Articles

   The role of repulsive and attractive forces at the molecular level in the aging process is a constant, omnipresent part that occurs over time, in all chemical processes, not just biochemical ones. The same thing happens in concrete, because as time goes by, it tends to become more and more compact, which is a result of the repulsive forces being minimized and the attractive ones being optimized.

   A number of viral, immune-mediated, or toxic causes can cause myocarditis, an acute or chronic inflammatory reaction of the heart muscle [1]. Even though the term "myocarditis" unambiguously refers to myocardial inflammation, the clinical diagnosis is not always straightforward. First off, there is a vast range of clinical symptoms of myocarditis. Second, although being the gold standard for myocarditis diagnosis, endomyocardial biopsy (EMB) cannot be performed routinely due to its invasiveness [2, 8]. A non-invasive imaging modality called cardiac magnetic resonance imaging (CMR) has already been developed and is well-established for non-invasively detecting myocarditis.

   Xanthogranulomatous pyelonephritis (XGP) is a rare and severe form of kidney infection that primarily affects adults. Its occurrence in children is extremely uncommon, and less than 300 pediatric cases have been reported. XGP is characterized by the presence of yellowish nodules or abscesses in the renal parenchyma. The exact cause of XPG in children is not fully understood; however, it is believed to be a result of chronic urinary tract infections and obstructive uropathies. The clinical manifestations of XPG are nonspecific, including abdominal pain, unexplained fever, weight loss, or a palpable renal mass.

    A 5-year-old girl with hearing impairment was brought to the ophthalmology clinic by her parents for a very marked photophobia. On examination, the bright blue color of the iris was striking (Fig.1), the child had a large nasal base, synophris, a cantal dystopia with diffuse choroidal hypopigmentation in both eyes. The auditory evoked potentials revealed bilateral sensorineural hearing loss at 65 dB The diagnosis of Waardenburg syndrome was retained given the association of more than 2 major criteria: sensorineural deafness, canthi dystopia and depigmentation anomalies. The child received a hearing aid and speech therapy.

   The endometrium is the tissue that lines internal surface of the uterus and is made up mostly of mucosal tissue in two layers. The first layer, called stratum basalis, attaches to the layer of smooth muscle tissue (myometrium) of the uterus and serves as an anchor for the endometrium and stays relatively unchanged. The second layer called the stratum functionalis, is dynamic as it changes in response to the monthly flux of hormones that guide the menstrual cycle. It's the part of the endometrium where a fertilized egg will implant if conception occurs. This mucous membrane thickens in anticipation of a possible pregnancy in each menstrual cycle.

    Diabetic individuals are more likely to develop non-healing ulcers, especially if their blood sugar levels are high or if they've got a history of smoking and chewing tobacco. Poorly managed diabetes can lead to the narrowing of the major arteries that provide blood to the legs. Furthermore, it harms even smaller blood vessels. By harming the nerves and reducing feeling in the foot, this raises the chance of injury. Poor wound healing may be a sign that blood sugar levels need to be checked. A non-healing ulcer can develop for a variety of motives, including pressure, venous, or diabetic ulcers. Here is a couple of usual justification for each.

   A two-month-old full-term baby boy presented to our hospital with respiratory distress. He was the first child of a consanguineous parents. He was born full term by C- section delivery. Apgar score was normal. Birth weight was 2.550 gram. The second trimester morphology ultrasound showed a shortened spine with disordered vertebrae and thick skin and there was no family history of inherited skeletal dwarfism. He was noticed to have short neck / trunk and abdominal distension and the limbs though of healthy appearance appeared relatively longer. There was no evidence of any mental or neurologic deficit. He developed respiratory distress soon after birth. The chest cavity appeared small and asymmetric.

   Tracheal and carinal tumors which cause the obstruction of the airway can be managed by endoscopic resection, chemoradiotherapy, tracheal stent and surgical resection. However, surgical treatment is the major choice of the patients, which requires individualized strategies based on the location and the size of the tumor, as well as its extent of involvement [1-2]. The main principles include i) reducing anastomotic tension to avoid anastomotic leakage, ii) maintaining the continuity of the airway to preserve normal blood supply and ciliary function. iii) selecting appropriate materials to embed the anastomosis.

   A 63-year-old man presented with a self-limited episode of oliguria followed by pollakiuria and episodes of nonspecific incontinence. For months now, nocturia has been reported, with a weak and interrupted stream of urination. He had no medical history or regular treatment.

   Autoimmune hepatitis (AIH) is a rare chronic liver disease characterized by liver inflammation resulting from an abnormal immune response of the affected patients against their own liver cells [1, 2]. This disease remains poorly understood, and its diagnosis is challenging due to the presence of nonspecific clinical signs and its low prevalence (about 20/100 000) [3]. Early and accurate identification of autoimmune hepatitis is essential for tailored therapeutic management to prevent disease progression and potential complications.

   Donepezil is a reversible acetylcholinesterase inhibitor approved by the Food and Drug Administration for use in mild to severe Alzheimer’s Disease (AD) [1, 2]. It works by inactivating the enzyme acetylcholinesterase (AchE) and increasing acethylcholine(Ach) levels in the brain [3]. It has also been shown to reduce the emergence of neuropsychiatric symptoms (NPS) such as psychosis (hallucinations and delusions) and other behavioral changes associated with cholinergic deficiency in approximately 60 – 90% of AD patients [4].

   Airborne infectious diseases, such as tuberculosis (TB) and coronavirus disease 2019 (COVID-19), mostly transmit in congregated and confined spaces with limited ventilation per person and a high accumulation of exhaled air that may contain airborne infectious particles [1,2]. TB and COVID-19 transmission occur through respiratory droplets from infectious individuals, and are highly correlated with social interactions, airspace per person, pathogen strains, proximity, frequency, and duration of exposure to infectious individuals [1, 3, 7,8].

   Neonatal diabetes is defined as persistent hyperglycemia occurring within the first 6 months and occasionally between 6 to 12 months of life [1]. The cause is most of the times a genetic defect hence the need to conduct genetic analysis in all infants presenting within the first 6 months of life [1]. Several genes have been studied as the cause of this condition and they can be classified into those that regulate pancreatic development like PDX1, HNF4A, HNFA1, FOX1, NEUROD1; those that are related to abnormal beta-cell function like INS, GCK, SLC19A2, GLUT2, KCNJ11, ABCC8 and those that are associated with beta cell destruction like WRS1, IER3IP1 and EIF2AK3 [2].

   Extramedullary myeloma is a type of MM defined by the presence of extraskeletal (soft tissue or visceral) clonal plasma cells infiltrates. Orbital involvement is very rare and has been reported to involve conjunctiva, cornea, retina, orbital bones, and rectus muscles [1]. Orbital involvement presents as a solitary soft-tissue tumor originating from bone deposits and may be associated with no bone destruction. Orbital involvement is more frequently extraconal (90%) and located in the superior-temporal quadrant (75%); the involvement of recti muscles is very rare [2].

   A 37-year-old female, devoid of prior pathologic history, exhibiting a brown tumor on her back for many years. Over the past year, the tumor grew larger, turning dark, becoming painful, and prone to bleeding. She reported occasional traumas during bathing and dressing. Clinical examination unveiled a 3cm tumor with a rough surface and a sessile base, encircled by peripheral bleeding. Upon dermoscopic examination, circular movements on the lesion revealed the tumor’s mobility, known as the “dimpling” sign. Furthermore, we observed the emergence of black dots and a central black, pavement-like area with reddish-purple hemorrhagic suffusion.

   A 72-year-old male farmer came to our clinic with a tumor in his lower lip. The patient had a history of arterial hypertension, with a chronic and intense exposure to sunlight, and smoking (30 pack-year) for 45 years. He informed us that the tumor in his lower lip had appeared as a small ulcer for two years which gradually increased in size. Physical examination showed a fungating and bleeding lower lip tumor.

   Dietary diversity is described as the consumption of a variety of food types during a certain period. Increasing the variety of foods and food groups in the diet helps to ensure adequate intake of es-sential nutrients. Diet-related malnutrition affects one out of three individuals globally. Despite economic and social progress, childhood malnutrition remains a major public health and social issue in Pakistan. The current study objective was to see the effects of a dietary diversity awareness campaign on the feeding practices of mothers of children aged under 5 years.

   In the doctor-patient interview, there is a tendency to think of a dichotomy between content or background (the patient's complaint, his symptoms, medical decision-making subject to evidence -evidence-based medicine (EBM)-, drug prescription, etc.) and the process or form of the interview (the modality of the doctor-patient relationship, empathy/assertiveness, sympathy, compassion, transference and countertransference, the placebo effect, etc.). This approach is as reductionist as the usual mind-body dualism.

   S.pyogenes infections were first described in the 5th century by Hippocrates, who wrote of a scarlet fever epidemic [1]. During the late 19th century, Rosenbach classified this pathogen as Streptococcus pyogenes [2]. In 1919, Brown described the classic streptococcal hemolytic patterns on blood agar plates, including beta (complete) hemolytic, which is seen in S. pyogenes. Classification of streptococcal infections drastically changed in the early 1930’s when Dr. Rebecca Lancefield, an American bacteriologist, pioneered a new technique of identifying and typing by streptococcal sero groups [3].

   Cancer is one of the illnesses where the stage at which the disease is diagnosed plays a crucial role patients survival and quality of life [1]. A diagnostic indicator that can detect cancer in early stages is of great significance, especially for breast cancer (BC), as it is the most common cancer in woman [2]. One field of interested is that of tumor markers, due to their noninvasive, rapid and simple nature [3]. Despite their low sensitivity and specificity, the carcinoembryogenic antigen (CEA) and cancer antigen 153 (CA153) are the commonest markers used.

   Cardiac tamponade is a life-threatening condition characterized by the accumulation of fluid, blood, pus, clots, or even gas within the pericardium which compromise of cardiac function. It can occur due to various causes such as inflammation, trauma, heart rupture, aortic dissection. Recently it has become increasingly common as a complication of complex cardiac interventions usually caused by epicardial artery rupture. In this case, we present a patient who developed delayed cardiac tamponade following percutaneous coronary intervention, with no apparent cause identified despite extensive investigation using imaging methods. After antiplatelet therapy de-escalation pericardial bleeding in ceased and patient had survived with full recovery.

   Ibrutinib is a small-molecule drug approved for the treatment of mantle cell lymphoma, chronic lymphocytic leukemia, and Waldenstrom macroglobulinemia. Although it has been connected to ocular side effects, few clinical cases explain cystoid macular oedema associated with long-term Ibrutinib treatment. A case of Cystoid Macular Oedema (CMO) caused by ibrutinib in a patient with chronic lymphocytic leukemia is presented. In our case study, an 85-year-old man’s vision deteriorated over 6-7 months. His right eye’s presenting vision was 0.76 and his left eye was 0.2. There was bilateral macular oedema on inspection. His ibrutinib treatment lasted 12 months. The temporal correlation between ibrutinib treatment modifications and the ocular inflammation in our patient points to a causal relationship. Ibrutinib is thought to cause drug-induced cystoid macular oedema.

   We report a case of a 33-year-old woman, who complains of a progressive loss of visual acuity for 6 years. Visual acuity was 4/10 which cannot be improved in both of eyes. The examination of the anterior segment of both of eyes was normal. Fundus examination reveals the existence of a rounded yellowish macular lesion with major macular atrophy in both of eyes (Panel A and B), the peripheral retina was normal. Auto fluorescence picture describe a bull’s-eye maculopathy limited by a hyperautofluorescent ring (Panel C). Macular OCT shows loss of the outer segments of the foveal photoreceptors (Panel D). The electroretinography confirmed the diagnosis of cone dystrophy by demonstrating an absence of response under photopic conditions, while the scotopic response is preserved.

   Dermatophytes, a group of keratinophilic filamentous fungi thriving on the keratin substrate, are the etiological agents responsible for causing superficial fungal infection in human and animals with an estimated global prevalence of approximately 20 percent as per the World Health Organization (WHO) report. Predominant in the tropical and subtropical countries; especially in the developing countries like India, the hot and humid climate is favorable to the acquisition and maintenance of the disease [1].

   Cerebral stroke, also known as “stroke” and “cerebrovascular accident”, is an acute cerebrovascular disease, including ischemic and hemorrhagic stroke. Cerebral stroke is the first cause of death and adult disability among Chinese residents [1], characterized by high incidence, high mortality, high disability and high recurrence [2]. Recent studies have found that intestinal flora may affect the occurrence and development of cerebral stroke through various channels such as nervous, neuroendocrine, and immune systems [3]. The immune and inflammatory responses of cerebral stroke patients continue to participate in the whole process of brain tissue injury and repair. As the largest immune system, the digestive tract plays an important role in regulating the immune function of the body [4].