Oneilllange4806

Overall, male anesthesiologists had a higher h-index, number of publications, and number of citations (p = 0.001, p = 0.001, and p = less then 0.001, respectively) than women. Conclusion Despite growing numbers of women entering the academic workforce, women are underrepresented in senior academic ranks and leadership positions. In addition, men and women have significant differences in measures of publication productivity. This study underscores the importance of directed efforts to promote equity in career outcomes.Background The fatal outcomes by COVID-19 are accompanied by cytokine storm syndrome, and thereby it is reported that disease severity is dependent on the cytokine storm syndrome. This cytokine storm can be assessed by evaluating the serum ferritin levels. The objective of this study was to assess the activities of serum ferritin and treatment outcomes among COVID-19 patients who were treated with dexamethasone and vitamin C. Materials and methods A single-center, prospective, observational study was conducted among SARS-CoV-2 infected patients from July 2020 to August 2020. The diagnosis was confirmed by real-time polymerase chain reaction (RT-PCR) and computed tomography (CT) imaging of the lungs. Serum ferritin levels were compared with the treatment outcomes of COVID-19 positive patients who were treated with dexamethasone and vitamin C. Results A total of 50 COVID-19 patients were included in the study. The mean age was 41.70 years. The recovery rate (94%) was remarkably high and is a good sign of COVID 19 treatment with vitamin C and dexamethasone as key modalities. The mean serum ferritin levels among recovered and expired patients were 478.81 ng/ml and 1410 ng/ml, respectively. Conclusion The serum activities of ferritin were markedly increased in COVID-19 patients who could not survive as compared to the patients who finally recovered from the infection.Metastasis to distal phalanx is a rare site for metastasis. It is often misdiagnosed as osteomyelitis because of similar clinical features, symptoms, and radiologic findings. If preceded by trauma, the diagnosis could be difficult. We are presenting a case of a 69-year-old male cigarette smoker, who presented with progressive painful swelling of the right second digit for two months duration after he lacerated his finger by a fingernail clipper. After receiving several unsuccessful courses of antibiotics, he was admitted for further treatment. Based on the CT scan of the right hand, he was treated for osteomyelitis and scheduled for elective surgery. As a part of the preoperative workup, his chest X-ray (CXR) revealed a left lower lobe infiltrate, and a subsequent CT of the chest demonstrated a 6 cm mass in the left lower lobe. The pathologic findings of lung mass and finger biopsy revealed a poorly differentiated carcinoma. The patient was treated with several cycles of chemotherapy before he decided to seek hospice care. Certain malignancies have increased receptors for wound-healing factors. For those malignancies, trauma will promote local metastasis by releasing wound-healing factors that create a favorable environment for micrometastasis cell growth. Some of these components currently are targets for therapy, while other components may be targets for therapy in the future.Post-infectious glomerulonephritis (PIGN) is an injury to glomerules mediated by the immune response after infection, and it is commonly seen in children. However, the elderly with immunocompromised conditions are at higher risk of developing PIGN after a recent infection. A 74-year-old female presented to the ER with a history of severe, sharp, on and off left flank pain for two days. Initial laboratory results workup were suggestive of acute kidney injury with no obvious reason. Dialysis was required as the renal function was deteriorating. Serologic test was negative for ANA (anti-neutrophil antibodies), C-ANCA (anti-neutrophil cytoplasmic antibodies), and P-ANCA (perinuclear anti-neutrophil cytoplasmic antibodies). C3 level was low, and anti-streptolysin O titer was high. Renal biopsy was performed. With reference to the clinical and histological examination, she was diagnosed with PIGN and diabetic nephropathy. After six months, the renal function was improving gradually until hemodialysis was stopped, and the PermcathTM (Medtronic) was removed with a creatinine level of 120 µmol/L. The elderly diabetic female developed PIGN with crescents that required dialysis, and dialysis was stopped after six months with good prognosis. Since PIGN is a very rare entity, the suspicion of PIGN in the elderly with acute kidney injury should be raised after a history of upper respiratory tract or skin infection.Introduction Despite the sunny climate, women in Pakistan are prone to vitamin D deficiency and subsequent low bone mineral density. The current study explores the extent of this deficiency in both pre- and postmenopausal women in our setting. Methodology A cross-sectional study was conducted at the outpatient departments of Lady Reading Hospital and Hayatabad Medical Complex Peshawar, Pakistan during the time period between March 2018 and June 2019. Hundred premenopausal women (control group) and 100 postmenopausal women (study group) were inducted in the study. Serum vitamin D levels were determined in patients with suspected vitamin D deficiency. Bone mineral density (BMD) was determined for each patient and the cost of each scan was afforded by our department. A dual-energy x-ray absorptiometry (DEXA) scan was used to perform the bone mineral density assessment. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 26 (IBM, Chicago, IL). Results Serum 25OHD concentration in postmenopausal women was significantly lower compared to premenopausal women (p less then 0.001). In the study group, 36.0% of women had a severe deficiency of serum vitamin D levels, whereas, in the control group, only two women suffered from severe deficiency of vitamin D. Similarly, bone mineral density was also significantly correlated with the menopausal status of the women (p less then 0001). It was found that three-fifths of the postmenopausal women had a low bone density. Twenty-four percent of postmenopausal women had very low BMD. In comparison, only a single premenopausal woman was found to have a Z-score of below -2.0. Conclusion The current study highlights the impact of menopause on vitamin D levels and BMD. In our study, we found a significant difference between vitamin D levels and BMD in women of reproductive age compared to postmenopausal women.Background Sleep-disordered breathing (SDB) has a potential association with the pathogenesis of congestive heart failure (CHF). We assessed the prevalence and patterns of obstructive sleep apnea (OSA) in patients presenting with CHF. Method This was a prospective, observational, all-comers study of consecutive 77 confirmed cases of CHF. All these patients were clinically assessed and evaluated for OSA with sleep study after routine blood testing, electrocardiogram (ECG), chest X-ray, and echocardiography. Results Of 77 patients with CHF 38 (49.4%) had apnea-hypopnea index (AHI) 5. Of these 39, 37 (94.8%) patients showed the clinical features of OSA. The majority (64.9%) of them were males. The majority of OSA (64.9%) had coronary artery disease (CAD) (p less then 0.05) as the etiology of CHF, followed by dilated cardiomyopathy (32.4%) and valvular heart disease (2.7%). The prevalence of OSA was higher amongst New York Heart Association (NYHA) class 2 (51.4%) as compared to NYHA class 3 (37.8%) and NYHA class 4 (10.8%). There were 12 (32.8%) patients, each having OSA with a heart rate between 71 and 80 bpm and 81 and 90 bpm. Twenty-two (59.5%) had systolic blood pressure (BP) more than 120 mmHg and 20 (54.1%) had diastolic BP more than 80 mmHg. The majority (64.9%) patients had the lowest O2 saturation between 80% and 90%. A significantly large number of patients (62.2%) had ejection fraction 21%-30% (p less then 0.05). The majority (62.16%) of patients with OSA had AHI between 5 and 15. With 5-15 AHI, 20 (87%) patients with OSA had a snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) score between 3 and 7 with AHI 5-15 (p less then 0.05). Conclusions In our cohort, the prevalence of OSA in CHF was 50.6%. Predictors of OSA in CHF were left ventricular ejection fraction (LVEF) 20%-30% and NYHA class 2. The majority had AHI between 5 and 15. Sleep apnea screening should be routinely implemented in the evaluation and follow-up of heart failure patients.Choanal atresia is a rare developmental condition that is defined as a narrowing or complete blockage of the nasal passages. Rapid surgical management is crucial in cases of bilateral choanal atresia since it may develop into a life-threatening emergency. We present the case of a full-term female newborn who developed mild respiratory distress soon after birth. The pediatrician was not able to insert a feeding tube through the nostrils despite repeated attempts. Cranial computed tomography confirmed the diagnosis of bilateral choanal atresia with an ectopic nostril. Furthermore, echocardiography demonstrated moderate atrial septal defect. 4-Chloro-DL-phenylalanine The newborn underwent a successful correction of this anomaly via the trans-nasal surgical approach.A four-month-old female infant presented for a thoracoscopic aortopexy for severe tracheomalacia. The case proceeded uneventfully until a specimen bag was introduced into the chest to remove the thymus. The child developed significant ST segment elevations in all 12 leads on electrocardiogram. An emergent intraoperative echocardiogram was performed but did not reveal any findings to account for the diffuse ST segment elevations. The ST segment elevations remained elevated for 48 hours following the procedure with no apparent hemodynamic instability or structural damage to the heart. Troponin levels returned to normal a few days later, and the child was discharged home without sequelae. The incidence of ST segment elevations in children without congenital heart disease is rare but can potentially lead to significant morbidity and mortality. This case report seeks to highlight the importance of swift recognition of ST changes in the pediatric population, discuss possible causes, and describe appropriate workup.Patellar clunk syndrome (PCS) occasionally occurs after posterior stabilized total knee replacement (PS-TKR), and is characterized by a painful palpable audible clunk of the patella when the knee moves from flexion to extension. It has been classically attributed to the formation of fibrous nodule at the junction of the proximal pole of the patella and the undersurface of the distal quadriceps tendon. However, various intra-articular peripatellar proliferative fibrous formations have also been reported with a wide spectrum of symptoms, ranging from crepitation to frank patellar clunk. Treatment of the syndrome remains essentially surgical, and usually consists of resection of the fibrous nodules. This paper reports two cases of PCS and aims at bringing attention to this entity in terms of pathogenesis, clinical diagnosis, and treatment, through a review of the literature.