Celiac disease affects 1% of the world population; however it is under diagnosed in UAE. The disease has many clinical manifestations, ranging from severe malabsorption to minimally symptomatic or non-symptomatic presentation. Hypocalcaemia is a common finding in celiac disease and could be the only presentation of the disease; however hypercalcemia has been previously reported in patients with celiac disease either due to primary hyperparathyroidism or tertiary hyperparathyroidism due to prolonged hypocalcaemia. A normal calcium level on the other hand in patients with untreated celiac disease who also have primary hyperparathyroidism can be due to interplay of these two conditions and may delay the diagnosis of primary Hyperparathyroidism. We report the very first case from our practice in UAE with untreated celiac disease and normal calcium level at presentation, where a diagnosis of primary hyperparathyroidism was not entertained initially. Patient went on gluten free diet which then caused normalization of intestinal abnormalities and likely calcium absorption manifesting as hypercalcemia on subsequent labs. This led to further work up and finally the diagnosis of Primary hyperparathyroidism due to parathyroid adenoma.
Here we reported an interesting case of an 84-year-old woman with acute onset of paresis of left arm and paresthesia of left face and arm. The symptoms resolved within two hours. She also had a similar prior episode two weeks ago with only left arm paresthesia. Her MRI revealed different stages of lacunar ischemic lesions. Interestingly, the SWAN sequences showed lateralized rather than global multiple microhemorrhages over the right MCA and PCA territory, and the sulcal hyperintensity on FLAIR was also seen with no associated susceptibility effect and minimal enhancement, indicating probable cerebral amyloid angiopathy (CAA) based on Boston Criteria.
It has been acknowledged that the CAA could manifest with certain localization preference. Cerebral microinfarct and white matter disease in CAA have been more often observed in the posterior circulation territory, however the restricted lateralization reported in our case has not been seen. Since CAA is often diagnosed when the characteristic MRI findings are picked up incidentally, recognizing this as a potential “TIA mimic” will be important for guiding treatment due to its higher risk of bleeding. In summary, this case highlights that the CAA could present as restricted lateralized lesions and occur as transient neurologic deficits, which to our knowledge has not be reported before. Recognition of it as a potential manifestation of CAA will be valuable in the clinical diagnosis process.
Deepak Bansal*, Murlidhar Kamat, Rahul Ralegaonkar and Yashika Bansal
Published on: 3rd August, 2022
Buildings are demolished, when they outlived their service life, become structurally/functionally unfit, or have been built illegally. In India, an RCC framed, 40-storied high-rise building, with a built-up area of about 75,000 sqm, built without relevant approvals along with lots of violations of building bye-laws, has been demolished. There is nothing new in this demolition process, but its effect on the environment is unavailable. A study has been conducted to understand the environmental impact of this demolition. Based on the main primary construction materials, the embodied energy of this demolished building has been computed as 7.07 GJ/sqm.The civil construction cost of the building was found to be about INR 200 Crores (USD 27 million, assuming a conversion rate of 1 USD 75 INR in the year 2022). Expected GHGs emissions corresponding to this embodied energy were estimated as 42.42 × 103 MT. Energy in the demolition of the building has been computed to be about 8.7 GJ/sqm. The situation, in which this building can be retrofitted and made compliant with local building bye-laws, has been analyzed for its environmental impact.
Chronic foot and heel pain is a clinical dilemma that Pain Physicians often encounter in their daily practice. In the younger active patients, this is often attributed to plantar fasciitis but other rarer etiologies should also be considered. In patients who present with pain over the medial calcaneus, entrapment neuropathy of the inferior calcaneal nerve, the first branch of the lateral plantar nerve (FBLPN), also known as “Baxter’s nerve” must be considered [1,2]. Initially described in 1984 by Baxter and Thigpen, it is often overlooked as a cause of medial heel pain, particularly in athletes, where it may coexist with plantar fasciitis [3]. The nerve has a tortuous course in the foot and can be entrapped as it passes through the fascia of the abductor hallucis, travels in close proximity to a plantar spur or the medial calcaneal tuberosity, or gets enmeshed in scar tissue from prior surgery [1,3].
Andrzej Mioduszewski*, Mikołaj Wróbel and Emilia Hammar
Published on: 28th April, 2023
Study design: Descriptive study.Background: Many risk factors contributing to ankle sprains have been studied in medical literature with coordination and balance being two of the major endogenous factors described. These are influenced by lateralization – a developmental and adaptive ability determined by the asymmetrical construction of the human brain, with cross-laterality referring to mixed limb dominance.Objectives: To determine whether cross lateralization is a risk factor for the severity of ligamentous injuries in ankle sprains since no data is yet available on such correlation. Methods: Two hundred forty-four patients with acute ankle sprains (136 men and 108 women) were prospectively evaluated between April 2006 and March 2009. The mean age was 30 (ranging from 18 to 76). Clinical and ultrasonographic examinations were performed on the study subjects. Laterality was then assessed by the Coren questionnaire and the AOFAS score was calculated. Patients with syndesmotic injuries and fractures were excluded from the study. Those qualified were divided into straight and crossed groups, according to their laterality type. Results: One hundred forty-four patients displayed straight lateralization, while cross-laterality was found in 100 subjects. Patients in the crossed group experienced more multi-ligamentous injuries than those in the straight group (p = 0.02). Following trauma, a higher AOFAS score was attributed to subjects that displayed a straight lateralization pattern, in comparison to subjects presenting with crossed laterality (p = 0.04).Conclusion: Crossed lateralization is associated with higher severity of ligament injuries in ankle sprains and may be considered a risk factor for calcaneofibular ligament injuries.
Based on paraffin-wax include, volcano-based antimony-bearing, phospholipid, antimony found in gold deposit and TIPSb/triisopropylantimony ever predicted as the room temperature organic superconductor compound. Many flourishing explanations have been declared, from variational method to inductive deduction, with all indicating the presence of C9H21O3Sb.PBr6.We consider that aplications in mesoscale regime, at least when using multiscale fractal of critical parameter that affects physical & chemical properties and to adopt “mesoscopic scale” ever stated as “superconductors” by Holmvall (2017). Then the mathematical induction of variational method of exploitation on integers & natural numbers herewith paraffin-wax etc can be resembled the ever built antimony containing compounds to keep the realm of predictions.
The study aimed to investigate the threats to the biodiversity of ethnomedicinal plants and to find consensus information on conservation and management practices of ethnomedicinal plants to contribute sustainable utilization of ethnomedicinal plants in Kore district, Southeastern Ethiopia. The result of the survey revealed that sixty-one medicinal plants were reported by the informants from the study area. These plants are distributed in 59 genera and 37 families. Family Lamiaceae and Asteraceae were represented by 5 (8.2%) species for each family and this is the highest number of species and followed by 4 (6.5%) species of Solanaceae and Fabaceae for each family. Preference ranking analysis shows that Eucalyptus globulus scored 47, indicating that it is the most used plant for firewood in the community, followed by Olea europaea (45) and the least used plant for firewood is Juniperus procera scored 36. Paired comparison analysis showed that Olea Europeae ranked first followed by Podocarpus falcatus for the use of charcoal production in the study area. The major purposes of plant species in the study area were construction, Charcoal, Firewood, Furniture, and Fences as well as for medicinal uses. Based on direct matrix ranking analysis Juniperus procera, Eucalyptus globulus, Podocarpus falactus, Olea europaea, Hagenia abyssinica, Croton macrostachyus, and Cordia africana were the most preferred medicinal plants by local people in the study area. The analysis's findings indicated that anthropogenic influences are endangering medicinal plants. In this study area, only about 13% of medicinal plants are collected from home gardens. This shows that the effort made by the community to conserve medicinal plants is not satisfactory. Therefore, encouraging NGOs and Government offices to participate in the conservation of medicinal plants to encourage the local people to plant indigenous trees for domestic use is necessary.
VS Abrukov*, KA Konnova, EN Egorov, DA Anufrieva and NI Koltsov
Published on: 28th August, 2023
A new technique for the use of Artificial Neural Networks (ANN) for the generalization and visual presentation of the results of experimental studies is proposed. The possibility of using ANN for cases for which their use was previously considered impossible is shown. ANN calculators have been created that summarize the results of experimental studies on the effect of trans-polynorbornene and basalt fiber on the characteristics of a rubber compound based on general-purpose rubbers (isoprene SKI-3, butadiene-methylstyrene SKMS-30ARK and butadiene SKD), which also contained vulcanizing agents (N, N′-dithiodimorpholine, thiuram D), vulcanization accelerators (sulfenamide C, 2-mercapto-benzothiazole), vulcanization activators (zinc white, stearic acid), emollients (industrial oil I-12A, rosin) and antioxidants (acetonanil H, diaphene FP). The rubber mixture was prepared on laboratory rollers LB 320 160/160. Subsequently, the rubber mixture was vulcanized in a P-V-100-3RT-2-PCD press. For the resulting vulcanizates, the physical and mechanical properties and their changes were determined after daily exposure to air and in a standard SZhR-1 hydrocarbon liquid at a temperature of 100 °C. We also studied the change in the mass of vulcanizates after exposure to industrial oil I-20A and water. The dynamic parameters (modulus of elasticity and mechanical loss tangent) of vulcanizates, which characterize their noise and vibration-absorbing properties, were studied on a Metravib VHF 104 dynamic mechanical analyzer. The created ANN calculators allow solving a direct problem - interpolating the dependences of all rubber characteristics on the content of basalt fiber, as well as solving inverse problems - to determine the required content of basalt fiber to create rubber with the required performance properties. The autonomous executable modules of the calculators developed by ANN were made and can be passed to everyone.
This study investigates into the historical evolution and contemporary applications of Computed Tomography (CT) in renal stone estimation, with a focus on the innovative use of CT to quantify renallcalculiistrain for estimating potentiallsymptomatic incidents.Historically, CT has played a pivotal role in diagnosing renal calculi, offering unparalleled sensitivity and specificity in detecting stones of varying composition and size. However, the clinical significance of renal calculi extends beyond mere detection, prompting researchers to explore novel approaches to predict symptomatic events associated with stone disease. This research aimed to determine the right way to classify asymptomatic radiographic calculi strain on computed tomography (CT) scans in Al-Hussein Teaching Hospital, Al-Muthanna, Iraq. A survey was made available to calculi formers who had a CT scan during asymptomatic after a calculi clinical assessment. A survey and a study of medical records revealed symptomatic calculi route incidents after a CT scan. The amount of calculus, the biggest calculi thickness, electronic total calculi size (TSV), and two-pronged calculus were measured radiographically and linked as predictors of calculi events. There were 55 calculi formers in the study, and 61% had a calculi event one year after the CT scan. The calculus number was (0–1, 2–3, 4–6, 7), the highest calculi diameter was (0–2, 3–4, 5–7, 8 mm), and 48% had bilateral calculus. The number of calculus per quartile had a danger ratio of 1.30 (p = 0.001), the largest calculi diameter had a hazard ratio of 1.26 (p 0.001), TSV had a hazard ratio of 1.38 (p = 0.001), and bilateral calculus had a hazard ratio of 1.80 (p = 0.001). Only TSV wass an unbiased measure offsymptomaticceventssin multivariable regression (HR = 1.35 per quartile, p = 0.01). TSV-related incidents were also unaffected by demographics, urinary chemistry, or calculi composition. A drastic rise in TSV between CT scans (> 31 mm3/year) expected additional eventssin the 49 patients with interim events (HR = 2.8, p = 0.05). For calculating calculi pressure on CT scan, automated TSV is more accurate for asymptomatic events than physical approaches.
Karthik Baburaj*, Priya Thottiyil Nair, Abeed Hussain and Vimal MV
Published on: 15th May, 2024
A 51-year-old female with a history of multinodular goitre presented with vomiting, abdominal discomfort, and generalized tiredness. Investigations revealed hypercalcemia (ionized calcium 1.41 mmol/L), hypokalaemia, suppressed parathyroid hormone, and significantly elevated free thyroxine (> 7.77 ng/dL) with a suppressed thyroid-stimulating hormone level consistent with hyperthyroidism. Further, the workup confirmed Graves’ disease as the underlying aetiology. Hyperthyroidism is occasionally associated with mild to moderate hypercalcemia, but severe hypercalcemia or hypercalcaemic crisis is an extremely rare complication. Prompt recognition and treatment are crucial to prevent life-threatening complications. The patient was treated with intravenous fluids, a low-calcium diet, zoledronic acid, carbimazole, and a beta-blocker, leading to improvement in her condition. This case highlights a rare occurrence of hypercalcaemic crisis in a patient with thyrotoxicosis due to Graves’ disease. Hyperthyroidism-induced hypercalcemia requires prompt recognition and multidisciplinary management involving endocrinologists, internists, and critical care specialists to prevent potentially life-threatening complications. Healthcare providers should consider the hypercalcaemic crisis in the differential diagnosis of hypercalcemia in the context of hyperthyroidism.
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