Pectoralis Major Tendon Rupture in an Occupational Medicine Setting: A Case Report.

Pectoralis major (PM) rupture is a rare injury, commonly misdiagnosed, that affects mostly young male athletes aged 20-40 years. This type of injury is typically associated with weight lifting, especially bench pressing. In an occupational medicine setting, it is extremely rare and not much reported in the literature. We present the case of a 30-year-old trauma technician male who presented with right shoulder and chest pain following a popping sensation while pushing in full momentum a patient on a gurney accidentally set on break mode. PM rupture was suspected clinically. Magnetic resonance imaging confirmed the diagnosis and revealed a complete rupture of the sternal head of PM. Surgical reconstruction was performed to restore the anatomy and functionality of the shoulder girdle.

Effect of Melatonin on Alpha Synuclein and Autophagy in Dopaminergic Neuronal Differentiation of Adipose Mesenchymal Stem Cells.

Background: The current work investigated the effect of melatonin on differentiation of adipose mesenchymal stem cells (AD-MSCs) into dopamine producing cells and its effect on autophagy process and alpha-Synuclein (α-Syn) secretion. Methods: AD-MSCs were characterized by flow cytometry and divided into 4 groups; i) control group (AD-MSCs without any treatment), ii) M+MSCs group (MSCs treated with 1 µM melatonin for 12 days), iii) DN group (MSCs cultured in neurobasal A medium and essential neuronal growth factors for 12 days) and iv) DN+M group (MSCs cultured in neurobasal A medium and 1µM melatonin for 12 days. By the end of experiments, the dopamine and α-Syn levels using ELISA, the expression of MAP-2, m-TOR and α-Syn genes at the level of mRNA and detection of autophagosomes formation using transmission electron microscope were performed. Results: We found that the isolated cells were MSCs due to their positivity expression for CD105 and CD90 and negativity expression for CD34 and CD45. The concentration of dopamine was significantly higher and α-Syn concentration was significantly lower in DN+M group when compared to other groups (P< 0.005). Also, this group showed the highly expression for MAP-2 gene and less expression for m-TOR and α-Syn genes (P< 0.005). Moreover, there was significantly increase in autophagosomes formation in this group than another group (P< 0.005). Conclusions: It is concluded that the melatonin promotes the differentiation of rat AD-MSCs into dopaminergic cells via induction of autophagy process and reduction of α-Syn secretion.

Post-cholecystectomy Hepatic Artery Pseudoaneurysm Rupture.

Pseudoaneurysm of the hepatic and/or less frequently the cystic artery is a rare but potentially fatal complication following laparoscopic cholecystectomy. While the procedure is safe with minimal morbidity, complications do occur even in experienced hands. Moreover, patient selection is of utmost importance. These aneurysms usually present with hemobilia a few weeks after surgery; however, free rupture into the peritoneal cavity can occur. Transarterial embolization is the initial management approach when available and feasible. We present a case of a ruptured hepatic pseudoaneurysm three weeks after laparoscopic conversion to open cholecystectomy. The aim is to shed light on this rare but potentially fatal complication.

Association of GSTP1 p.Ile105Val (rs1695, c.313A > G) Variant with the Risk of Breast Carcinoma among Egyptian Women.

Several reports examined the association of the GSTP1 p.Ile105Val (rs1695, c.313A > G) variant with the elevated risk of multiple cancerous diseases involving breast carcinoma, but with inconclusive findings. The primary purpose of this study is to test the association of this essential variant with the risk of breast carcinoma among Egyptian females. This case-control study was conducted based on 200 participants involving 100 women diagnosed with breast carcinoma and 100 unrelated cancer-free controls from the same district. The genomic DNA for all participants was genotyped utilizing T-ARMS-PCR procedure. The frequencies of the GSTP1 p.Ile105Val (rs1695, c.313A > G) variant indicated a statistically significant with the elevated risk of breast carcinoma under various genetic models, including allelic (OR = 2.48, P-value < 0.001) and dominant (OR = 2.36, P-value = 0.003) models. In conclusion, the GSTP1 p.Ile105Val (rs1695, c.313A > G) variant was considered as an independent risk factor for breast carcinoma among Egyptian women.

Multifunctional Aspects of the Synthesized Pyrazoline Derivatives for AP1 5L X60 Steel Protection Against MIC and Acidization: Electrochemical, In Silico, and SRB Insights.

The inhibitory impact of low-cost synthesized pyrazoline derivatives named Pz series (Pz1 and Pz2) on the corrosion of API 5L X60 carbon steel in 5 M HCl was inspected to serve as corrosion inhibitors against such a solution for its usage in the oilfield well acidization process. Also, the same compounds were unitized as biocides for sulfate-reducing bacteria (SRBs) to inhibit the microbial-induced corrosion effect. This study was conducted via several electrochemical techniques, namely, electrochemical potentiodynamic polarization (EP) and electrochemical impedance spectroscopy (EIS), in addition to computational density functional theory (DFT). The inhibition efficiency (IE) of Pz series on the corrosion of 5L X60 carbon steel in 5 M HCl was found to increase whenever the Pz series molecule concentration was increased. EP measurements revealed that Pz1 and Pz2 have both cathodic and anodic features (mixed inhibitor) and their corrosion IEs were around 90%. The physicochemical properties of the Pz1 and Pz2 compounds were studied using Langmuir adsorption isotherms, where the equilibrium adsorption data were found to follow it accurately. EIS outputs were found to comply with the values obtained from EP. Scanning electron microscopy was used to examine the topographic anisotropy between the inhibited and uninhibited 5L X60 carbon steel samples to double-check the electrochemical findings. DFT calculations and Monte Carlo simulations were utilized to predict the behavior of inhibitors and to rationalize the experimental results. The serial dilution bioassay technique was used to assess the Pz series as potential biocides to counter the effect of SRBs in compliance with the TM0194-2014-SG standard test method, and the results showed the potency of Pz series in inhibiting such bacterial growth.

Adrenal Angiomyolipoma: A Case Report.

Angiomyolipoma (AML) is a mesenchymal tumor that arises from perivascular epithelioid cells most commonly seen in the kidney and rarely in extrarenal sites. Adrenal AML is a rare clinical entity with only 16 cases reported in the literature according to the World Health Organization report in 2017. We present a 68-year-old male evaluated in our emergency room with worsening chronic right upper quadrant abdominal pain. Computerize tomography (CT) revealed a large right adrenal mass. Adrenelectomy was performed, and the histopathology report confirmed the diagnosis and the tumor size was the largest ever reported. Patient was discharged uneventfully.

Horse Kick to the Abdomen Causing a Triad of Injury: A Case Report.

A 35-year-old male, a horse trainer, was brought to the emergency room after being kicked in the abdomen, which resulted in an abdominal wall hematoma and a blow-out rupture of the proximal jejunum, with a mesenteric tear and posterior lumbar disc herniation. The initial evaluation did not raise significant concerns; however, the patient's abdominal pain progressively worsened after the administration of oral contrast in preparation for the computed tomography (CT) scan. The patient did well after abdominal exploration and operative repair of the small bowel injury. Our objective is to shed light on this mechanism of injury that can be underestimated during a patient's initial evaluation.

Inferior Vena Cava Calcified Thrombus Presenting With Abdominal Pain: A Case Report.

De novo thrombosis of the inferior vena cava (IVC) can cause significant morbidity and mortality. Calcified thrombus of IVC is an extremely rare incidental finding and is associated with recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE). We present a case of abdominal pain secondary to a calcified thrombus in the supra-hepatic region of the IVC.

Small Bowel Intussusception Caused by Metastatic Melanoma: A Case Report.

Intussusception, as a rare cause of small bowel obstruction, can be secondary to benign or malignant pathology. Malignant lesions causing intussusception can be primary or metastatic lesions. Metastasis can occur many years later. We present a case of metastatic melanoma in a 69-year-old man as the underlying etiology of his intussusception. The patient had laparoscopic Roux-en-Y gastric bypass four years prior to his presentation and did recall excision of a skin melanoma at age 64. Laparoscopic or open surgical resection is the best therapeutic option in cases such as this.

Howship-Romberg Sign and Bowel Obstruction: A Case Report.

Small bowel obstruction (SBO) is associated with high morbidity and mortality in acute care surgery practice, with hernias constituting a significant portion of the underlying etiology. Physical examination and maneuvers such as changing the extremity position of the patient can further improve clinician's diagnostic acumen to identify the cause of the disease. We present a case of SBO in an 83-year-old female whose physical exam was consistent with an underlying obturator hernia.

Seat Belt Aortic Dissection: A Case Report.

Eighteen-year-old restrained male driver involved in a flip over motor vehicle accident resulting in a seatbelt injury triad ( rectus abdominis muscle disruption, injury to the sigmoid colon and infra-renal aortic dissection). The patient did well after the surgical resection of the sigmoid colon, repair of the rectus abdominis muscle and endovascular repair of the aorta. Our objective is to shed light on this potentially fatal injury.

Small Bowel Obstruction in a Virgin Abdomen: A Case Report.

Small bowel obstruction (SBO) is a major cause of morbidity and financial burden in hospitals around the world. Foreign body (FB) ingestion as a cause is rare. While most cases are straight forward, some can be extremely subtle. We present a case of SBO caused by an undigested piece of pineapple core.

A Memorable Moment During Laparoscopic Cholecystectomy: A Case Report.

Common bile duct (CBD) stones are encountered in 14%-15% of patients with symptomatic gall stone disease. Endoscopic retrograde cholangiopancreatography (ERCP) is a primary modality for the management of pancreaticobiliary disorders. We present a case of unintentional stent placement into the gall bladder discovered during surgery.

Potential chemical transformation of phosphinic acid derivatives and their applications in the synthesis of drugs.

The chemical transformation of phosphinic acid is a well-considered mature area of research on account of the historical significant reactions such as Kabachnik-Fields, Mannich, Arbuzov, Michaelis-Becker, etc. Considerable advances have been made over last years especially in metal-catalyzed, free-radical processes and asymmetric synthesis using catalytic enantioselective. As a result, the aim of this synopsis is to make the reader familiar with advances in the approaches of phosphinic acids toward the synthesis of highly functionalized and valuable buildings blocks. Another purpose of this survey is to provide the current status of the applications of phosphinic acids in the synthesis of drugs.

Surgical Removal of Numerous Foreign Body Gastric Bezoar: A Case Report.

A 53-year-old mentally retarded male was brought to our emergency room after vomiting a plastic glove. Computed tomography revealed marked gastric distention containing large amount of residual food debris. Endoscopic retrieval was unsuccessful. Surgical removal of the foreign bodies was done. The patient did well and was discharged from the hospital.

Anastomotic Leak after Esophagectomy for Esophageal Cancer Treated with a Stent: A Case Report.

Intrathoracic esophageal anastomotic leaks after cancer resection are very morbid and challenging problems. Esophageal stents play an integral role in the management of these patients. Herein, we present a case of lower esophageal cancer who developed a leak at his gastroesophageal anastomosis after resection and was successfully managed with a fully covered metal stent. Our objective was to remind our colleagues regarding a safe alternative treatment for this complication.

Grade III Spleen Laceration After a Colonoscopy Treated with Splenic Artery Embolization: A Case Report.

Our patient is a 58-year-old female who presented to our emergency room with left upper quadrant abdominal pain the day after outpatient screening colonoscopy. A computed tomography (CT) scan of the abdomen and pelvis revealed a grade III spleen injury. She was admitted to our intensive care unit, and a gradual decline in her hematocrit was noticed. The patient did well and was discharged from hospital the day after splenic artery embolization.

Is Routine Chest X-Ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely?: A Population-Based Retrospective Study of 6,875 Patients.

BACKGROUND: A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. The goal of this study was to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion. METHODS: This population-based retrospective cohort study was performed to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. A logistic regression analysis was performed to examine the potential risk factors associated with these complications, and a cost analysis was conducted to evaluate the economic impact. RESULTS: Of 18,274 patients who had a CVC inserted, 6,875 patients were included. The overall incidence of pneumothorax and catheter misplacement was 0.33% (95% CI, 0.22-0.5) (23 patients) and 1.91% (95% CI, 1.61-2.26) (131 patients), respectively. The site of catheterization was the major determinant of pneumothorax and catheter misplacement; left subclavian vein catheterization was the site at a higher risk for pneumothorax (OR, 6.69 [95% CI, 2.45-18.28]; P < .001), and catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine postprocedural CXR were US $105,000 to $183,000 per year at our institution. CONCLUSIONS: This study found that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare, and the costs of a postprocedural CXR were exceedingly high. We concluded that a routine postprocedural CXR is unnecessary and not a wise choice in our setting.

Escherichia coli Bacteremia-induced Purpura Fulminans: A Case Report.

Purpura fulminans (PF) is a dermatologic manifestation of an underlying life-threatening condition associated with disseminated intravascular coagulation and skin necrosis. The known categories include protein C deficiency or abnormalities of other coagulation systems (inherited or acquired), acute infectious PF and idiopathic. We describe a case of PF induced by Escherichia coli-associated bacteremia.