Uncommon Culprit, Familiar Foe: A Case of Septic Thrombophlebitis of the Internal Jugular Vein Triggered by Klebsiella Bacteremia.

Septic thrombophlebitis of the internal jugular vein is characterized as Lemierre syndrome. Patients typically present with sore throat and fever and may present with a tender neck mass due to thrombophlebitis of the internal jugular vein. We present the case of a 57-year-old male with neck pain, fever, chills, and headaches who was diagnosed with internal jugular vein septic thrombophlebitis associated with catheter-related introduction of bacteria.

Case of Circulating Tumor Cells Discovered in Extensive Deep Venous Thrombosis in a Patient with Known Urothelial Carcinoma.

Background: Currently, minimal data are available to explore the composition of venous thromboembolism in patients with cancer. This case report discusses a presentation of venous thromboembolism in a patient with high-grade urothelial carcinoma and highlights the pathology findings in thrombi. Case Presentation. A 55-year-old female who was diagnosed with high-grade urothelial carcinoma with multiple metastases developed an extensive deep vein thrombosis in her left lower extremity. Endovascular revascularization was indicated due to left lower extremity pain and swelling not responsive to anticoagulation. A mechanical thrombectomy was performed, and samples were sent for pathology. Pathologic examination discovered minute fragments of metastatic carcinoma, admixed with laminated blood clots (thrombus). The morphology of metastatic carcinoma and the immunostain profile were compatible with metastatic carcinoma of bladder origin. Conclusion: Cancer is a well-known risk factor for developing VTEs, and it is estimated that approximately 4-20% of cancer patients will experience VTE at some stage, the rate being the highest in the initial period following diagnosis. Annually, 0.5% of cancer patients will experience thrombosis compared with a 0.1% incidence rate in the general population (Elyamany et al., 2014). Despite knowing the increased incidence of VTEs in cancer patients, there are few studies to date that analyze the composition of thrombi in patients with cancer.

Myasthenia Gravis Associated With COVID-19 Infection.

COVID-19 first emerged in Wuhan, China in late December 2019. The disease majorly involves the lungs leading to various respiratory complications; however, neurological manifestations of the disease are also described in the literature. Here, we report a case of COVID-19-induced seronegative myasthenia gravis (MG). We discuss the cases of COVID-19 and MG already described in the literature in regard to their presentation and serological findings to better understand the association between the two disease processes. MG may be missed in patients after COVID-19 infections because of the comorbidities and anti-acetylcholine receptor and anti-muscle-specific tyrosine kinase antibodies being negative. Evidence from more studies will help analyze the pathological timeline of the disease process and the immunological characteristics of COVID-19-induced MG which can prove to have morbidity and mortality benefit in patients with COVID-19-induced MG.

A Rare Case of High-Grade Atrioventricular Block in Granulomatosis With Polyangiitis.

Granulomatosis with polyangiitis (GPA) is an autoimmune disease that affects small and medium-sized vessels. It is classically known to present with renal and respiratory tract symptoms. However, the disease can manifest in other organ systems, especially cardiovascular involvement. Though there are multiple reports of cardiac involvement in GPA, it is not commonly evaluated and is often overlooked in patients with GPA. Heart disease in GPA has a wide range of presentations ranging from subacute and silent to severe abnormalities, which can prove fatal if not identified and treated appropriately. Identifying cardiac involvement early in patients with no apparent signs can help with prevention strategies and follow-up to avoid significant complications. Pericarditis is the most common pathology noted in GPA, followed by cardiomyopathy, coronary artery disease, valvular disease, and conduction abnormality. In our report, we present a case of GPA in a young male with asymptomatic conduction abnormality of the heart. Although it was silent at the presentation, identifying the initial electrocardiogram (ECG) changes prompted us to admit him to the telemetry floor. Continuous telemetry monitoring helped us identify the progression of the conduction abnormality, which otherwise could have been missed. This led us to correlate to his symptoms which he later developed during his admission course. His symptoms subsided after prompt treatment. If not identified early, these cardiac abnormalities can delay management, leading to increased disease burden and morbidity. Hence, essential cardiac work with at least ECG and continuous telemetry monitoring is recommended.

Heat and mass transfer of generalized fourier and Fick's law for second-grade fluid flow at slendering vertical Riga sheet.

In this analysis, the generalized Fourier and Fick's law for Second-grade fluid flow at a slendering vertical Riga sheet is examined along with thermophoresis and Brownian motion effects. Boundary layer approximations in terms of PDE's (Partial Differential Equations) are used to build the mathematical model. An appropriate transformation has been developed by using the Lie symmetry method. PDE's (Partial Differential Equations) are transformed into ODE's (Ordinary Differential Equations) by implementing the suitable transformation. A numerical method called bvp4c is used to explain the dimensionless system (ODE's). Graphs and tables are used to interpret the impact of the significant physical parameters. The curves of temperature function declined due to enchanting the values of the thermophoresis Parameter. The temperature is produced at a low level due to enchanting the values of thermophoresis because this force transports burn at a low 10 µm diameter so the temperature becomes lessor. Increments of thermophoresis parameter which enhanced the values of concentration Function. As the concentration boundary layer increased which declined the mass transfer due increment in thermophoresis. The curves of temperature function are increasing due to enhancing the values of the Brownian parameter because addition in the Brownian motion, improved the movement of particles ultimately increasing the kinematic energy of fluid which improved the heat transfer phenomena. Increments of Brownian parameter which declined the values of concentration function. Physically, the kinematic energy improved which declined the mass transfer rate near the surface.

Severe COVID-19-Induced Hemophagocytic Lymphohistiocytosis.

We reported a case of secondary hemophagocytic lymphohistiocytosis (HLH), a rare and life-threatening condition, which was suspected to have been triggered by a severe case of coronavirus disease 2019 (COVID-19). A 50-year-old man with a past medical history of ulcerative colitis with recent pancolitis status post colectomy and ileostomy two weeks before presentation presented to the emergency department with one week of subjective fevers, weakness, watery diarrhea, and decreased oral intake. A CT scan showed fluid in the rectum and post-surgical changes from his recent colectomy along with diffuse reticulonodular opacities of the lungs. His COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. Over the subsequent days, the patient's condition worsened as he developed worsening acute hypoxic respiratory failure with diffuse lymphadenopathy, splenomegaly, worsening cytopenias, and increased ferritin of >100,000 ng/ml on hospital day six. Hematology oncology was consulted and he was started on empiric steroid therapy followed by etoposide. However, his condition continued to worsen, and eventually, the patient passed away on hospital day eight.

Transportation of nanomaterial Maxwell fluid flow with thermal slip under the effect of Soret-Dufour and second-order slips: nonlinear stretching.

In this study, impact of second order slip for Maxwell fluid at vertical exponential stretching sheet is deliberated. Dufour and Soret impact for vertical exponential stretching sheet under nonlinear radiation are deliberated. Thermal and concentration slips with viscous dissipation are taken into account under the Buongiorno's model. Under the above assumptions, the differential model constructed using the boundary layer approximations using the governing equations. The similarities transformations are introduced which applied the differential model (partial differential equations) and developed the dimensionless differential equations (ordinary differential equations). The dimensionless differential equations are cracked by numerical scheme. The impact of physical parameters are presented by tables and graphs. The curves of fluid velocity enhanced due to increasing the values of velocity slip. Velocity slip is a fluid-boundary interaction in physics. If the velocity slip increased, the fluid velocity profile would eventually become increasing. Temperature curves declined by improving values of [Formula: see text]. The thermal thickness reduced when improved the values of [Formula: see text].

Oxygen Overshoot: A Case Report Navigating the Perils of Unsupervised Supplementation in Chronic Obstructive Pulmonary Disease (COPD).

Supplemental oxygen administration is a delicate balance in managing chronic obstructive pulmonary disease (COPD), where the risk of exacerbating hypercapnia must be carefully considered. This case report describes a 69-year-old male with COPD who, after self-medicating with commercially available portable oxygen bottles, experienced hypercapnic respiratory failure and severe respiratory acidosis, leading to intensive care unit (ICU) admission and non-invasive ventilation. The patient's unsupervised use of commercially available portable oxygen bottles emphasizes the risks associated with unregulated supplemental oxygen in COPD. This case highlights the critical importance of cautious oxygen supplementation in COPD, urging high-risk patients to seek medical guidance, even with over-the-counter products. This case emphasizes the need for expert medical opinion to ensure safe oxygen use in vulnerable populations.

Darcy resistant of Soret and Dufour impact of radiative induced magnetic field sutterby fluid flow over stretching cylinder.

The incompressible two-dimensional steady flow of Sutterby fluid over a stretching cylinder is taken into account. The magnetic Reynolds number is not deliberated low in the present analysis. Radiation and variable thermal conductivity are considered to debate the impact on the cylindrical surface. The Dufour and Soret impacts are considered on the cylinder. The mathematical model is settled by employing boundary layer approximations in the form of differential equations. The system of differential equations becomes dimensionless using suitable transformations. The dimensionless nonlinear differential equations are solved through a numerical scheme(bvp4c technique). The flow parameters of physical effects on the velocity, temperature, heat transfer rate, and friction between surface and liquid are presented in tabular as well as graphical form. The velocity function declined by improving the values of the Sponginess parameter. The fluid temperature is reduced by increment in curvature parameter.

A Case of Left-Sided Infective Endocarditis of Multiple Native Valves Complicated by Valve Leaflet Perforation, Multiple Septic Emboli, Thromboembolic Events, and Cardiac Arrhythmias.

Coagulase-negative staphylococci (CoNS) can uncommonly cause native valve endocarditis. We present a case of left-sided infective endocarditis of native valves presenting with splenic, lung, and brain infarcts along with aortic and significant mitral valve involvement with mitral valve perforation. The patient was also found to be in atrial flutter and atrial fibrillation. Left-sided endocarditis is reported to cause brain and spleen infarcts but pulmonary embolisms are usually a complication of right-sided endocarditis. Atrial fibrillation is also known to increase mortality in patients with infective endocarditis.

Solution of differential equations with infinite delay via coupled fixed point.

This manuscript aims to prove exciting results that unify and generalize several fixed point results for metric spaces endowed with graphs. As an application, we apply our own results to give and introduce sufficient conditions to guarantee existence solutions of such differential equations with infinite delay.

A Case of Peripartum Spontaneous Coronary Artery Dissection in a Woman With a History of Obesity.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) with a high prevalence in young pregnant females. A 38-year-old female with a history of morbid obesity status post-bariatric surgery presented with chest pain. The electrocardiogram (EKG) revealed ST-segment elevation in the inferior leads as well as slightly elevated troponin. Urgent cardiac catheterization showed SCAD, and she was subsequently managed with medical therapy. We hypothesize that the history of obesity leads to a compromise in the coronary vasculature, thereby predisposing the patient to SCAD.

Pakistan Registry of Intensive CarE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia.

INTRODUCTION: In resource-limited settings - with inequalities in access to and outcomes for trauma, surgical and critical care - intensive care registries are uncommon. AIM: The Pakistan Society of Critical Care Medicine, Intensive Care Society (UK) and the Network for Improving Critical Care Systems and Training (NICST) aim to implement a clinician-led real-time national intensive care registry in Pakistan: the Pakistan Registry of Intensive CarE (PRICE). METHOD: This was adapted from a successful clinician co-designed national registry in Sri Lanka; ICU information has been linked to real-time dashboards, providing clinicians and administrators individual patient and service delivery activity respectively. OUTPUT: Commenced in August 2017, five ICU's (three administrative regions - 104 beds) were recruited and have reported over 1100 critical care admissions to PRICE. IMPACT AND FUTURE: PRICE is being rolled out nationally in Pakistan and will provide continuous granular healthcare information necessary to empower clinicians to drive setting-specific priorities for service improvement and research.

The Effect of Long-Term X-Ray Exposure on Human Lymphocyte.

The aim of the paper is to investigate effects of long term x-ray exposure on the human lymphocyte, reactive lymphocyte parameters and morphology of lymphocytes in x-ray technicians at Kirkuk hospitals. The study included 54 apparently healthy male x-ray technicians were matched with another 54 apparently healthy control to show any alteration in the lymphocytes, reactive lymphocytes and morphology. The investigated samples were divide into two groups depending on the work experience and working hours per day. The samples were tested for hematological parameters by complete blood cells count (CBC). The results showed that strong significant (P<0.0001) increasing was recorded for the reactive lymphocytes in all groups of the diagnostic technicians compared with their controls and significantly increasing of lymphocytes observed for some groups. It was concluded that chronic exposure of x-ray can vary lymphocyte and reactive lymphocyte parameters significantly and working hours per day have discernible effects on lymphocyte morphology.

Recent Updates on the Dynamic Association Between Oxidative Stress and Neurodegenerative Disorders.

Free radicals are generated as byproduct of our body metabolism, and their adverse effect on normal functioning of our body is prevented by body's own antioxidant machinery. Any perturbation in the defense mechanism of antioxidants inside body, its abnormal production or its induction from environment to our body lead to serious threats and is responsible for the development of various neurodegenerative disorders (NDDs). Perturbed antioxidants result in sensory and functional impairments in neuronal cells, which in turn cause NDDs. Free radical attack on neuronal cells plays a catastrophic role in NDDs. Impaired metabolism and generation of excessive reactive oxygen species also lead to a range of NDDs. Free radical induced toxicity is responsible for DNA injury, protein degradation, damage to tissue inflammation and cell death. Besides various genetic and environmental factors, free radical induced oxidative stress is also a major cause of NDDs. Application of upstream and downstream antioxidant therapy to counter oxidative stress can be an effective option in alteration of any neuronal impairment besides free radical scavenging. In the present manuscript, we have presented a comprehensive update on the symptoms, causes and cures of NDDs in relation with their dynamic association with oxidative stress.

Prevalence of and Factors Associated with Dural Thickness in Patients with Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND AND PURPOSE: We performed this study to evaluate the prevalence of and factors associated with dural thickening in patients with mild cognitive impairment and Alzheimer's disease. METHODS: Alzheimer's disease neuroimaging initiative participants with axial FLAIR sequence magnetic resonance imaging (MRI) images were analyzed. Dural thickness was defined by a linear strip of hyperintense tissue signal along the dura mater observed in at least two different images without evidence of leptomeningeal involvement. RESULTS: Dural thickening was seen in 83 (34%) of 242 persons analyzed (mean age [±SD] 74±7 years: 150 were men) with either mild cognitive impairment or Alzheimer's disease. The mini mental score was not different in persons with (26±0.3) and without (26±0.2) dural thickening (p = 0.6). The proportion of patients with moderate or severe cognitive impairment (defined by mini mental status score) was similar at baseline and at 12-month evaluations. The rates of annual progression according to Alzheimer's disease assessment scale (p = 0.06) and clinical dementia scale (p = 0.001) were higher in persons without dural thickening. The annual rate of volume loss in entorhinal cortex was higher among persons with dural thickening. CONCLUSIONS: We found relatively high prevalence of dural thickening in patients with mild cognitive impairment and Alzheimer's disease.

Numerical prediction of algae cell mixing feature in raceway ponds using particle tracing methods.

In the present study, a novel technique, which involves numerical computation of the mixing length of algae particles in raceway ponds, was used to evaluate the mixing process. A value of mixing length that is higher than the maximum streamwise distance (MSD) of algae cells indicates that the cells experienced an adequate turbulent mixing in the pond. A coupling methodology was adapted to map the pulsating effects of a 2D paddle wheel on a 3D raceway pond in this study. The turbulent mixing was examined based on the computations of mixing length, residence time, and algae cell distribution in the pond. The results revealed that the use of particle tracing methodology is an improved approach to define the mixing phenomenon more effectively. Moreover, the algae cell distribution aided in identifying the degree of mixing in terms of mixing length and residence time.

Protein misfolding and aggregation in Alzheimer's disease and type 2 diabetes mellitus.

In general, proteins can only execute their various biological functions when they are appropriately folded. Their amino acid sequence encodes the relevant information required for correct three-dimensional folding, with or without the assistance of chaperones. The challenge associated with understanding protein folding is currently one of the most important aspects of the biological sciences. Misfolded protein intermediates form large polymers of unwanted aggregates and are involved in the pathogenesis of many human diseases, including Alzheimer's disease (AD) and Type 2 diabetes mellitus (T2DM). AD is one of the most prevalent neurological disorders and has worldwide impact; whereas T2DM is considered a metabolic disease that detrementally influences numerous organs, afflicts some 8% of the adult population, and shares many risk factors with AD. Research data indicates that there is a widespread conformational change in the proteins involved in AD and T2DM that form ß-sheet like motifs. Although conformation of these ß-sheets is common to many functional proteins, the transition from α-helix to ß-sheet is a typical characteristic of amyloid deposits. Any abnormality in this transition results in protein aggregation and generation of insoluble fibrils. The abnormal and toxic proteins can interact with other native proteins and consequently catalyze their transition into the toxic state. Both AD and T2DM are prevalent in the aged population. AD is characterized by the accumulation of amyloid-ß (Aß) in brain, while T2DM is characterized by the deposition of islet amyloid polypeptide (IAPP, also known as amylin) within beta-cells of the pancreas. T2DM increases pathological angiogenesis and immature vascularisation. This also leads to chronic cerebral hypoperfusion, which results in dysfunction and degeneration of neuroglial cells. With an abundance of common mechanisms underpinning both disorders, a significant question that can be posed is whether T2DM leads to AD in aged individuals and the associations between other protein misfolding diseases.

Incidence and pattern of thyroid dysfunction in patients on chronic amiodarone therapy: experience at a tertiary care centre in oman.

OBJECTIVE: To determine the incidence and pattern of thyroid dysfunction (TD) in patients on chronic amiodarone therapy. METHODS: A retrospective study which evaluated 59 patients who had received amiodarone therapy regularly for at least 12 months from a period of 3 years from October 2007 to October 2010. The patients were followed-up at the cardiac clinic at Sultan Qaboos University Hospital, Muscat, Oman. RESULTS: The mean age of the cohort was 63 ± 13 years ranging from 27 to 98 years. Fifty-one percent (n = 30) of the patients were female. There were 11 (19%) cases of thyroid dysfunction (TD). Seven (12%) patients were hypothyroid, 3 (5%) had hyperthyroidism and 1 (2%) patient had sub-clinical hypothyroidism; no cases of sub-clinical hyperthyroidism were noted. Female gender and presence of anti-thyroid peroxidase antibodies were significantly associated with amiodarone-induced hypothyroidism (p = 0.001) while age, amiodarone dose and duration of therapy were not correlated with the development of TD (all p-values > 0.05). CONCLUSION: Amiodarone-induced thyroid dysfunction is prevalent. Hypothyroidism was more frequent and seen more in female patients and those who had positive anti-thyroid peroxidase antibodies. Initial screening and periodic monitoring of thyroid function is mandatory for all patients on amiodarone therapy.

Molten globule of hemoglobin proceeds into aggregates and advanced glycated end products.

Conformational alterations of bovine hemoglobin (Hb) upon sequential addition of glyoxal over a range of 0-90% v/v were investigated. At 20% v/v glyoxal, molten globule (MG) state of Hb was observed by altered tryptophan fluorescence, high ANS binding, existence of intact heme, native-like secondary structure as depicted by far-UV circular dichroism (CD) and ATR-FTIR spectra as well as loss in tertiary structure as confirmed by near-UV CD spectra. In addition, size exclusion chromatography analysis depicted that MG state at 20% v/v glyoxal corresponded to expanded pre-dissociated dimers. Aggregates of Hb were detected at 70% v/v glyoxal. These aggregates of Hb had altered tryptophan environment, low ANS binding, exposed heme, increased ß-sheet secondary structure, loss in tertiary structure, enhanced thioflavin T (ThT) fluorescence and red shifted Congo Red (CR) absorbance. On incubating Hb with 30% v/v glyoxal for 0-20 days, advanced glycation end products (AGEs) were detected on day 20. These AGEs were characterised by enhanced tryptophan fluorescence at 450 nm, exposure of heme, increase in intermolecular ß-sheets, enhanced ThT fluorescence and red shift in CR absorbance. Comet assay revealed aggregates and AGEs to be genotoxic in nature. Scanning electron microscopy confirmed the amorphous structure of aggregates and branched fibrils of AGEs. The transformation of α-helix to ß-sheet usually alters the normal protein to amyloidogenic resulting in a variety of protein conformational disorders such as diabetes, prion and Huntington's.