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Prescriptions for psychoactive substances such as Pregabalin, Methamphetamine, Caffeine, Clonazepam and Mirtazapine (PM-CCM) are common in the treatment of a variety of disorders. Indeed, the PM-CCM has been used in different therapeutic areas, including insomnia, anxiety, seizure disorders, etc. Unfortunately, these psychoactive substances are present in the illegal street market, leading to a lot of drug abuse among some addicted users, road insecurity and suicide. Hence, it has become essential to validate and develop a rapid and effective method to analyze the PM-CCM, a modified illicit drug, for drug abuse in the forensic sciences. A simple, rapid, specific and sensitive Gas Chromatography-Mass Spectrometry(GC-MS) method has been developed for the identification of Pregabalin, Methamphetamine, Caffeine, Clonazepam and Mirtazapine (PM-CCM) in forensic exhibits. At room temperature, the sample was ultrasonicated for 5 minutes before being extracted with methanol. A highly precise auto-injector is used to inject a very small quantity of samples for analysis. Helium is used as a carrier gas with a flow rate of 1 ml/min. The separation of PM-CCM was performed on SH-RXi-5 MS, ID.25 mm, film thickness. 25 µm, length of 30 m column. The constituents of PM-CCM were identified by the mass-to-charge ratio (m/z ratio) of fragments of the parent compound by comparing them with the NIST-17 MS Library. Separation and identification of PM-CCM were achieved within a 15-minute run. The proposed method has been successfully used for the routine analysis of PM-CCM in complex illicit drug preparations and in forensic exhibits as well. The application of above discussed qualitative analysis method and screening of PM-CCM, modified illicit drug samples demonstrates the potential and applicability of the technique to the fast chemical profiling of illicit samples.  

Hypochlorous acid (HOCl) is a potent antimicrobial agent that has recently gained attention as a potential alternative to conventional antibiotics. HOCl is produced by the human immune system in response to infection and is known for its broad-spectrum antimicrobial activity. It is effective against a wide range of microorganisms, including bacteria, viruses, and fungi, and has been shown to be more effective than many conventional antibiotics. One of the key advantages of HOCl is its ability to kill bacteria without promoting the development of antibiotic resistance. Unlike conventional antibiotics, which target specific bacterial structures or processes, HOCl acts by disrupting multiple cellular components, making it much more difficult for bacteria to develop resistance. Another advantage of HOCl is its safety profile. Unlike many conventional antibiotics, HOCl is not toxic to human cells and does not cause side effects such as gastrointestinal upset or allergic reactions. Overall, HOCl shows great promise as a potential alternative to conventional antibiotics, particularly in the face of rising antibiotic resistance. With further research, it may become an important tool in the fight against infectious diseases. Herein, we discuss the mechanisms of HOCl antimicrobial action, its potential clinical applications, and future directions for research. This review aims to provide an overview of the use of hypochlorous acid (HOCl) as an antibiotic agent.

Background: Measurement of health-related quality of life (HRQOL) in children and adolescents with type 1 diabetes mellitus (T1DM) is as important as metabolic control in the management and prevention of diabetes-related complications. Aim: To describe the self-reported HRQOL outcomes in Ghanaian children and adolescents with T1DM compared with healthy controls and perceived HRQOL by caregivers.Setting: Out-patient clinics of the Departments of Child Health, Medicine and Therapeutics, Family Medicine, and Ophthalmology, the National Diabetes Management and Research Centre (all at the Korle Bu Teaching Hospital), and the Cape Coast Teaching Hospital (CCTH).Methods: Socio-demographic and clinical characteristics of study participants were documented. Participants completed the PedsQL™ 4.0 Generic Core Scales. Data analysis was done with SPSS Version 25.0. An unpaired t-test was used in comparing the HRQOL scores between children and adolescents with T1DM and controls, and parental proxy reports. Results: Fifty children and adolescents with T1DM, 50 parents/caregivers, and 80 healthy non-diabetic controls took part in this study. There was no significant difference in mean score between the patients and the caregivers for overall HRQOL (p = 0.270). Patients reported significantly worse overall HRQOL than their controls (p = 0.001). Males with diabetes reported better HRQOL than females (p = 0.007). Conclusion: Children and adolescents with T1DM and their parents/caregivers reported lower HRQOL scores compared to healthy controls. Males reported better HRQOL than females. Potential implications: HRQOL should be routinely assessed together with proxy reports from parents to identify those who might benefit from further attention including referral to a psychologist.

Between coronary artery anomalies, myocardial bridging means an epicardial coronary artery, mostly left anterior descending artery (LAD), running through an intramyocardial “tunnel” (usually in the middle segment), leading during systolic contraction, flow reduction, through the vessel. When this anomaly is associated with a coronary fistula, which “steals” more from the bloodstream, the symptoms are more pronounced, and the management complex is surgical in particular. Despite the presence from birth remains asymptomatic and it becomes clinically manifest later in the third to fourth decade of life, with a diverse palette of symptoms; angina, arrhythmias, and acute myocardial infarction up to sudden death. Diagnosis and particular management, medical, interventional, and surgical should avoid major cardiac complications and sudden death. We present two adult patients, with coronary artery bridging, one case associated with coronary artery fistula, LAD to pulmonary artery trunk, very symptomatic with surgical management, and the second only myocardial bridging controlled with medication and supervision.

This article contains modern data on the etiology, clinical presentation and treatment as well as the differential diagnosis of a rare dermatosis, Sneddon-Wilkinson disease.Clinical observation of subcorneal pustular dermatosis in a 68-year-old woman is reported. Histopathological examination played a key role in making the correct diagnosis. Treatment consisted of a physiotherapeutic approach (311 nm UVB phototherapy) in combination with systemic glucocorticosteroids (dexamethasone). This therapeutic approach (instead of dapsone therapy) can be used due to its relatively good safety profile.

A survey was conducted in the agricultural farms in Dhulikhel Municipality, mid-hill, Kavre, Nepal aiming at assessing the status of agrobiodiversity with the purpose of understanding its role in food security taking altogether 133 farming households scattered in several settlements with lowland, upland, and home garden being the general agricultural land use systems. Biodiversity index: Shannon-Wiener Index was used to assess diversity of plant. The main purpose was to assess the farm agrobiodiversity and to find out whether biodiversity level has a direct link to household food self-sufficiency. For descriptive analysis frequency, percentage, mean and standard errors were used. In the case of inferential statistics independent sample t - test and binary logistic was used to find the odd ratio of practicing home garden. The result showed that the average landholding size was 0.66 ha/household with 0.37 ha, 0.3 ha, and 0.06 ha being upland, low land, and home garden, respectively. A total of 136 plant species were documented out of which 74 were the effective number of species in the study area. Among the used plants, fodder shared 27% of the total plant diversity followed by fruit (21%), vegetable (19%), medicinal plants (8%), pulses (8%), spices (7%), oilseeds (5%) and cereals (5%). Similarly, the mean livestock unit (LSU) was 2.65. The overall Shannon-Wiener Index was 4.30 indicating high diversity of species and 87.7% of the species were evenly distributed. The Index was higher for vegetable (3.11) followed by fruits (2.9) and fodder (2.85). Higher diversity was found in fodder trees in lowlands whereas vegetable species were more diverse in upland and home garden. Similarly, the Index was 4.29 in the upland whereas it was 4.078 in the home garden followed by 3.13 in the lowland. The evenness was 0.899, 0.87, and 0.74 in upland, home garden and lowland, respectively. Higher species diversity revealed that the site was rich in agrobiodiversity. A significant positive correlation (0.22) was observed between Shannon-Wiener Index and farming years. Similarly, positive correlation (0.33) was found between an increase in the level of agrobiodiversity and food self-sufficiency. The result demonstrated that increasing crop diversity increases the household’s ability towards food sufficiency implying the need for the formulation and implementation of efficient policy to conserve the agrobiodiversity at municipality as well as national levels.

mRNA drugs are synthesized using cell-free systems without complex and stringent manufacturing processes, which makes their preparation simple, efficient, and economical. Over the past few years, mRNAs encoding antibodies have been one of the research frontiers of antibody drug development. In cancer immunotherapy, mRNAs encoding immune checkpoint antibodies may be advantageous regarding antibody persistence and durability of the anti-tumor immune response of patients. In our previous study, a candidate antibody—AET2010—targeting the novel immune checkpoint TIGIT was reported. Its anti-tumor activity was also investigated using adoptive transfer of NK-92MI cells in a xenograft mouse model, but the limitations of the model did not facilitate precise evaluation. In the present study, we further investigated the therapeutic potential of AET2010 for cancer in TIGIT-humanized BALB/c mice. Next, we explored the design, synthesis, and optimization of mRNAs encoding AET2010 and ultimately obtained a candidate mRNA (mRNA-BU) with favorable in vitro and in vivo expression levels of active AET2010. Particularly, lipid-nanoparticle-encapsulated mRNA-BU delivered to mice produced AET2010 with significantly higher peak concentration and expression duration than an equivalent dose of original AET2010. This study provides a sound basis for developing novel drugs targeting TIGIT.

There is an urgent need for predictive preclinical models to enhance the success rate of clinical trial outcomes. One of the main reasons for drug attrition is the lack of translational models, methods using human cells are particularly in the spotlight of regulatory bodies as they offer an alternative to in vivo studies and have the potential to improve the translational of preclinical trials. Organs-on-Chips (OoCs) are sensible candidates to reduce the cost and the ethical burden of animal models while accelerating and de-risking drug development. The innovation of such systems is based on both the increased relevance of the cells used and the ability to build precise, yet physiologically relevant, complex architectures. The use of microfluidic technologies with human induced pluripotent stem cells (hiPSCs) opens new routes to create relevant in vitro approaches as they will soon be able to reproduce clinical characteristics of donors or specific populations. The adoption of OoC models by pharmaceutical industries, and in fine by regulatory agencies, still requires: (i) establishing standardized, reproducible, robust, and replicable cell culture protocols with specific validation and characterization criteria, (ii) evidence that the technology predicts human responses, thus allowing to contribute efficiently and reliably to clinical trials success of novel therapeutics, and (iii) evidence that the models refine and reduce animal testing without compromising with the quality and the pertinence of the data generated.

In engineering, all moving rotating objects exhibit gyroscopic effects resulting from the action of an external torque on a rotating object. Gyroscopic effects are the action of a set of inertial moments and movements of an object around three axes of a three-dimensional Cartesian coordinate system. Moments of inertia are created by centrifugal and Coriolis forces, as well as the moment of change in angular momentum, which is expressed by their kinetic energy. The values of the moments of inertia directly depend on the speed of rotation of the object and its rotation around the axes. A short-term effect of an external load on a running gyroscope with displaced support can be manifested by its oscillations. The physics of gyroscope oscillations is not well explained in publications. This article describes the oscillations of a gyroscope by the action of the external torque which is its potential energy converting into kinetic energy of the inertial torques of the gyroscope. The conversion is carried out by the principle of mechanical energy conservation which is the same as for oscillations of a spring with a load.

Gliomas are known to be one of the most grievous malignant central nervous system (CNS) tumors and have a high mortality rate with a low survival rate severe disability and increase risk of recurrence. Aim of his study is to determine the diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low-grade and high-grade gliomas, taking histopathology as the gold standard. It is a Cross-sectional validation study conducted at the Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, Pakistan from 28th February 2022 to 27th August 2022.Materials and methods: A total of 215 patients with focal brain lesions of age 25-65 years of either gender were included. Patients with a cardiac pacemaker, breastfeeding females, de-myelinating lesions and malignant infiltrates, and renal failure were excluded. Then diffusion-weighted magnetic resonance imaging was performed on each patient by using a 1.5 Tesla MR system. The area of greatest diffusion restriction (lowest ADC) within the solid tumor component was identified while avoiding areas of peritumoral edema. Results of ADC were interpreted by a consultant radiologist (at least 5 years of post-fellowship experience) for high or low-grade glioma. After this, each patient has undergone a biopsy in the concerned ward, and histopathology results were compared with ADC findings. Results: Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low- and high-grade gliomas, taking histopathology as the gold standard was 93.65%, 87.64%, 91.47%, 90.70% and 91.16% respectively. Conclusion: This study concluded that apparent diffusion coefficient (ADC) is the non-invasive modality of choice with high diagnostic accuracy in differentiating low- and high-grade gliomas.

The COVID-19 Pandemic, which began in March 2020, and its associated surges, had an immense impact on our medical staff and their ability to perform their daily duties.The COVID-19 Pandemic necessitated hospital modifications, including the expansion of the Emergency Department, ICU, and Isolation units. The overwhelmed staff and overburdened ER and ICU required adjustments to deal with the Inpatient impasse. For example, temporary patient care rooms needed to be set up for the overflow of patients. The tsunami of the Pandemic almost overwhelmed our hospital.With the challenges presented to our hospital during the Pandemic, we needed a fresh perspective to our multi-disciplinary approach. Thus, we fathomed that the use and cost-effectiveness of both Dalbavancin, a long-acting lipoglycopeptide antibiotic combined with the diagnostic Moleculight Imaging Device would be a sound decision.We hypothesized that with the use of this cost-effective antibiotic in conjunction with the use of the Moleculight Imaging Device, with its fluorescent imaging, we could detect the presence of bacteria and assist our wound treatment and decision-making.A shift in patients from the Emergency Room/Inpatient Department to the Outpatient Department/Wound Care Center was made possible with the use of these two novel products.

Therapies using autologous serum and platelet lysate have shown promise among blood and biological products in the treatment of various diseases. The autologous serum has been shown to be a superior alternative to traditional eye drops in treating eye diseases in ophthalmology. Platelet lysate (PL) has recently been considered a more interesting alternative for the treatment of multiple tissues, as it does not have the unfavorable reactions seen with traditional platelet-rich plasma (PRP), making it a valuable blood derivative for use in ocular therapy. There is no definitive comparison in veterinary medicine between PL and autologous serum in terms of the content of Transforming Growth Factor beta 1 (TGF-1), which is known to have chemotactic, mitogenic, matrix formation, and angiogenesis effects on tissues, and beneficial proteins in ocular tissue. This study aimed to estimate the concentrations of TGF-1, total protein, and albumin, as well as autologous serum and platelet lysate, in horses over an 8-day storage period at temperatures of 4 °C and 37 °C.To produce autologous serum, 63 ml of blood was collected from each animal in seven 9 ml tubes without anticoagulant. For platelet lysate, 180 ml of blood was collected in 50 tubes of 3.6 ml with 3.2% sodium citrate. The most significant findings were the positive relationship between the baseline platelet count in the blood and the final platelet concentration in PRP. Specifically, we found a correlation (R = 0.9) with a p - value of 0.005 between the average baseline platelet level of seven animals and their corresponding PRP results, both on an individual level and as a group. Additionally, there was a correlation between growth factor concentration and PRP platelets, with the highest growth factor concentration in PL. The temperature storage group exhibited higher concentrations of total protein and serum albumin, as well as the maximum amount of growth factor for both products at a temperature of 37 °C.

The construction sector consists of a collection of activities related to buildings and engineering constructions of all kinds. It is the close relationship between this sectors with other economic sectors, which distinguishes it. Therefore, it is an important indicator of the movement of the national economy, but this sector faces major risks, especially in the construction of luxury residential buildings, and these risks may affect the implementation of the project and may lead to increase costs, affect the quality and sometimes delay delivery. This study was carried out to evaluate the factors affecting the quality of luxury residential buildings in Iran using the fuzzy best-worst method (fuzzy BWM). The BWM method provides a consistent structural comparison of factors through best and worst criteria. And this method extended using a fuzzy set to address the ambiguity from the decision-maker’s judgment. The evaluation consists of five criteria: Strength and stability, physical comfort and mental peace, visual proportions and beauty, safety, security and environment, and welfare and health. To determine the fuzzy criteria’ weights, the nonlinearly constrained optimization problem was applied. The result indicated that the best and the worst criteria were Visual proportions and beauty and welfare and health.

Background: This work aims to show that the process of transfer of angular momentum ‑ spin supercurrent ‑ may provide the fulfillment of the fundamental law of ecology: “Everything is connected to everything else”.Results: The conducted investigations are based on the following properties of spin supercurrent: the equalization of the characteristics of interacting objects’ spins; dissipation-free; inertia-free (it is not accompanied by the emergence of kinetic mass); superluminal speed (there is no contradiction with Special Relativity, as Special Relativity postulates the speed limit only for an inertial process). The spin supercurrent emerges between virtual photons having a spin and being created by quantum objects of different types: living and non-living, electrically charged and neutral, magnetized and non-magnetized, having non-zero rest mass and having zero rest mass (such as photons). Conclusion: It is shown in this work that the properties of spin supercurrent may determine the following phenomena in ecology: the mimicry of animals and plants; the contactless (without living pathogenic microorganisms) spread of epidemics; the influence of the terrain relief on the population longevity; the use of water as information matrix; the stabilization of energy in the Earth’s core. Since the spin supercurrent possesses such properties as dissipative-free, superluminal speed, the non-electric and non-magnetic nature, it may perform interaction (quantum teleportation) of quantum objects between the Earth and Cosmic bodies. Thus, the extension of the biosphere’s border to Outer Space is possible.

To reduce bleaching side effects, the use of low concentrations of Hydrogen Peroxide (HP) agents associated with hybrid light (violet LED/Diode Laser) has gained interest. Case report: The aim of this report is to describe a case of a 16-year-old patient that presented a complaint related to the color of his teeth and a maxillary midline diastema. In-office bleaching with 6% HP associated with hybrid light (violet LED/Diode Laser) was performed. The bleaching gel was applied once on the teeth and light-activated for 1 minute (15 times) followed by 1min intervals (15 times) with a total bleaching time of 30 minutes. After the bleaching procedure, the teeth were polished and the desensitizer was applied for 4 minutes. Two bleaching sessions were performed at a 1-week interval. The diastema was closed with direct resin composite restorations without any tooth preparation. The conventional 3-step bonding agent was used and A1 dentin shade and B1 enamel shade were used followed by polishing discs. At 3-year recall, discoloration and fractures were not found on the the teeth or restorations and patient was completely satisfied. Conclusion: the conservative and safe option of bleaching with a low-concentrated HP gel associated with violet LED light is an interesting option for young patients and presents longevity over time.

Background: Measurable residual disease (MRD) status before allogeneic hematopoietic stem cell transplantation (AHSCT) is commonly associated with a high risk of relapse. It is still uncertain whether AHSCT could overcome the negative impact of MRD positivity (MRD+), especially in patients with high-risk Philadelphia negative acute lymphoblastic leukemia (Ph-negative ALL). Materials and methods: An observational retrospective study was conducted on patients with high-risk Ph-negative ALL who underwent AHSCT between January 2005 and June 2022. The patients selected were in complete remission (CR): with 80% in CR1 (n = 69) and 20% in CR2 (n = 17). Graft sources were bone marrow (BM) in 71% of patients and peripheral blood stem cells in 29% of patients. The conditioning regimen was TBI or chemotherapy-based (CT). Bone marrow MRD level was quantified using 4-6 color multiparametric flow cytometry (MFC). The threshold for MRD positivity was ≥ 0.1%. Results: The study included 86 patients (45 B-ALL and 41 T-ALL) with a median age of 18 years (range, 4–55 years). The median level of MRD pre-AHSCT (pre-MRD) was 0.4×10-3 (range, 0.01-75.6×10-3). After a median follow-up of 25 months (range 1-205 months), the cumulative incidence of relapse (CIR) was significantly higher in the MRD+ group (39% vs. 20%, p = 0.04). The median time of relapse post-AHSCT was 14 months (range, 1-203 months) in the MRD+ group and 32 months (range, 4-209 months) in the MRD- group (p = 0.28). Non-relapse mortality (NRM) was 15% in both groups (p = 0.97). The 2-year estimated overall survival (OS) and event-free survival (EFS) were 61% vs. 74% (p = 0.07) and 58% vs. 70% (p = 0.10) in the MRD+ and MRD- groups, respectively. A subgroup analysis in MRD+ patients showed that a TBI-based conditioning regimen was distinctly associated with lower CIR (22% vs. 60% respectively, p = 0.04), improved OS (82% vs. 36% respectively, p = 0.007) and better EFS (73% vs. 38%, p = 0.04) compared to CT-based. In a multivariate analysis, pre-AHSCT MRD+ status and non-TBI-based conditioning were significantly associated with inferior OS (OR, 2.30; 95% CI, [1.027-5.168], p = 0.04 and OR, 3.91; 95% CI, [1.624-9.418], p = 0.002, respectively). The only predicting factor of lower EFS was the non-TBI-based regimen (OR, 2.82; 95% CI, [1.308-6.097], p = 0.008). Non-TBI-based and CR2 were significantly associated with higher CIR (OR, 6.25; 95% CI, [1.947-20.055], p = 0.002 and OR, 4.74; 95% CI, [1.197-18.791], p = 0.03, respectively). Peripheral stem cell source was significantly associated with higher NRM (OR, 6.55; 95% CI, [1.488-28.820], p = 0.01). Conclusion: High-risk Ph-negative ALL patients with MRD ≥ 10-3 prior AHSCT had lower OS compared to MRD- patients and may benefit from TBI as a conditioning regimen before AHSCT.

Drug addiction remains a major health concern following its devastating consequences to the users and the economy. Current statistics show a rising trend in substance abuse around the globe with approximately 284 million people engaging in drug abuse. Various approaches are used to treat the victims of drug abuse. Cognitive behavior therapy, a form of nonpharmacological intervention, has also been shown to be an effective treatment option for drug addiction. The use of Cognitive Behavioral Therapy (CBT) has grown since the 1970s to become one of the most important models of psychotherapy in this decade. Various empirical studies have shown the efficacy of CBT in well-controlled trials. A total of 19 randomized trials (cases) (with over 1400 patients treated) were selected and studied. In the various cases, results showed that patients were treated for drug and substance abuse disorders with the majority being those who abused cannabis, cocaine, alcohol and other opioids. In most cases, the CBT techniques that were used for drug addiction included cognitive restructuring, relapse prevention and contingency management. Components of CBT for drug addiction include skills and training, amplification of non-substance-related activities, approaches for managing urges, drug rejection and improvement of social aptitudes. Cognitive restructuring focuses on the identification of misconceptions and influencing the way people think about themselves by eliminating distorted thinking. Relapse prevention focuses on the identification and prevention of high-risk situations that may trigger the patient to engage in drug abuse. Contingency management reinforces positive behaviors and reduces negative behaviors through the use of rewards and incentives.

In 2005 we reported for the first time on a chemical route aiming to synthesize stable magnetic carbon/graphite. By using the Nuclear Magnetic Resonance (NMR) technique we have verified that its magnetism is an intrinsic property of this synthesized material and not originated from ferromagnetic impurities of any kind. Through direct measurement of the local magnetic field using Carbon-13, we have concluded that its magnetism originated from defects in the structure. From its biocompatibility, we have been working on the use of magnetic carbon/graphite to deliver many compounds aiming to fight different diseases. Despite all the scientific and technological advances of the present day, cancer is a multifactorial and difficult-to-treat disease, killing hundreds of thousands of people a year worldwide. Therefore, the development of a new and efficient drug delivery system to fight cancer – among other diseases - is as important as the discovery of a novel active molecule. In this review of our own work, we show the drug delivery system named MAGUS® (an acronym for Magnetic Graphite Universal System) we have built based on nanostructured magnetic carbon/graphite. This is an innovative and promising system composed of a biocompatible nanostructured particle of magnetic carbon/graphite functionalized with different molecules and materials. MAGUS®, depending on what we link to its structure, is so versatile and can be used to detect a wide range of specimens, from tumors and cancers to chemical and biological agents used as non-conventional weapons. That is why we call it universal. In the present work, MAGUS® will be acting as a biosensor, where the magnetic carbon/graphite is functionalized with radioactive particles of Iodine-131 and antibodies of different types of cancer. Then, by focusing on both the antigen-antibody interaction and the spatial guiding through an external magnetic field we are providing our drug delivery system a double way to detect and reach just the target. Based on these strategies, the functionalized magnetic carbon/graphite will reach only the neoplasm and not the surrounding healthy cells around. In a general view, it means that we are giving specificity to the MAGUS® drug delivery system as a pioneering and effective way to detect and treat cancers. We are also working on this unprecedented and efficient drug delivery system using the principles of Boron Neutron Capture Therapy (BNCT) with Boron-10 instead of Iodine-131. BNCT technique uses neutrons as the external source and is frequently employed to treat specific tumors that are radio resistant or very difficult to kill using conventional radiation therapy. In summary, we show here for the first time that our Magnetic Graphite Universal System associated with nuclear techniques can be successfully used as a biosensor to detect and fight cancers and tumors with powerful features that conventional delivery drug systems and other treatments do not have at all.

Systemic sclerosis sine scleroderma is a rare subset of systemic sclerosis with isolated organ involvement. Scleroderma renal crisis is a severe manifestation of systemic sclerosis characterized by malignant hypertension, oligo/anuric renal failure, and thrombotic microangiopathy. We present a case of a 55-year-old male with uncontrolled hypertension who presented with hematospermia and was found to have acute renal failure, microangiopathic hemolytic anemia, concerning thrombotic microangiopathy. Empiric management for thrombotic thrombocytopenic purpura (TTP) with plasma exchange and corticosteroids yielded a paradoxical response, ultimately leading to the diagnosis of systemic sclerosis sine scleroderma presenting as scleroderma renal crisis (SRC) after serological confirmation. Given the morbidity and mortality associated with scleroderma renal crisis, it should be increasingly considered as a differential for thrombotic microangiopathy even without outward manifestations of systemic sclerosis. Additionally, the empiric management of TTP can include the use of corticosteroids which can exacerbate SRC, an early clinical clue in the diagnosis of this disease.

Background: Osteopoikilosis (OPK) is a rare osteosclerotic dysplasia. It is usually asymptomatic and diagnosis is made incidentally by radiographic findings. It has a unique radiographic presentation with multiple small, well-defined, circular, or ovoid radiodensities which are distributed symmetrically in the epiphysis and metaphysis of long bones.Aim of the work: In this case report, a 38-year-old man with mild joint discomfort was diagnosed with OPK according to his radiographic findings and literature review.Conclusion: It is important to diagnose OPK and to distinguish it from other medical conditions to calm the patient and to reduce unnecessary investigation.