Delirium is caused by an underlying physiological disturbance, and treatment requires identification of the underlying cause. Making this diagnosis requires careful differential diagnosis. However, often the cause of delirium is hard to recognize. The aim of this study was to report a case of sepsis-associated encephalopathy presented as delirium in a patient during alcohol withdrawal. This case study is about a 58-year-old male patient who had a significant history of alcohol dependence and was admitted for abdominal abscess-related sepsis. Delirium was noted during hospitalization.

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A 43-year-old female patient presented with the complaints of progressive hoarseness of voice for 6 months. There was no apparent evidence of immunodeficiency, abuse of voice, systemic infection, or trauma. Fiberoptic laryngoscopy revealed whitish plaques mimicking leukoplakia that involved both the vocal cords. Investigations ruled out malignancy and confirmed primary vocal cord aspergillosis. The lesions responded dramatically to oral antifungal drugs. High index of suspicion and micropathological awareness regarding such an entity are of utmost importance since the management depends on accurate diagnosis and timely introduction of proper antifungal therapy.

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Background: Chronic inflammation has been linked to stroke, but it is not known whether atopic dermatitis (AD), a chronically inflammatory skin disease, is related to stroke. The aim of this study was to investigate the association of AD and stroke. Materials and Methods: In this population-based, cohort study, data were collected from a Longitudinal Health Insurance Database released from the National Health Research Institute in Taiwan in 2011. All patients with AD between 2000 and 2006 without prior stroke were included and an age- and gender-matched cohort without prior stroke, 4-fold of the AD sample size, was served as the control group. The two cohorts were followed until the end of 2010 for stroke incidence. Cox's proportional hazards regressions were used to assess the difference in stroke risk between groups. Results: During the follow-up period of 4–11 years, 471 (incidence: 4.46/1,000 person-years) and 1497 (incidence: 3.56/1,000 person-years) stroke incidents were noted in the study and control cohort, respectively. The patients with AD had an increased incidence of ischemic stroke (adjusted hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.08–1.36) but not hemorrhagic stroke (adjusted HR: 0.97; 95% CI: 0.74–1.29). The severity of AD was significantly correlated with the risk of ischemic stroke. Conclusions: These results suggest that AD is independently associated with ischemic stroke but not with hemorrhagic stroke. The risk of ischemic stroke is correlated significantly with the severity of AD. Further research is necessary to explore the underlying mechanism.

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Objective: To evaluate the optimal effect-site concentration (Ce) of propofol during endotracheal suction (ETS) in the postoperative Intensive Care Unit (ICU) sedated patients. Design and Setting: The study design was a prospective randomized clinical study in a 13-bed ICU in a medical center. Patients: Thirteen mechanically ventilated patients were included in this study. Methods: All included postoperative patients received sedation by target-controlled infusion (TCI) of propofol under bispectral index (BIS) monitoring and 2–4 μg/kg/h fentanyl infusion for analgesia to keep numerical rating scale ≤4. While ETS was need, the sedation interventions were performed. We used the up-and-down method with a step size of propofol Ce 0.2 μg/ml for the next intervention. The sedation interventions of 1, 2, and 3 were baseline propofol Ce, baseline propofol Ce +0.2 mg/ml, and baseline propofol Ce +0.4 μg/ml, respectively. The predetermined propofol Ce was maintained for 5 min before ETS. Arterial systolic blood pressures (SBPs), arterial diastolic blood pressure (DBP), heart rates (HRs), and BIS before and after ETS were recorded. No moderate or severe coughing with limb movement was the primary outcome, and the surge of SBP, DBP, and HR ≤20% of baseline was the secondary outcome. Results: There were 39, 72, and 45 ETS were performed in the intervention 1, 2, and 3, respectively. In the primary outcome, the successful rates of ETS were 100%, 37.5%, and 15.4% in the intervention 3, 2, and 1, respectively (P < 0.001). In the secondary outcomes, the successful rates were 100% in all interventions. However, the surge of SBP (P = 0.009), DBP (P = 0.025), and HR (P = 0.009) were significant higher in the intervention 1 and 2 than the intervention 3. Right after the ETS, significant increase in BIS level was observed in the intervention 1 (13.9± 7.9) and 2 (14.4± 7.5) except for intervention 3 (−2.8± 14.5) (P = 0.003). Conclusions: An increase of propofol Ce 0.4 mg/ml for 5 min before ETS provided adequate sedation result in markedly attenuated ETS-induced coughing, limb movement, and hyperdynamic status during ETS while the use of TCI propofol sedation in postoperative ICU patients.

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Aims: ¹¹C-L-methionine, an amino acid tracer used to delineate certain tumor tissues, has proven to be a prevailing nonfluorodeoxyglucose positron emission tomography (PET) radiopharmaceutical. We intended to prepare ¹¹C-L-methionine by following modified synthetic strategies at a rebuilt working area to meet the PET drug current good manufacturing practice (cGMP) and Pharmaceutical Inspection Co-operation Scheme (PIC/S) regulations. Furthermore, we overcame the problem of pyrogen cross-contamination using a cleaner and more efficient program. Material and Methods: The task of upgrading air filtration equipment was integrated with the set of Web-Based Building Automation system (WebCTRL^®). ¹¹C-L-methionine synthesis was carried out in accordance with redesigned methods to meet the requirements of PET drug cGMP. The product quality was tested by a series of quality control tests and was found to be satisfactory. Depyrogenation was carried out by three different methods with different flow rates and flushing durations. The results were examined through limulus amebocyte lysate clotting test. Results: The level of air cleanliness in each section meets the PIC/S GMP standards after the reconstructions. Moreover, after delicate modifications, the radiochemical yield of ¹¹C-L-methionine was 36.20% ± 3.59% (based on ¹¹C-CH₃I, n = 7), which is about 10% higher than the average former yield. Besides, the used depyrogenation methods could wipe the bioburden off within 8 h. Conclusions: The modifications done not only offer a good production environment but also protect the products from contamination. The modified approaches in both ¹¹C-L-methionine production and depyrogenation resulted in prominent progress in stability and efficiency as well.

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Rheumatic heart disease is the most common cardiac disease associated with pregnancy in developing countries. In India, rheumatic mitral stenosis (MS) comprises 88% of heart diseases complicating pregnancy. Despite advances and improved anesthetic techniques, the management of parturients with cardiac valvular pathology can be challenging. Therefore, the anesthesiologist has to be vigilant and meticulous in planning the technique of anesthesia to aid in safe confinement. In this article, we present the anesthetic management of a parturient who presented to our hospital with a medical record of moderate MS, in active labor. We combined a technique most feasible at that moment, with tactful and detailed knowledge of the pathophysiology to guide our anesthetic management and facilitate a normal vaginal delivery. We have tried to highlight how clinically individualized and personalized care with sound pathophysiological knowledge of the patient's cardiac condition can achieve optimal outcomes, especially when conventional modes and techniques are not feasible.

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The incidence of neurovascular complications with paraplegia in patients of coarctation of the aorta (CoA) is very rare, and the prognosis of the outcome is poor. The traditional standardized management for the aortic coarctation is surgical repair, which can be associated with considerable intraoperative risk and postoperative morbidity. In this article, we present a case of diagnosis of the primary CoA complicated with acute epidural hematoma and paraplegia treated with endovascular repair with balloon angioplasty and stent placement successfully.

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Osteitis deformans, also known as Paget's disease, is characterized by accelerated osteoclastic activity followed by ineffective osteoblastic activity resulting in a deformed and fragile bone. It is more prevalent in Western Europe and relatively rare in Eastern Asia. It predominantly involves the lumbar spine, pelvis, and femur, frequently as polyostotic and rarely as monostotic disease. Here, we report a 64-year-old female, who presented with severe progressive back pain with no neurological symptoms. Radiographs revealed a picture frame L1 vertebra which was deformed and enlarged with loss of normal alignment. Magnetic resonance imaging revealed bone marrow changes involving all columns of L1 vertebra. Whole-body technetium-99 bone scan showed a solitary increased uptake of radioisotope by L1 vertebra. Considering the possibility of metastatic tumors, blood investigations were drawn for tumor markers which were within normal limits. A computed tomography-guided biopsy was done to facilitate diagnosis. Histopathology sections showed a mosaic pattern of bony trabeculae with multinucleated osteoclasts causing erosions and tunneling. A diagnosis of monostotic Paget's disease was made which satisfactorily responded to single-dose zoledronic acid treatment. A comprehensive literature review is provided.

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