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Jewelry within A down economy: How Social Cash Will help Lower-Income Jewish Mothers and fathers Climate the Economic Hardship of COVID-19.
The obtained results suggest that flagella have a role in movement of bacterium towards electrode for donating the electron in absence of oxygen, and pili aiding in adhering on the surface of electrode and forming biofilm. The cumulative effect of fli P and pil Q resulted in exo-electron transfer to the electrode and bio-electricity generation process. The open circuit potential (OCV) of + 0.7 V was produced with the maximum power density of 393 ± 14 mW/m2 in MFC. © King Abdulaziz City for Science and Technology 2020.INTRODUCTION Unprovoked venous thromboembolism (uVTE) may be the first manifestation of cancer. The main objectives of this study were to compare limited screening (LS) and extended screening (ES) and to make a protocol to approach these patients. METHODS This is a retrospective, unicentric observational study that included 245 patients with venous thromboembolism (VTE) admitted to an Internal Medicine Service for five years. The incidence of cancer and mortality during hospitalization, and at one and three years after admission were calculated in both LS and ES groups and compared. RESULTS Of the 245 patients with VTE, 59 (24.1%) had uVTE 35 (59.3%) were submitted to LS and 24 (40.7%) to ES, with 10 (4.1%) diagnosis of cancer. In the following three years, 10 more patients were diagnosed. There were no statistically significant differences in inpatient diagnosis rates (8.6% vs. 4.2%; p=0.51) or in-hospital mortality (2.9% vs. 4.2%; p=0.79) or mortality at one year (8.6% vs. 8.3%; p=0.97) and three years (20.0% vs. 20.8%; p = 0.94) between LS and ES groups respectively. The Computerized Registry of Patients with Venous Thromboembolism (RIETE) score was equal or superior to 3 in 69.5% (N=41) of the population with uVTE. DISCUSSION The results of our study are consistent with the literature; there are no differences between screenings, as the difference in the number of diagnoses does not reflect on mortality. CONCLUSION There were no statistically significant differences between the two types of screening in this population. We suggest a protocol that includes the RIETE score to better select the patients who might benefit the most from an ES. find more Copyright © 2020, Ferreira et al.Background and objective Cephalic excision of the lateral crus is the most used procedure in rhinoplasty when attempting to make the nasal tip smaller or narrower to improve the definition. However, due to its several drawbacks as external valve collapse, bossae formation, and alar retraction, a technique, known as the Turn-in flap, has been developed to overcome these complications and to provide better aesthetic and functional nasal tip outcomes. Therefore, we conducted this investigation to determine the long-term outcomes of such procedure. Methods During the period from 2007 to 2017, the charts of 120 patients who underwent the Turn-in flap procedure at King Saud University have been reviewed. The study included 42 males and 78 females with a mean age of 23 years. The follow-up duration ranged from one to 10 years with a mean duration of two years. Results The majority (30%) of our patients underwent Turn-in flap procedure due to combined lower lateral cartilage (LLC) convexity and bulbous tip. Satisfactory results have been observed in most cases with no post-operative complications. Only six cases required revision surgery. Conclusions The Turn-in folding of the cephalic part of lateral crus does not only provide functional support to the nose, but it also provides aesthetic improvement of the nasal tip with long-term satisfactory outcomes. Copyright © 2020, Alkarzae et al.BACKGROUND Acute kidney injury (AKI) complicating cardiogenic shock is associated with increased mortality. We hypothesize that renal replacement therapy (RRT) improves survival in cardiogenic shock supported by Impella-CP (Abiomed, Danvers, MA) complicated by AKI. METHODS A retrospective chart review identified 34 patients on Impella-CP for cardiogenic shock between January 2015 and December 2017. AKI was defined as an increase in serum creatinine≥0.3 mg/dL from baseline. Three groups were analyzed AKI plus RRT, AKI minus RRT, and no AKI. Pre-existing dialysis patients were excluded. The only indication for RRT was AKI not responding to diuretics. Thirty-day mortality was analyzed. RESULTS There were 13 patients with no AKI, 9 with AKI plus RRT groups, and 12 with AKI minus RRT. Thirty-day mortality was similar between no AKI and AKI plus RRT groups [30.8% (4/13) vs.22.2% (2/9), p=0.48; relative risk [RR] 2.25 (95% confidence interval [CI] 0.22-22.1)]. Thirty-day mortality was higher in AKI minus RRT group compared to the no AKI group [75.0% (9/12) vs. 30.8% (4/13); p=0.03; RR 6.75 (95% CI 1.16-39.2)]. CONCLUSION In cardiogenic shock patients on Impella-CP, AKI minus RRT is associated with a higher 30-day mortality compared to patients without AKI and/or patients with AKI plus RRT. Short-term mortality may improve in cardiogenic shock patients with AKI who are treated with RRT. Copyright © 2020, Fahad et al.Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in women. Early detection, accurate diagnosis and proper treatment are important prognostic factors due to the wide variety of breast cancer subtypes. This becomes of particular importance with rare breast tumors, which are difficult to diagnose due to their varying presentations. Malignant phyllodes tumor (PT) is one of the rare breast tumors that is difficult to diagnose. First reported in 1838, PT of the breast accounts for less than 1% of all breast masses. Based on histological features, PT is categorized on a spectrum of benign to malignant tumors. High-grade PTs are commonly seen in older patients but can also occur in young patients, as reported in this case of a 26-year-old female. Failure to detect the malignancy early and initiate appropriate treatment can lead to widespread metastasis and poor outcomes. Copyright © 2020, Nguyen et al.Hemophagocytic lymphohistiocytosis (HLH) is a rarely diagnosed fatal inflammatory disease associated with an overactive immune system. It occurs in a host of conditions, with human immunodeficiency virus (HIV) being a rare but serious cause, usually occurring in patients with acquired immunodeficiency syndrome (AIDS). The diagnosis of HLH can be very difficult, as it presents with vague signs and symptoms, which can be present in multiple diseases. This case highlights the diagnostic dilemma faced when treating this potentially fatal condition. Usually, treating the underlying trigger for HLH is sufficient to counteract the overwhelming inflammatory response; however, this can prove to be difficult, as demonstrated in our patient. We present a case of miliary tuberculosis in the setting of HIV/AIDS, complicated by HLH in a young male patient. Whether it was due to delays in treatment or the rapidly fulminant nature of the disease, our patient had a poor clinical outcome. Although rare, tuberculosis-associated HLH must be considered as a cause of secondary HLH in all patients, especially those who are immunosuppressed. Copyright © 2020, Parsi et al.Kratom or Mitragna speciosa is a tropical tree that is indigenous to Southeast Asia, where it has been used for various medicinal reasons. In the West, it is used in the self-treatment of opioid withdrawal, pain, and a variety of mood and anxiety states. Two active ingredients in kratom are mitragynine and 7-hydroxymitragynine, which have affinity at the mu-opioid receptor among others. Kratom is easily available over the Internet and its use is increasing in the United States. It is currently listed by the Drug Enforcement Administration as a drug of concern. In 2017, the U.S. Food and Drug Administration started issuing a series of warnings about kratom, and by early 2018, it released a statement identifying 44 deaths related to kratom use. The Centers for Disease Control and Prevention has also reported 91 deaths directly linked to kratom use in 2019. Although its safety profile needs additional research for clarification, there have been reports of kratom-induced or kratom-related respiratory depression, reated with anxiolytics, counseled to abstain from Kratom use, and was referred for substance use disorder treatment. This case highlights the life-threatening complications of Kratom that is easily available online. Copyright © 2020, Afzal et al.Intrahepatic cholangiocarcinomas or bile duct cancers comprise approximately 10-20% of all cholangiocarcinomas and may present with right upper quadrant pain, weight loss, liver enzyme abnormalities or they may be completely asymptomatic and be picked incidentally on routine abdominal imaging. Typically, hepatocellular carcinomas have been associated with various paraneoplastic syndromes such as hypercalcemia, erythrocytosis, hypoglycemia, diarrhea and skin changes though paraneoplastic syndromes in the setting of cholangiocarcinoma do occur as well. Cholangiocarcinomas are usually associated with dermal paraneoplastic syndromes (Sweet syndrome, porphyria cutanea tarda, acanthosis nigricans, necrotic migratory erythema, erythema multiforme, bullous pemphigoid), hypercalcemia, leukocytosis and limbic encephalitis. We present a case of an 80-year-old man with intrahepatic cholangiocarcinoma associated with high procalcitonin levels in the absence of infection, paraneoplastic syndromes of hypercalcemia, polycythemia and leukocytosis in the same individual. This constellation of symptoms, to the best of our knowledge, has not been previously reported in the scientific literature. Copyright © 2020, Meegada et al.Premature ventricular complexes (PVCs) are one of the most commonly encountered arrhythmias and are ubiquitous in clinical practice, both in the outpatient and inpatient settings. They are often discovered incidentally in asymptomatic patients, however, can cause myriad symptoms acutely and chronically. Long thought to be completely benign, PVCs have been historically disregarded without pursuing any further evaluation. Newer data have revealed that a high burden of PVCs with specific characteristics can significantly increase a patient's risk of developing PVC-induced cardiomyopathy. The aim of this literature review is to provide further clarification on the identification of high-risk PVCs, subsequent workup, and the currently available treatment options. PVCs arise from an ectopic focus within the ventricles. Patients with PVCs can be either asymptomatic or have severe disabling symptoms. The diagnostic workup for PVCs includes electrocardiogram (ECG) and 24-h Holter monitor to assess the QRS morphology aocus is recommended. Catheter ablation has been shown to reduce PVCs burden and improve left ventricular ejection fraction (LVEF) in those with PVC-induced cardiomyopathy. Copyright © 2020, Koester et al.We present the case of a patient who presented to the Emergency Department with Posner-Schlossman syndrome, also known as glaucomatocyclitic crisis. While this condition is uncommon, it is essential that physicians be aware of its characteristics and how to treat it, otherwise affected patients are at risk of developing permanent complications such as optic nerve atrophy and loss of vision. Copyright © 2020, Lippert et al.
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