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Psychiatrists should maintain diagnostic suspicion for PHPT in older adult female patients presenting with new-onset psychiatric illness. Several mechanisms involving the following may explain the variety of psychiatric symptoms in PHPT tyrosine hydroxylase, parathyroid hormone, interleukin-6, monoamine oxidase, calcium, and the sodium-potassium adenosine triphosphatase transporter. We recommend psychiatrists take a symptom-oriented approach to management. Treating a patient's psychosis, mania, depression, catatonia, delirium, or eating disorder pathology via conventional therapeutics seems like a rational approach despite the underlying medical etiology. Only parathyroidectomy has been proven to be definitive in the complete amelioration of psychiatric symptoms.Patellar tendon ruptures from the tibial tuberosity are very uncommon. Various surgical techniques are described for patellar tendon ruptures from the tibial tuberosity. A 58-year-old male without any predisposing factors had pain and swelling in the right knee due to a road traffic accident. Tense swelling and ecchymosis were present around the right knee with a palpable defect over the patellar tendon and an inability to extend the right knee. An MRI report revealed avulsion of the distal patellar tendon from the tibial tubercle insertion and medial meniscus tear. Primary repair was done with a double-loaded suture anchor and augmentation was done by using a Gracilis tendon. After the months, the knee range of motion (ROM) of the patient reached up to 90 degrees, and there was no extension lag on straight leg raise. Hamstring augmentation with a primary repair is the safest and a good surgical option in elderly patients with patellar tendon ruptures from the tibial tuberosity.This systematic review focuses on different genetic mutations identified in studies on natural short sleepers, who would not be ill-defined as one type of sleep-related disorder. The reviewed literature is from databases such as PubMed, PMC, Scopus, and ResearchGate. Due to the rare prevalence, the number of studies conducted on natural short sleepers is limited. Hence, searching the search of databases was done without any date restriction and included animal studies, since mouse and fly models share similarities with human sleep behaviors. Of the 12 articles analyzed, four conducted two types of studies, animal and human (cross-sectional or randomized-controlled studies), to testify the effects of human mutant genes in familial natural short sleepers via transgenic mouse or fly models. The remaining eight articles mainly focused on one type of study each animal study (four articles), cross-sectional study (two articles), review (one article), and case report (one article). Hence, those articles brought different perspectives on the natural short sleep phenomenon by identifying intrinsic factors like DEC2, NPSR1, mGluR1, and β1-AR mutant genes. Natural short sleep traits in either point-mutations or single null mutations in those genes have been examined and confirmed its intrinsic nature in affected individuals without any related health concerns. Finally, this review added a potential limitation in these studies, mainly highlighting intrinsic causes since one case study reported an extrinsically triggered short sleep behavior in an older man without any family history. The overall result of the review study suggests that the molecular mechanisms tuned by identified sleep genes can give some potential points of therapeutic intervention in future studies.Introduction Tumor staging plays an important role in determining treatment in colorectal cancer. In the recent past, the neutrophil-lymphocyte ratio (NLR) has been used as a predictive marker of inflammation for different types of clinical entities. Our study aims to determine if NLR can predict tumor staging in patients with colorectal cancer. Materials and methods We retrospectively analyzed all cases that underwent surgical treatment for colorectal cancer from 2014 to 2020. The NLR, tumor stage, and histology report for all patients were reviewed. Recommended cut-off values for NLR for tumor stage (T), lymph node stage (N), and metastatic stage (M) were determined using receiver operating characteristic (ROC) analysis. Results NLR was found to be significantly higher in patients with T3-T4 tumors as compared to T1-T2 tumors (mean 5.8 vs. 2.6, respectively p less then 0.001). The NLR values were higher in cases of N1-N2 groups as compared to N0 groups (mean 5.7 vs. 3.5, p = 0.07). The NLR was also higher in M1 patients as compared to M0 patients (32.1 vs. 4.5, respectively, p = 0.24) but failed to show a statistical significance. Conclusion NLR is a useful predictor of colorectal cancer which can give us some information about the type of tumor we may encounter during surgery.We report a case of a 63-year-old man who presented with a four-day history of fever, night sweats, and left lower back pain, which radiated down to his left buttock and leg. He also had a short-lived episode of chest pain and breathlessness. He had a medical history of chronic back pain, which had been diagnosed as sciatica three years ago. Initial investigations revealed raised inflammatory markers due to a Staphylococcus aureus urinary tract infection. Despite treatment, his inflammatory markers did not improve and the left lower back pain persisted. A magnetic resonance imaging scan demonstrated features consistent with pyomyositis of the left lumbar erector spinae (paraspinal) and iliacus muscles. After prolonged antibiotic therapy, his symptoms completely resolved. Pyomyositis is a rare tropical infection of the skeletal muscles most commonly caused by Staphylococcus aureus. Risk factors include trauma and immunosuppression. This case highlights a nearly missed diagnosis of paraspinal and iliacus pyomyositis in patients with a background history of chronic lower back pain. Early diagnosis and treatment are pivotal in preventing serious complications such as septicemia and multi-organ failure.Sofosbuvir/velpatasvir therapy can safely treat hepatitis C virus (HCV)-related decompensated cirrhosis and has been shown to improve liver function at an early stage. However, the pathophysiology of the liver during treatment remains unclear. In this case report, we analyzed hepatic morphology on magnetic resonance imaging during the treatment period and confirmed that liver function and malnutrition were greatly improved with the elimination of HCV, and that rapid hemodynamic changes were occurring in the liver.Gestational diabetes mellitus (GDM) is a growing pregnancy-related health problem all over the world. It has been noticed that women with high serum ferritin levels have a strong relationship with GDM by increased insulin resistance and increased insulin secretion from the pancreas resulting in pancreatic beta-cell exhaustion. Heme iron is also responsible for increasing the body's iron store and hence causing oxidative injury to pancreatic cells. In this systematic review, we researched the association between high serum ferritin levels and GDM. Three databases were consulted for articles related to GDM and high ferritin. These include Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed, and PubMed Central (PMC). Additional articles were retrieved from the institutional database. After filtering, 10 articles were finally selected, and quality was checked using the Joanna Briggs Institute (JBI) Critical Appraisal quality check tool. Serum iron biomarkers including ferritin, iron, and soluble transferrin receptor (sTfR) were measured. Our systematic review indicates that high maternal serum ferritin has a significant role in the development of GDM. We have also noticed the importance of sTfR and serum hepcidin as biomarkers to monitor high ferritin levels. Our study also observed a positive relationship between high heme iron intake and gestational diabetes mellitus. Therefore, more research is required to understand this relationship to identify populations at risk.Objective Hemiarthroplasty has been identified as the treatment of choice for displaced intracapsular femoral neck fractures. A modular prosthesis is sometimes preferred for its sizing options in narrow femoral canals, despite its higher cost and no advantage in clinical outcomes. Thus, in this study, we investigated the factors affecting surgeons' choice of prosthesis, hypothesizing that modular hemiarthroplasty is overused for narrow femoral canals compared to monoblock hip hemiarthroplasty. Methods A retrospective study of a regional level 1 trauma center was conducted. Patients who had sustained femoral neck fractures from March 2013 to December 2016 were included in this study. Axitinib ic50 Inclusion criterion was modular hemiarthroplasty for a narrow femoral canal. A matched group of patients who underwent monobloc hemiarthroplasty (MH) was created through randomization. The main outcome measurements were sex, age, Dorr classification, and femoral head size. We measured the protrusion of the greater trochanter beyonis especially true for female patients with small femoral head and narrow femoral canal dimensions (Dorr A and B). They would require extensive careful planning. Surgical techniques should be explored through education intraoperatively to achieve lateralization during femoral stem preparation. This may avoid prolonged anesthetic time and achieve potential cost savings.Purpose The frequency of periprosthetic knee infections increases yearly because of the popularity of the total knee prostheses. Revision knee arthroplasty is an annoying problem for both the surgeons and the patients. Debridément, antibiotics, and implant retention (DAIR) is a popular alternative for the treatment of periprosthetic knee infections. Little is known about the fate of the failed DAIR patients. This study aims to investigate the effect of the failed DAIR on the clinical result after two-staged revision arthroplasty. Method Ninety-nine two-staged revision arthroplasties and 85 DAIR patients from two reference clinics were retrospectively analyzed. The minimum follow-up was 36 months. Patients were grouped according to the treatment as, two-staged revision without DAIR, two-staged revision after failed DAIR, and successful DAIR. Their Knee Society Scores (KSS), functional KSS (KSS-f) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were analyzed and compared. Results DAIR has a 52.9% success rate for the treatment of infection. Elevated erythrocyte sedimentation rates and C-reactive peptide levels are not risk factors for failure, but the time passed since the index surgery is a risk factor for worse outcome scores. Failed DAIR is not a risk factor for reinfection after two-staged revision. Last KSS after failed DAIR, successful DAIR, and two-staged revision were 83.98±7.033, 91.89±4.386, and 91.38±4.735, respectively. Last KSS-f after failed DAIR, successful DAIR, and two-staged revision were 86.25±9.524, 94.56±8.106, and 94.85±5.996, respectively. Last WOMAC after failed DAIR, successful DAIR, and two-staged revision were 86.16±7.745, 94.750±4.964, and 93.319±5.961, respectively. Conclusion Failed DAIR is associated with lesser, but still good, or excellent clinical scores. DAIR is suggested as a promising treatment option for periprosthetic knee infections in well-selected patients.