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0001) of gastric cancer. Conclusions MPV is an inflammatory marker that correlates with nodal disease and aids in the staging and prognostication of locally advanced gastric cancer. This inexpensive, convenient marker can aid in the risk stratification of locally advanced gastric cancer.Introduction Hypospadias is the abnormal opening of the urethra at the undersurface of the penis. Hypospadias repair is performed in such patients to treat the condition. The success level of hypospadias repair in adults still needs to be established on a larger scale. Therefore, we conducted this study to document the success level of hypospadias repair in adults in our setting to add to the literature. Materials and methods This prospective study was conducted at a major metropolitan hospital in Karachi over a period of six months. A total of 75 male patients aged between 20-50 years and diagnosed with hypospadias of any level with or without mild to moderate chordee were included. Demographic features such as age and the duration of hypospadias were noted. Hypospadias repair using a tubularized incised plate (TIP) urethroplasty technique was performed, and the patients were observed for three days in the ward and for three months in the outpatient department for any complications. The procedure was conside6%). The stratification of patient age and the duration of hypospadias with the success of hypospadias repair showed a significant inverse relationship (p = 0.017). The data relating to patient age and the duration of hypospadias showed the same values as hypospadias is a birth defect. Conclusion Adult patients undergoing primary hypospadias repair generally show good outcomes. However, the chances of favorable outcomes gradually decrease with age. Hence, patients should be encouraged to undergo the procedure as early in their lives as possible. Patients who are middle-to-old aged should especially be counseled about the relatively higher risk of unsuccessful procedures. Further analysis is needed to confirm the validity of these findings.Supratentorial hemangioblastomas have rarely been described in the literature. Pituitary stalk hemangioblastomas are extremely rare and almost always are associated with von Hippel Lindau disease. Herein, we report a sporadic case of pituitary stalk hemangioblastoma in a 36-year-old male and review the current literature regarding this pathology. this website In our case, complete resection of the lesion was achieved using the transglabellar approach.A new tumor delineation technique for brain metastases has been proposed by jointly referring to thin-slice contrast-enhanced T1-weighted and thin-slice contrast-enhanced fluid-attenuated inversion recovery magnetic resonance (MR) images. A single-isocenter six-arc noncoplanar volumetric modulated arc radiotherapy (VMAT) plan for 16 brain metastases was created by the Monaco treatment planning system (Elekta AB, Stockholm, Sweden) with a photon energy of 6 MV. Each gross target volume (GTV) was very carefully delineated on all three orthogonal planes of the above two different MR images. A dose of 37.5 Gy was prescribed to 96% of the whole brain in 15 fractions with a simultaneous integrated boost (SIB) dose of 57 Gy to 95% of each of the eight GTVs each having a volume larger than 0.05 cm3 and another SIB dose of 52.5 Gy to 90% of each of the remaining eight smaller GTVs. For accurate tumor localization, an in-house thermoplastic mask was developed by modifying a commercial thermoplastic shell, in such a way that a portion of the thermoplastic shell was pushed into a patient mouth so that the patient can bite it with the lips and the teeth. The outer cylinder of a syringe was additionally pushed into the resulting mouthpiece portion, thereby providing an air duct for easier mouth breathing. Immediately before the VMAT delivery, bone matching was performed between planning CT and on-board cone-beam CT images; thereafter, a six-degrees-of-freedom couch was activated to correct the translational and rotational set-up errors. The treatment time per fraction was approximately 30 minutes including the couch rotations.Ocular myasthenia gravis and orbital metastases have overlapping symptoms but divergent diagnostic and treatment strategies. Here, we present a 58-year-old female, with a 20-year history of advanced metastatic breast cancer, who presented to the neurology clinic with fatigue, muscle weakness, bilateral ptosis, and diplopia that worsened throughout the day. While the initial presentation was consistent with ocular myasthenia gravis, a subsequent evaluation revealed bilateral metastatic lesions of breast origin within the orbits. This case highlights the variable nature of metastatic disease and underscores the importance of a comprehensive neoplastic workup in patients with new-onset symptomatology and a prior history of advanced cancer despite purported remission status.Over the last few months, the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians across the world. While much has been described in the literature about lung infiltrates and respiratory failure associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pneumothorax remains a relatively rare presentation with current literature indicating a rate of one percent. We describe a case series of three patients each of whom tested positive for SARS-CoV-2 on reverse-transcriptase polymerase chain reaction testing of nasopharyngeal swab specimens and presented with pneumothorax. These patients were treated at the New York City Health and Hospitals (NYC H+H) system, a network of eleven hospitals in four different boroughs of New York City. None of these patients had a history of lung disease and one patient was a previous smoker. One out of three patients died. Inflammatory markers were noted to be elevated in each of these patients to levels that have been associated with severe COVID-19 infection. CT scans in these patients showed bilateral air space disease consistent with COVID-19 pneumonia and pneumothorax with other features including pneumomediastinum, subcutaneous emphysema, and pneumatoceles. This may indicate the underlying pathogenesis of pneumothorax in these patients to involve inflammation-induced pulmonary parenchymal injury and necrosis with subsequent development of air leaks into the pleural cavity, a mechanism similar to that noted in patients during the severe acute respiratory syndrome (SARS) outbreak in 2003. Conservative management with chest tube drainage or observation was adequate for two of three patients while one patient developed multi-organ system dysfunction and eventual death.This case illustrates a rare, underdiagnosed disease, with a high mortality rate that is frequently misdiagnosed as acute bacterial endocarditis. Clinicians should include non-bacterial thrombotic endocarditis (NBTE) as a differential diagnosis in patients with culture-negative endocarditis, so that its underlying etiology can be further investigated.Hypopituitarism is a rare disorder. Hypopituitarism can present as a deficiency of individual anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone) or posterior pituitary hormones (e.g., oxytocin, vasopressin) or as the deficiency of all these pituitary hormones, also known as panhypopituitarism. Here, we discuss a 59-year-old man who presented with two episodes of unwitnessed syncope after an episode of vomiting. On admission, the patient was hypotensive to 88/54 mmHg, afebrile, and with a leukocyte count of 21.43 K/µL (reference range 3.80 to 10.50 K/µL). CT scan of the head revealed a hyperdensity in the left intracranial internal carotid artery just proximal to the bifurcation, suggesting an artifact or presence of an embolus. Additional findings included a sellar mass with calcifications and suprasellar extensions. The patient was admitted for further workup of syncope. Other differential diagnoses included sepsis, stroke, cardiac arrhythmias, and pulmonary embolism. Sepsis, stroke, and cardiac workup were negative for significant findings. The patient remained persistently hypotensive despite aggressive intravenous hydration, raising suspicion for an underlying endocrine disorder. MRI of the brain was negative for stroke but again was significant for a sellar mass. Additional workup showed a deficiency of all the anterior pituitary hormones likely secondary to mass effect. The patient was diagnosed with panhypopituitarism due to pituitary macroadenoma.Oculogyric crisis is a rare ocular dystonia first appearing at the turn of the last century in postencephalitic patients. In the modern era, they were most frequently associated with first-generation D1 dopaminergic receptor blocking antipsychotic medication. We present an unusual case of acute oculogyric crisis in a 74-year-old woman with long-standing Parkinson disease following exposure to the second-generation neuroleptic ziprasidone, which has dopaminergic (D2) and serotoninergic (5-HT2A) receptor blocking effects and is used for severe delusions and psychosis. To the best of our knowledge, there are no other published reports.There are many benign breast lesions that mimic breast cancer on breast imaging. Postlumpectomy scar, hematoma, fat necrosis, diabetic mastopathy, and granulomatous mastitis are examples of benign breast lesions that have suspicious breast imaging findings. Mammogram and breast ultrasound are the imaging studies to evaluate breast findings. CT scan is not used to evaluate breast findings because it delivers high radiation dose to the breast, and breast tissue is often confused as breast masses on CT scan. The following case demonstrates an incidentally detected breast mass on CT scan performed to assess for pulmonary embolism. The CT scan and subsequent breast ultrasound both demonstrated suspicious breast imaging findings. Final pathology from ultrasound-guided biopsy revealed hematoma. This benign finding was concordant with the patient's medical history of cirrhosis with low platelet count and medication history of warfarin.COVID causing Banti's syndrome has not been reported in literature yet. link2 Banti's syndrome is a rare disorder characterized by splenomegaly, ascites, and portal hypertension without coexisting cirrhosis of the liver. Here we report a case of a 32-year-old man who presented with hematemesis, and further workup revealed that the patient had bleeding varices, ascites, and splenomegaly, thus completing the picture of Banti's syndrome. Although this is a rare disorder, Banti's syndrome must be taken into account in a patient presenting with hematemesis and splenomegaly. The patient had flu-like symptoms for three weeks but did not seek any medical help and eventually presented with Banti's syndrome. His serology was positive for COVID-19. The coronavirus (COVID-19), discovered in 2019, has been creating havoc since it first emerged in China and is now spreading worldwide. Its presentation is somewhat similar to influenza.Purpose Medical teaching is a highly demanding and complex task. The advanced integrated curriculum and modern educational practices demand the roles of the medical teacher be redefined. This study was designed to understand the perceptions of the faculty of the Dental College, Qassim University, about their key roles as a teacher. These perceptions can be used to design faculty development workshops to enhance the awareness of the faculty about their educational responsibilities and achieve their potential. Methods It was a cross-sectional descriptive survey conducted on the faculty of the College of Dentistry, Qassim University, KSA. The study used a validated 12-item e-questionnaire to measure the perceptions of faculty about their teaching roles. Results A total of 44 faculty members submitted the e-questionnaire. link3 Most faculty members perceived the most important role of the medical teacher as an information provider (90%) in clinical settings, followed by an on-job role model (89%). The least important role perceived was curriculum evaluator (82%) followed by curriculum planner (79%).