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OBJECTIVE: Endoscopic ultrasonography (EUS) is an emerging method with a wide range of potential uses in gastroenterology, including the detection of bile duct stones and the identification of early ductal alterations in suspected patients. This study was designed to compare the diagnostic yield of EUS and transabdominal ultrasound (TUS) in the detection of gallbladder and common bile duct (CBD) microlithiasis. METHOD: Patients with biliary colic with normal initial TUS were the subjects of this prospective study. EUS scan was performed on all recruited patients and linear endoscopes were used for the EUS examination. Cholecystectomy and histological analysis were done in patients within two weeks after EUS revealing cholelithiasis whereas the cases of CBD stone/microlithiasis were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The mean values of all hematological characteristics were independently determined for males and females and then compared using Student's t-test. For statistical significance, a p-value of 0.05 or below was used. RESULTS: A total of 131 patients, including 77 females and 54 males, with a mean age of 38.41 ± 14.78 years were examined. All 78 (59.5%) individuals who had cholecystectomy were found to have gallstones or microlithiasis as successfully diagnosed by EUS. The sensitivity and specificity of EUS were 92.9% and 100%, respectively, for CBD stones and 98.8% and 100%, respectively, for the detection of gallbladder microlithiasis. The agreement between EUS and TUS was fair for CBD stones (κ = 0.214) and very weak for microlithiasis (κ = -0.093). CONCLUSION: EUS demonstrates a superior yield over TUS in detecting gallbladder stones and CBD microlithiasis, offering a more reliable diagnostic modality. LIMITATION: This was a single-center study.
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This case report explores the efficacy of warfarin compared to apixaban in managing antiphospholipid syndrome (APS), an autoimmune disorder characterized by recurrent thrombosis. We emphasize the constraints of direct oral anticoagulants (DOACs) such as apixaban in APS management. This case discusses a 41-year-old female patient with APS who did not respond to apixaban therapy. The report details her transition to warfarin, resulting in symptom resolution and no further complications, thus alluding to warfarin's effectiveness in APS management over apixaban. The case contributes to the ongoing debate on the suitability of modern DOACs in APS treatment.
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BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is a very rare benign defecation disorder characterized by distinct clinical features and histological findings. Conventional measures are often shown to be ineffective for the treatment of ulcers. Argon plasma coagulation (APC) has recently been shown to be an effective treatment method for SRUS that is refractory to conventional therapy. OBJECTIVES: Determine the efficacy of APC treatment for patients suffering from SRUS. DESIGN: Prospective, single center. SETTINGS: Gastroenterology department at a military hospital in Pakistan. PATIENTS AND METHODS: This prospective study included patients with symptoms of rectal bleeding diagnosed with SRUS. Patients were recruited on the basis of clinical, sigmoidoscopic, and histological findings from September 2022 to March 2023. All patients had received conventional treatment initially and were assessed for persistence of symptoms. APC was performed only for those patients who were refractory to standard treatment. MAIN OUTCOME MEASURES: Effectiveness of APC for resistant SRUS. SAMPLE SIZE: 99 patients. RESULTS: The 99 patients diagnosed with SRUS had a median (minimum-maximum) age of patients was 20 (9-41) years. All the patients had undergone conventional treatment, which included the use of laxatives, drinking plenty of water and practicing biofeedback. After this standard treatment, 19 patients (19.19%) recovered fully. However, the remaining 80 patients did not show improvement and underwent APC sessions, out of which 61 patients (76.3%) achieved complete healing of ulcers, while the remaining 19 (23.8%) had no improvement at all. None of the patients reported post session complications. CONCLUSION: APC is an effective therapy with very promising results for rectal ulcer hemorrhage. It also helps with ulcer healing and alleviates clinical symptoms. However, further controlled investigations are required to consolidate the use of APC in SRUS patients. LIMITATIONS: Single centered.
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Enfermedades del Colon , Enfermedades del Recto , Humanos , Adulto Joven , Adulto , Estudios Prospectivos , Úlcera/terapia , Úlcera/diagnóstico , Úlcera/patología , Coagulación con Plasma de Argón/efectos adversos , Enfermedades del Recto/cirugía , Enfermedades del Recto/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugíaRESUMEN
It is more isolating to patients if you aren't familiar with the resources: A pilot test of a clinician sensitivity training on eating disorders in pregnancy.(IRB Number: 1909705198).Background Pregnant women with a history of eating disorders (EDs) or active EDs have greater maternal and child health complications. They are also unlikely to disclose their history with an ED to their clinician, few of which are confident in their knowledge to provide appropriate care for patients who present with EDs. This study's goal was to evaluate changes to knowledge, behavior, and attitudes for health professionals who were part of a sensitivity training (to provide information of and awareness, address potential clinician biases, and offer strategies for more patient-centered care with de-stigmatizing language) about eating disorders and pregnancy compared with those who received a reference document.Methods Our pilot study compared responses of health professionals before and after this sensitivity training (N = 54) with a group who were provided a clinician reference document about the same topic (N = 61).Results Mann-Whitney Wilcoxon tests showed significant differences between the sensitivity training and reference document groups, with the sensitivity training resulting in increases to participants' perception of ED's relevance to overall treatment (p = 0.018), comfort in providing resources (p < 0.0001), frequency of ability to introduce strategies (p = 0.001), and interest in additional strategies/recommendations in treating patients with eating disorders (p = 0.009). Thematic analysis of the open-ended responses indicated four major themes: Resources and support, Treatment, Additional training, and Clinician Strategies. Discussion Results indicated that the sensitivity training improved training outcomes compared to the reference document group. Qualitative responses from both groups indicated four themes that can help inform ED-centered care. This study provides context for future directions for continuing education courses as well as clinical training recommendations for treating pregnant patients with EDs.
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Trastornos de Alimentación y de la Ingestión de Alimentos , Niño , Humanos , Femenino , Embarazo , Proyectos Piloto , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Personal de Salud/educación , LenguajeRESUMEN
Catamenial pneumothorax is one of the most common extra-pelvic presentations of endometriosis, with the gastrointestinal tract being the most common location. Catamenial pneumothorax is defined as spontaneous recurrent pneumothorax occurring in women of reproductive age in a temporal relationship with menses. Symptoms include dyspnea, sharp chest pain, and hypoxemia. A much rarer presentation is the involvement of endometriosis with the diaphragm. In this case, we present a 31-year-old female who presented with signs of pneumothorax. She has had multiple episodes leading to suspicion of catamenial pneumothorax. However, it wasn't until her surgery that the extent of diaphragmatic involvement, characterized by numerous holes secondary to endometriosis, was discovered. She was surgically treated, which led to a drastic improvement in symptoms and a reduction in subsequent episodes. We hope that this case can add to the current limited literature on diaphragmatic endometriosis cases. Since this patient presented with mainly catamenial pneumothorax symptoms, we urge clinicians to still consider diaphragmatic involvement as a primary cause in patients with recurrent episodes of pneumothorax.
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Objective: To evaluate the diagnostic accuracy of different imaging modalities in patients with partial biliary obstruction with no obvious aetiology on initial imaging. Methods: This is a prospective single-centre cohort study carried out at Pak Emirates Military Hospital, Rawalpindi from June 2019 to June 2021 with non-probability consecutive sampling. Patients with ages 16 to 75 years, presenting with partial biliary obstruction and undetermined aetiology on initial imaging (TUS and MRCP) were enrolled. EUS was performed for each of these patients and the case was regarded as "true positive" or "true negative" if the findings of imaging modality correlated to those of ERCP. ROC curve, sensitivity, specificity, PPV, NPV and AUC (with 95% confidence interval) were drawn for all the diagnostic tools using SPSS V. 21. Results: A total of 65 patients were enrolled over a period of two years with male to female ratio of 1.4:1. Forty-four patients had an intermediate risk of choledocholithiasis upon preliminary evaluation whereas, 48(74%) of the participants had CBD calculi or sludge confirmed upon subsequent ERCP. Trans-abdominal ultrasound showed the lowest sensitivity (29.2%), specificity (85%), NPV 12% and PPV 93% for diagnosing CBD calculi. This was followed by MRCP with a sensitivity of 37.5%, specificity of 100%, NPV of 36.2% and PPV of 100%. EUS showed the maximum diagnostic accuracy with AUC of 1.0 and a 100% sensitivity and specificity when compared with ERCP as gold standard. Conclusion: EUS is superior to MRCP in terms of diagnostic accuracy as minimally invasive diagnostic tool and EUS superiority is particularly relevant in patients with intermediate risk of choledocholithiasis.
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Examining the quality perceptions of consumers has often been recommended as an international research paradigm. This study is grounded in the Pakistani consumer market to evaluate the impact of food packaging cues on perceived product quality. The moderating effect of consumer knowledge was also taken into consideration in the study. A signaling theory was used in the study for its established predictive power in consumer behavior, marketing, and various fields of research. Based on the essence of the signaling theory, this study hypothesized that food packaging cues cast a positive impact on perceived product quality and consumer knowledge moderates these relationships. By using the sample of 504 consumers, data were gathered using the mall intercept method following a multi-stage sampling technique. The responses were analyzed using Statistical Package for Social sciences (SPSS) and Smart Partial Least Square (PLS). The findings of this study unveil that the extrinsic cues' brand name, price, nutritional labels, and precautionary labels were positively and significantly related to the perceived product quality. However, the country of origin cast no impact on the perceived product quality. Consumer knowledge reflected a moderation effect on the relationships between brand name and country of origin with the perceived product quality whereas it exerted no moderation impact on the relationships of price, nutritional labels, and precautionary labels with the perceived product quality. As the results exhibit that Pakistani consumers rely on food packaging cues for perceiving a product, hence it is recommended that marketers and policymakers develop appropriate marketing strategies focused on the significance of food packaging cues.
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Abuse of synthetic cannabinoid receptor agonists (SCRAs) has been associated with young individuals. The abuse of SCRAs is very rare in elderly people, but a few cases highlight the SCRAs-induced side effects. These substances lead to a variety of clinical and psychiatric symptoms including seizures. Here we report recurrent seizures after SCRA abuse by an elderly patient.
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Agonistas de Receptores de Cannabinoides/efectos adversos , Convulsiones/inducido químicamente , Trastornos Relacionados con Sustancias/complicaciones , Anciano , Servicio de Urgencia en Hospital , Humanos , MasculinoRESUMEN
The microphthalmia family of transcription factors (MiT/TFEs) controls lysosomal biogenesis and is negatively regulated by the nutrient sensor mTORC1. However, the mechanisms by which cells with constitutive mTORC1 signaling maintain lysosomal catabolism remain to be elucidated. Using the murine epidermis as a model system, we found that epidermal Tsc1 deletion resulted in a phenotype characterized by wavy hair and curly whiskers, and was associated with increased EGFR and HER2 degradation. Unexpectedly, constitutive mTORC1 activation with Tsc1 loss increased lysosomal content via upregulated expression and activity of MiT/TFEs, whereas genetic deletion of Rheb or Rptor or prolonged pharmacologic mTORC1 inactivation had the reverse effect. This paradoxical increase in lysosomal biogenesis by mTORC1 was mediated by feedback inhibition of AKT, and a resulting suppression of AKT-induced MiT/TFE downregulation. Thus, inhibiting hyperactive AKT signaling in the context of mTORC1 loss-of-function fully restored MiT/TFE expression and activity. These data suggest that signaling feedback loops work to restrain or maintain cellular lysosomal content during chronically inhibited or constitutively active mTORC1 signaling, respectively, and reveal a mechanism by which mTORC1 regulates upstream receptor tyrosine kinase signaling.
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Lisosomas/fisiología , Diana Mecanicista del Complejo 1 de la Rapamicina/fisiología , Factor de Transcripción Asociado a Microftalmía/fisiología , Proteínas Proto-Oncogénicas c-akt/fisiología , Transporte Activo de Núcleo Celular , Animales , Factores de Transcripción Básicos con Cremalleras de Leucinas y Motivos Hélice-Asa-Hélice/metabolismo , Células Cultivadas , Receptores ErbB/fisiología , Ratones , Regiones Promotoras Genéticas , Receptor ErbB-2/fisiología , Proteína 1 del Complejo de la Esclerosis Tuberosa/fisiologíaRESUMEN
BACKGROUND: Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones. OBJECTIVES: The aim of this study is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use. METHODS: The picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed. RESULTS: Of the patients discharged, 278 patients did not receive antibiotics in the ED or a prescription. Of these, 8 patients had positive culture, 4 patients followed up, and one developed and was treated for a urinary-tract infection. One hundred ninety two patients were not given antibiotics in the ED but received an antibiotics prescription, and 4 patients had positive cultures grow. Two followed up and had no infection-related complications. Fourteen patients were discharged without a prescription after receiving a single dose of antibiotics in the ED, with no positive urine cultures and 9 patients following up without complication. CONCLUSION: Antibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.
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Antibacterianos/uso terapéutico , Bacteriuria/tratamiento farmacológico , Servicio de Urgencia en Hospital , Pautas de la Práctica en Medicina/estadística & datos numéricos , Piuria/tratamiento farmacológico , Cálculos Ureterales/terapia , Infecciones Urinarias/tratamiento farmacológico , Adulto , Anciano , Bacteriuria/diagnóstico , Bacteriuria/etiología , Bacteriuria/orina , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Piuria/diagnóstico , Piuria/etiología , Piuria/orina , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Cálculos Ureterales/complicaciones , Cálculos Ureterales/diagnóstico , Cálculos Ureterales/orina , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/etiología , Infecciones Urinarias/orinaRESUMEN
Rodent species, such as monogamous and biparental California mice, produce vocalizations as a means of communication. A temporal examination of vocalizations produced by California mice pups in isolation was performed. Pup recordings were performed for 3 min at â¼10.00 and 14.00 hrs on early postnatal days (PND) 2-4, 7, 21, and 28. Once initial recordings were finished, pups were returned to the home cage with parents and any siblings for 5 minutes to determine if active biparental responses resulted in an enhanced vocalization response when pups were isolated and retested. We also sought to determine whether potential reduction in vocalizations by older pups might be due to procedure-habituation procedure associated with less anxiety and/or possibly decreased need for parental care. Vocalizations were measured in weanling (30 days of age) "naïve" pups not previously isolated. Results show older pups took significantly longer to vocalize, indicated by increased latency before producing their initial syllable compared to earlier ages. With increasing age, pups demonstrated decreased syllable duration, reduced number and duration of phrases, and decreased number of syllables per phrase. No differences in pup vocalizations were observed before and after being placed back with parents, suggestive biparental potentiation may not exist in California mice pups. Comparison of the naïve to habituated weanling pups indicated the former group had more total calls but no other differences in vocalization parameters were detected between these 2 groups. Collectively, the findings suggest that as California mice pups mature and approach weaning they generally vocalize less in isolation. (PsycINFO Database Record
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Animales Recién Nacidos , Conducta Animal , Vocalización Animal , Animales , California , Ratones , Peromyscus , Conducta SocialRESUMEN
BACKGROUND: Autosomal recessive congenital hereditary endothelial dystrophy (CHED2) is a recessively inherited eye disorder that is more common in consanguineous populations. METHODS: Two families affected with CHED2 were recruited from the Punjab province of Pakistan to identify the underlying genetic defect. Blood samples from both the families, designated as CH01 and CH02, were collected. Genomic DNA was isolated. Initially, linkage analysis using microsatellite markers was carried out to confirm the linkage to the SLC4A11 gene, previously reported to be implicated in the pathology of the disease. Later on, sequencing was carried out to find the pathogenic mutation in the enrolled families. Identified variation was further confirmed by typing 50 ethnically matched normal control samples. RESULTS: The results of linkage analysis indicated the putative linkage to SLAC4A11 gene, located at the CHED2 locus on chromosome 20p13-p12 in both families. Mutational analysis revealed an unidentified homozygous mutation c.2024A>C (p.E675A) in the affected members of both the families. Haplotype analysis of both the families showed that the affected members carry the same haplotype, thereby indicating a possibility of a common ancestral mutation. Use of bioinformatic tools including PolyPhen and SIFT suggested that a single amino acid change of E to A at position 675 affected the function of the protein. CONCLUSION: This study reports a newly identified mutation (c.2024A>C) in the SLC4A11 gene segregating with the diseased haplotype in two consanguineous Pakistani families.
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Proteínas de Transporte de Anión/genética , Antiportadores/genética , Distrofias Hereditarias de la Córnea/genética , Mutación Missense , Consanguinidad , Femenino , Ligamiento Genético , Haplotipos , Humanos , MasculinoRESUMEN
Herein we describe the development of a new class of antimicrobial and anti-inflammatory peptidomimetics: cyclic lipo-α-AApeptides. They have potent and broad-spectrum antibacterial activity against a range of clinically relevant pathogens, including both multidrug-resistant Gram-positive and Gram-negative bacteria. Fluorescence microscopy suggests that cyclic lipo-α-AApeptides kill bacteria by disrupting bacterial membranes, possibly through a mechanism similar to that of cationic host-defense peptides (HDPs). Furthermore, the cyclic lipo-α-AApeptide can mimic cationic host-defense peptides by antagonizing Toll-like receptor 4 (TLR4) signaling responses and suppressing proinflammatory cytokines such as tumor necrosis factor-α (TNF-α). Our results suggest that by mimicking HDPs, cyclic lipo-α-AApeptides could emerge as a new class of antibiotic agents that directly kill bacteria, as well as novel antiinflammatory agents that act through immunomodulation.