Case Report: Parapharyngeal Mucormycosis Rare Presentation with Literature Review.

Mucormycosis is a rare fungal infection that typically involves the rhino-cerebral area with a high morbidity and mortality. Involvement of the parapharyngeal space and gastrointestinal tract with perforation is rare and may be related to dissemination of the disease. The current antifungal treatment has been shown to be inadequate with variable outcomes and is often instituted late in the disease process with unfortunate outcomes.

Legacy effect of short-term alirocumab in familial hypercholesterolaemia: A case report.

Homozygous familial hypercholesterolaemia (FH) is a rare genetic disorder with aberrantly high level of low-density lipoprotein cholesterol (LDL-C) requiring multiple combined aggressive lipidlowering therapy to reduce the progression of atherosclerotic cardiovascular disease. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) has been approved for treatment of FH, which requires further lowering of LDL-C in addition to diet modification and maximally tolerated statin therapy. We report the response of short-term alirocumab treatment on a young patient with clinically and genetically confirmed FH, who suffered from acute coronary syndrome, and in particular, discussed the hypothesised legacy effect of PCSK9i. The patient was initially treated with a combination of high-intensity statin and ezetimibe for 12 weeks. Subsequently, alirocumab was added to the patient's lipid-lowering regime and he managed to attain guideline recommended LDL-C target within 10 weeks. However, alirocumab was stopped at week 54 due to financial constraint. Interestingly, despite cessation of PCSK9i therapy for a period of 30 weeks, the patient's LDL-C level rose slightly not returning to his baseline level.

A covid-19 Patient with Cavernous Sinus Thrombosis Post Dental Extraction a Diagnostic Dilemma.

Prior to the antibiotics era, the mortality rate from cavernous sinus thrombosis (CST) was very high reaching 100%. There have been very few reports of CST associated with tooth extraction on the same time Coronavirus disease of 2019 (COVID-19) is known to increase the risk of developing venous thromboembolism; therefore, patients with COVID-19 may present with cerebral venous sinus thrombosis. We present a case with diagnostic dilemma and first to be reported in the literature.

Internal Jugular Vein Phlebectasia in a Child: A Case Report.

Neck swellings that appear on straining, crying, and Valsalva maneuver are usually suggestive of laryngocele. Phlebectasia of jugular veins can cause a similar sign but is rare compared to laryngocele. Jugular vein phlebectasia (JVP) is of unknown etiology and is caused by vein dilatation without tortuosity, which is rare in children. It transiently appears during straining as a soft cystic neck mass. Such cases are frequently misdiagnosed or managed inappropriately due to their rarity. We report a case of a four-year-old boy with right internal JVP and right hydrocele.

Health-related regional and neighborhood correlates of sexual minority concentration: A systematic review.

BACKGROUND: A growing literature explores spatial patterns of regional and neighborhood correlates of sexual minority (e.g., lesbian, gay, bisexual) concentration. Such patterns have implications for health and wellbeing if there are differences in health-promoting or health-hindering resources in neighborhoods or regions. We conducted a systematic review to assess sexual minority concentration in relation to area unit characteristics. METHODS: We included only records published after 1973 and made no exclusions by geography or language. We searched 11 databases (Academic Search Complete, CINAHL, Embase, GeoBase, GeoRef, LGBT Life, PsycINFO, PubMed/MEDLINE, Scopus, Sociological Abstracts, Web of Science) on November 19-21, 2016. We searched reference lists of included records. We used the following inclusion criteria: (1) Record is a quantitative study (that is, it uses statistics to describe or associate two or more variables); (2) Record is about (a) migration or internal migration of, (b) area unit selection by, or (c) concentration of sexual minority people (defined by identity, behavior, or attraction); (3) Criterion 2 is linked to the characteristics of regions or neighborhoods (at any spatial scale). RESULTS: Dual independent coding resulted in 51 records meeting inclusion criteria from the original pool of 5,591. From these records, we identified the 647 reported results linking sexual minority concentration with area unit characteristics. Of these, 132 were unadjusted relationships between sexual minority concentration and four theory-informed domains of neighborhood influence on health. We identified greater concentration of sexual minorities in regions with more resources and in more urban regions. A limited but troubling literature at the neighborhood level suggested potentially higher concentrations of sexual minorities in neighborhoods with fewer resources. CONCLUSIONS: There are substantial gaps in the literature. We discuss the implications of our findings and gaps in relation to key theories of sexual minority health. REGISTRATION: The review was not registered with PROSPERO because it was not eligible for registration at the time of the research project's initiation due to the outcome of interest.

Factors associated with smoking frequency among current waterpipe smokers in the United States: Findings from the National College Health Assessment II.

BACKGROUND: Some waterpipe smokers exhibit nicotine dependent behaviors such as increased use over time and inability to quit, placing them at high risk of adverse health outcomes. This study examines the determinants of dependence by measuring frequency of use among current waterpipe smokers using a large national U.S. METHODS: Data were drawn from four waves (Spring/Fall 2009 and Spring/Fall 2010) of the American College Health Association-National College Health Assessment datasets. The sample was restricted to students who smoked a waterpipe at least once in the past 30 days (N=19,323). Ordered logistic regression modeled the factors associated with higher frequency of waterpipe smoking. RESULTS: Among current waterpipe smokers, 6% used a waterpipe daily or almost daily (20-29 days). Daily cigarette smokers were at higher odds of smoking a waterpipe at higher frequencies compared with non-smokers of cigarettes (OR=1.81; 95% CI=1.61-2.04). There was a strong association between daily cigar smoking and higher frequency of waterpipe smoking (OR=7.77; 95% CI=5.49-11.02). Similarly, students who used marijuana had higher odds of smoking a waterpipe at higher frequencies (OR=1.57; 95% CI=1.37-1.81). CONCLUSIONS: Daily consumers of other addictive substances are at a higher risk of intensive waterpipe smoking and thus higher risk of waterpipe dependence. Intervention programs must incorporate methods to reduce waterpipe dependence and subsequently prevent its deleterious health effects.

Smoking Among Sexual Minorities: Are There Racial Differences?

INTRODUCTION: Smoking prevalence is higher among sexual minorities compared to their heterosexual peers. However, very little is known about potential racial differences in smoking among sexual minority populations. We examined differences by race in smoking status among a robust sample of sexual minorities. METHODS: We used data from the 2010 Social Justice Sexuality project, a large national convenience sample of sexual minority adults that oversampled individuals from racial minority groups. Log-Poisson multivariable regression models were employed to determine the risk of current smoking among sexual minority individuals by race after controlling for socio-demographic characteristics. RESULTS: Among smokers, 22.35% identified as White, 26.98% identified as Black, 19.38% identified as Latino/Hispanic, 5.58% identified as Asian American, and 25.67% were other/multiracial. In fully adjusted gender stratified models, Black men (adjusted risk ratio [aRR] = 0.61, 95% confidence interval [CI] = 0.50, 0.75) and Asian American men (aRR = 0.61, 95% CI = 0.50, 0.75) were at lower risk of smoking compared to White men. Black women were the only to remain statistically significant for decreased risk of smoking in fully adjusted gender stratified models (aRR = 0.78, 95 % CI = 0.65, 0.95). CONCLUSIONS: Among sexual minorities, Black and Asian American individuals consistently were at decreased risk of current smoking compared to their White peers. Future research should seek to understand the mechanisms that contribute to decreased smoking status among racial sexual minorities.

B-type natriuretic peptide in the cardiology department.

Heart Failure is one of the fastest growing cardiovascular diseases of the 21st century. Echocardiogram is considered the gold standard for diagnosis, but is costly, time consuming and not readily accessible to all patients. Our aim was to assess the diagnostic utility of BNP to risk stratify patients for ECHO. Seventy-four GP referred, non-pregnant patients of > or = 18 years with a working diagnosis of HF were recruited. Patients were given two appointments to attend the Cardiology Department and at each, were examined by the same cardiologist, had their medications recorded and blood drawn for BNP analysis. ECHO was performed at the second visit. The diagnosis of HF was confirmed in 49 of 74 patients (66%). The clinical utility of BNP to rule-in HF was evaluated using ROC curve analysis. The AUC was satisfactory at 0.691 (C.I. 0.573-0.793). The positive likelihood ratio (+LR) was 5.87, negative likelihood ratio (-LR) was 0.58, the positive predictive value was 92% and a negative predictive value was 47%. One-third of patients (n = 25) had a BNP >178 pg/mL, 23 of whom had HF confirmed. At this decision threshold BNP correctly classified 23 of 25 patients who were confirmed not to have HF (Specificity for HF of 92%). A BNP of > or = 178 pg/mL can be used to prioritise GP patients for ECHO.

Rare case of temporal bone carcinoma with intracranial extension.

Temporal bone cancer, a relatively rare disease, accounting for less than 0.2% of all tumors of the head and neck and is associated with a poor outcome; often presents in a subtle manner, which may delay diagnosis. It should be suspected in any case of persistent otitis media or otitis externa that fails to improve with adequate treatment. Despite advances in operative technique and postoperative care, long-term survival remains poor). It includes cancers arising from pinna that spreads to the temporal bone, primary tumors of the external auditory canal (EAC), middle ear, mastoid, petrous apex, and metastatic lesions to the temporal bone. Here is a report on a case of temporal bone carcinoma presenting with right otalgia, otorrhea and facial paralysis. The patient was initially diagnosed as mastoiditis and later the clinical impression was revised to temporal bone carcinoma (undifferentiated type), based on the pathologic findings.

Tetrahydrobiopterin deficiency and dopamine loss in a genetic mouse model of Lesch-Nyhan disease.

Hypoxanthine-guanine phosphoribosyltransferase (HPRT) is an enzyme that catalyses the conversion of hypoxanthine and guanine into their respective nucleotides. Inherited deficiency of the enzyme is associated with a loss of striatal dopamine in both mouse and man. Although HPRT is not directly involved in the metabolism of dopamine, it contributes to the supply of GTP, which is used in the first and rate-limiting step in the synthesis of tetrahydrobiopterin (BH4). Since BH4 is required as a cofactor for tyrosine hydroxylase in the synthesis of dopamine, any limitation in the supply of GTP could interfere with the synthesis of dopamine. The current studies were designed to address the hypothesis that the reduced striatal dopamine in mice with HPRT deficiency results from reduced availability of BH4. The mutant mice had small reductions in striatal BH4, with normal BH4 levels in other brain regions. Liver BH4 was normal in HPRT-deficient mutant mice, and a phenylalanine challenge test failed to reveal any evidence for impaired hepatic phenylalanine hydroxylase, another BH4-dependent enzyme. Although striatal BH4 content is not normal, supplementation with BH4 or L-dopa failed to correct the striatal dopamine deficiency of the mutant mice, suggesting that BH4 limitation is not responsible for the dopamine loss.

Phenylketonuria presenting in adulthood as progressive spastic paraparesis with dementia.

A 57 year old woman living independently in the community presented with four years of progressive spastic paraparesis and dementia. An extensive evaluation for the usual causes of these difficulties was unrevealing, but her serum phenylalanine concentration was markedly elevated and genetic analysis demonstrated mutations in the phenylalanine hydroxylase gene consistent with classic phenylketonuria. A protein restricted diet was associated with improvement in her condition. Although untreated phenylketonuria is typically associated with severe neurological dysfunction beginning in early childhood, this case shows that disability may be delayed until adulthood.

Indoor air pollution and asthma in hospitalized children in a tropical environment.

We performed a hospital-based study to examine a hypothesis that indoor air pollution was associated with acute asthma in young children living in Kuala Lumpur City. A total of 158 children aged 1 month to 5 years hospitalized for the first time for asthma were recruited as cases. Controls were 201 children of the same age group who were hospitalized for causes other than a respiratory illness. Information was obtained from mothers using a standardized questionnaire. Univariate analysis identified two indoor pollution variables as significant factors. Sharing a bedroom with an adult smoker and exposure to mosquito coil smoke at least three nights in a week were both associated with increased risk for asthma. Logistic regression analysis confirmed that sharing a bedroom with an adult smoker (OR = 1.91, 95% CI 1.13, 3.21) and exposure to mosquito coil smoke (OR = 1.73, 95% CI 1.02, 2.93) were independent risk factors. Other factors independently associated with acute asthma were previous history of allergy, history of asthma in first-degree relatives, low birth weight, and the presence of a coughing sibling. There was no association between asthma and exposure to kerosene stove, wood stove, aerosol mosquito repellent, type of housing, or crowding. We conclude that indoor air pollution is an avoidable factor in the increasing morbidity due to asthma in children in a tropical environment.

Effect of lovastatin on the secretion of very low density lipoprotein lipids and apolipoprotein B in the hypertriglyceridemic Zucker obese rat.

Recent studies demonstrated that inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase lower plasma triglyceride primarily by decreasing hepatic secretion of very low density lipoproteins (VLDL). A possible mechanism is that inhibition of cholesterol synthesis interferes with the assembly of VLDL particles. Since one molecule of apolipoprotein (apo) B is required for the proper assembly and secretion of each VLDL and secretion of apo B may be regulated by various lipid components of the lipoproteins, question arises whether HMG-CoA reductase inhibitors also decrease the secretion of apo B. To address this issue, we investigated the effect of lovastatin on the secretion rate of VLDL-apo B and on the composition of VLDL in the Zucker obese rat; a model for genetic hypertriglyceridemia. Lovastatin treatment (4 mg/kg day x 13 days), as compared with placebo, decreased the concentrations of fasting plasma triglyceride (1740 +/- 170 vs. 3130 +/- 790 micrograms/ml) and VLDL-triglyceride (1379 +/- 59 vs. 3082 +/- 715 micrograms/ml). There was a small but non-significant decrease in VLDL-apo B (19 +/- 2 micrograms/ml vs. 26 +/- 7 micrograms/ml). Thus, lovastatin significantly decreased the ratio of triglyceride to apo B in VLDL (76 in lovastatin vs. 124 in placebo group). Secretion rates of VLDL-lipids and VLDL-apo B were measured after intravenous injection of Triton WR-1339.(ABSTRACT TRUNCATED AT 250 WORDS)

Verapamil prevents chronic renal failure-induced abnormalities in lipid metabolism.

Hypertriglyceridemia is common in chronic renal failure (CRF); this derangement is due to decreased peripheral removal of triglycerides. Certain data indicate that the state of secondary hyperparathyroidism of CRF is, at least in part, responsible for derangements in lipid metabolism. It has been proposed that chronic excess of parathyroid hormone exerts its deleterious effects on many organs through its ability to raise basal levels of cytosolic calcium. Prevention of the latter by a calcium channel blocker is followed by the correction of organ dysfunctions. The present study examined the effect of treatment of CRF rats with verapamil on several parameters of lipid metabolism. Chronic renal failure rats displayed hypertriglyceridemia, fat intolerance, reduced postheparin plasma lipoprotein and hepatic lipase activities, decreased hepatic lipase in liver homogenate, and elevated calcium content in liver and epididymal fat. Treatment of the CRF rats with verapamil prevented all these derangements in lipid metabolism. These effects of verapamil were similar to those produced by parathyroidectomy of CRF rats. The data are consistent with the formulation that chronic excess of parathyroid hormone increases the calcium burden of liver and adipose tissue and consequently impairs the synthesis and/or release of lipoprotein and hepatic lipases. Reduced availability of these enzymes in plasma results in impared peripheral removal of triglycerides, leading to hypertriglyceridemia.

Dietary marine fish oils and insulin action in type 2 diabetes.

Supplementation of omega-3 fish oils (n-3 FO) usually worsens the glycemic control in type 2 diabetic subjects. This may be a dose-related phenomenon and is reversed after discontinuation of the n-3 FO supplementation. An increase in the daily caloric intake, due to the fat content of n-3 FO supplements, and a consequent weight gain may contribute to the increase in hyperglycemia. Mechanisms of the increase in hyperglycemia include: (1) n-3 FO may interfere with insulin secretion from the pancreas, and this in turn can cause an increase in the hepatic glucose output and/or a decrease in the glucose uptake by the peripheral tissues; (2) n-3 FO may primarily decrease the sensitivity of liver to insulin action and consequently increase gluconeogenesis and/or glycogenolysis and/or decrease the glycogenesis; (3) n-3 FO may primarily affect the sensitivity of peripheral tissues to insulin, resulting in decreased glucose-uptake; (4) n-3 FO may increase the availability of gluconeogenic substrates by directly altering the partitioning of the metabolic fuels for different pathways in the liver. [formula: see text] Direct experimental testing of these possibilities has been difficult, because n-3 FO affects the carbohydrate metabolism differently in animal models than in humans. The available data suggest that n-3 FO inhibits insulin secretion in response to glucose load, mixed meal, and glucagon but not at the fasting state. Hepatic glucose output is increased. Sensitivity of the peripheral tissues to insulin is not changed. An encouraging observation is that the hyperglycemic effect of n-3 FO may decrease with time even when therapy is continued. Proper use of this treatment modality requires careful evaluation of the risk/benefit ratio for every individual patient.

Dietary and anthropometric determinants of plasma lipoproteins during a long-term low-fat diet in healthy women.

Long-term (1 y) effects of dietary fat intake on lipoprotein metabolism were determined in 72 healthy women receiving either a 15%-fat diet (n = 34) or usual diet (n = 38). Every three months food records, weight, waist-hip ratio (W:H), percent body fat, fasting plasma triglyceride, cholesterol (C), high-density-lipoprotein cholesterol (HDL-C), HDL2-C, and HDL3-C; apolipoprotein B and A-I, and postheparin lipoprotein lipase (LPL) and hepatic triglyceride lipase activities were determined. In one year, the low-fat-diet (LFD) group had 17% and the non-intervention-diet group had 36% dietary fat. The LFD group showed decreases in cholesterol: 7% TC, 13% low-density lipoprotein (LDL), and 8% HDL. Apolipoprotein A-I, decreased early. Apolipoprotein B did not change. Plasma triglyceride correlated with weight. Percent body fat and W:H correlated with the total and LDL-C. Changes in HDL-C and/or HDL2-C and LPL correlated directly with the changes in dietary fat and inversely with dietary carbohydrate. Changes in total-C or LDL-C correlated with the changes in weight and W:H, but not with the changes in nutrient intake.

Effect of the prostaglandin E1 analog enisoprost on glucose and lipid metabolism in patients with type II diabetes mellitus.

Short-term studies have suggested that analogs of prostaglandin E may have favorable effects on the carbohydrate and lipid metabolism in patients with type II diabetes mellitus. The present study was undertaken to investigate the long-term effects of a prostaglandin E1 analog on the regulation of glycemic control and plasma lipids. Twenty patients with type II diabetes received enisoprost, 300 mcg/day, for three months. Fasting serum glucose, glycosylated hemoglobin, insulin and C-peptide levels as well as triglyceride, total cholesterol, high density lipoprotein cholesterol and its subfractions, apolipoproteins B and AI and post-heparin lipoprotein lipase and hepatic triglyceride lipase activities were determined. During the first month, enisoprost treatment caused significant decreases in plasma glucose (baseline = 8.72 +/- 0.39 mmol/L, 4 week = 7.78 +/- 0.5 mmol/L, change = -0.94 +/- 0.28 mmol/L, p less than 0.01) and total cholesterol (baseline = 5.30 +/- 0.23 mmol/L, 4 week = 5.01 +/- 0.26 mmol/L, change = -0.28 +/- 0.06 mmol/L, p less than 0.05). The decrease in cholesterol level was due to a reduction in high density lipoprotein, specifically in high density lipoprotein2 fraction (baseline = 1.29 +/- 0.1 mmol/L, 4 week = 1.12 +/- 0.08 mmol/L, change = -0.018 +/- 0.04 mmol/L, p less than 0.05 for the former and baseline = 0.40 +/- 0.06 mmol/L, 4 week = 0.27 +/- 0.03 mmol/L, change = -0.12 +/- 0.03 mmol/L, p less than 0.05 for the latter): All of these values returned to the pretreatment levels despite continuation of enisoprost.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms of triglyceride-lowering effect of an HMG-CoA reductase inhibitor in a hypertriglyceridemic animal model, the Zucker obese rat.

Inhibitors of 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase have been approved for treatment of hypercholesterolemia in humans. This class of therapeutic agents, in addition to lowering plasma cholesterol, reduces plasma triglyceride levels. We have investigated the mechanism of triglyceride-lowering effect of lovastatin in the hypertriglyceridemic state by using a rodent model of hypertriglyceridemia and obesity, the Zucker obese (fa/fa) rat. Lovastatin treatment (4 mg/kg), as compared to placebo, caused a 338% reduction in plasma triglyceride (146 +/- 5 vs. 494 +/- 76 mg/dl), a 58% decrease in total cholesterol (99 +/- 13 vs. 156 +/- 18 mg/dl), and a 67% reduction in high density lipoprotein (HDL)-cholesterol (69 +/- 8 vs. 115 +/- 15 mg/dl). The fall seen in plasma triglyceride was due to a decrease in hepatic secretion of very low density lipoproteins (VLDL), determined after blocking the clearance of triglyceride-rich lipoproteins with Triton WR-1339. Lovastatin treatment did not affect either the activities of hepatic lipogenic enzymes, glucose-6-phosphate dehydrogenase, or malic enzyme, or the activities of the lipolytic enzymes of adipose tissue, lipoprotein lipase, or liver, hepatic triglyceride lipase. Supplementation of mevalonolactone in the diet partially reversed the changes in plasma triglyceride (265 +/- 37 vs. 146 +/- 5 mg/dl), but not in total or HDL-cholesterol. These data demonstrate that, in the hypertriglyceridemic Zucker rat model, HMG-CoA reductase inhibitors reduce the rate of secretion of VLDL and this effect can be partially reversed by administration of mevalonolactone.

Relationships between the amount of weight loss and post-heparin lipoprotein lipase activity in patients with type II diabetes.

The objective of this study was to investigate the changes in plasma post-heparin lipoprotein lipase activity, as it relates to the total amount of weight loss and the changes in plasma lipoproteins, during acute weight reduction and after weight maintenance in type II diabetic patients. Twenty-eight severely obese (mean weight = 106 +/- 21.7 kg, BMI = 36.4 +/- 6.0 kg/m2), diabetic patients lost, on the average, 13.3 kg on a 500 kcal (2100 kJ) diet in eight weeks. Weight loss was maintained throughout the study, which lasted 24 weeks. At the baseline, post-heparin lipoprotein lipase activity did not correlate with degree of obesity, but correlated inversely with fasting plasma glucose (r = -0.64, P less than 0.0001) and triglyceride (r = -0.63, P less than 0.0001). Both during acute caloric restriction and after weight maintenance suppression in post-heparin lipoprotein lipase activity correlated directly with the amount of weight reduction (r = 0.37, P less than 0.05 during weight loss and r = 0.42, P less than 0.03 during weight maintenance). At the end of the study patients were divided into tertiles according to the amount of weight loss achieved and baseline characteristics of the highest and lowest weight loss groups were compared. Before weight loss, despite having similar weights, the highest weight loss group had higher lipoprotein lipase activity (211 +/- 32 mU/ml vs 166 +/- 35 mU/ml, P less than 0.05) and lower plasma triglyceride (1.64 +/- 0.62 mmol/l vs 2.81 +/- 1.28 mmol/l, P less than 0.05) as compared to the lowest weight loss group.(ABSTRACT TRUNCATED AT 250 WORDS)