Boltonpham9224

Ischemic stroke is an acute episode of neurological dysfunction resulting from the focal brain and spinal cord infarction. Many etiologies have been reported and vary significantly with the age of the patients. This study aims to show the association of G20210A prothrombin gene mutation and cerebral ischemic stroke in young patients. The prothrombin gene mutation is the second most common inherited thrombophilia after the factor V mutation. In this single missense mutation, guanine is substituted by adenine base pair in the nucleotide position 20210 of the 3'-untranslated region of the prothrombin gene, resulting in abnormal thrombin production predisposing to both arterial or venous thrombosis. Forty-seven relevant articles were selected after a thorough screening process using a regular keyword 'G20210A Prothrombin' and/or 'Ischemic Stroke' mostly from the PubMed database. We included the studies that are published in the last 22 years with patients age ≤57 years. This review article depicts the association of G20210A prothrombin gene mutation with ischemic stroke in young patients irrespective of ethnicity and zygosity status of their genotype. However, more multicenter prospective studies are needed to better understand the application of prothrombin gene mutation in predicting the associated risk of ischemic stroke in young patients and its importance in deciding the patients' treatment or prognosis.

For medical students seeking additional specialty experience in Med-Peds, in-person electives have often been a source of mentorship and guidance.The COVID-19 pandemic has impacted the ability for the completion of in-person clerkships for medical students across the nation.Virtual opportunities to increase exposure to Med-Peds programs and didactics are lacking at this time. Objective To develop a virtual Med-Peds student elective that serves to increase awareness of the Med-Peds specialty, exposure to Med-Peds topics and relevant didactics, and exposure to Med-Peds specific mentorship when on-site clerkships are not available due to the COVID-19 pandemic. MethodsFifteen medical students participated in a virtual Med-Peds student elective utilizing Zoom (Zoom Inc, San Jose, CA).Three separate cohorts of five students each completed two-week elective experiences.The virtual elective curriculum was created using asynchronous and synchronous learning modalities.Sessions were composed of self-directed learning the number of students who continue to consider dual-application to include either categorical Internal Medicine, categorical Pediatrics, or Family Medicine did not differ before and after completion of the virtual elective. Conclusions Implementation of a virtual medical student elective focusing on exposure to Med-Peds can strengthen medical students' interest in the combined specialty despite a paucity of previous experiences or an affiliated Med-Peds program. This new type of rotation can positively impact a student's view of a hospital system and a residency program when in-person clinical rotations are not available.This case describes a 52-year-old female who developed encephalopathy after being hospitalized with sepsis from a recently placed Permcath. A grade two decubitus ulcer was also a potential source of infection. Cefepime and Vancomycin were empirically begun, and the patient improved hemodynamically and clinically. She developed encephalopathy on day six of hospitalization. When the Cefepime was discontinued the encephalopathy promptly resolved. The causes of hospital acquired encephalopathy and potential difficulties in making this diagnosis are discussed with special emphasis on Cefepime induced encephalopathy.

In 2013, the World Health Organization (WHO) recommended new criteria for diagnosing gestational diabetes mellitus (GDM). Our study aimed to compare the incidence of GDM and its complications among Omani pregnant women using the new diagnostic criteria compared to previous criteria published in 1999.

This retrospective cohort study was conducted between January and December 2016 at the Bawshar Specialized Polyclinic in Muscat, Oman. A total of 613 Omani women were included in the study. Baseline maternal characteristics such as age, body mass index, parity, and socioeconomic status were recorded in addition to maternal and neonatal outcomes.

Based on the current diagnostic criteria, the incidence of GDM was 48.5% (n = 297); however, this dropped to 26.4% (n = 162) when applying the old criteria. Moreover, rates of maternal complications including polyhydramnios (5.6% vs. 4.6%), pregnancy-induced hypertension (3.2% vs. 1.5%), and preterm delivery (3.2% vs. 1.5%) were slightly higher among women with GDM d postnatal services.

We sought to analyze the neutrophil-to-lymphocyte ratio (NLR) as an alternative marker of neonatal sepsis.

In this cross-sectional study, we undertook consecutive sampling in all inborn neonates admitted to the Neonatal Intensive Care Unit with clinical manifestations of neonatal sepsis. Neonates with congenital anomalies and referred neonates were excluded. Complete blood count, C-reactive protein (CRP), and blood culture were carried out as the septic workup examinations based on the local Clinical Practical Guidelines. NLR is obtained by dividing the absolute count of neutrophils from lymphocytes manually. A cut-off value of NLR is obtained using a receiver operating characteristic curve.

The median NLR value of the 104 neonates who met the inclusion and exclusion criteria was 3.63 (2.39-6.12). HRO761 in vivo Neonates with NLR of 2.12 have the area under the curve of 0.630 (95% confidence interval (CI) 0.528-0.741) and 0.725 (95% CI 0.636-0.814) when combined with CRP = 2.70 mg/dL. Neonates with NLR ≥ 2.12 in clinical neotnatal sepsis had almost double the risk of providing positive blood culture results (relative risk = 1.867, 95% CI 1.077-3.235;

0.011).

NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.

NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.