Idiopathic hypoparathyroidism presenting as fatigue.

Fatigue is a common symptom encountered in clinical practice, often posing a diagnostic challenge due to its myriad underlying causes. A comprehensive clinical history can serve as a valuable guide in such diagnostic dilemmas. A man in his 30s presented with a history of intermittent fatigue.

Ammonia in liver diseases: A glimpse into the controversies and consensus.

Ammonia is a byproduct of the metabolism of nitrogen-containing micro and macromolecules. The key source of bodily ammonia in humans is the small intestine, from diet, luminal bacterial activity, and deamination of glutamine in enterocytes. It is disposed of from the system, mainly in the liver, through the urea cycle.

Navigating the 'Pits and Perils' of Analgesic Therapy in Advanced Liver Disease and Cirrhosis.

The role of the liver in drug metabolism makes individuals with hepatic dysfunction more susceptible to adverse drug reactions, necessitating careful consideration in analgesic selection and dosing. Acetaminophen, despite being a common cause of liver failure, is considered safe within recommended dosages. Nonsteroidal anti-inflammatory drugs (NSAIDs), while effective, pose risks in cirrhosis due to complications like renal failure and gastrointestinal bleeding.

Schmidt's Syndrome: An Uncommon Cause of Spontaneous Hypoglycemia.

Schmidt's syndrome, or autoimmune polyendocrine syndrome type 2 (APS-2), is an uncommon disorder characterized by the co-occurrence of autoimmune thyroiditis and adrenalitis. APS-2 is defined as a combination of Addison's disease, autoimmune thyroid disease, and/or type 1 diabetes mellitus. It is an autosomal dominantly inherited polygenic disorder with incomplete penetrance; the candidate genes include but are not limited to HLA-DR3, HLA-DR4, CTLA-4, PTPN22, and CD25-IL-2.

A giant hydronephrosis disguised as abdominal obesity.

Abdominal obesity is common in clinical practice. However, it is important to rule out other causes of abdominal distension. We are reporting a case of giant hydronephrosis misdiagnosed as abdominal obesity for a long time.

Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis.

Purpose: Enhanced recovery after surgery (ERAS) was characterized as patient-centered, evidence-based, multidisciplinary team-developed routes for a surgical speciality and institution to improve postoperative recovery and attenuate the surgical stress response. However, evidence of their effectiveness in osteoarthroplasty remains sparse. This study aimed to develop an ERAS standard and evaluate the significance of ERAS interventions for postoperative outcomes after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Acetaminophen: A Liver Killer or Thriller.

Acetaminophen, or paracetamol, ranks among the most extensively utilized analgesic and antipyretic medications globally. The administration of acetaminophen to individuals with underlying liver disease has long sparked concerns regarding the potential risk of hepatotoxicity. However, the available literature and recommendations consider it a safe option in all forms of liver diseases and is deemed safe when used at recommended doses.

Possible Mechanism and Treatment Results of Combined Pediatric Fractures of the Humeral Lateral Condyle and Ipsilateral Ulnar Olecranon.

Objective: Combined fractures of the lateral condyle of the humerus and the ipsilateral ulnar olecranon are rarely seen in children. Therefore, the mechanism and suitable treatments remain debatable. This study describes the possible mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures and presents the treatment results.

A novel pre-bending tool for elastic stable intramedullary nailing: An efficient and accurate study.

Purpose: The elastic stable intramedullary nail has been recognized as an accepted technique for treating pediatric long bone fractures. The principle of the technique is "3-point support and fixation," and it should be followed to achieve the optimum outcome without implant failure and complications. However, tools have yet to be reported for pre-bending of the elastic stable intramedullary nail.

Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis.

Background: Osteonecrosis of the humeral head (ONHH) is a severe complication after the internal fixation of proximal humeral fractures (IFPHF). The risk factors remain controversial though many studies have reported. In this research, meta-analysis was used to evaluate which surgeon-level factors can be modified to lower the risk and we hope to provide evidence-based support for preventing ONHH.

A Combination of Ilizarov Frame, Externalized Locking Plate and Tibia Bridging for an Adult with Large Tibial Defect and Severe Varus Deformity Due to Chronic Osteomyelitis in Childhood: A Case Report.

: Various techniques have been reported to treat large, segmental tibial defects, such as autogenous bone graft, vascularized free fibula transfer and bone transport. We present a case of a 24-year-old male with a 17-year history of chronic osteomyelitis with obvious lower limb length discrepancy and severe varus deformity of the tibia secondary to osteomyelitis in childhood. : The aim of this work is to provide an alternative choice for treating patients in developing countries with severe lower limb deformity caused by chronic osteomyelitis.

Adverse events of bevacizumab for triple negative breast cancer and HER-2 negative metastatic breast cancer: A meta-analysis.

Triple-negative breast cancer (TNBC) and HER-2 negative metastatic breast cancer (HER-2 negative MBC) are intractable to various treatment schemes. Bevacizumab as a novel anti-VEGF drug, its safety for these two high-risk breast cancers remains controversial. Therefore, we conducted this meta-analysis to assess the safety of Bevacizumab for TNBC and HER-2 negative MBC.

Prevalence, Awareness, Treatment, and Control of Hypertension in Young Adults (20-39 Years) in Kerala, South India.

Objective: We sought to study the prevalence of hypertension and the levels of awareness, treatment and control of hypertension in the young adults in Kerala, India compared to older adults.

Methods: We identified 1,221 young adults (men 36.7%) in the age group 20-39 years from the 5,150 participants of the Cardiological Society of India Kerala Coronary artery disease (CAD) and its Risk factors Prevalence (CSI Kerala CRP) Study.

Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices.

Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice.

Materials And Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios.

A Curious Case of Ear Necrosis Salvaged by a Composite Temporalis Flap: Conchal Cartilage Graft Reconstruction.

Hemangiomas are commonly encountered benign vascular tumors in clinical practice. They are easily diagnosed clinically, but it is essential to know atypical and rare varieties of these tumors to avoid confusing them with vascular malformations. The traditional approach in managing hemangiomas has been a "wait and watch" policy as most of these lesions undergo spontaneous regression with time.

Prostatic Abscess in a Neonate.

Urinary tract infection (UTI) is the most commonly occurring serious bacterial infection in young infants. Uncircumcised male infants have a higher rate of UTI when compared with circumcised male infants and girls. A prostatic abscess is a very rare clinical variety of UTI, especially in neonates.

First case of cough-induced combined intercostal artery rupture with partial diaphragm tear.

We describe a case of vigorous cough-induced left intercostal artery rupture with partial diaphragmatic tear in a 60-year-old obese male with chronic obstructive pulmonary disease. He presented with left hemothorax, a rapidly spreading chest and abdominal wall hematoma, and progression of anemia. Computed tomography (CT) scan revealed a bleeding focus from the left 8th intercostal artery.

Fever and large pericardial effusion after valve surgery: can be malaria.

A 37-year-old man underwent mechanical mitral valve replacement for rheumatic heart disease. One week after discharge, he presented with high-grade fever with chills, malaise, and shortness of breath. Echocardiography showed pericardial effusion with no evidence of vegetation.

Pseudomesotheliomatous Type of Sarcomatoid Squamous Cell Lung Cancer Presenting With Hemothorax.

A 44-year-old man presented with spontaneous massive hemothorax. Computed tomographic scan revealed thickened and nodular pleura with no evidence of lung tumor. The patient underwent right open total pleurectomy.

Tracheobronchopathia Osteochondroplastica as a Single Mass in Lingular Bronchus.

We describe a rare case of tracheobronchopathia osteochondroplastica (TBO) in a 35-year-old man who presented with recurrent chest infection and hemoptysis. Bronchoscopy and computed tomography scan revealed a single 1.5-cm hard nodular mass lesion in the lingular bronchus associated with collapse and bronchiectasis of the lingula.

Patch testing in suspected allergic contact dermatitis to cosmetics.

Background. Increasing use of cosmetics has contributed to a rise in the incidence of allergic contact dermatitis (ACD) to cosmetics. It is estimated that 1-5.

Multiple autoimmune syndrome.

We report a case in which the presence of dermatological autoimmune conditions, vitiligo and alopecia areata, led to the diagnosis of a systemic autoimmune disease, ulcerative colitis.