Emerging infection: streptococcal toxic shock-like syndrome caused by group B Streptococcus (GBS), Streptococcus agalactiae.

Streptococcus agalactiae or Group B Streptococcus (GBS) infections are commonly associated with infections in neonates and pregnant women. However, there has been a rising incidence in nonpregnant adults. The risk of GBS infection in nonpregnant adults is increased for patients of advanced age and those with underlying medical conditions such as diabetes mellitus and cancer. We present a 77-year-old female with type-2 diabetes mellitus, hypertension, and bilateral foot ulcers that presented in probable septic shock with necrotic foot ulcers and necrotizing fasciitis and underwent bilateral lower limb amputations. The patient fulfilled the Streptococcal Toxic Shock Syndrome (STSS) criteria as defined by The Working Group on Severe Streptococcal Infections. These criteria were created for group A Streptococcus (Streptococcus pyogenes). Our patient fulfilled the Working Group's criteria, except that the blood culture was positive for group B Streptococcus (Streptococcus agalactiae). Numerous studies demonstrate the importance of early detection and antibiotic treatment for GBS infections in general and early surgical management for necrotizing soft tissue infections (NSTIs) such as necrotizing fasciitis.

Effect of counseling model on diabetic women regarding sexual dysfunction: a quasi-experimental study.

BACKGROUND: Complications of diabetes in women have adverse effects on their self-image, quality of life, health, and other social relationships, thereby leading to sexual dysfunction. maternity nurse care can play a critical role in assessing the knowledge about needs for sexual health. AIM: The present study aims to evaluate the effect of the counseling model on female patients with diabetes regarding sexual dysfunction. METHOD: A quasi-experimental research design was used to conduct the study at the diabetic and obstetric outpatient clinic in 2 hospitals (Al Salam Port Said General Hospital, Elzohor General Hospital), and in five centers in Port Said City (El-Kuwait Center, Othman Ibnafan Center, El-arab 1 center, El-manakh center, El-arab2 center). A purposive sample of 178 female diabetic patients was included in the study. Two tools were used for collecting data consisted of; (1 interview questionnaire sheet) including personal characteristics, medical history, and present sexual problem of the studied female patients, (and 2 female sexual function index (FSFI). RESULTS: the current study revealed that there was a high statistical difference between female sexual function in post with mean ± SD (23.3 ± 4.1) compared to pre-educational intervention with mean ± SD (19.5 ± 3.7), while there was a high statistically significant difference among pre- & post-program application regarding female sexual function index (p > 0.001). CONCLUSION: the counseling model had a positive effect in improving the sexual function among female patients with diabetes. TRIAL REGISTRATION NUMBER (TRN): The study protocol was approved by the Research Ethics Committee of the Faculty of Nursing, Port Said University (code number: NUR 12/9/2021-6).

A Portable Non-Invasive Electromagnetic Lesion-Optimized Sensing Device for the Diagnosis of Skin Cancer (SkanMD).

The article presented herein proposes an alternative skin cancer screening method that delivers non-invasive diagnosis and monitoring of skin lesions by leveraging electromagnetic waves with radio frequency technology and circuits. The proposed handheld device, named SkanMD, comprises a sensitive electromagnetic sensor, customized radio frequency wave analyzer circuits, and machine learning algorithms. The device is used in clinical studies that are performed on a total of 46 individuals that are composed of 18 patients with pre-diagnosed skin cancer, 10 individuals with benign nevi, 7 patients with arbitrary diseases, and 11 healthy individuals. These studies included the measurement of the reflection coefficient, S11, on multiple skin regions and recording the obtained complex values to build a Support Vector Machine (SVM)-based classification model. Due to the lesion-optimized sensor and the unified cross-patient classifier, our results differentiate between cancerous and non-cancerous skin lesions with a sensitivity that exceeds 92% and a specificity that exceeds 81.4%. These reported results are based on a limited population size study. They also demonstrate that SkanMD is a promising solution that could augment conventional diagnosis methods to greatly improve patient comfort and enable instantaneous and accurate diagnosis.

TEMPORAL EFFICACY AND STERILITY TESTING OF POVIDONE-IODINE FROM AN OPEN BOTTLE.

PURPOSE: To investigate the temporal efficacy and sterility of povidone-iodine (PI) against bacteria associated with postinjection endophthalmitis in an in vitro study. METHODS: A single PI bottle was opened and tested for sterility and antibacterial efficacy. Povidone-iodine from the open bottle was inoculated onto a blood agar plate and evaluated for growth 24 hours later to test sterility; this was repeated for five consecutive days. To test for antibacterial efficacy, PI was instilled onto the surface of plates of Staphylococcus , Streptococcus , Enterococcus , Pseudomonas , and Haemophilus species. The plates were then evaluated 24 hours later for a clear zone of inhibition (i.e., no growth) where the PI was placed. This process was repeated for five consecutive days. RESULTS: Sterility testing showed no growth of organisms on the blood agar plates for each of the five days of testing. For antibacterial efficacy testing, zones of inhibition of growth were seen on each plate of bacterial colonies only where PI was placed, for each of the five days of testing. CONCLUSION: In this study, PI from an open bottle maintained its sterility and antibacterial efficacy for five days. These data could help support repeated use of the same bottle, reducing waste and costs for retina practices.

Wearable flexible body matched electromagnetic sensors for personalized non-invasive glucose monitoring.

This work introduces novel body-matched, vasculature-inspired, quasi-antenna-arrays that act as electromagnetic sensors to instantaneously, continuously, and wirelessly sense glucose variations in the bloodstream. The proposed sensors are personalized, leverage electromagnetic waves, and are coupled with a custom machine-learning-based signal-processing module. These sensors are flexible, and embedded in wearable garments such as socks, which provide conformity to curved skin surfaces and movement resilience. The entire wearable system is calibrated against temperature, humidity, and movement resulting in high accuracy in glucose variations tracking. In-Vivo experiments on diabetic rats and pigs exhibit a 100% diagnostic accuracy over a wide range of glucose variations. Human trials on patients with diabetes and healthy individuals reveal a clinical accuracy of continuous glucose monitoring of 99.01% in twenty-eight subjects who underwent Oral Glucose Tolerance Tests. Hence, our approach ensures the continuous tracking of glucose variations from hypo-to-hyper glycemic levels with great fidelity.

The first report on CFTR mutations of meconium ileus in cystic fibrosis population in Saudi Arabia: A single center review.

Introduction: Meconium ileus (MI) is one of the most common causes of intestinal obstruction in newborns. It is the earliest clinical manifestation of cystic fibrosis (CF). MI is suspected if a baby fails to pass meconium shortly after birth and develops symptoms of bowel obstruction, such as distention of the abdomen or vomiting. MI can lead to bowel perforation, a twisting of the bowel, or inflammation and infection of the abdominal cavity. Objectives: To find the incidence and prevalence of meconium ileus in cystic fibrosis patients and to report on the most common gene mutation of MI in CF patients. Methodology: Retrospective review of the medical documentations of all MI patients during the period of 1989-2018. Results: A total of 40 CF confirmed patients were presented with MI. Twenty-nine patients (71%) are alive and 11 patients (29%) died or lost to follow-up. The following CFTR mutations were found: Eight patients (20%) with c.2988+1G>A; Intron 18. Seven patients (17.5%) with c.1418delG; Exon 11. Five patients (12.5%) with c.579+1G>T; Intron 5. Four patients (10%) with c.1911delG; Exon 14. Four patients (10%) with c.1521_1523delCTT; Exon 11. Four patients (10%) with c.416A>T; Exon 13. Three patients (7.5%) with c.2421A>G; Exon 14. Two patients (5%) with c.3908A>C; Exon 21. One patient (2.5%) with c.3889dupT; Exon 24. One patient (2.5%) with c.1657C>T; Exon 12. One patient (2.5%) with c.2547C>A; Exon 14a. Eighteen patients (45%) were presented with vomiting, 38 patients (95%) had postnatal radiological findings, 7 patients (17.5%) had electrolytes imbalance. Five patients (12.5%) had cholestasis and 4 patients (10%) developed chronic liver disease. Thirty-five patients (79.5%) underwent surgical repair and 9 patients (20.5%) were treated medically. Mean age of operation was 2.25 (2) days. Of 9 patients, 6 (66.6%) were treated with gastrograffin enema, 2 patients (22.2%) with oral N-acetylcysteine and 1 patient (11.1%) with saline rectal wash. Thirteen patients (31.5%) required TPN. Five patients had recurrent operation. Conclusion: CF and meconium ileus are commonly present in CF patients in Saudi Arabia. Prognosis is similar to other CFs without MI, if treated early. Thirty percent of our CF/MI patients have intronic mutations.

Management of Phantom Limb Pain through Thalamotomy of the Centro-Median Nucleus.

BACKGROUND: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients' lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9-10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.

Twenty Years After Glioblastoma Multiforme Diagnosis: A Case of Long-Term Survival.

Glioblastoma multiforme (GBM) is an aggressive tumor that has a poor prognosis with a median survival of 15 months with treatment and 3-4 months without treatment. Subsets of patients are found to survive longer than two years, some survivors lived more than 10 years, and rare cases survived 20 years or more with treatment. Better prognosis has been found to be associated with many factors. Some of these factors are related to patients' characteristics, biological factors that impact tumor aggressiveness, and/or factors associated with treatment. However, the exact contribution for extended survival is still not known. Finding the factors that have a strong impact on the long survival is of high importance and can help give hope to better treat glioblastoma cases. In this report, we present a case of a glioblastoma patient who was diagnosed at the age of 47 years with more than 20-year survival. We further discuss the suggested factors that may have contributed to a better prognosis with a focus on the possible role of varicella-zoster infection in mediating long-term survival.

Pharmacological Approaches in Neurofibromatosis Type 1-Associated Nervous System Tumors.

Neurofibromatosis type 1 is an autosomal dominant genetic disease and a common tumor predisposition syndrome that affects 1 in 3000 to 4000 patients in the USA. Although studies have been conducted to better understand and manage this disease, the underlying pathogenesis of neurofibromatosis type 1 has not been completely elucidated, and this disease is still associated with significant morbidity and mortality. Treatment options are limited to surgery with chemotherapy for tumors in cases of malignant transformation. In this review, we summarize the advances in the development of targeted pharmacological interventions for neurofibromatosis type 1 and related conditions.

Acute and Post-Acute Neurological Complications of COVID-19.

Coronavirus disease 2019 (COVID-19) is an emerging global health emergency caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The global outbreak of SARS-CoV-2 infection has been declared a global pandemic by the World Health Organization (WHO). The clinical presentation of SARS-CoV-2 infection depends on the severity of the disease and may range from an asymptomatic infection to a severe and lethal illness. Fever, cough, and shortness of breath are among the most common symptoms associated with SARS-CoV-2 infection. Accumulating evidence indicates that COVID-19 patients commonly develop neurological symptoms, such as headache, altered mental status, anosmia, and myalgia. In this comprehensive literature review, we have summarized the most common neurological complications and reported neurological case studies associated with COVID-19, and neurological side effects associated with COVID-19 treatments. Additionally, the post-acute COVID-19 syndrome and long-term neurological complications were discussed. We also explained the proposed mechanisms that are involved in the pathogenesis of these neurological complications.

Complete resolution of a large squamous cell carcinoma of the lacrimal duct in a young African American male after non-surgical management.

PURPOSE: The following case describes a 28-year old African American male who presented with squamous cell carcinoma of the lacrimal duct. Despite its size and location, his tumor showed complete resolution with non-surgical treatment. OBSERVATIONS: The patient presented with a 4-month history of dacryocystitis-like symptoms in the right eye, with no prior medical history and a history of tobacco smoking. Pathology indicated that SCC arose as nests within a benign sinonasal inverted papilloma. He received cisplatin chemotherapy and radiotherapy with tumor resolution in 4 months. Several months after the end of treatment, he experienced irreversible visual deterioration which led to enucleation of the right eye. The patient has remained in remission for 4 years following the treatment. CONCLUSIONS: The complete resolution of the mass with non-surgical management supports the most recent literature endorsing a multidisciplinary approach for localized tumors. Our patient is the only African American identified in the literature and the youngest reported patient to present with this tumor. Most case studies have not emphasized race, ethnicity and demographics, although it is known that morbidity in malignancy is impacted by these factors.

Noninvasive, wearable, and tunable electromagnetic multisensing system for continuous glucose monitoring, mimicking vasculature anatomy.

Painless, needle-free, and continuous glucose monitoring sensors are needed to enhance the life quality of diabetic patients. To that extent, we propose a first-of-its-kind, highly sensitive, noninvasive continuous glycemic monitoring wearable multisensor system. The proposed sensors are validated on serum, animal tissues, and animal models of diabetes and in a clinical setting. The noninvasive measurement results during human trials reported high correlation (>0.9) between the system's physical parameters and blood glucose levels, without any time lag. The accurate real-time responses of the sensors are attributed to their unique vasculature anatomy-inspired tunable electromagnetic topologies. These wearable apparels wirelessly sense hypo- to hyperglycemic variations with high fidelity. These components are designed to simultaneously target multiple body locations, which opens the door for the development of a closed-loop artificial pancreas.

Retinal and choroidal capillaries contribution to age-related macular degeneration (AMD) phenotypes in murine models of the disease.

Mouse models of age-related macular degeneration (AMD) such as Ccl2-/- and Ccl2-/-/Cx3cr1-/- have not yet been fully characterized ultrastructurally. Although we have previously shown extranuclear DNA (enDNA) leakage into the cytoplasm and damaged mitochondria in the retinal pigment epithelium (RPE) of these AMD mouse models, little is known about the state of their vascular capillaries of the retina and choroid. Our ultrastructural survey shows that the aberrations were not restricted to the RPE cells, but also extended to the vasculature of the retina and choroid. Their endothelial aberrations included cytoplasmic degeneration, pyknotic DNA, hypertrophic nuclei, and loss of fenestration in addition to duplication of basement membrane and loss of density in Bruch's membrane. Moreover, the state of the vasculature in the mutant mice models suggests that the capillaries could also be active contributors to the pathological findings seen in AMD. The goal of this study is to gain insights into the early events of AMD that may lead to a better understanding of AMD's pathogenesis, improve our preventative measures, and formulate designed therapeutic regimens that are tailored to target the initial pathological events.Abbreviations: AMD: age-related macular degeneration; BM: Bruch's membrane; DPC: degenerate pericyte; EN: endothelial nucleus; enDNA: extranuclear DNA; GCL: ganglion cell layer; HEN: hypertrophic endothelial nucleus; IPL: inner plexiform layer; NFL: nerve fiber layer; OPL: outer plexiform layer; RBC: red blood cell; RPE: retinal pigment epithelium; SNPs: Single nucleotide polymorphisms.

A Double Blind, Placebo Controlled, Randomized Trial to Evaluate the Efficacy and Tolerability of On-Demand Oral Pregablin (150 mg and 75 mg) in Treatment of Premature Ejaculation.

INTRODUCTION: Although premature ejaculation (PE) is a common sexual dysfunction, the available options for PE treatment remain unsatisfactory. AIM: To evaluate the effect of on-demand oral pregabalin on the intravaginal ejaculation latency time (IELT). METHOD: We conducted a multiarm double-blinded placebo-controlled randomized clinical trial that enrolled 120 patients with PE who were divided equally into 3 groups (A, B, and C). 4 patients were excluded, 39 patients received 150 mg pregabalin (group A), 39 patients received 75 mg pregabalin (group B), and 38 patients received placebo (group C). All patients were encouraged to engage in sexual relations twice per week for 2 weeks and to take the medication 1-2 hours before sexual intercourse. A stopwatch was used to evaluate IELT. MAIN OUTCOME MEASURE: The main outcome measure are the improvement of IELT and the reported adverse events. RESULTS: IELT significantly improved in patients who received 150 mg pregabalin, but there was no change in the other groups. CLINICAL IMPLICATIONS: Most PE patients showed a significant improvement after receiving on-demand pregabalin (150 mg). STRENGTH & LIMITATIONS: The strength of this study is that it is the first randomized controlled trial to evaluate the efficacy of pregabalin in treatment of PE. The main limitations were the small number of patients, IELT was the only primary outcome of the study, and the pregabalin cap can be identified by the patient. CONCLUSION: Oral pregabalin seems to be a promising drug for additional evaluation as a new treatment for PE. More studies are needed to evaluate the suitable dose, duration, timing, and its safety profile. El Najjar MR, El Hariri M, Ramadan A, et al. A Double Blind, Placebo Controlled, Randomized Trial to Evaluate the Efficacy and Tolerability of On-Demand Oral Pregablin (150 mg and 75 mg) in Treatment of Premature Ejaculation. J Sex Med 2020;17:442-446.

A Case Report of a Nerve Sheath Myxoma of the Lower Eyelid in a Young Male.

Myxomas are rare, benign tumors of uncertain etiology. Based on the published data, there have been few reported cases of eyelid nerve sheath myxomas and two cases of orbital myxomas. Eyelid nerve sheath myxomas have a similar presentation to neurothekeoma of the myxoid variety, and historically these two diagnoses have been considered interchangeable. At present, the proper diagnosis can be found through protein immunoreactivity with histological staining. Currently in published literature, there has not been documentation of a family history with eyelid growth in patients diagnosed with nerve sheath myxomas. In this case report, we present a 19-year-old male with a potential third recurrence of nerve sheath myxoma who reports a family history of similar eyelid lesions.

Perceived Barriers to Breast Cancer Screening among Saudi Women at Primary Care Setting

Background: Screening for breast cancer (BC) is of low rate in Saudi Arabia; although it is provided in the country free of charge to the population. This cross-sectional study aimed at investigating the perceived barriers towards BC screening in Al Hassa, Saudi Arabia. It is crucial for increasing the rate of utilization of screening to identify the possible barriers for seeking BC screening in order to enhance early diagnosis and improve outcome. Materials and Methods: A total of 816 adult Saudi women aged ≥ 30 years attending for routine primary health services or accompanying patients at the selected primary health care centers (PHCs) were randomly selected from 12 PHCs (8 urban and four rural) using multi-stage sampling method. Participants were invited to personal interview using semi-structured data collection instrument including inquiries about socio-demographics, reproductive history, previous histories of diagnosed breast lesions and breast cancer. The perceived individual barriers towards screening, their attitudes, the reasons for not attending previously held screening campaigns in Al Hassa, were also included. Results: Low utilization of BC screening has being significantly associated with woman's age (OR=2.55; 95% CI= 1.71-3.83), higher educational status (OR=2.98; 95% CI=2.05-4.34), higher family income (OR=1.96; 95% CI=1.31-2.93), using hormonal contraception (OR=1.46; 95% CI=0.99-2.13) and positive history of previous breast (OR=12.16; 95% CI=6.89-21.46), as shown by the results of the logistic regression model. Exploratory factor analysis showed that personal fears (especially fear of doctors/ examiners, fear of hospitals and health facilities and fear of consequences/results) were the major factors that hinder women from utilizing the free of charge BC screening with high loading eigenvalue of 3.335, explaining 30.4% of the barriers. Conclusion: Educational interventions aim at improving breast cancer knowledge and addressing barriers should be incorporated as core component of the screening program in Saudi Arabia.

Genetic Polymorphisms of TLR4 and MICA are Associated with Severity of Trachoma Disease in Tanzania.

AIM: To examine the association of TLR4 Asp299Gly and MICA exon 5 microsatellites polymorphisms with severity of trachoma in a sub-Saharan East Africa population of Tanzanian villagers. METHODS: The samples were genotyped for MICA exon 5 microsatellites and the TLR4 299 A/G polymorphism by Restriction Fragment Length Polymorphism (RFLP), and GeneScan®, respectively. The association of TLR4 Asp299Gly and MICA exon 5 microsatellites with inflammatory trachoma (TI) and trichiasis (TI) were examined. RESULTS: The results showed an association between TLR4 and MICA polymorphisms and trachoma disease severity, as well as with protection. TLR4 an allele was significantly associated with inflammatory trachoma (p=0.0410), while the G allele (p=0.0410) was associated with protection. CONCLUSION: TLR4 and MICA may modulate the risk of severity to trachoma disease by modulating the immune response to Ct. In addition; the increased frequency of MICA-A9 heterozygote in controls may suggest a positive selection of these alleles in adaptation to environments where Ct is endemic.

Extranodal marginal zone B cell lymphoma of the orbit in a patient with sarcoidosis: a case report.

OBJECTIVE: To describe a case of extranodal marginal zone B-cell lymphoma (EMZL) "mucosa associated lymphoid tissue (MALT)" of the orbit that presented with stage IV disease in a patient with sarcoidosis. DESIGN: Clinicopathologic case report. METHODS: Biopsies of the lesion were performed in the operating room and the samples were submitted for pathology processing. Pathology analysis identified the lesion as an extranodal marginal zone B-cell lymphoma "mucosa associated lymphoid tissue (MALT)" via flow cytometry, histopathology, cytogenetics, and immunohistochemical staining and fluorescent in situ hybridization (FISH). The institutional review board of Howard University Hospital waived the need for IRB approval for this intraoperative finding. RESULTS: A 70-year-old Black woman with biopsy-proven sarcoidosis presented complaining of foreign body sensation, redness, swelling of her left upper eyelid and tearing. The patient was found to have an orbital lymphoproliferative malignancy. CONCLUSIONS: It is still unclear if the presence of immunosuppression or an autoimmune disease increases the risk of lymphoproliferative malignancies {6}. Malignancy should always be suspected and investigated.

Attitude to blood donation in Saudi Arabia.

BACKGROUND AND OBJECTIVES: The blood donor system in the Kingdom of Saudi Arabia depends on a combination of voluntary and involuntary donors. The aim of this study is to explore the attitudes, beliefs and motivations of Saudis toward blood donation. MATERIALS AND METHODS: The study was conducted at the Donor Centers at King Khalid University Hospital (KKUH) Blood Bank and King Saud University Students Health Center, Riyadh. A self-administered questionnaire was distributed to donors (n = 517) and nondonors (n = 316), between February and June 2008. All were males. RESULTS: Ninety-nine percent of the respondents showed positive attitude toward blood donations and its importance for patients care, and object the importation of blood from abroad. Blood donors: Ninety-one percent agree that that blood donation is a religious obligation, 91% think no compensation should be given, 63% will accept a token gift, 34% do not object to donating six times/year and 67% did not mind coming themselves to the donor center to give blood. Nondonors: Forty-six percent were not asked to give blood and those who were asked mentioned fear (5%) and lack of time (16%) as their main deterrents. Reasons for rejection as donors include underweight and age (71%) and health reasons (19%). Seventy-five percent objected to money compensation but 69% will accept token gifts and 92% will donate if a relative/friend needs blood. CONCLUSION: These results reflect an encouraging strong positive attitude toward blood donation. Further future planning with emphasis on educational/publicity programs and careful organization of donor recruitment campaigns could see the dream of total voluntary nonremunerated blood donations should not take long to be true.