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Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat. Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and, in some cases, opioids. NSAIDs are a broad class of drugs with different attributes such as cyclo-oxygenase (COX)-1 or COX-2 selectivity, onset of action, and analgesic potency. NSAIDs are associated with gastrointestinal and cardiovascular side effects and should be administered at the lowest effective dose for the shortest effective duration but can be effective in postoperative pain. The role of opioids in postoperative analgesia is long-standing but has recently come under scrutiny. Opioids are often used in multimodal analgesic combinations in such a way as to minimize the total consumption of opioids without sacrificing analgesic benefit. Special clinical considerations are required for surgical patients already on opioid regimens or with opioid use disorder. A particularly useful fixed-dose combination product for postoperative analgesia is dexketoprofen-tramadol, which confers safe and effective postoperative pain control and reduces the risk of persistent postoperative pain.Ectopic liver tissue is a rare developmental abnormality, and its association with hourglass constriction of the stomach is undocumented to date. This case report describes the discovery of morphologic variations in the liver of an adult female cadaver during routine dissection. The variations include a small, pedunculated, club-shaped accessory lobe covered by a glistening fibrous capsule connecting it to the gallbladder wall, with vessels radiating into the lobe. Two additional lobes were present, one attached to the right upper margin of the caudate lobe, overlapping the inferior vena cava, and another near the quadrate lobe. The right lobe had an abnormal shape with multiple incomplete fissures and furrows. The left lobe was hypoplastic with an elongated end, resembling a lingular process. Further dissection revealed a prominent fibrous band on the posterior surface of the stomach, which continued anteriorly, giving it an hourglass appearance. [https://www.selleckchem.com/products/medica16.html MEDICA16] Knowledge of such variations helps surgeons and radiologists rule out related abnormalities.<br /><br /> The coronavirus disease 2019 (COVID-19) pandemic has taken the world to different dimensions. With the surge of the second wave in India, the number of cases with mucormycosis has increased. Mucormycosis is a potentially life-threatening, opportunistic, invasive, fungal infection that can occur in immunocompromised states. The aim of the study is to analyze the clinicopathological parameters of patients with mucormycosis in the surge of the second wave of COVID-19.<br /><br /> All cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in South India from March 2021 to June 2021 were included in the study. The patient details were retrieved from the Medical Records section. The patient characteristics, location, associated comorbidities, management and treatment outcomes were analyzed and compared to similar studies reported worldwide.<br /><br /> Of 58 cases, 38 (65%) were males and 20 (35%) were females. The ages ranged from 34 to 77 years. Severe acute respiratory syndrome coronavirus 2 (SARSng them 45% underwent extensive surgical debridement and 15% underwent orbital decompression. Orbital exenteration (2%) was the other modality of management.<br /><br /> Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.<br /><br />Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem involvement and most commonly affects women of childbearing age. Most of the patients, if not all, have positive antinuclear antibody (ANA) in their serum. ANA-negative SLE is extremely rare. Here, we present a case of a 15-year-old girl presenting with pancreatitis due to ANA-negative SLE.The incidence of infections by rapidly growing mycobacteria has increased in recent decades. nontuberculous mycobacteria(NTM) represent over 190 species and subspecies and can cause both pulmonary and extrapulmonary symptoms. The Mycobacterium abscessus complex (MABC)is among the most drug-resistant mycobacterial species, and prompt diagnosis and effective eradication are burdensome. We present the clinical course of a 55-year-old female who was diagnosed with M. abscessus and explore her clinical diagnosis and possible treatment options. This case report emphasizes the challenges clinicians face in the prompt diagnosis of M. abscessus and discusses the treatment options in light of the recent guidelines.Sanjad-Sakati syndrome (SSS) is an autosomal recessive genetic condition, with the first report discussing this condition presented in Saudi Arabia. This case report describes an iatrogenic stone as a result of hypocalcemia overtreatment, along with its subsequent management procedure. The current literature concerning the iatrogenic stone occurrence and the operative outcome of percutaneous nephrolithotomy in individuals with SS is scarce, warranting further investigation.Cone-beam computed tomography (CBCT) amounts to an excellent diagnostic tool to evaluate the peri-implant bone thickness in all dimensions. Despite the unquestionable advantages of CBCT, potential artifacts around dental implants might disturb the proper assessment of the surrounding structures. The artifacts may mask osseointegration, shallow bone defects, and other types of radiolucency, which make it difficult to establish an early diagnosis of bone loss. Proper diagnosis of bone defect is necessary to decide about surgical intervention. The aim of this literature review is to assess the CBCT exposure causing artifacts on the peri-implant structures. An electronic search of MEDLINE (PubMed) database includes studies published before July 2021 and supplemented by manual research. Clinical, ex vivo, in vitro, and animal studies evaluating the relationship between exposition parameters and occurrence of artifacts around the dental implant in CBCT studies were included. A literature review revealed that kilovoltage, tube current, and field of view may affect the occurrence of artifacts around dental implants, all of which would compromise radiological evaluation. Therefore, it is feasible to reduce the incidence of artifacts and improve the image quality by appropriate modification of the exposure parameters. However, the reduction of artifacts is often associated with a significant increase in radiation exposure; hence, an effort should be made to minimize the radiation dose in line with the ALARA (as low as reasonably achievable) principle.Background The first COVID-19 wave resulted in a significant decline in acute cardiac admissions (ACAs) and delays to hospital presentation in Malta, as well as an excess of out-of-hospital cardiac arrests. The aim was to investigate the impact of the observed delays in presentation in 2020 on mortality and cardiac readmissions at six months. Methods All ACAs between 28th February and 30th April 2020 (first wave of COVID-19 in Malta) were included, and the corresponding 2019 period was used as a control. ACA was defined as an unplanned admission of an adult (aged ≥16 years) under the care of a cardiologist. Outcomes over the six months following the index ACA included death, cardiac readmission, and planned cardiac intervention at discharge. The term 'death' referred to all-cause mortality. Cardiac readmissions referred to unplanned admissions for acute cardiac pathology following the index ACA. During sub-analyses, ACAs were divided into acute coronary syndrome (ACS) and non-ACS. A first analysis compared thch to patients' in-hospital care during 2020 aimed at reducing further hospital contact post-discharge, and a selection bias secondary to an excess of out-of-hospital cardiac arrests during the initial wave of COVID-19. Further studies will be required to truly assess the collateral impact of non-COVID-19-related illness. Public education on cardiovascular health is vital and must be emphasized during the pandemic.Background Focal segmental glomerulosclerosis (FSGS) is characterized by the presence of glomerular damage on histopathological examination. The major defining symptom of FSGS is proteinuria, which indicates damage to the glomerular filtration barrier. Additionally, FSGS is the most common cause of primary nephrotic syndrome. However, in Saudi Arabia, there is a paucity of research on this topic. Therefore, this study was designed to examine the clinical features, laboratory findings, and presence of comorbidities in patients with FSGS to determine their effects on clinical outcomes. Methods We retrospectively analyzed the histopathological and clinical data of patients diagnosed with FSGS via biopsy at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, during the period 1989-2020. Biopsy samples were labeled according to the Columbia classification as tip, perihilar, cellular, collapsing, or not otherwise specified (NOS). Results We included 39 children and 21 adults. Males accounted for 54.1% of the sample. Hypertension was the most common comorbidity. Regarding FSGS subtypes, 60.9% of the lesions in the adult patients were collapsing lesions, followed by NOS (26.1%). In pediatric patients, 36.8% of the lesions were NOS, followed by collapsing lesions (28.9%). We also observed a very low rate of remission. In both age groups, the most common clinical presentation was nephrotic syndrome. Conclusion We found a high prevalence of collapsing and NOS FSGS subtypes in both the adult and pediatric age groups. The most prevalent outcome was the persistence of nephrotic syndrome with low rates of remission.The photosynthesis of wheat glumes makes important contributions to the yield. Stomata play a crucial role in regulating photosynthesis and transpiration in plants. However, the genetic base of wheat glume stomata is not fully understood. In this study, stomatal length (SL), stomatal width (SW), stomatal density (SD), potential conductance index (PCI) of stomata, stomatal area (SA), and stomatal relative area (SRA) were measured in different parts of wheat glumes from a doubled haploid (DH) population and their parents. Quantitative trait loci (QTLs) of these traits were anchored on a high-density genetic linkage map of the DH population. A total of 61 QTLs for stoma-related traits were mapped onto 16 chromosomes, and each one accounted for 3.63 to 19.02% of the phenotypic variations. Two QTL hotspots were detected in two marker intervals, AX-109400932∼AX-110985652 and AX-108972184∼AX-108752564, on chromosome 6A. Five possibly candidate genes (TraesCS6A02G105400, TraesCS6A02G106400, TraesCS6A02G115100, TraesCS6A02G115400, and TraesCS6A02G116200) for stoma-related traits of wheat glumes were screened out , according to their predicted expression levels in wheat glumes or spikes.