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Aim: To examine the relationship between the levels of HbA1c and hospital admission rates.Methods: We recorded HbA1c levels of all diabetic patients in Tripoli University Hospital over one year.Results: The mean HbA1c was 8.03%, with no difference between males and females. Over half of patients (56.5%) were admitted through their diabetes was well-controlled. Over half of the patients with type 1 diabetes (57/102, 55.9%) had a high HbA1c at admission compared to 42.1% of patients with type 2, who were mainly admitted with HbA1c level within the acceptable range set for this study. The HbA1c level was positively and significantly correlated with the length of hospital stay (R = 0.93, p = 0.000), and was significantly associated with hyperglycemia, diabetic ketoacidosis, coronary artery disease, limb ischemia, cataract, osteomyelitis, and non-alcoholic steatohepatitis.Conclusion: HbA1c is correlated significantly with hospitalization in type 1 diabetes but not in type 2.

Background: An association between Atrial Fibrillation (AF) and Metabolic Syndrome (MS) a constellation of abnormalities (high blood pressure, hyperglycemia, dyslipidemia, and abdominal obesity), has been demonstrated. There have been many studies that have shown that elevated blood pressure (BP), was significantly associated with an increased risk of AF. It is uncertain whether maintaining the optimal BP levels can prevent AF in the patients with MS categorized as ‘high-risk’ patients.Objective: The aim of this study was to evaluate the influence of control of BP on the occurrence of new-onset atrial fibrillation in patients with Metabolic Syndrome.Methods: Into this observational study, was enrolled 435 consecutive patients (210 males and 225 females) aged 45-79 years who fulfilled criteria for MS. Participants were selected among primary and secondary care patients, who were receiving ongoing care for arterial hypertension in the period from November 2018 till November 2021. The study was conducted at outpatients in 5 Health Care Clinics (3 Secondary Health Care Clinics and 2 Primary Health Clinics). Patient were categorized according to their BP levels as Group 1-patients with controlled BP, {(patients aged < 65 years Systolic Blood Pressure (SBP) of 120 - 130 mmHg, patients aged ≥ 65 years SBP of 130 - 139 mmHg)} and Diastolic Blood Pressure (DBP), {(patients aged < 65 years of < 80 mmHg. but not < 70 mmHg; patients aged ≥ 65 years of 85 - 89 mmHg)}, or Group 2-patients with uncontrolled BP(> 130/80 mmHg),and in patients aged ≥ 65 years BP (≥ 140/90 mmHg ). Results: New-onset of AF, was more frequent in participants with uncontrolled BP, respectively (34.7% vs. 19.5%, p = 0.009).Patients with uncontrolled BP have more frequent persistent AF (15.2% vs. 0.04%) and permanent AF (0.08% vs. 0.02%), whereas there was not significant changes between groups in relation to frequency of paroxysmal AF, respectively (12.8% vs. 10.9%, p = 0.29). There was observed significant association of uncontrolled BP with: increased frequency of AF (OR = 2.193; 95% CI 1.390 - 3.439), persistent AF (OR = 3.931; 95% CI 1.771 - 8.084), permanent AF (OR = 4.138; 95% CI 1.383-12.381), LA. Dimension ≥ 2.2 cm/m2 (OR = 2.089, 95% CI 1.330 - 3.252), BMI (OR = 5.226, 95% CI 3.155 - 8.659) and 5-risk factors for MS, respectively (OR = 2.998, 95% CI 1.833 - 4.901).Conclusion: Optimal BP levels, can reduce the frequency of new-onset AF in patients with MS categorized as ‘high-risk’ patients. Uncontrolled BP was associated with an increased risk of both subtypes of AF (persistent and permanent) in the patients with MS categorized as ‘high-risk’ patients.

Background: Many institutional factors predispose University students to mental health issues, including depression. However, with no central database for depression in Uganda, literature on depression and associated institutional factors among undergraduate students is scarce. This study examined the prevalence of and institutional factors associated with depression among undergraduate students at Gulu University.Methods: This was a cross-sectional survey among 452 undergraduate students at Gulu University in the academic year 2018/2019 in February and March 2019. A stratified simple random sampling was used to identify the participants. A self-administered questionnaire was used to collect data. Descriptive statistics, including mean and frequency, were used. We conducted a bivariate analysis to determine the association between variables employing Pearson’s chi-square test or Fischer’s exact test. We conducted a multivariate analysis with factors that had significant P-values of less than 0.05.Results: The average age of the respondents was 22.4 (SD - 2.4), more than half (53.1%) were male and 38.50% were in the second year. The results show that 31.19% reported depression. After controlling for age and sex, the results showed that there was a statistically significant correlation between depression and faculty (aOR - 1.15), year of study (aOR - 0.77), happiness with the course (aOR - 0-0.49), satisfaction with academic performance (aOR - 0.45), and satisfaction with academic quality (aOR - 0.61). The results indicated that the predictors of depression among undergraduate students were faculty, year of study, satisfaction with academic performance, and satisfaction with academic quality. Conclusion: A substantial proportion of Gulu University undergraduate students reported high levels of depression. The results, therefore, showed that depression in undergraduate students is an identifiable disorder that needs diagnosis, prevention, and treatment. Faculty, year of study, satisfaction with academic performance, satisfaction with academic quality were predictors of depression. Thus there is an urgent need for counseling, psychoeducation, and preventive mental health services as an essential part of the university setup.

Background: Sepsis among newborns is common and a major cause of neonatal deaths in developing countries. Annually, about 4 million neonatal deaths occur around the world. Of these, more than 30% are caused by infections majority of which start as umbilical cord infections. Topical umbilical cord care can reduce omphalitis (umbilical cord infection) and neonatal mortality among newborns.Objective: This study aimed to compare the incidence of omphalitis in different cord care interventions (Dry, Chlorhexidine, and Alcohol) in Nakuru County, Kenya. Methodology: A randomized controlled trial was carried out between July 2018 and June 2019. A total of 540 newborns were randomly assigned to receive 1 of 3 cord care regimens; twice cord cleansing with 4% chlorhexidine (Group 1), twice cord cleansing with 70% alcohol (Group 2), and dry cord care (Group 3) as control. Results: The risk of omphalitis was significantly reduced in the chlorhexidine group than in dry and alcohol cord care groups. The incidence of omphalitis was 1.95 times more likely to occur among the dry cord care group [AOR = 1.95; 95% CI = 1.13-3.38; p = 0.017] compared to the chlorhexidine group. Similarly, babies in the alcohol group were nearly 2 times more likely to develop omphalitis [AOR = 1.98; 95% CI = 1.15-33.40; p = 0.014] compared to those in the chlorhexidine group.Conclusion and recommendation: Chlorhexidine topical cord care significantly reduces the risk of umbilical infection in neonates when compared to both topical alcohol application and dry cord care approach. It should be recommended to be used topically for the prevention of omphalitis in our setup.

Helminthiasis is also known as worm infection, is any macroparastic disease of humans and other animals in which a part of the body is infected with parasitic worms known as helminths. Anthelmintic agents are medicines that used for treatment and inhibition of parasitic infections caused by helminths; which involve both flat worms, such as, flukes and tapeworms and round worms, such as, nematodes. Anthelmintics are categorized into groups depending on the basis of their identical chemical structure and mode of action. Thiabendazole, mebendazole, and albendazole belong to benzimidazoles group of antihelmenthic medicines. From benzimidazoles group of antihelmenthic, thiabendazole was first discovered in 1961 and already a mentioned number of more benzamidazoles were interpolated as wide spectrum anthelmintics. Praziquantel has a particular effect on the enveloping layer of trematodes and increases permeability of calcium ion influx leading to uncontrolled muscle contraction and paralysis. Praziquantel has a particular toxic effect on schistosome parasites, where its mode of action has been resulted more extensively than in cestodes. Coadministration of mebendazole with CYP450 inhibitors medications such as cimetidine, ketoconazole and etc may be increases plasma levels of mebendazole, by extending the half-life and decreasing plasma clearance.

Background: There is a paucity of data on the burden of acute kidney injury (AKI) in hospitalized HIV-infected patients in Sub-Saharan Africa in the “test and treat” era.Objectives: To study the incidence, risk factors, and outcomes of AKI among HIV-positive medical admissions in a secondary hospital.Materials and methods: We prospectively screened adult HIV-positive patients who gave their informed consent and were admitted to the Bamenda Regional Hospital for AKI from February to June 2020. We excluded participants with Chronic Kidney Disease (CKD) Stage 5 and those with confounders of serum creatinine. On admission and after 2-7 days, we extracted a venous blood sample from each participant to evaluate serum creatinine and diagnose AKI. The participants were then followed up on until they were discharged or died. We measured the need for dialysis, access to dialysis, and renal recovery at three months for patients with AKI. The amended KDIGO 2012 criteria were used to define and classify AKI. The University of Bamenda’s institutional review board provided ethical approval.Results: A total of 206 participants (39.8% men) were enrolled, with a mean (SD) age of 45.71(13.13) years. On enrolment, 89.8% (n = 185) of the participants were on combination antiretroviral therapy (c-ART), with 81.6% (n = 151) on tenofovir-containing regimens. The WHO HIV clinical stages 3 and 4 were present in 81.5% (n = 168) of the individuals. The most common reason for hospitalization was opportunistic infections (69.8%; n = 142). AKI was found in 30.6% (n = 63) of the patients, with 58.7% (n = 37) of them being classified as KDIGO stage 3. A total of 12 (42.9%) participants out of the 28 in need, were dialyzed. AKI was independently associated with use of traditional medicines (aOR = 2.9; 95% CI 1.4-6.3; p = 0.006), WHO HIV stages 3 and 4 (aOR = 4.1; 95% CI 1.1-15.7; p = 0.038), hypotension (aOR = 3.3; 95% CI 1.4-7.8; p = 0.008) and low haemoglobin level ≤ 8.0 g/dl (aOR = 3.5; 95% CI 1.7-7.4; p = 0.001). The AKI group used to have a significantly higher mortality rate (42.9% vs. 16.1%; p < 0.001). Renal recovery was complete in 66.7% of the 30 survivors at three months, partial in 13.3%, and no recovery in 20% of the survivors.Conclusion: Despite the growing use of combination antiretroviral medication, significant immunosuppression is still common in hospitalized HIV-positive patients, increasing the risk of AKI and worsening prognosis. In this high-risk population, early detection of AKI with renal function monitoring may improve results.

Plant-parasitic nematodes are ubiquitous in nature and cause large losses in agriculture. The current concerns regarding the use of chemical pesticides have increased the interest in new control alternatives. One of these is the one based on Bacillus thuringiensis (Bt). These Gram-positive bacteria have the ability to synthesize pesticide proteins during sporulation. Some of these proteins have nematicidal properties. Studies have shown that preparations of certain strains of Bt can prevent or slow down the infestation of phytonematodes. The expression of some Bt nematicidal genes in transgenic plants has also demonstrated their effectiveness. Bt is nowadays an effective ecological alternative for controlling plant-parasitic nematodes.

Background: COVID-19 is the extreme smash of the present-day century that emaciated fitness, financial system, and ordinary life.Objectives: This research assessed the condition and relation of tests, infections, recoveries, and deaths of SARS-CoV-2 from January to May 30, 2022. Methods: The research plan was carried out from January 1 to May 31, 2022 (n = 151 days) to state the position of Bangladesh towards widespread COVID-19. The facts in this study became acquired from extraordinary government groups.Results: The total cases, infections, recoveries, and deaths were 2633750, 367208, 357309, and 1053, respectively, during the study period. In January 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 987194, 213294, 19112, and 315, respectively. In February 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 922657, 143744, 250422, and 643, respectively. In March 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 353555, 5810, 49727, and 63, respectively. In April 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 152691, 977, 12490, and 7, respectively. In May 2022, the total number of COVID-19 tests, infections, recoveries, and deaths was 127950, 1016, 6166, and 4, respectively. The maximum and the minimum number of COVID-19 tests were 49492 and 1653 on January 25 and May 4, respectively. The maximum and the minimum number of COVID-19 infestations were 16033 and 1653 on January 22 and May 5, respectively. The maximum and minimum number of COVID-19 recovered were 13853 and 1653 on February 13 and May 9, respectively. The maximum and the minimum number of COVID-19 death was 43 and 0 on February 8 and in several days in 2022, respectively. In the 0.01 level of the two-tailed Spearman, the relationship was positive to moderate to strong relationships and the total number was n=151. The mean Spearman correlation for tests was 0.83 (range 0.973 to 0.633), for infested was 0.81 (range 0.579 to 0.973), for recovered was 0.61 (range 0.633 to 0.618), for death was 0.81 (range 0.553876 to 0.618). This research additionally showed a moderate to strong relationship between tests, infections, recoveries, and deaths of SARS-CoV-2.Conclusion: COVID-19 has spread out unexpectedly to 64 districts in Bangladesh. The persevering with the occurrence of COVID-19 infections has emphasized the significance of the short and accurate and advanced 118 laboratory diagnoses to restriction it unfolds. In this situation, human beings must keep away from public gatherings as plenty as possible and pass return home as speedy as possible after finishing work in a public place. It is safer now because the vaccine controlled the infestation and death rate of COVID-19 in Bangladesh.

Background: Worldwide, studies show negative attitudes among medical students toward psychiatry and mental illness. The knowledge of the attitude and awareness of the undergraduate medical students toward mental health and psychiatric disorders are most important as they are going to be involved in the care of these patients either directly or indirectly during the years of their careers.Aim: To explore, the knowledge, attitude, and behavior of undergraduate medical students towards mentally ill Patients before their planned psychiatry rotation in the fourth year of undergraduate medical study, faculty of medicine, Suez Canal University, Ismailia, Egypt.Objectives: To assess mental health-related knowledge, attitudes and intended behavior of undergraduate medical students towards mentally ill patients.Subjects and methods: A descriptive, cross-sectional study, conducted on 120 fourth-year undergraduate medical students affiliated with the faculty of medicine-Suez Canal University. A comprehensive sample was used to include all of the students in the fourth year of undergraduate medical study, and the study group participants completed a semi-structured questionnaire including four parts to assess their knowledge, attitudes, and behavioral responses towards individuals with mental illnesses. The data of the study was collected in September-October 2019.Results: Based on the participants’ scores, the cut-off points estimated to dichotomize the responses as poor or good, for mental health-related knowledge, belief towards mental illness and intended behavior were, 17, 55 and 8.5 respectively. This study showed that the study participants had marginally poor mental health-related knowledge with a median score of 17, poor beliefs about mental illness with a median score of 49.5 and poor intended behavior towards the mentally ill with a median score of 7. Conclusion: In this study, undergraduate medical students showed marginally poor mental health-related knowledge, poor stigmatizing beliefs, and behavior towards mentally ill patients. More controlled studies are needed to eliminate the inherent response biases in survey studies and to measure the outcomes of anti-stigma educational and curricular interventions. 

Heterologous expression of proteins often pursues high expression levels, but it can easily result in misfolding and loss of biological function. L-α-glycerophosphate oxidase (GlpO) is a flavin adenine dinucleotide (FAD)-dependent oxidase which is widely used in the clinical determination of triglycerides. We found that the total enzymatic activity of GlpO expressed in Escherichia coli (E. coli) was extremely low, probably due to the absence of FAD cofactors and the misfolding of GlpO at a high synthesis rate. Therefore, decreasing the expression rate was used to improve the activity of GlpO. The specific activity of GlpO expressed on the pUC19 vector with lac promotor was approximately 30 times higher than that expressed on the pET28a vector with T7 promotor, but the expression levels of GlpO on the two vectors were completely opposite. It indicated that the specific activity of GlpO was increased as the expression level decreased. However, too low expression greatly influences the total amount and activity of the functional enzyme. In order to resolve this problem, two new plasmids, GlpO-CG4 and GlpO-CG6, were constructed by inserting 4 or 6 nucleotides, respectively, between the ribosome binding site (RBS) and the start code (ATG) on pET28a. Compared with the expression on the GlpO-pET vector, the expression rates of GlpO on the GlpO-CG4 and GlpO-CG6 were dramatically decreased. The total activity of GlpO expressed on GlpO-CG6 was 11 times and 1.5 times higher than that expressed on the GlpO-pET and GlpO-pUC, respectively. Results suggest that the activity of GlpO can be improved by decreasing the expression rate. 

Bacterial blight (BB), is a disease caused by Xanthomonas oryzae PV. oryzae (Xoo), was first reported in Senegal by Trinh in 1980. BB represents a severe threat to rice cultivation in West Africa. Characterizing the pathotypic diversity of bacterial populations is a key to the management of pathogen-resistant varieties. Pathogenicity tests show that all strains are virulent on the susceptible rice variety Azucena, and interact differentially with twelve near-isogenic rice lines, each carrying a single resistance gene. On this rice panel, six races were identified, two of which were previously reported in Mali (A3) and Burkina Faso (A1). Four races (S2, S4, S5, and S6) are described for the first time in Africa. Races A1, isolated in Ndiaye and Ndioum areas is the most prevalent in Senegal. The Xa1 gene controls 100% of the isolates tested and xa5 controls all isolates except S4 strains. The geographical distribution of Xoo races is contrasted. Four races are detected in the North and two in the South East of the country. Race S4 can be a major risk to rice cultivation because strains from this race are the most virulent and can only be controlled by Xa1. To identify local sources of resistance, we screened Xoo strains representative of the various races on twenty-three rice varieties grown by farmers in Senegal. Four rice varieties namely Sahel210, Sangangbye, Dansna2, and Sahel305 effectively control all the isolates tested. Our characterization of the first collection of Senegalese Xoo strains provided insight into the races present in the country and identified sources of resistance in local rice varieties. This information will help design effective breeding programs for resistance to bacterial leaf blight in Senegal. 

Infections caused by extended-spectrum β-lactamases (ESBLs)-producing bacteria in particular Klebsiella Pneumoniae (KPE+), are on a constant rise and are a noted cause of outbreaks in neonatal intensive care units (NICUs). In the NICU of Policlinico di Foggia, an outbreak of infections in 2018 brought to the start of a serial check of presence and favorable conditions associated with KPE+ diffusion. The outbreak was controlled by improving basic hygiene measures such as hand washing, the use of disposable gloves and gowns, and removing a potential environmental contamination source such as the water bottle warmer.

Subacute sclerosing panencephalitis is a rare, slow, and insidious neurodegenerative disease caused by measles. This disease mostly has a classic course. However, sometimes it can be presented with atypical manifestations. In this paper, we aim to present a six years old male patient that was hospitalized due to seizures and ataxia. Cerebral magnetic resonance imaging was normal on the first day of admission, but within a few days, the patient started to be apathetic. On the seventh day, magnetic resonance imaging showed hyperintense lesions in the thalamic, brainstem, and periventricular areas. Periodic epileptiform discharges were detected in the repeated electroencephalogram. Investigations from the cerebrospinal fluid showed markedly elevated measles virus IgG at 230U/ml consistent with the diagnosis of SSPE which should always be ruled out when a patient comes in with uncontrollable seizures, ataxia and apathy.

In the long run people around the globe particularly those who live in underdeveloped Countries in Africa, especially in Ethiopia a large number of communities has a misconception that disease may be transmitted by utilizing health service due to a lack of trust in health service delivery system, Most of the population strongly related with religion, they claimed that it is sin or God or Allah driven. According to a health behavior model, knowledge and practice are contributing factors for increasing healthcare seeking among patients with low levels of trust [1,2]. 

Objectives: To examine the effect of dietary supplements on diabetic risk progression, blood glucose level, and lipid profiles.Methods: A randomized, double-blind, placebo-controlled study was conducted at Rajavithi hospital, Thailand. Participants with prediabetes were randomly allocated to three arms of dietary supplements: placebo (PL) or curcumin plus fish oil and vitamin D (CFD), or curcumin plus fish oil (CF) for 24 weeks. Primary outcomes were the progression of glycemic status and the progression to overt diabetes at 24-week and 36-week follow-ups. Secondary outcomes were changes in glycemic profiles (fasting plasma glucose, 75 g OGTT 2-h plasma glucose or HbA1C), body weight, BMI and lipid profiles.Results: A total of forty-seven participants (PL, n = 16; CFD, n = 15; CF, n = 16) were included in the study. At the 24-week follow-up, the participants with worsening glycemic status in the intervention groups were lower, CFD, CF and Placebo, 14.29%, 13.33% and 31.25%, respectively. However, the primary outcome, progression of glycemic status, was statistically different, with p - value = 0.046 (p < 0.05) when excluding previous diabetes in the study. As well as the incidence of type 2 diabetes at 24-week follow-up was not statistically different between the three groups, 14.29%, 13.33%, and 12.5%, p - value = 0.699 (p < 0.05) in CFD, CF, PL group, respectively. The secondary outcomes also failed to demonstrate the effect of dietary supplements on blood glucose, lipid profiles, weight, BMI and blood chemistry.Conclusion: The combined dietary supplements which contained curcumin-fish oil-vitamin D,could lower the glycemic status progression in prediabetes at six months follow-up and were well-tolerated among the participants.

Oncological diseases are one of the most significant medical and social diseases in most countries of the world. Over the past decades, the search and development of new drugs, treatment regimens and methods of molecular diagnostics of malignant neoplasms remains relevant. In turn, an important goal of molecular genetic research is to suppress the expression of genes responsible for the development of tumors. The key targets taken into account in the development of antitumor drugs are proteins involved in carcinogenic changes in the cell. One of the promising molecular targets for the development of medicinal compounds in targeted therapy of tumor diseases is poly(ADP-ribose)polymerase 1 (PARP1). A potential way to inhibit PARP1 even at the stage of protein translation is RNA interference due to small interfering RNAs (siRNAs). For the penetration of siRNAs into the target cell, it is necessary to develop a method of their transportation controlled in space and time. An actual direction for solving this problem is the use of highly stable porous silicon-based nanoparticles. In the current study, in order to increase the functionality of nanoparticles, their surface was modified with various agents (functionalization), providing increased efficiency of drug loading and more uniform release. 

Between coronary artery anomalies, myocardial bridging means an epicardial coronary artery, mostly left anterior descending artery (LAD), running through an intramyocardial “tunnel” (usually in the middle segment), leading during systolic contraction, flow reduction, through the vessel. When this anomaly is associated with a coronary fistula, which “steals” more from the bloodstream, the symptoms are more pronounced, and the management complex is surgical in particular. Despite the presence from birth remains asymptomatic and it becomes clinically manifest later in the third to fourth decade of life, with a diverse palette of symptoms; angina, arrhythmias, and acute myocardial infarction up to sudden death. Diagnosis and particular management, medical, interventional, and surgical should avoid major cardiac complications and sudden death. We present two adult patients, with coronary artery bridging, one case associated with coronary artery fistula, LAD to pulmonary artery trunk, very symptomatic with surgical management, and the second only myocardial bridging controlled with medication and supervision.

Dentistry is an ever-evolving field that has seen significant advances in recent years. This article sheds light on some of the current and emerging trends in oral health care, including digital dentistry, regenerative medicine, and the use of lasers. For example, digital dentistry involves the use of computer-aided design and manufacturing technology, which enables more accurate and efficient production of dental devices. On the other hand, regenerative medicine and nanoDentistry can be considered promising area that combines the use of stem cells, growth factors, biomaterials, and nanotechnology to regenerate damaged tissue and improve treatment outcomes. Lasers are increasingly being used in dentistry for a range of applications, including the treatment of gum disease and teeth whitening. Other developing technologies such as 3D printing and artificial intelligence are also being increasingly incorporated into dentistry, providing improved treatment options for our patients. Last yet definitely would/will not least, controlled drug delivery systems are being developed to deliver drugs to specific target sites in a localized and sustained manner, reducing the risk of adverse effects. Currently, these emerging trends are transforming the landscape of odontology and beyond. Hence, in this mini-Review, we explore such trends in oro-dental and cranio-maxillo-facial indications to highlight the potential benefits, advancements, and opportunities of applications for improved patient care.

Drug addiction remains a major health concern following its devastating consequences to the users and the economy. Current statistics show a rising trend in substance abuse around the globe with approximately 284 million people engaging in drug abuse. Various approaches are used to treat the victims of drug abuse. Cognitive behavior therapy, a form of nonpharmacological intervention, has also been shown to be an effective treatment option for drug addiction. The use of Cognitive Behavioral Therapy (CBT) has grown since the 1970s to become one of the most important models of psychotherapy in this decade. Various empirical studies have shown the efficacy of CBT in well-controlled trials. A total of 19 randomized trials (cases) (with over 1400 patients treated) were selected and studied. In the various cases, results showed that patients were treated for drug and substance abuse disorders with the majority being those who abused cannabis, cocaine, alcohol and other opioids. In most cases, the CBT techniques that were used for drug addiction included cognitive restructuring, relapse prevention and contingency management. Components of CBT for drug addiction include skills and training, amplification of non-substance-related activities, approaches for managing urges, drug rejection and improvement of social aptitudes. Cognitive restructuring focuses on the identification of misconceptions and influencing the way people think about themselves by eliminating distorted thinking. Relapse prevention focuses on the identification and prevention of high-risk situations that may trigger the patient to engage in drug abuse. Contingency management reinforces positive behaviors and reduces negative behaviors through the use of rewards and incentives.

Systemic sclerosis sine scleroderma is a rare subset of systemic sclerosis with isolated organ involvement. Scleroderma renal crisis is a severe manifestation of systemic sclerosis characterized by malignant hypertension, oligo/anuric renal failure, and thrombotic microangiopathy. We present a case of a 55-year-old male with uncontrolled hypertension who presented with hematospermia and was found to have acute renal failure, microangiopathic hemolytic anemia, concerning thrombotic microangiopathy. Empiric management for thrombotic thrombocytopenic purpura (TTP) with plasma exchange and corticosteroids yielded a paradoxical response, ultimately leading to the diagnosis of systemic sclerosis sine scleroderma presenting as scleroderma renal crisis (SRC) after serological confirmation. Given the morbidity and mortality associated with scleroderma renal crisis, it should be increasingly considered as a differential for thrombotic microangiopathy even without outward manifestations of systemic sclerosis. Additionally, the empiric management of TTP can include the use of corticosteroids which can exacerbate SRC, an early clinical clue in the diagnosis of this disease.