it was found that she had started taking a new supplement called "Gut Health", which contained artemisinin, for weight loss and menopausal symptoms. After discontinuing the supplements and symptomatically treating her for acute liver failure, her transaminitis resolved.

The Effects of Growth Factors and Cytokines on Hepatic Regeneration: A Systematic Review.

The incidence of liver disease increases throughout the years due to many lifestyle factors; thus, the only definite treatment available for chronic liver disease is a liver transplant. However, the liver has a natural ability to repair itself and regenerate its hepatic tissue from stem cells. It is hypothesized that by inducing the liver with specific growth factors and cytokines such as interleukin 6 (IL-6) compared to general growth factors like growth differentiation factor 15 (GDF-15), it can regenerate, decreasing the need for liver transplant procedures. MEDLINE, the Journal of Hepatology, and Google Scholar were used to find articles. Various studies, including epidemiological studies dated from the year 2000 and greater, were used for the introduction. The results used only randomized control trials, experimental studies, and primary articles published since 2000. This compared the results of manipulating variables to determine the effects of hepatic regeneration by either specific hepatocyte growth factors or general growth factors like GDF-15. A total of 10 collected studies showed increased levels of gene expression and function, improved gross morphology, and histological appearance of the liver when induced by cytokines and specific growth factors versus general growth factors. Overall, the hypothesis was proven. The effects of GDF-15 were not significant compared to the effects of hepatocyte-specific growth factors and cytokines like IL-6 because they have two different effects on the liver after liver injury. Future studies should investigate this topic on the human hepatic regenerative ability, plus compare the effects of general growth factors like GDF-15 and specific hepatocyte growth factors and cytokines such as IL-6 in human liver tissue.

Medicinal Plants as an Alternative to Control Poultry Parasitic Diseases.

Parasitic infections are a major public health concern affecting millions of people universally. This review elaborates on the potential impacts of plants and their bioactive components that have been widely used in the cure of several parasitic infections of poultry. The medicinal importance of natural herbs depends upon their bioactive ingredients, which are originated from crude plants, consequently leading to the specific action on the body. Due to the limited availability of effective drugs and high cost, the development of drug resistance in several harmful parasites and microbes leads to huge economic losses in the poultry industry. This will impose the development of innovative sources for drugs to overwhelm the therapeutic failure. Moreover, the environment-friendly feed additives which can be applied as a substitute to antibiotic growth promoters (AGP) for broilers were proven. The application of natural products with therapeutic characteristics is an ancient practice that is appropriately gaining more acceptance. Globally, it is assessed that some 20,000 species of higher plants are used medicinally, although traditional medicine has a scarcity of knowledge on its efficiency and wellbeing. This review explores the usage of medicinal herbs for parasitic infections, emphasizing the recent knowledge available while detecting the research gaps which may be explored to find the usage of herbal medicines for parasitic infections in poultry. In conclusion, herbal medicines are the effective source of prime components for drug detection and the formation of phytopharmaceuticals in the control of devastating parasitic infections. There is a prerequisite to applying the traditional medicine information in clinical applications via value addition.

Prevalence and Extent of Subclinical Atherosclerosis and Associated Cardiovascular Risk Factors in Adult Patients With Psoriatic Arthritis: A Systematic Review.

Psoriatic arthritis (PsA) is a chronic T cell-mediated inflammatory condition affecting a considerable proportion of psoriasis (PSO) patients and a small segment of the general population. Recent studies have shown that patients with PsA are prone to premature atherosclerosis and are at an increased risk of cardiovascular disease (CVD) events, but the extent and prevalence of this are unknown. Our objective was to evaluate the prevalence and extent of subclinical atherosclerosis by measuring the intima-media thickness (IMT) of arteries in adult patients with PsA, as well as identify cardiovascular (CV) risk factors associated with PsA. An extensive literature search was conducted using PubMed as our main database. The articles exploring the association between PsA and subclinical atherosclerosis were included. We also searched other databases like MEDLINE and PubMed Central (PMC). A total of 2,561 studies published between 2005-2021 were obtained by searching the databases, and after the screening process, a total of nine studies were included for review and an additional 22 studies for comparison and backup evidence. As for results, our review included a total of 542 patients with PsA from nine different studies. All the reviewed studies showed a significant association between subclinical atherosclerosis and PsA, as endothelial functions were found to be impaired in PsA patients as deduced by measuring the carotid intima-media thickness (CIMT). PsA patients exhibited greater IMT than healthy controls. Increased IMT independently correlated with parameters of disease activity and conventional risk factors of atherosclerosis. An increased prevalence of CV risk factors such as hypertension, diabetes, obesity, and metabolic syndrome was also found in PsA patients.

Survey of Stress in COVID Patient Post Treatment: A Qualitative Research.

AIM: The purpose of our study was to examine the mental health status of patients with coronavirus disease-19 (COVID-19) who were hospitalized. METHODOLOGY: In this cross-sectional study, 106 inpatients with COVID-19 who had stable clinical conditions were evaluated psychologically by questionnaire: Depression, anxiety, and stress scales-21 (DASS-21). RESULTS: About one-third of patients had comorbidities. In totality, 97.2% of patients with COVID-19 had some grade of depression. Extent of depression, assessed with the help of the DASS questionnaire, was 85.8%. All patients (100%) had serious (0.9%) and grave level of (99.1%) anxiety. Regarding to stress levels, 97.1% of patients had some degree of stress. In the worsening of stress category, 84.9% of patients had high-stress levels. CONCLUSION: The presence of such increased prevalence and seriousness of psychiatric disorders among hospitalized patients with COVID-19 underlines the necessity for serious consideration to the mental health standing of these patients.