Synchronous bilateral breast cancer with heterogeneous hormone receptor status: a case report.

The expression of estrogen, progesterone, and HER2 receptors in breast cancer cells helps guide treatment and predict outcomes. When the status of these receptors is heterogeneous, it makes treatment planning more complex. We present the case of a 72-year-old woman with bilateral breast cancer with heterogenous receptor status and subsequent challenges in management.

Tunable FSRS measurements with reduced background signals: Using an etalon filter to generate picosecond pump pulses in the 460-650 nm range.

Generating wavelength-tunable picosecond laser pulses from an ultrafast laser source is essential for femtosecond stimulated Raman scattering (FSRS) measurements. Etalon filters produce narrowband (picosecond) pulses with an asymmetric temporal profile that is ideal for stimulated resonance Raman excitation. However, direct spectral filtering of femtosecond laser pulses is typically limited to the laser's fundamental and harmonic frequencies due to very low transmission of broad bandwidth pulses through an etalon.

Amended biochar in constructed wetlands: Roles, challenges, and future directions removing pharmaceuticals and personal care products.

Pharmaceuticals and personal care products (PPCPs) in wastewater pose significant threats to both human health and aquatic ecosystems. Wastewater discharge from various sources is the primary cause of these contaminants, and proper treatment is essential for protecting the environment. Traditional treatment technologies are often too expensive and ineffective in removing PPCPs.

Long-standing retroperitoneal schwannoma in a 36-year-old female: A case report.

Introduction: Schwannomas are encapsulated nerve sheath tumors derived from Schwann cells, primarily found in the head, neck, and extremities. Retroperitoneal schwannomas are rare and typically asymptomatic.

Case Presentation: A 36-year-old female presented with a long-standing, asymptomatic right lower abdominal mass.

Evolutionary origins and innovations sculpting the mammalian PRPS enzyme complex.

The phosphoribosyl pyrophosphate synthetase (PRPS) enzyme conducts a chokepoint reaction connecting central carbon metabolism and nucleotide production pathways, making it essential for life. Here, we show that the presence of multiple PRPS-encoding genes is a hallmark trait of eukaryotes, and we trace the evolutionary origins and define the individual functions of each of the five mammalian PRPS homologs - three isozymes (one testis-restricted) and two non-enzymatic associated proteins (APs) - which we demonstrate operate together as a large molecular weight complex capable of attaining a heterogeneous array of functional multimeric configurations. Employing a repertoire of isogenic fibroblast clones in all viable individual or combinatorial assembly states, we define preferential interactions between subunits, and we show that cells lacking PRPS2, PRPSAP1, and PRPSAP2 render PRPS1 into aberrant homo-oligomeric assemblies with diminished metabolic flux and impaired proliferative capacity.

Gastrointestinal Stromal Tumor (GIST) in a Young Adult: A Rare Presentation and a Multidisciplinary Approach.

A gastrointestinal stromal tumor is a rare gastrointestinal tumor of mesenchymal origin. We present a rare case of a 32-year-old male patient with a history of iron deficiency anemia who presented with nocturnal cramping abdominal pain, nausea, non-bloody vomiting, loss of appetite, and weight loss. The patient had no significant family history of cancer.

Phylogenetic analysis linked fatal neurologic disease in leopards (Panthera pardus) to Asia-5 lineage of canine distemper virus in Nepal.

Canine distemper virus (CDV) is responsible for a highly contagious and often fatal neurological disease that affects various carnivores, including domestic dogs. In Nepal, recent reports of CDV exposure and illness in leopards (Panthera pardus) have raised concerns about the transmission of the virus among domestic dogs and wild carnivores. To investigate the genetic lineage and spread of CDV, our study utilized archived post-mortem samples from four leopards that exhibited clinical signs suggestive of canine distemper infection.

Insights into core-mantle differentiation from bulk Earth melt simulations.

The earth is thought to have gone through complex physicochemical changes during the accretion and magma ocean stages. To better understand this evolution process at the fundamental level, we investigate the behavior of a bulk earth melt system by simulating the composition FeMgSiO (in wt%) at high pressure. A deep neural network potential trained by first-principles data can enable accurate molecular dynamics simulation of large supercells that greatly enhances sampling for reliable evaluation of elemental partitioning.

Amitriptyline, Pregabalin and Duloxetine for Treatment of Painful Diabetic Peripheral Neuropathy.

Background: Painful diabetic peripheral neuropathy is one of the frequent presenting complaints in diabetes and endocrine clinics. Our main objective was to compare effectiveness of three commonly prescribed drugs: amitriptyline, pregabalin and duloxetine for treatment of painful diabetic peripheral neuropathy.

Methods: This was a comparative, prospective, observational study conducted among 99 diabetic patients with painful diabetic peripheral neuropathy having numeric rating pain scale ≥ 4.

Foodborne Botulism Type F: A Rare Presentation of Neurologic Manifestation and Successful Management.

Botulism is a neuroparalytic syndrome resulting from the systemic effects of an exoneurotoxin produced by gram-positive, rod-shaped, spore-forming, obligate anaerobic bacterium . Here, we present the case of a 40-year-old male, presenting with a sudden onset of abdominal pain associated with vomiting. He was admitted for conservative management once the CT of the abdomen and pelvis revealed partial small bowel obstruction with no signs of bowel perforation or ischemia.

Coexistence of cecal duplication cyst and Meckel's diverticulum presenting as intestinal obstruction: A case report.

Introduction: Enteric duplication cysts (EDC) are rare anomalies of the gastrointestinal tract, with only 0.4 % occurring in the cecum. Meckel's diverticulum (MD) is a common congenital anomaly affecting up to 2 % of the population.

Idiopathic Intracranial Hypertension in an Adolescent With Recent Human Immunodeficiency Virus (HIV) Diagnosis: A Challenging Etiological Dilemma.

Idiopathic intracranial hypertension (IIH) or benign intracranial hypertension affects the neuro-ophthalmological system and leads to elevated intracranial pressure. Elevated opening pressure during lumbar puncture is diagnostic of IIH. Here in, we present an interesting case of a 15-year-old girl, recently immigrated and with a high BMI, presenting with recurrent fever, abdominal issues, weight loss, and other symptoms, leading to a diagnosis of pelvic inflammatory disease (PID) and HIV infection.

Adult-onset Still's Disease: A Case Report.

Unlabelled: Pyrexia of unknown origin refers to a fever of over 38.3°C on multiple occasions for at least three weeks without a known aetiology, even after a week of hospitalization. Adult-onset Still's disease is a rare systemic auto-inflammatory disorder with a prevalence of 0.

Laparoscopic deroofing of a large hepatic cyst to relieve atypical cardiac symptoms.

A woman in her 60s was referred to the hepato-pancreato-biliary clinic for further assessment of a large hepatic cyst, which was incidentally identified by echocardiography. She was being investigated for possible crescendo angina on the backdrop of a 6-month history of increasing chest pain, shortness of breath, sweating, orthopnoea and paroxysmal nocturnal dyspnoea. Coronary angiography and echocardiography demonstrated normal cardiac physiology.

Intrahepatic pancreatic pseudocyst (wayward cyst): A rare presentation of traumatic pancreatitis.

Introduction: Cystic lesions in the liver are commonly encountered space-occupying lesions having various etiologies such as simple cysts, malignancies, hydatid cysts, and pancreatic pseudocysts.

Case Presentation: An eight-year-old girl initially presented with acute abdominal pain, fever, and a cystic lesion in the upper abdomen. Surgical intervention was performed based on an initial diagnosis of an inflammatory cyst.

Prevalence of non-convulsive seizures and electroencephalographic abnormalities in critically ill patients-A retrospective observational study.

Objective: Electroencephalographic (EEG) abnormalities especially non-convulsive status epilepticus (NCSE) have been found to be associated with worse outcomes in critically ill patients. We aimed to assess the prevalence of non-convulsive seizures and electroencephalographic abnormalities in critically ill patients. Furthermore, we aimed to investigate any association between the type of EEG abnormality and outcomes including ICU mortality and successful ICU discharge.

Preventing Job Burnout: Could Workplace Support Protect Maternal and Child Health Professionals Who Are Doing Public Health Equity Work?

Purpose: To assess the potential of workplace support to protect public health equity workers against job burnout and to identify key workplace support components.

Description: This mixed-methods, explanatory sequential study analyzed survey and interview data collected between August 2020 and June 2021. Participants included governmental and non-governmental public health employees whose programs largely focus on Maternal and Child Health populations and who reported that their jobs involved working to reduce health inequities ("equity work").

Painless Aortic Dissection with Catastrophic Consequences Presenting as Sudden Loss of Consciousness with no Prodromal Symptoms.

Unlabelled: This case report presents a complex clinical scenario involving a 71-year-old female with aortic dissection accompanied by hypotension. The patient's initial presentation of sudden loss of consciousness unveiled a large pericardial effusion and cardiac tamponade, leading to emergency surgery. Subsequent diagnostic findings revealed an intramural haematoma with an intimal tear in the ascending aorta.

An Uncommon Side Effect of Rivaroxaban: A Drug-Induced Liver Injury.

Rivaroxaban is rarely associated with drug-induced liver injury (DILI). A 57-year-old male was sent to the emergency room from an endocrine clinic for a presyncope evaluation. His exam was non-focal, and his laboratory work was remarkable for the hepatocellular pattern of liver injury.

Comparison of abdominal depth with subcutaneous fat thickness in predicting surgical site infection among patients undergoing hepatopancreatobiliary surgery: a prospective observational study.

Introduction: Surgical site infection (SSI) is a significant cause of postoperative morbidity resulting in an increased hospital stay and cost. Various measures have been used to predict SSI such as subcutaneous fat thickness (SCFT) and abdominal depth (AD) in case of abdominal surgeries. The objective of the study was to compare SCFT with AD to predict SSI in HPB surgeries.

Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal.

Key Clinical Message: Actinomycosis is a rare cause of appendicitis with an incidence of 0.3-1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination.

The incidence of post cholecystectomy pain (PCP) syndrome at 12 months following laparoscopic cholecystectomy: a prospective evaluation in 200 patients.

Objectives: Post cholecystectomy pain syndrome can cause significant distress, impairs quality of life and exacerbations often result in emergency visits. Poorly controlled postoperative pain is a recognized cause of persistent postsurgical pain. Abdominal myofascial pain syndrome is an underdiagnosed cause of persistent pain in this cohort.

A Rare Case of Elevated Transaminases With Incomplete Abortion Due to Cytomegalovirus Infection: An Experience From a Resource-Limited Setting.

Cytomegalovirus (CMV) infection during pregnancy may cause spontaneous abortion, stillbirth, and death of newborns. CMV is the most common congenital infection in newborns. It generally has a benign course in immunocompetent individuals, while the severe disease is usually seen in immunocompromised patients.