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ion. Postoperatively, the patient was refitted for lower extremity prosthetics. Similar to burns and trauma, the development of heterotopic ossification in patients with purpura fulminans may be directly related to the inflammatory process and amount of tissue damage. In some cases, heterotopic ossification could be caused from daily living activities, so the timing of diagnostic imaging techniques and clinical intervention is crucial. Copyright © 2020, Asif et al.Purpose In this article, we report on Gamma Knife radiosurgery performed on patients with more than 10 brain metastases. Although the standard treatment for multiple brain metastases is currently believed to be whole-brain irradiation, many patients are averse to it due to the potential for serious complications such as cognitive impairment. Cases and Methods Here, 70 cases of Gamma Knife radiosurgery for metastatic foci originating from various primary cancer are reviewed. Several different treatment protocols were selected (1) single session, (2) two or three consecutive sessions, (3) fractionated irradiation for large tumor and stereotactic radiosurgery (SRS) for small ones, and (4) salvage treatment for recurrent tumors after whole-brain irradiation. Results Despite the long beam-on-time (BOT) necessary for Gamma Knife radiosurgery and unavoidable spillage irradiation to the entire brain, all the treatments were completed without any major difficulties. Conclusion SRS or radiotherapy might be a treatment choice for patients with more than 10 brain metastases. However, the very long treatment time and big spillage irradiation to the entire brain warrants that large metastatic foci should be removed before or after radiosurgery. Copyright © 2020, Kida et al.Due to lower clinical significance, the management of Dieulafoy and Dieulafoy-like lesions is less commonly reported than the management of their impending venous equivalent, variceal bleeding. Though Dieulafoy and Dieulafoy-like lesions are often benign, they can become life-threatening in certain clinical scenarios, especially with substantial changes in hemodynamic blood flow, which results in hemorrhage. Post-procedural hemodynamic blood flow should be carefully monitored in patients who receive procedures that drastically alter hemodynamic flow pressures. Factoring in the presence of Dieulafoy and Dieulafoy-like lesions might deepen the complexity of an intuitive surgical or interventional procedure for an experienced operator, and should, therefore, involve the cooperative effort between surgical, interventional, and diagnostic services to appropriately manage the patients. The case we present demonstrates the dire consequences of a routine splenectomy when a considerable change in hemodynamic pressure across benign Dieulafoy-like lesions occurs in a patient with both splenic artery and venous thrombosis. Copyright © 2020, Faraji et al.Background Cognitive impairment is a phenomenon that appears late in many diseases. Many clinicians do not seriously consider cognitive impairment until there has been significant deterioration over time. Cognitive function can be assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methods Using an observational case-control study design, we examined the relationship between coronary artery disease (CAD) and cognitive impairment. Participants (57 patients with CAD and 60 healthy controls; age 30-60 years) were recruited and sampled using a non-probability quota sampling technique. Self-administered questionnaires were used to collect data about participants' demographic information. Blood chemistry samples were obtained to evaluate patients for CAD. Mini-Mental State Examination (MMSE) and CANTAB using three subsets including intra-extra dimensional set shift, spatial span (SSP), and pattern recognition memory (PRM) were used to assess participants' cognitive function. Results The SSP and PRM were significantly lower in patients with CAD as compared with healthy controls. There were significant relationships of PRM with creatine kinase- muscle/brain, aspartate aminotransferase, and total cholesterol. On the other hand, SSP was found to have a significant relationship with triglycerides. Conclusion There is cognitive impairment in CAD patients that needs to be assessed for early interventions to maintain cognitive functions. Copyright © 2020, Balbaid et al.Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, aggressive hematological syndrome. It is caused by an increased and unchecked proliferation of T lymphocytes and histiocytes. Tacrolimus These cells secrete a large number of inflammatory cytokines and infiltrate various tissues causing multi-organ system failure. HLH may be primary or associated with different types of infections, autoimmune disorders, or malignancies. Primary or familial HLH is fatal and is frequently considered a disorder of infants and young children. Only a few cases of primary HLH have been reported in adults. We present a case of a 37-year-old man who presented with fever, pancytopenia, and hepatosplenomegaly. Lymph node biopsy showed collections of histiocytes with lymphoplasmacytic cells. After excluding all the secondary causes a final diagnosis of primary HLH was made. The patient was started on HLH-2004 protocol (etoposide, cyclosporin A, dexamethasone) along with empiric antituberculous drugs as necrotic granulomas were also noted in the biopsy. HLH has a very poor prognosis and familiarity with clinical symptoms, and diagnostic criteria can aid in timely diagnosis. Copyright © 2020, Memon et al.Introduction Various researches have stated the correlation between serum uric acid (sUA) and cardiovascular disease (CVD); however, no local studies are available. In this study, we will determine the prevalence of hyperuricemia in patients with acute myocardial infarction and compare with the control group. Methods This case-control study was conducted from March to November 2019 in the tertiary care hospital in Pakistan. In all, 119 patients with acute myocardial infarction were enrolled in this study, and 119 controls were identified from the outpatient department. Their sUA levels were measured within 24 hours of acute myocardial infarction. Results The mean sUA levels were significantly higher in patients with acute myocardial infarction (AMI) in comparison to the control group (6.17 ± 2.12 vs. 5.51 ± 1.89, p-value; 0.01). Overall, there were more patients with hyperuricemia in the case group compared to the control group (47.89% vs. 33.6%, p-value = 0.04) Conclusion In this study, after adjustment of other known factors, hyperuricemia is associated with AMI.
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