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The case also addresses high-grade methotrexate (MTX)-based chemotherapy as a treatment that improves mortality in patients with primary central nervous system (CNS) lymphoma.Afferent loop syndrome is an uncommon postoperative complication. Currently, we lack a therapeutic option for treatment of malignant afferent loop obstruction following procedures like Whipple's. Here we present a case of afferent loop obstruction in a known case of pancreatic carcinoma, status after Whipple's procedure, in which we used a percutaneous transhepatic approach to relieve the afferent loop obstruction using a self-expanding bare metal stent.The objective of our study was to compare a potent drug of the anti-TNF class family, infliximab, with a potent drug of the IL-inhibitors family, risankizumab, in terms of efficacy and safety endpoints. Online databases were searched for relevant placebo-controlled, randomized trials. The following efficacy outcomes were included PASI-75, PASI-90, and sPGA, as well as the incidence of any adverse events and serious adverse events. The risk ratios (RR) with the respective 95% confidence intervals (CIs) of different psoriasis scores were pooled in a meta-analysis model, using the Mantel-Haenszel method. The combined risk ratios (RR) showed that infliximab and risankizumab are effective in increasing the number of patients with more than 75% improvement in the PASI (RR= 26.68, 95% CI [14.98, 47.51] p less then 0.001) and (RR= 10.17, 95% CI [7.24, 14.30] p less then 0.001), respectively. Test for subgroup differences showed that risankizumab is more effective. Regarding PASI-90 outcome, risankizumab and infliximab are more effective than placebo (RR= 26.22, 95% CI [14.20, 48.41], p less then 0.001), and (RR= 15.18, 95% CI [8.72, 26.45], p less then 0.001) respectively. The results showed that risankizumab does not cause significant serious adverse events (RR = 0.59, 95% CI [0.31, 1.13], p=0.12) while, on the other hand, infliximab causes significant serious adverse events (RR = 2.30, 95% CI [1.08, 4.88], p=0.03). The test of subgroup difference showed that risankizumab is safer (p less then 0.001). Analysis of the incidence of any adverse events showed that risankizumab is safer as well (p=0.007). Infection rates were similar among both drugs (p=0.05). In conclusion, risankizumab is preferred for the treatment of psoriasis than infliximab, and is significantly more effective and safe.Cutaneous larva migrans is a fairly common parasitic skin disease typically found in more tropical climates such as the southeastern United States, with the most commonly encountered organism known as the hookworm, Ancylostoma braziliense. Löeffler's syndrome is a rare pulmonary manifestation with vague diagnostic criteria but frequently characterized by diffuse migratory pulmonary infiltrates on imaging studies with accompanying serum eosinophilia. Here, we present a unique case of Löeffler's syndrome secondary to cutaneous larva migrans.Congenital central nervous system (CNS) malformations are relatively rare conditions present in fetuses that may result in intrauterine fetal deaths (IUFDs). We report a case of a 42-year-old female who presented at 29 weeks gestation with lack of a fetal heart beat likely due to a congenital malformation resulting in IUFD. This case report and literature review provides a better understanding of the encephalocele as a harbinger for IUFD.Pulmonary tuberculosis is a common endemic disease in developing countries but its thrombogenic tendency is not well-studied and established yet. Pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. There are reports stating the relation of pulmonary embolism (PE) and deep vein thrombosis (DVT) with a severe infection of tuberculosis but no data is available to establish a mutual association between pulmonary tuberculosis and pulmonary thromboembolism. Herein, we report the case of a 51-year-old male who presented with a one-month history of productive cough, shortness of breath, and fever associated with chills and night sweating. He reported an 8 kg weight loss in the last month. He was found to have pulmonary tuberculosis. On further investigations for leg swelling and tachycardia. Deep vein thrombosis and sub-massive saddle bilateral pulmonary embolism were diagnosed, which was treated with thrombolysis therapy (alteplase). He responded well to initial therapy and was discharged on anticoagulation with anti-tuberculous therapy (ATT).
Strabismus means ocular misalignment. It is also one of the most prevalent types of amblyopiaand the leading cause of pediatric visual impairment.

This study aims to determine the frequency of different types of strabismus and the associated refractive errors and amblyopia in patients younger than 16 years of age. This study also aimsto compare the age at presentation and gender between the geographic locations and between different strabismus types.

A cross-sectional retrospective study was done using the archives of Beirut Eye and ENT specialist hospital between January 2014 and December 2018. Lebanese pediatric patients aged <16 years having strabismus were included in this study.

There was a total of 787 pediatric patients with strabismus, 62.6% of cases had esotropia (ET) and 30.2% exotropia (XT), with ET/XT 2.07/1. Mt Lebanon had the highest number of cases, whereas Nabatieh was the only governorate with reversed ET/XT ratio. Most patients were diagnosed at the age of 1-5 years, with ET being the most common diagnosis, while XT was mostly found in patients aged 11-15. Hyperopia was the most common (55.4%) refractive error detected in our cohort of strabismus patients, followed by myopia and simple astigmatism. Amblyopia was found in 18.9% of cases, where Nabatieh had the highest count.

Strabismus pattern was investigated for the first time across Lebanonto shed the light on the crucial role of early ophthalmologic examination, to detect early refractive error and strabismus, and to prevent amblyopia.
Strabismus pattern was investigated for the first time across Lebanon to shed the light on the crucial role of early ophthalmologic examination, to detect early refractive error and strabismus, and to prevent amblyopia.Introduction Difficulty with bag-mask ventilation after the induction of general anesthesia and muscle relaxation places the patient at risk for a prolonged period of apnea and hypoxia and thus, at an increased risk of morbidity and mortality. This study was designed to assess the accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation (DMV) in patients receiving general anesthesia for elective surgical procedures. Methods It was a prospective cross-sectional, observational study conducted at a university teaching hospital. A total of 530 patients undergoing surgery under general anesthesia with endotracheal intubation were enrolled. STOP-Bang questionnaire was filled at pre-operative anesthesia assessment. Ease or difficulty of mask ventilation was assessed and documented by a senior resident responsible for intraoperative anesthetic management. Results Out of 530 patients, 139 (26.22%) had a STOP-Bang score of ≥ 3, of whom 55 (39.5%) were found to have DMV. Out of 391 patients with a STOP-Bang score of less then 3, only 29 patients (7.5%) had DMV (P ≤0.001). Snoring, high blood pressure, BMI more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender were significantly associated with DMV. The accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation was 78.68% (95% CI 74.99-81.95) with a negative predictive value of 92.58%. GSK3685032 cost The sensitivity and specificity were found to be 65.48% and 81.17% respectively. Conclusion STOP-Bang score has a high negative predictive value and can be very useful in ruling out the possibility of difficult mask ventilation.Gastrointestinal lipomas are rare, often colonic tumors. The stomach is an unusual site of involvement of lipomas, accounting for less than 5% of all gastrointestinal lipomas and less than 3% of all benign gastric neoplasms. They are usually asymptomatic, and symptoms develop as the tumor grows. Gastric lipomas can present with massive bleeding from an ulcerating tumor and can be life-threatening if left untreated. We present a case of an ulcerating gastric lipoma that presented as an acute upper gastrointestinal hemorrhage. The patient was treated with Billroth II procedure and final pathology showed an ulcerating submucosal lipoma. The diagnosis of gastric lipoma is often suspected incidentally on imaging, then confirmed via biopsy. Definitive treatment of large lesions typically requires surgery, however, newer endoscopic techniques are being utilized for resection of these benign tumors.Background Currently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology is recommended only for seroprevalence. We think it could be useful in differentiating coronavirus disease 2019 (COVID-19) stages, which could in terms of helping improve our therapeutic interventions. Methods The medical records of adult patients admitted to the hospital with probable COVID-19 were extracted and analyzed. We excluded patients with no serology and no clear outcome at the end of data collection. Patient demographics, medical history, and biochemical and clinical data were retrieved. Results A total of 202 patients were included; 57% were males, the majority were Hispanic (45%), followed by African Americans (22%). Hypertension is the most common comorbidity, followed by diabetes mellitus and chronic kidney disease. We classified them into three groups based on their serology subacute stage (47 patients) with both immunoglobulin M (IgM) and IgG negative; acute stage (116 patients) with IgM positive and late-stage (39 patients) with IgM negative and IgG positive. We found that elevated lactate dehydrogenase (LDH) and ferritin were present in the IgM+ and IgM-/IgG+ subgroups (p-value of 0.0061 and p-value 0.0013, respectively) while C-reactive protein (CRP) and D-dimer were more elevated in the IgM-/IgG- and IgM+ subgroups (P less then 0.0001 and p-value of 0.0452, respectively). The IgM+ group had the worst prognosis, with high mortality despite receiving remdesivir and dexamethasone. Conclusion Our findings suggest that the use of serology in patients hospitalized with COVID-19 could predict prognosis; this will need to be validated in a larger prospective study.In this report, we present a case of ventricular fibrillation (VF) arrest in an asymptomatic coronavirus disease 2019 (COVID-19) patient with no cardiac history and normal cardiac workup. Cardiac involvement in COVID-19 has been described previously in hospitalized patients with severe COVID-19. To our knowledge, this is the first report to describe VF arrest in a patient who was incidentally found to have COVID-19.Brucellosis is a zoonotic infection caused by facultative intracellular bacteria of the genus Brucella. The ability of the organism to invade both phagocytic and non-phagocytic cells and survive in the intracellular environment makes brucellosis a systemic infection that can affect various organs of the body. Complications of brucellosis occur when the infection involves one or more focal body sites. Early identification of complications of brucellosis and initiation of appropriate treatment is the key to a better outcome. Here we present two cases of complicated brucellosis, both having multiple body site involvement.
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