aging

Objectives: We describe the clinical course and management of two patients with post-capillary pulmonary hypertension due to diffuse pulmonary venous baffle calcification decades post-Mustard procedure.Background: From the late 1950s to the early 1990s, the definitive surgical repair for children with D-transposition of the great vessels (D-TGA) was an atrial switch procedure (either Senning or Mustard operation) which utilizes atrial-level baffles to shunt pulmonary venous blood to the morphologic right (systemic) ventricle and caval blood to the morphologic left (sub-pulmonary) ventricle. From a hemodynamic standpoint, baffle leaks and stenoses as well as precapillary pulmonary hypertension have all been described as both early and late complications [1]. Recently, delayed post-capillary pulmonary hypertension (in the absence of discrete baffle obstruction) decades post-atrial switch has also been described [2]. The underlying pathophysiology for this postcapillary pulmonary hypertension is unclear but is theorized to involve impaired diastology referable to the pulmonary venous baffle. Methods/Results: Using hemodynamic and imaging data, we describe two patients with extensive pulmonary venous baffle calcification and resultant pulmonary hypertension from the so-called “stiff left atrial (LA) syndrome.” This problem can be difficult to treat medically and is not amenable to catheter-based interventions. We hypothesize that this is an underlying mechanism for pulmonary hypertension in at least some post-Mustard and Senning patients. Conclusion: We describe the treatments and clinical course for each of these patients, and in particular describe how the surgical revision of the pulmonary venous baffle in one case led to the complete resolution of symptoms.

The case report presents a neuromyelitis optica in a 19 years old male. Brain and spinal cord MRI showed bilateral optic neuropathy, multiphasic demyelinating process involving the cervical and thoracic spinal cord. Cerebrospinal fluid showed negative NMO Ig G. We will describe the radiological aspect of neuromyelitis optica with a review of the literature.

Background: Diabetic retinopathy (DR) is one of the most common causes of preventable blindness. Patients with Diabetes Mellitus (DM) develop not only DR but also corneal endothelial damage leading to anatomical and physiological changes in cornea. Central corneal thickness (CCT) is a key parameter of refractive surgery and Intraocular pressure (IOP) estimation. The role of CCT and higher glycemic index in DR needs to be researched upon.Objectives: To identify the corneal endothelial morphology in patients with type 2 DM, to measure the Central Corneal thickness (CCT) in patients with type 2 Diabetes Mellitus, to assess the relationship of CCT with HbA1C levels in the study group and to correlate the CCT with the severity of Diabetic retinopathy in the study group.Methods: A cross-sectional observational study was conducted between January 2018 and June 2019 in Vydehi Institute of Medical Sciences and Research Centre, Bangalore. The study included 100 subjects with type 2 DM for 5 years or more. Patients with comorbidities that may affect the severity of DR or alter CCT and other corneal endothelial parameters such as glaucoma, previous ocular surgery or trauma, corneal degenerations and dystrophies, chronic kidney disease and Hypertension were excluded. DR was assessed by dilated fundoscopy, fundus photography and optical coherence imaging of the macula and graded as per the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. CCT and other corneal endothelial parameters were measured through specular microscopy. Relevant blood investigations including blood sugar levels were done for all patients.Statistical analysis: Relationship between CCT and grades of DR and HbA1c levels were established using the Chi-Square test. The level of significance was set at p < 0.05.Results: The mean CCT in patients with no diabetic retinopathy, very mild and mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe and very severe NPDR and PDR was 526.62 ± 8.084 μm, 542.07 ± 8.713 μm, 562.16 ± 8.255 μm, 582.79 ± 7.368 μm and 610.43 ± 18.256 μm respectively. Analysis of the relationship between CCT and severity of DR showed a statistically significant positive correlation between the two parameters (Pearson r = 0.933, p = 0.001). Beyond this, a correlation was found between all the corneal endothelial parameters and severity of DR. Multivariate analysis showed that advanced DR was positively correlated with CV (r  = 0.917) and CCT (r = 0.933); while it was negatively correlated with ECD (r = -0.872) and Hex (r = -0.811). A statistically significant correlation was also found between CCT and HbA1c. Also increasing age, duration of DM and higher glycemic index were positively correlated with severity of DR. Conclusion: This study, by demonstrating a strong correlation between the central corneal thickness to the severity of DR and HbA1c levels emphasizes the importance of evaluation of corneal endothelial morphology in the early screening and diagnosis of microvascular complications of DM.

Intrasellar meningioma (IM) is a rare occurrence that is difficult to distinguish preoperatively from the most common non-functioning pituitary adenoma. Here we describe a case of psammomatous IM occurring in a 68-year-old woman, presented with visual defects. On magnetic resonance imaging (MRI) she was found to have an intrasellar mass with suprasellar extension that was approached with transsphenoidal surgery. Subtle radiological hints, namely dural tail sign, intralesional calcifications and a marked and homogenous early enhancement of IM on MRI after gadolinium administration, may aid clinicians in achieving an accurate pre-operative diagnosis and choosing the proper surgical approach. The clinical and neuroradiological features of IM described in the literature has been reviewed.

Aim: Accumulating data imply that glaucoma may represent a neurodegenerative disorder affecting the entire visual system. We evaluated retrobulbar glaucomatous damage with favorable techniques for 1.5T diffusion-tensor magnetic resonance imaging and we compared those techniques with clinical data in a large case series. Material and methods: This Cross-sectional study included 130 eyes of 65 patients with primary open-angle glaucoma. Patients with no known ocular or systemic concomitant disorders, neurological diseases, previous glaucoma surgeries, or antioxidant usage were selected. A decrease in thickness and deterioration in the optic nerve diffusion of severely glaucomatous eyes of patients with asymmetrical involvement was observed in optic nerve tractography. Optical coherence tomography and visual field results of the subjects were recorded. Glaucoma analysis with optical coherence tomography and standard automated perimetry results of the subjects were recorded. Diffusion-tensor magnetic resonance imaging analysis of optic nerves and radiations were performed, computing fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity. Correlation between the diffusion-tensor magnetic resonance imaging and clinical eye parameters of glaucomatous neurodegeneration were statistically evaluated. Results: The correlations between diffusion parameters and age were highly significant. Statistically significant correlations were found between ganglion cell complex and apparent diffusion coefficient, axial and radial diffusivities of optic nerves. Conclusion: Eye-brain connection in glaucoma can be evaluated with routine clinical instruments. Our study also revealed a limited correlation of retrobulbar glaucomatous neurodegeneration with ophthalmic damage. A better understanding of retrobulbar damage will enable us to develop more efficient strategies and a more accurate understanding of glaucoma.

Invasive fungal infections are described as a continuous and severe harm to human health and they are associated with at least 1.5 million deaths worldwide each year. Amphotericin B exerts its activity through hydrophobic interactions with cell membrane ergosterol, cause the rupturing or leakage of cell membrane. The antifungal azole medicine group is classified as imidazoles (clotrimazole, ketoconazole, miconazole) and triazoles (fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole) that are named according to the number of nitrogen atoms in the azole ring. Flucytosine is a first-line treatment for the management of cryptococcal meningitis. The most routine adverse effects of fluconazole involve accelerated liver enzymes, gastrointestinal complaints, headache, and skin rash. If antacids, PPIs, H2 blockers administered together with ketoconazole medicines; they will reduce the blood levels of ketoconazole by increasing gastric pH because ketoconazole requires an acidic media for dissolution and systematic absorption. Griseofulvin ruptures mitotic spindle during metaphase by interacting with fungal microtubules-(-), fungal mitosis (metaphase arrest), adequate to block expansion of fungi (drug is static), preventing them from damaging.

The lips and perioral region play an important role in facial aesthetics. Aging induces a loss of volume and contour of the lips, a flattening of the cupid's bow, and the appearance of perilabial wrinkles. Thus, aesthetic procedures are common in this area because fillers can reduce these alterations, improving facial harmony. Although the application of the fillers is based on some systematized framework, undesirable results could occur. The Light Lips Technique is a method that applies a very small amount of small-particle hyaluronic acid, only 0.4 ml, to six specific points of the lips. The objective of the technique is to provide lifting of the labial commissures, highlighting some labial points, such as the Glogau-Klein points of the cupid's bow and its equivalent points on the lower lip. After the application of this technique, it is possible to observe an improvement of the lips with very natural-looking results.

Median arcuate ligament syndrome is a rare entity. This clinical condition develops by compression of the root of a celiac artery with the median arcuate ligament. The typical triad of this syndrome is the following; abdominal discomfort and pain, especially after a meal, and weight loss. In diagnosis, other causes should be ruled out and compression must be demonstrated by any type of imaging method. The main principle of treatment is cutting down the median arcuate ligament. A 54-year-old woman presented with untreatable recurrent abdominal pain and was diagnosed with median arcuate ligament syndrome by imaging with angiographic computed tomography. This patient was operated on. We performed laparoscopic division of median arcuate ligament with the retrograde surgical dissection technique. The patient was discharged from the hospital without any complaint on the third day after surgery. She was still symptom-free after 12 months.The laparoscopic retrograde dissection approach is a safe and feasible treatment modality for median arcuate ligament syndrome.

Pancreatic lipoma is a benign, mesenchymal-derived tumor. It is an uncommon entity that is rarely reported. The diagnosis is usually made on a CT scan or MRI. We present a case of a pancreatic lipoma incidentally discovered on imaging in a 53-years old patient presenting for acute cholecystitis.

Introduction: The world is currently facing the SARS-CoV-2 pandemic with evolving 2nd wave. The COVID-19 patients present most commonly with Severe Acute Respiratory Illness (SARI) in an emergency room with acute onset fever, cough, and breathlessness. However, not all SARI cases as per definition are due to COVID-19 infection, which is well proven in this case series of 113 cases of SARI. This is just the opposite of the other SARI series done in the pre-COVID-19 era. Also, no previous SARI case series data has shown significant association with Diabetes Mellitus, including new-onset diabetes thus figuring out the major Pathophysiological association of COVID-19 with glucose metabolism and has a bearing on the pathogenesis, treatment, and outcome of COVID-19 infection and perpetuity of pandemic of this magnitude. Here we raise concern for the first time about the growing association of an infectious pandemic with the lifestyle disorders which are non-communicable diseases but carry with them the potential of fertile soil for rapidly spreading epidemics.Aim and objective: To find out the etiology, clinical profile, treatment outcome, and mortality rate in different sub-groups of SARI cases in a tertiary care hospital and the incidence of new-onset Diabetes Mellitus in them and to investigate theoretically the hypothesis that maintaining normal glucose metabolism could prevent progression of a mild Flu-like illness (FLI) to a severe form of Severe Acute Respiratory Illness (SARI) and consequent complications such as Cytokine Storm Syndrome and Multi-Organ failure.Design: Retrospective, single-center case series of 113 SARI patients at a tertiary care hospital in Agra India between 1 March- 30 October 2020.Main outcome: The demographics, clinical, pathological, imaging, and treatment outcome data were collected. The SARI cases analyzed were defined as “Severe acute respiratory infections (SARIs) an acute respiratory illness of recent onset (within seven days) manifested by fever (≥38°C), cough and shortness of breath or difficulty in breathing requiring hospitalization and were sub-classified according to the primary etiology producing SARI in them. The findings were compiled and compared. Conclusion: Of the 113 patients of SARI – 32.7 %were associated with Diabetes, with 9.74% new-onset Diabetes and 26 % previously known Diabetes. This was mainly due to SARS-CoV-2 (24 Diabetics out of 52 COVID-19 cases- 46.1 %).The Average hospitalization stay of SARI cases was 10 days with a maximum in SARS-CoV-2 and a minimum stay of 5.22 days in Bacterial Pneumonia and 5.66 days in Koch’s Lungs.The death rate was maximum (4 out of 26) 15.3%. Hospitalized TB/Koch’s Lung patients who presented as SARI and 3.8% in Bacterial Pneumonia, 2.43% in SARS-CoV-2, and <1% in Sepsis.Those SARI cases who were euglycemic at the time of initial presentation recovered early and carried a good prognosis with less mortality as compared to those who were hyperglycemic on presentation. Also, those FLI cases who maintained euglycemia or did not have any other risk factor which predisposes them to stress (Diabetes, Prolonged fasting, Obesity, major organ disorder, Psychological disorder, and Cancer) did not progress to SARI as the endogenous steroid secretion and sympathetic activation did not occur, the intracellular pH levels remained in the alkaline range.10.18% of cases developed new-onset diabetes (a total of 11 cases) out of which 10 were in COVID-19. Thus 19.2% incidence of new-onset diabetes in SARS-CoV-2 and a prevalence of 26.9% in SARS-CoV-2, making total diabetes 46.1% in SARS-CoV-2, and out of all SARI cases, 26 % of patients developed pulmonary fibrosis with consequent long-term complications. In COVID-19 patients, it was seen only in diabetics SARS CoV-2 male patients, thus no death in non-diabetic females in COVID-19 in this case series.

Cancer metastasis to the pituitary gland is rare, but in most cases, it originates from a late-stage breast tumor or lung cancer. The most common symptoms of metastasis to the pituitary gland are diabetes insipidus and visual disturbance. The common site of metastasis is the posterior portion of the pituitary gland because it is highly vascularized. Metastases to this site represent 1% of all tumors [1]. Metastasis to the pituitary gland is difficult to diagnose by hormonal analysis and magnetic resonance imaging of the brain and requires biopsy for confirmation [2].

Given improvements in neonatal care and the increased survival rates of infants born pre-term, Cortical Visual Impairment (CVI) is now the leading cause of visual impairment (VI) in the developed world. In this study, Step VEPS, transient VEPS and Vernier Sweep VEPs all demonstrated unbiased relationships with Preferential looking (PL) cards over the whole range of Visual Acuity (VA) in children with CVI, allowing equations for clinical use to be derived. The results also suggested that a slower, vernier steady-state stimulus of 80% contrast and presented with the Step VEP algorithm could further improve VA agreement with PL and optimise developmental sensitivity. An eye tracking device has proved very useful in the clinical assessment of this cohort. It is also now known that children can have good VA and CVI, and that sweep VEPS can highlight higher processing deficits. As well as negative findings, compensatory neuroplasticity is thought to occur during maturation and it is now realistic to study this mechanism, and other age-related changes across VI with functional tests and neuroimaging (including VEPS). A cross-sectional study of adults would highlight CVI’s ultimate functional limitations.

The epidemics of heart failure and an aging population resulted in an exponential rise in the use of cardiac implantable devices (CIEDs) in developed countries. This is paralleled by the increased rate of complications such as system infection or malfunction. The higher number of complications, and longer patient life expectancies, are followed by an increase in the need for lead extractions. 

Cerebral brain injuries (CBIs) account for up to 20% of all injuries in boxing. Approximately 97% of sports-related brain injuries are mild, their neurological symptoms are unexpressed, and young, strong, highly motivated athletes tend to dismiss the severity of their injuries. This may lead to an underestimation of the severity and extent of brain injuries. Changes in computed tomography (CT) and magnetic resonance imaging (MRI) in mild traumatic brain injury are absent in the early stages, making diagnosis difficult. Frequent repetitive traumatic brain injuries, including mild brain injuries, can result in functional and structural brain lesions that affect athletes’ performance and, in the long term, significantly impair their quality of life. Also, the consequences of cerebral brain injuries, including mild brain injury, can be affected by the individual condition of the Circle of Willis.

Objective: Pelvic masses can be classified as low risk (likely benign) and high risk (likely malignant) based on an initial clinical risk assessment, which involves a detailed history, physical exam, basic laboratory tests, and imaging. In recent years, the Risk of Ovarian Malignancy Algorithm (ROMA), which combines CA125, HE4 and menopausal status, has emerged as a powerful tool in the classification of pelvic masses and triage of patients to either a generalist gynecologist or a gynecologic oncologist for management. The objective of this study was to evaluate whether the use of ROMA, alone or in combination with Initial Clinical Risk Assessment (ICRA), provides cost savings compared to triage based on ICRA alone.Methods: A health-economic decision model was developed to assess clinical and cost differences associated with three different clinical pathways of risk assessment for a pelvic mass: ICRA alone, ROMA alone, or ICRA + ROMA in combination. Using previously reported accuracy rates and patient characteristics from a prospective, multicenter, blinded clinical trial, total healthcare costs were modeled for each clinical pathway using the Medicare 2020 reimbursement rates.Results: A total of 461 patients with pelvic masses were included with 10.4% ultimately diagnosed with epithelial ovarian cancer. Total healthcare costs for patients with benign disease, EOC, or low malignant potential tumors (LMP) (n = 441) triaged using ROMA alone were 3.3% lower than when triaged using ICRA alone. While lab costs increased 55% using ROMA, the use of ROMA alone resulted in a 4% decrease in laparoscopy costs and a 3.1% decrease in laparotomy costs compared with ICRA alone. Similarly, total costs associated with a combination of ICRA + ROMA were 3.9% lower than total costs associated with ICRA alone. The model also predicted a 63% reduction in repeat surgeries resulting from false negative ICRA when using ROMA to triage patients.Conclusion: Triage of women with pelvic masses using the more sensitive ROMA score lowers overall healthcare costs compared to ICRA alone. With fewer false negative results than ICRA alone, the ROMA score improves initial detection of malignancy and reduces second surgical treatments in women with pelvic masses.

As a vital index of the mitochondrial micro-environment, mitochondrial micro-viscosity plays a fundamental role in cell life activities. Normal mitochondrial viscosity is a necessary condition for the maintenance of normal life activities of mitochondria. Abnormal mitochondrial viscosity can lead to a series of mitochondria-related diseases. Therefore, it is essential to observe mitochondrial viscosity for physiological and pathological processes. Given the conventional viscosity measurement methods (viscometer, etc.) cannot monitor the changes in mitochondrial viscosity, the fluorescence method supplemented with the fluorescent probe is widely used to observe the changes in mitochondrial viscosity. In view of the booming development in this area, this review describes the applications of viscosity-responsive mitochondrial fluorescent probes in biological samples from the cellular and tissue levels. We hope that this review will deepen our understanding of mitochondrial viscosity and related fields, and promote the development of viscosity-sensitive mitochondrial probes and other organelle fluorescence probes.

Hepatic Actinomycosis (HA) is a very rare abdominal actinomycosis that can be confused with hepatic involvement due to a tumor. Liver involvement can occur from an abdominal focus or by blood dissemination from another focus. This disease is much more common in men between 50 - 70 years and in a situation of immunosuppression. Symptoms are nonspecific and diagnosis includes histopathology, cultures, and imaging test. Treatment includes prolonged antibiotic therapy with antibiotics such as penicillin and drainage of abscesses.We present a case of a 54-year-old man patient with a record of three years of chronic pancreatitis of probably alcoholic origin, who developed hepatic actinomycosis, requiring drainage of liver abscesses and directed antibiotic treatment.

Neuropathy is when nerve damage interferes with the functioning of the peripheral nervous system (PNS). When the cause can’t be determined, it’s called idiopathic neuropathy(Idiopathic neuropathy, now designated as chronic idiopathic axonal polyneuropathy (CIAP).There are three kinds of nerves within the PNS. Sensory nerves relay messages from the sense organs to the brain. This allows sensations of temperature and touch. Motor nerves transmit signals from the brain to the muscles. This helps the brain control the muscles. Autonomic nerves control body functions like heart rate, breathing, and digestion.Damage to nerve cells can affect how the PNS communicates with the rest of the body. Symptoms can include numbness, pain, and balance issues.It’s called acute neuropathy when symptoms develop suddenly. Alternately, it’s called chronic neuropathy when symptoms start slowly and increase over time. Diagnosis involves physical examination and review of medical history. Diagnostic testing may include blood tests, nerve testing, and imaging tests.There is no cure for idiopathic neuropathy. Treatments including medication, physical therapy, and lifestyle modifications can help you function and feel better.We report a case of idiopathic polyneuropathy presented with frequent acute pulmonary edema for a year.

Pretreatments and drying are commonly used before drying tomatoes to inactivate enzymes, improve the drying process, and improve the quality of dried tomato powders. In this review, the effects of different pretreatments (osmotic solutions), dehydration methods, and packaging materials on the quality attributes of tomato powder were summarized. These include pretreatments and osmotic agent solutions (potassium metabisulfite, calcium chloride, sodium metabisulphite, ascorbic acid, citric acid, sodium chloride, and sodium benzoate), thermal blanching (steam blanching and hot water) and non-thermal-processes-like-freezing, sulfuring, etc. and drying methods (oven, sun, and indirect solar dryer). The tomato powders were dried to preserve, store, and transport them. Drying implies not only physical changes, which the consumer can easily detect through visual inspection but also chemical modifications. These are responsible for alterations in color, flavor, and nutritional value, which compromise the overall quality of the final tomato powder. Maximum lycopene, vitamin A, and C contents were found in freeze-dried and direct sundried than samples dried using other methods at low drying temperatures. Freeze driers showed in keeping the nutritional quality of tomato powder with a combination of different pretreatments. Different pretreatments including osmotic agent solutions have their own merits and demerits for the final tomato powder. To overcome the drawbacks of nutritional quality, non-thermal pretreatment categories may be a better alternative to thermal blanching, and more fundamental research is required for better design and scale-up.

Neurological disorders are a significant cause of mortality and disability across the world. The current aging population and population expansion have seen an increase in the prevalence of neurological and psychiatric disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis and schizophrenia. These pose a significant societal burden, especially in low - and middle-income countries. Many neurological disorders have complex mechanisms and lack definitive cures; thus, improving our understanding of them is essential. The pathophysiology of neurological disorders often includes inflammation, mitochondrial dysfunction and oxidative stress. Oxidative stress processes, especially the generation of reactive oxygen species, are key mechanisms in the development of neurological disorders. Oxidative stress refers to an imbalance between the production of reactive oxygen species and antioxidants that can counteract them. Through their impacts on the pathophysiology of neurological disorders, nutrients with anti-inflammatory, neuroprotective and antioxidative properties have been suggested to prevent or mitigate these disorders. Certain vitamins, minerals, polyphenols and flavonoids may have therapeutic effects as adjuvant treatments for neurological disorders. Diet quality is also a risk factor for some neurological and psychiatric disorders and addressing nutritional deficiencies may alleviate symptoms. Therefore, optimizing nutritional intake may represent a potential treatment or prevention strategy. This review summarizes a selection of promising nutrients for the prevention and amelioration of neurological disorders to provide a summary for scientists, clinicians and patients, which may improve understanding of the potential benefits of nutrients in the treatment of neurological disorders.