Flexible and Convergent Enantioselective Total Synthesis of (R)-Juglanaloids A and B: Two Phthalide Spiro Alkaloids with Potential Alzheimer's Disease Inhibitory Activity

Juglanaloids A and B are recently isolated natural products characterized by an unprecedented spiro bicyclic isobenzofuranone-tetrahydrobenzazepinone framework and a promising antiamyloid activity. Here reported is a straightforward convergent total synthesis of these natural products, which were obtained in high enantiomeric purity (94% and >99% ee for juglanaloids A and B, respectively) through an eight-step longest linear sequence, based on an efficient and reliable enantioselective phase-transfer-catalyzed alkylation step. Considering the interesting biological activity of juglanaloids, this convenient, highly enantioselective, flexible, and predictable synthetic strategy promises to be a powerful tool for accessing potentially bioactive spiro bicyclic phthalide-tetrahydrobenzazepinone derivatives.

Exposure to zinc oxide nanoparticles induced reproductive toxicities in male Sprague Dawley rats

BACKGROUND

This research delves into the reproductive toxicology of zinc oxide nanoparticles (ZnO-NPs) in male Sprague Dawley rats. It specifically examines the repercussions of Zn accumulation in the testes, alterations in testosterone levels, and histopathological changes in the gonadal tissues.

AIMS

The primary objective of this study is to elucidate the extent of reproductive toxicity induced by ZnO-NPs in male Sprague Dawley rats. The investigation aims to contribute to a deeper understanding of the potential endocrine and reproductive disruptions caused by ZnO-NPs exposure.

METHODS

Characterization techniques including SEM-EDX and XRD affirmed the characteristic nature of ZnO-NPs. Twenty-five healthy post weaning rats (200-250 g) were intraperitoneally exposed to different concentrations of ZnO-NPs @ 10 or 20 or 30 mg/kg BW for 28 days on alternate days.

RESULTS

Results showed significant dose dependent decline in the body weight and testicular somatic index of rats. It also showed significant dose dependent accumulation of Zn in testis with increasing dose of ZnO-NPs. Conversely, serum testosterone level and sperm count were reduced with increasing dose of ZnO-NPs. Histological results showed dose dependent abnormalities i.e., vacuolization, edema, hemorrhage, destruction of seminiferous tubules, loss of germ cells and necrosis in rat testis.

CONCLUSION

The findings of this study clearly indicate that high doses of zinc oxide nanoparticles (ZnO-NPs) can adversely affect the structural integrity and functional efficacy of the male reproductive system. Given these results, it becomes crucial to implement stringent precautionary measures in the utilization of ZnO-NPs, particularly in cosmetics and other relevant sectors. Such measures are imperative to mitigate the toxicological impact of ZnO-NPs on the male reproductive system and potentially on other related physiological functions. This study underscores the need for regulatory vigilance and safety assessments in the application of nanotechnology to safeguard human health.

Liver-boosting potential: chicory compound-mediated silver nanoparticles for hepatoprotection-biochemical and histopathological insights

Background: Liver disease is a serious health concern in today's world, posing a challenge to both healthcare providers and pharmaceutical companies. Most synthetic drugs and chemicals cause liver damage accounting for approximately 10% of acute hepatitis and 50% of acute liver failure. Purpose: The present study aimed to evaluate the hepato-protective activity of an extract of chicory formulation assisted by silver nanoparticles against carbon tetra chloride (CCl4)-induced hepatic damage in rat's liver. Methods: Rats of the Wistar strain (Rattus norvegicus) were used to test the in vivo hepato-protective efficacy at various doses. Rats were randomly divided into nine groups, each containing six rats. The groups were as follows: first group (control), second group (CCl4), third group, silymarin (20 mg/kg of body weight), fourth group (CCl4+chicory) (1.75 mg/kg of b. wt), fifth group (CCl4 + chicory at the dose of 2.35 mg/kg), sixth group (CCl4 + chicory of 3.25 mg/kg), seventh group (CCl4 +AgNPs 1.75 mg/kg of b. wt.), eighth group (CCl4 + AgNPs 2.35 mg/kg of body weight), and ninth group (CCl4 + AgNPs 3.25 mg/kg of b. wt.). Blood samples were taken 24 h after the last administration (i.e., 30th day). The blood samples were analyzed for different serum enzymes such as ALP (alkaline phosphatase), ALT (alanine transaminase), bilirubin (Blr), triglyceride, and cholesterol. Histology liver sections were performed. Results: Treatment with AgNPs and chicory extract showed significant hepato-protective activity in a dose-dependent manner. In three doses, the chicory extract at a rate of 3.25 mg/kg of body weight significantly reduced elevated levels of biochemical markers in comparison to CCl4-intoxicated rats. Histology of the liver sections from CCl4-treated rats revealed inflammation of hepatocytes, necrosis, cytoplasmic degeneration, vacuolization, and a deformed central vein. The chicory formulation extract exhibited a remarkable recovery percentage in the liver architecture that was higher than the drug (i.e., silymarin). While treatment with AgNPs also repaired the degenerative changes and restored the normal form of the liver, chicory formulation extract possessed more hepato-protective potential as compared to AgNPs by regulating biochemical and histo-pathological parameters. Conclusion: This study can be used as confirmation of the hepato-protective potential of chicory compounds for possible use in the development programs of drugs to treat liver diseases.

Analysis of two layered peristaltic-ciliary transport of Jeffrey fluid and in vitro preimplantation embryo development

The analysis of peristaltic-ciliary transport in the human female fallopian tube, specifically in relation to the growing embryo, is a matter of considerable physiological importance. This paper proposes a biomechanical model that incorporates a finite permeable tube consisting of two layers, where the Jeffrey fluid model characterizes the viscoelastic properties of the growing embryo and continuously secreting fluid. Jeffrey fluid entering with some negative pressure gradient forms the core fluid layer while continuously secreting Jeffrey fluid forms the peripheral fluid layer. The resulting partial differential equations are solved for closed-form solutions after employing the assumption of long wavelength. The analysis delineated that increasing the constant secretion velocity, Darcy number, and Reynolds number leads to a decrease in the appropriate residue time of the core fluid layer and a reduction in the size of the secreting fluid bolus in the peripheral fluid layer. Eventually, the boluses completely disappear when the constant secretion velocity exceeds 3.0 Progesterone ([Formula: see text]) and estradiol ([Formula: see text]) directly regulate the transportation of the growing embryo, while luteinizing hormone (LH) and follicle-stimulating hormone (FSH), prolactin, anti-mullerian hormone (AMH), and thyroid-stimulating hormone (TSH) have an indirect effects. Based on the number and size of blastomeres, the percentage of fragmentation, and the presence of multinucleated blastomeres two groups were formed in an in vitro experiment. Out of 50 patients, 26 (76.5%) were pregnant in a group of the good quality embryos, and only 8 (23.5%) were in a group of the bad quality embryos. The transport of growing embryo in the human fallopian tube and preimplantation development of human embryos in in vitro are constraint by baseline hormones FSH, LH, prolactin, [Formula: see text], AMH, and TSH.

Struvite separation from wastewater and its use with sulfur-oxidizing bacteria improves phosphorus utilization in alkaline soil

A major portion of phosphatic fertilizer comes from the limiting natural resource, rock phosphate, which demands a timely alternative. Struvite, a crystalline mineral of low solubility, is a worthwhile alternative. Evaluation of the local wastewater streams for their ability to precipitate struvite and its capability as phosphatic fertilizer under an alkaline soil environment was studied. Two stirring speeds, a pH range of 8.0-11.0, and a constant molar ratio were used to optimize local wastewater streams for struvite precipitation. Struvite was used in five different combinations to assess the release of phosphorus (P), including control (no P source), single superphosphate, struvite, struvite + sulfur, and rock phosphate with or without inoculation of sulfur-oxidizing bacteria (SOB). For struvite precipitation, low stirring speeds are ideal because the precipitates readily sink to the bottom once they form. Furthermore, the amalgamation of SOB with sulfur significantly improved P use efficiency under alkaline soils through increased phosphorus sources solubility and enabled optimum wheat production due to its low solubility in an alkaline soil condition. Due to its capacity to recycle phosphorus from wastewater, struvite is poised to emerge as a sustainable fertilizer and had an opportunity to capture a share of this expanding market.

Advances in Computational Intelligence Techniques-Based Multi-Intersection Querying Theory for Efficient QoS in the Next Generation Internet of Things

An environment of physically linked, technologically networked things that can be found online is known as the "Internet of Things." With the use of various devices connected to a network that allows data transfer between these devices, this includes the creation of intelligent communications and computational environments, such as intelligent homes, smart transportation systems, and intelligent FinTech. A variety of learning and optimization methods form the foundation of computational intelligence. Therefore, including new learning techniques such as opposition-based learning, optimization strategies, and reinforcement learning is the key growing trend for the next generation of IoT applications. In this study, a collaborative control system based on multiagent reinforcement learning with intelligent sensors for variable-guidance sections at various junctions is proposed. In the future generation of Internet of Things (IoT) applications, this study provides a multi-intersection variable steering lane-appropriate control approach that uses intelligent sensors to reduce traffic congestion at many junctions. Since the multi-intersection scene's complicated traffic flow cannot be accommodated by the conventional variable steering lane management approach. The priority experience replay algorithm is also included to improve the efficiency of the transition sequence's use in the experience replay pool and speed up the algorithm's convergence for effective quality of service in the upcoming IoT applications. The experimental investigation demonstrates that the multi-intersection variable steering lane with intelligent sensors is an appropriate control mechanism, successfully reducing queue length and delay time. The effectiveness of waiting times and other indicators is superior to that of other control methods, which efficiently coordinate the strategy switching of variable steerable lanes and enhance the traffic capacity of the road network under multiple intersections for effective quality of service in the upcoming IoT applications.

Bismuth-Rich Co/Ni Bimetallic Metal-Organic Frameworks as Photocatalysts toward Efficient Removal of Organic Contaminants under Environmental Conditions

Active photocatalysts with an efficiency of 99% were prepared for the degradation of the industrial dye, methylene blue (MB), under visible light irradiation. These photocatalysts comprised Co/Ni-metal-organic frameworks (MOFs), to which bismuth oxyiodide (BiOI) was added as a filler to prepare Co/Ni-MOF@BiOI composites. The composites exhibited remarkable photocatalytic degradation of MB in aqueous solutions. The effects of various parameters, including the pH, reaction time, catalyst dose, and MB concentration, on the photocatalytic activity of the prepared catalysts were also evaluated. We believe that these composites are promising photocatalysts for the removal of MB from aqueous solutions under visible light.

A Reversible Cause of Cutaneous Rash in a Patient With Alcohol Consumption

The most common cutaneous manifestations of alcoholism include urticarial reaction, flushing, porphyria cutanea tarda, psoriasis, rosacea, seborrheic dermatitis, and pruritus. Here, we present a case of a young male with a history of alcohol abuse who presented with non-blanching, petechial, and perifollicular macular rash secondary to vitamin C deficiency in view of poor oral intake. The rash improved significantly with vitamin C supplementation. Although rare in developed countries, clinicians should keep vitamin C deficiency as a differential diagnosis for skin rash in alcohol consumers.

Co-occurrence of CML Blast Crisis and Severe COVID 19 Infection: A Case Report

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affecting multiple organ systems. It can cause severe cytokine storms leading to intensive care unit admission requiring mechanical ventilation. However, there have been few studies establishing the outcomes of chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitors who are infected with COVID-19. We present a 69-year-old male with a history of CML on imatinib therapy with COVID-19 who developed acute respiratory distress syndrome needing mechanical ventilatory support, shock requiring vasopressors, and worse outcome secondary to blast crisis.

Synthesis of Functionalized N-(4-Bromophenyl)furan-2-carboxamides via Suzuki-Miyaura Cross-Coupling: Anti-Bacterial Activities against Clinically Isolated Drug Resistant A. baumannii, K. pneumoniae, E. cloacae and MRSA and Its Validation via a Computational Approach

N-(4-bromophenyl)furan-2-carboxamide (3) was synthesized by the reaction furan-2-carbonyl chloride (1) and 4-bromoaniline (2) in the presence of Et₃N in excellent yields of 94%. The carboxamide (3) was arylated by employing triphenylphosphine palladium as a catalyst and K₃PO₄ as a base to afford N-(4-bromophenyl)furan-2-carboxamide analogues (5a-i) in moderate to good yields (43–83%). Furthermore, we investigated the in vitro anti-bacterial activities of the respective compounds against clinically isolated drug-resistant bacteria A. baumannii, K. pneumoniae, E. cloacae and S. aureus. The molecule (3) was found to be the most effective activity against these bacteria, particularly NDM-positive bacteria A. baumannii as compared to various commercially available drugs. Docking studies and MD simulations further validated it, expressing the active site and molecular interaction stability.

Rice: a potential vehicle for micronutrient fortification

The choices of consumer towards food have been changed. Consumer prefers to eat food which is not only safe but also nutritious. Now a day, they like to eat the food which promote their health and help in minimizing nutrition related health hazards. Rice is a staple food in many countries, but most emerging issue is that rice is deficit in minerals. Rice ranks second among cereals in dietary uses around the world. Rice is deficit in iron (Fe) zinc (Zn) and these are important micronutrients for infants, men and women. Fortification of rice with iron and zinc would help to minimize nutrient deficient disorders among humans. Present study is aimed to introduce nutrients rich rice for consumers and also to encourage food-fortification organizations for diverting their focus on rice fortification. In south Asian countries, micronutrient deficiency especially Fe and Zn deficiency is very common. The rice because of its use as a staple food can be utilized as a carrier medium for transporting micronutrients from plants sources to human beings. Hence, rice fortification with microminerals can prove as a miracle for the virtual eradication of nutrition related diseases in humans.

Knowledge of Neural Tube Defects and Prevention Through Folic Acid Use Among Women in Faisalabad, Punjab, Pakistan: A Cross-Sectional Survey

Objective

Neural tube defects (NTDs) are one of the most common congenital abnormalities of the central nervous system and are associated with significant mortality, morbidity, and major life-long disability. Periconceptional folic acid reduces the risk of NTDs by up to 70%; however, in Pakistan, no public information program exists concerning the risks of NTDs or promoting folic acid use. As such, the aim of this study was to assess levels of knowledge about NTDs and folic acid use among women attending the gynaecology department of DHQ Hospital, Faisalabad, Pakistan.

Design

A cross-sectional survey.

Setting

The gynaecology department of the District Head Quarter (DHQ) Hospital in Faisalabad, Pakistan.

Participants

Three hundred and fifty-five married women.

Primary and Secondary Outcome Measures

Primary outcome measures included knowledge of NTDs and knowledge of folic acid use.

Results

About 85.4% of participants had no knowledge of neural tube defects and 76.7% reported no knowledge about folic acid use. The majority of participants (86.2%) were unaware that folic acid protects against NTDs. Lack of knowledge of NTDs was significantly associated with education (P = 0.001), husband’s education (P = 0.002), planned pregnancy (P = 0.002), sources of antenatal care (P = 0.003), knowledge of folic acid (P = 003), knowledge that folic acid protects against NTDs (P = 0.002), and health decision-making (P = 0.003). Knowledge of folic acid use was significantly associated with age (P = 0.000), education (P = 0.004), husband’s education (P = 0.002), monthly income (P = 0.003), planned pregnancy (P = 0.003), pregnancy trimester (P < 0.001), sources of antenatal care (P < 0.001), knowledge of NTDs (P = 0.002), knowledge that folic acid protects against NTDs (P < 0.001), use of folic acid (P < 0.001), sources of vitamin information (P < 0.001), and health decision-making (P = 0.002).

Conclusion

These findings highlight extremely low levels of knowledge about NTDs and folic acid use of women in Pakistan. There is an urgent need to increase knowledge and awareness of the risks of NTDs and preventative approaches, through health education programs delivered by trusted health professionals.

A Case of Idiopathic Cold Agglutinin Hemolytic Anemia Successfully Treated With Steroids

Cold agglutinin disease (CAD) is a type of hemolytic anemia in which cold agglutinins can cause agglutination of red blood cells in cold parts of the body and hemolytic anemia. Cold agglutinin-mediated hemolytic anemia can occur in the setting of an underlying viral infection, autoimmune disorder, or lymphoid malignancy, referred to as a secondary cold agglutinin syndrome, or without one of these underlying disorders, referred to as primary CAD (also known as idiopathic CAD). We present a case of a 71-year-old female with hemolytic anemia due to primary CAD. The secondary causes of CAD, including infections, autoimmune disorders, and malignancy, were ruled out. She was successfully treated with prednisone.

Development of high temperature simultaneous saccharification and fermentation by thermosensitive Saccharomyces cerevisiae and Bacillus amyloliquefaciens

Scarcity of energy and pollution are two major challenges that have become a threat to all living things worldwide. Bioethanol is a renewable, ecological-friendly clean energy that may be utilized to address these issues. This study aimed to develop simultaneous saccharification and fermentation (SSF) process through high temperature-substrate adaptation and co-cultivation of S. cerevisiae with other potential amylolytic strains. In this study, we adapted our previously screened thermosensitive Saccharomyces cerevisiae Dj-3 strain up-to 42 °C and also screened three potential thermotolerant amylolytic strains based on their starch utilization capability. We performed SSF fermentation at high temperature by adapted Dj-3 and amylolytic strains using 10.0% starch feedstock. Interestingly, we observed significant ethanol concentration [3.86% (v/v)] from high temperature simultaneous saccharification and fermentation (HSSF) of adapted Bacillus amyloliquefaciens (C-7) and Dj-3. We attribute the significant ethanol concentration from starch of this HSSF process to C-7’s high levels of glucoamylase activity (4.01 U/ml/min) after adaptation in starch (up-to 42 °C) as well as Dj-3's strong glucose fermentation capacity and also their ethanol stress tolerance capability. This study suggests the significant feasibility of our HSSF process.

Dysbiosis in salivary bacterial diversity of postpartum females and its association with oral health problems and APOs

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In present study, salivary microbial diversity of postpartum females was compared with nonpregnant females.

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Microbial colonization was raised in postpartum females especially those having oral health issues.

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Isolated bacterial species showed enhanced biofilm forming and multi drug resistance.

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Alpha diversity was decrease in postpartum female having oral health issues with PLWB.

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Bray-Curtis dissimilarity was highest between females with dental issues and different pregnancy outcomes.

The present study investigates the dysbiosis in salivary bacterial diversity by culture-dependent and independent methods. Culturable aerobic and facultative anaerobic bacterial diversity was studied in saliva collected from 267 postpartum and 54 nonpregnant females by using standard microbiological methods. For unculturable bacterial diversity, DNA from saliva samples of four selected females was sequenced by targeting V4 region of 16S rRNA. In postpartum females, S. mutans was significantly more prevalent. Its colonization was also seen significant among females having gingivitis (P < 0.01), dental caries (P < 0.01), and in those giving birth to low weight baby. In postpartum group, 65.16% females were culture positive for Staphylococcus, 12.73% Gram positive rods, 10.48% N. meningitides, 6.36% K. pneumoniae, 5.61% Enterobacter species and 2.62% E. coli. Isolates showed high biofilm forming ability and antibiotic resistance. Upon analysis of unculturable bacterial diversity, a total of 16 phyla and 156 genera were observed. Alpha diversity was decrease in postpartum female having oral health issues with pre-term low weight birth, compared to females with full term birth. Bray-Curtis dissimilarity was highest between female with dental issues and different pregnancy outcomes. Bacterial diversity and abundance altered among females with different oral health conditions and pregnancy outcomes, and also have pathogenic potential.

Imatinib-Resistant Gastrointestinal Stromal Tumor Presenting as a Large Abdominal Mass

Gastrointestinal stromal tumors (GISTs) are the stromal or mesenchymal neoplasms affecting the gastrointestinal tract. Although they constitute 1% of primary gastrointestinal tumors, they are the most common nonepithelial tumors involving the gastrointestinal tract. They mostly present as overt or occult gastrointestinal bleeding. We present a case in which a 77-year-old female presented with a large abdominal mass. The origin of the mass was unclear on CT and MRI scan of the abdomen. Upper gastrointestinal endoscopic ultrasonography showed a cystic lesion in the perigastric region. A fine-needle biopsy of the lesion was performed, which was consistent with spindle type GIST. After the initial failure of imatinib therapy, the tumor was managed surgically.

May-Thurner Syndrome: A Rare Case of Unilateral Deep Vein Thrombosis in an Elderly Woman

Patient: Female, 78-year-old

Final Diagnosis: May-Thurner syndrome

Symptoms: Lower extremity edema • lower extremity pain

Medication: —

Clinical Procedure: —

Specialty: Critical Care Medicine • Hematology • General and Internal Medicine • Radiology

Organ-Specific Hypereosinophilic Syndrome Presenting as Eosinophilic Gastroenteritis

Gastrointestinal (GI) diseases have a substantial impact on the population health and healthcare resources of the United States. They constitute billions of dollars in expenditure and millions of office and hospital visits. With advancing diagnostic and treatment modalities, rare diseases are increasingly recognized and managed. However, after close to 80 years since the first description, eosinophilic GI disorders (EGID) are still uncommon, and only around 300 cases have been reported to date. Hypereosinophilic syndrome (HES) is well studied, but there are still no guidelines to direct management. We report the case of a 56-year-old female who presented with gastroenteritis and a persistent eosinophil count above 7 x 10⁹/L. Imaging was suggestive of bowel wall thickening, and endoscopy revealed normal-appearing mucosa. However, histologic examination revealed eosinophilic infiltration of the GI tract. She was diagnosed with HES and treated with oral prednisone with remarkable improvement of her symptoms.

Biliary Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a syndrome caused by either dyskinesia or stenosis of the sphincter of Oddi. It has been categorized into biliary and pancreatic SOD based on clinical features and laboratory findings. We present a case of a 51-year-old female (post-cholecystectomy) who presented with intermittent chronic right upper quadrant pain. Laboratory investigations showed persistently elevated liver function tests and a dilated common bile duct without the presence of any stones. Endoscopic retrograde cholangiopancreatography with manometry showed an elevated sphincter of Oddi pressure, thus confirming the diagnosis of SOD. She underwent endoscopic sphincterotomy and papillotomy with normalization of liver function tests and resolution of her chronic symptoms.

Erythrocytosis, embolism in a woman with antiphospholipid antibodies: A diagnostic challenge

Systemic thromboembolism, along with acute multiorgan failure, should raise clinical suspicion for CAPS. Timely management, even in suspected cases, can have a significant impact on mortality.

Chronic Intestinal Pseudo-Obstruction in a Young Male With Alcohol Abuse Disorder

Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome associated with significant mortality and morbidity. It mimics the signs and symptoms of intestinal obstruction in the absence of an anatomic lesion causing obstruction. Here we present a case of a young male with severe alcohol abuse disorder who initially presented with signs and symptoms of alcohol withdrawal but was found to have abdominal distension. Imaging studies revealed severe small and large bowel dilatation without any organic lesion. He continued to have marked intestinal dilatation for the subsequent few months. Alcohol cessation eventually led to a marked reduction in his symptoms and a decrease in intestinal dilatation. The occurrence of CIPO because of alcohol abuse is rare, and we explore the possible association between the two entities. 

Fulminant Pseudomembranous Colitis Leading to Clostridium Paraputrificum Bacteremia

Clostridium species are spore-forming gram-positive anaerobic rod bacteria that cause a broad range of infections in humans, including intra-abdominal infections, myonecrosis, and bacteremia. Pseudomembranous colitis (PMC) is a severe form of infection caused by Clostridioides difficile. Clostridial bacteremia usually occurs in the settings of neutropenia, alcohol abuse, diabetes mellitus, sickle cell anemia, malignancy, hemodialysis, inflammatory bowel disease, and AIDS. We report a case of fulminant PMC leading to C. paraputrificum bacteremia in an otherwise immunocompetent patient. To our knowledge, this is the first case report of such an occurrence. 

A 58-Year-Old Man with a Painful Gluteal Mass as the First Presentation of Metastatic Adenocarcinoma of the Lung

Patient: Male, 58-year-old

Final Diagnosis: Metastatic lung adenocarcinoma

Symptoms: Gluteal mass

Medication:—

Clinical Procedure: —

Specialty: Oncology • Pulmonology

Ramucirumab-Induced Hepatocellular Carcinoma Rupture and Gastrointestinal Perforation

BACKGROUND Hepatocellular carcinoma (HCC) is a primary liver malignant tumor that typically but not always develops in the setting of chronic liver disease, particularly in patients with cirrhosis or chronic hepatitis B virus infection. Advanced HCC portends a poor prognosis; however, recent advances in first-line and second-line treatment options yield significant survival improvements. Ruptured HCC is an uncommon presentation that occurs in approximately 3-26% of patients. CASE REPORT We present a case of a patient with HCC who was undergoing treatment with the antiangiogenic monoclonal antibody ramucirumab. Subsequently, he presented with signs and symptoms of acute abdomen. The abdominal imaging revealed pneumoperitoneum with multiple abdominal and pelvic collections. The patient underwent exploratory laparotomy and was found to have necrotic liver parenchyma, which appeared to be perforated. Also, a microperforation was noted in the proximal duodenum. The pathology report from liver specimens showed fragments of hepatocellular cancer with extensive necrosis. CONCLUSIONS The mechanism of tumor rupture in HCC is poorly understood. The so-called vascular injury hypothesis states that collagen expansion and elastin proliferation in the arterial wall supplying the tumor could be the leading cause of HCC rupture. We believe that the process mentioned above was accelerated in our patient using the antiangiogenic factor ramucirumab. A similar antiangiogenic mechanism is also implicated in gastrointestinal hemorrhage and perforation related to this drug.

Antitumor effects of sodium selenite on acute lymphocytic leukemia

Selenium is obligatory for proper functioning of body as it is the part of enzyme protection system. Its both organic and inorganic forms are thought to be active as an antitumor agent. We trialed the different dosages (0 × 10⁶ M, 2.7 × 10⁶ M, 5.4 × 10⁶ M, and 8.1 × 10⁶ M) of sodium selenite given to the acute lymphocytic leukemia cell lines incubated for 24, 48, and 72 h. The ratios of dead cells to live cells when treated with sodium selenite were very high as compared to the control with no treatment. This dosage-dependent apoptosis increased with the incubation time.

Hemorrhagic Pericardial Effusion Leading to Cardiac Tamponade: A Rare Initial Presentation of Adenocarcinoma of the Lung

Malignancy associated pericardial effusion is a serious condition and testifies to poor prognosis. Cardiac tamponade can be the first presentation of underlying adenocarcinoma of the lung. We present a 78-year-old female with no known history of any malignancy, who presented with symptoms of abdominal and respiratory pathology. The physical exam findings were significant for a possible cardiac tamponade. Computed tomography (CT) of the abdomen and chest confirmed moderate bilateral pleural effusions, large pericardial effusion, left upper lobe mass, possible lymphangitic spread of carcinoma in the left lung, and adenopathy in the mediastinum. The echocardiography findings further confirmed tamponade. Cardiology and pulmonary medicine were taken on board for a possible malignancy associated pleural effusion leading to cardiac tamponade. Pericardial fluid analysis showed atypical cells suggestive of malignancy. Transbronchial biopsy confirmed moderately differentiated invasive adenocarcinoma. Positron emission tomography (PET) scan revealed metastatic spread to the mediastinum and right hilum with possible pleural metastatic disease seen posteriorly in the left hemithorax. The patient was discharged home with oncology follow up for chemotherapy.

Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Diagnostic Trap

Patient: Male, 50-year-old

Final Diagnosis: Submassive pulmonary embolism

Symptoms: Chest pain • dyspnea

Medication: —

Clinical Procedure: Cardiac catheterization

Specialty: Cardiology • Critical Care Medicine • Pulmonology

COVID-19 and the Brain: Acute Encephalitis as a Clinical Manifestation

Central nervous system (CNS) viral infections result in the clinical syndromes of aseptic meningitis or encephalitis. Although the primary target of coronavirus disease 2019 (COVID-19) is the respiratory system, it is increasingly being recognized as a neuropathogen. The hallmark clinical feature is altered mental status, ranging from mild confusion to deep coma. Most patients with encephalopathy or encephalitis are critically ill. We present a case of COVID-19-related encephalitis who presented with acute delirium and new-onset seizures. The patient responded well to treatment with intravenous immunoglobulins and rituximab.

Superior Mesenteric Artery Syndrome: A Forgotten Cause of Duodenal Obstruction

Superior mesenteric artery (SMA) syndrome has been described in medical literature as a rare cause of duodenal occlusion. It has a varied presentation, with distressing gastrointestinal symptoms such as nausea, abdominal pain, and further weight loss. Several conditions contribute to duodenal obstruction in SMA syndrome. We present a case of SMA syndrome in a patient with malignant breast cancer who presented with sudden onset of severe nausea and voluminous vomiting. Various imaging studies revealed a distended proximal intestine with a transition point in the third part of the duodenum. The patient was managed conservatively with nasogastric decompression and fluid electrolyte management, leading to symptomatic relief.

Gastrointestinal and pancreatic neuroendocrine tumours and carcinomas; a review of rare tumour type

Neuroendocrine tumours are a rare tumour type involving neuroectodermal cells. They are also termed carcinoids. Gastroenteropancreatic system is most commonly involved. They are classified as low, intermediate or high grade depending upon mitotic index and Ki-67 index. Their diagnosis involves measurement of chromogranin A levels. Ultrasound is the initial imaging modality for their evaluation. Endoscopic ultrasound allows close evaluation of the tumour. Staging is commonly undertaken by computed tomography scan. These tumours typically show hyper-enhancement on arterial phase. Their metastasis to the liver also shows arterial enhancement. Small bowel carcinoids tend to have hepatic and mesenteric spread. Mesenteric spread of disease gives a characteristic spoke wheel appearance. On magnetic resonance imaging, these tumours typically appear as hypointense on T1 weighted image, hyperintense on T2 weighted image and show avid enhancement on postcontrast scan. Surgical resection is appropriate treatment with follow-up at 6-month intervals during the first year. The current review was planned to cover the aetiology, diagnosis, staging, imaging techniques, imaging features and treatment of these rare tumours that need prompt diagnosis.

Patent Ductus Arteriosus with Infective Vegetations in Grandmultipara

Patent ductus arteriosus (PDA) usually presents during childhood, less frequently in adolescence, and rarely in late adulthood. The usual mode of presentation is left ventricular failure and respiratory symptoms. Here is a case of a female with patent ductus arteriosus, who was apparently in quite good state of health and gave birth to six offsprings without herself having any problem. At the age of 40, she presented with infected vegetations at the site of PDA, causing fever and clinical signs of PDA, confirmed by echocardiography.

Doppler evaluation of breast solid masses differentiation of benign and malignant masses role of resistive index

Objective: To know the usefulness of color and spectral doppler in evaluation of solid breast masses using vascularity and resistive index. Material and methods: We performed duplex doppler sonography on 100 patients presenting with breast mass. Resistive index and vascularity of the vessels were detected and analyzed and correlated with histopathological results. Results: 70% of the benign lesions were found having ri below 0.8 and 45 out of 50 patients had low vascularity.43 malignant lesions had high vascularity and 80% had ri above 0.8. Conclusion: High flow visualization on power doppler and indicates a higher possibility of malignancy lesions with ri greater than 0.8 gives high probability of malignancy.

Regulation of CD40 and CD40 ligand by the AT-hook transcription factor AKNA

Proteins containing AT hooks bind A/T-rich DNA through a nine-amino-acid motif and are thought to co-regulate transcription by modifying the architecture of DNA, thereby enhancing the accessibility of promoters to transcription factors. Here we describe AKNA, a human AT-hook protein that directly binds the A/T-rich regulatory elements of the promoters of CD40 and CD40 ligand (CD40L) and coordinately regulates their expression. Consistent with its function, AKNA is a nuclear protein that contains multiple PEST protein-cleavage motifs, which are common in regulatory proteins with high turnover rates. AKNA is mainly expressed by B and T lymphocytes, natural killer cells and dendritic cells. During B-lymphocyte differentiation, AKNA is mainly expressed by germinal centre B lymphocytes, a stage in which receptor and ligand interactions are crucial for B-lymphocyte maturation. Our findings show that an AT-hook molecule can coordinately regulate the expression of a key receptor and its ligand, and point towards a molecular mechanism that explains homotypic cell interactions.

The interaction between fibronectin and DNA

An examination of the DNA binding domain structure of bovine plasma fibronectin (Fn) was undertaken by a combination of limited proteolytic cleavage and Western blotting. A time course digestion of fibronectin with cathepsin D produced a number of proteolytic fragments possessing DNA binding activity. After two min digestion, two DNA binding fibronectin fragments of Mr approximately 180kd and 120kd were detected. Upon further digestion, a fibronectin fragment of Mr 18kd was detected. Thus it would appear that under physiological ionic strength only a single DNA binding domain exists in the fibronectin molecule. It was also demonstrated that the interaction of fibronectin with DNA is not ionic in nature, as heat denaturation of protein totally abolishes the DNA binding activity. An examination of possible sequence specificity of DNA binding activity of fibronectin was also undertaken by dot blotting the bovine plasma fibronectin and using [32P] labelled lambda FC 40 DNA containing approximately 16 kd of 5' end of the chicken fibronectin gene. Its binding to fibronectin was approximately twice the binding of [32P] labelled wild type lambda, where as binding to control of equimolar concentration of calf thymus histone H 2 A was approximately equal. The use of a smaller subcloned region, a approximately 1.9kb fragment of DNA from the 5' end of chicken fibronectin gene and wild type lambda DNA showed approximately 2 fold increase in histone binding and approximately 7 fold increase in fibronectin binding, indicating preferential fibronectin binding with eukaryotic DNA as compared to prokaryotic DNA. Further investigation of sequence specificity showed that a 0.45kb DNA fragment from the 5' end of chicken fibronectin gene, containing a number of elements characteristic of promoter, demonstrated approximately 2 fold higher level of binding with fibronectin and approximately 3.5 fold less binding activity with equimolar concentration of histone H2A when compared with a 1.4kb fragment of chicken fibronectin gene from the 1st exon. These results suggest fibronectin binding may be preferential to the promoter region of its own gene which could have possibly a regulatory function.