Background: Fracture of the tibia shaft accounts for 17% of lower extremity fractures, with concurrent fibula fracture in about 78% of these cases. Intramedullary fixation for fibula fractures can restore fibula alignment and thus facilitate fracture reduction, especially in cases with comminuted shaft or distal metaphyseal tibia fractures. Methods: Patients who had internal fixation of comminuted tibia shaft or distal metaphyseal tibia fracture and a concurrent fibular fracture treated with intramedullary Steinman pin fixation were included in this study. Patients' demographic data and fracture patterns were analyzed retrospectively. Postoperative X-rays were used for fracture union evaluation and alignment analysis. Results: Nine males and one female were included in the present study. Tibia fractures were classified as four OTA42 and as six OTA43, including one type I, two type II, one type IIIA, and three type IIIB open fractures. Intramedullary nail and locking plate were used as definitive fixation in four and six cases, respectively. Complications required additional surgeries including wound debridement for one patient, bone graft for three patients, and revision surgery from a broken plate to an intramedullary nail for one patient. A total of 14 fibula fractures were identified in ten patients due to four segmental fractures. Eight were Weber type C, one was Weber type B, and five were midshaft fractures. The mean duration of fibula fracture healing according to radiographs was 6.9 months. Conclusions: This study suggests that intramedullary Steinmann pin fixation for concurrent fibula fracture is a critical procedure when dealing with comminuted shaft or distal metaphyseal tibia fractures.

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Idiopathic gingival fibromatosis (IGF) is a hereditary condition with esthetic, functional, and periodontal impairment in patients. It is slowly progressive in nature. The enlargement might be nodular or localized and symmetrical in nature all along the dentition in both the arches and similar gender prediction uniformly. The present case report of IGF in a 21-year-old female patient covering three-fourths of crowns in posterior areas. The gingival enlargement was excised by external bevel gingivectomy along with the use of electrocautery. The gingival fibromatosis can be genetic, hereditary, or drug-influenced covering marginal, papillary or in severe, long-standing cases, it might cover crown of teeth, thus hampering mastication henceforth, functional impairment. The prognosis is uncertain, and the recurrence of risk is high.

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Cutaneous adverse drug reactions (CADRs) are the common adverse reactions ranging from mild self-limiting skin rash to the life-threatening severe cutaneous adverse reactions. Aims: The aim of the study was to describe the demographic characteristics of patients, different clinical patterns, and implicated drugs. Methods: This was a retrospective study by analyzing the database established for all ADRs reported from January 1, 2018, to December 31, 2018, in a tertiary care teaching hospital in Taipei, Taiwan. Results: A total of 126 cases of CADRs were reported in 2018. The mean age of patients was 59.06 ± 21.63 years, with a peaking at 60–79-year-old (31.7%) and followed by 40–59-year-old (25.4%). The male-to-female ratio was 1.03:1. The most common skin reaction pattern was maculopapular eruptions (59.5%), followed by angioedema (11.9%), phlebitis (6.3%), and urticaria (6.3%). Most of the CADRs were reported with antibacterials (66.7%), followed by anti-inflammatory products (11.9%), contrast media (4.8%), and antithrombotic agents (3.2%). Conclusions: We listed the patient characteristics, each pattern of CADRs, and their associated drugs. Such information could help health-care professionals to assess CADRs and evaluate suspected drugs timely and accurately.

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Reversible splenial lesion syndrome (RESLES) is rare findings that are described in various etiological conditions. A few recent reports suggested hyponatremia as a potential etiological agent of RESLES. In this report, we illustrate a 46-year-old-male with RESLES who manifested with impairment of consciousness and recovered rapidly after normalization of hyponatremia. We discuss hyponatremia as a factor which might be playing a role either as a primary agent or a contributory one in this manifestation. Besides, we also discuss the possible significance of the other clinical factors including concurrent sinusitis and medication usage in association with RESLES. We think that the detailed illustration of this case may present substantial perspectives regarding the unknown aspects of the pathophysiology of RESLES. The clinical impact and underlying pathogenesis of this entity are warranted to be clarified in future large-scale studies.

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Approximately 50% of oncology patients receive radiotherapy, with the dose of radiation often being limited to mitigate normal tissue damage of proximal critical/sensitive structures. Currently, no preclinical models exist to study a putative drug's efficacy in terms of functional recovery of tissues adversely effected by radiation exposure. Such limitations inhibit the development of targeted therapeutics. To this end, we developed a model of radiation-induced soft-tissue damage with quantitative outcomes of tissue function. Mice received a single administration of radiation focused on the posterior limb while under anesthesia. A blinded observer weighed each mouse and performed motors skills assessments weekly for the duration of the study. At the end of the study, mice were euthanized, assessed for hindlimb range of motion and histological analysis was performed, evaluating tissue morphology and fibrotic scarring. Mice presented numerous significant ambulatory deficits that positively correlated with the dose of radiation administered. Irradiated mice presented with reduced range of motion and increased fibrotic scarring upon histological assessment across all dose groups as compared to controls. The current study is the first to describe a preclinical model of functional skeletal muscle deficits following focal radiation injury of a posterior limb, which will be useful for the assessment of novel drug candidates to treat radiotherapy-induced soft-tissue damage.

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Ethambutol is the primary commonly used antitubercular drug for the treatment of tuberculosis and atypical mycobacterial infection. Central nervous system toxicity other than optic neuropathy is not widely reported. We describe a case of a 46-year-old female with abdominal tuberculosis who developed mania after the commencement of ethambutol, and symptoms fully resolved with its cessation. She was prescribed rifampicin, pyrazinamide, isoniazid, and ofloxacin and has no further manic symptoms. This case supports that the patients being treated with ethambutol can develop mania which improves quickly within days of stopping it. A trial of antimanic drugs is needed for short-term rapid improvement of manic symptoms, whereas other anti-tubercular medications can be continued safely.

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Background: Vitamin D deficiency became increasingly common worldwide and was related to various disorders. However, there was little information concerning the relationship between serum 25-hydroxyvitamin D (25(OH) D) level and shift work. The aim of this paper was to investigate the relation between serum 25(OH) D level and shift work in the American citizens. Methods: From the 2005–2006 NHANES, a total of 3025 participants were included. The relation between serum 25(OH) D level and shift work was investigated through the regression models. Results: There was an inverse relationship between serum 25(OH) D level and female shift worker in the fully adjusted models (β coefficient = −8.774, 95% confidence intervals [CI] = −16.83–−0.71, P = 0.03). Additionally, a negative correlation was presented between serum 25OHD level and Mexican American (β coefficient = −9.825, 95% CI = −19.31–−0.33, P = 0.04). No significant differences in serum 25(OH) D level were presented among indoor/outdoor works or manual/nonmanual works. However, long working hours (>40 h/week) were remarkably correlated with low serum 25(OH) D level (β coefficient = −8.007, 95% CI = −15.32–−0.68, P = 0.03). Conclusions: Our study concluded there was an inverse correlation between serum 25(OH) D level and shift work, especially in female population.

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Background: Endoscopic procedures in gastroenterology (GE) imaging suite are conducted primarily under moderate sedation (MS) and general anesthesia (GA). Various factors determine the choice of the technique such as the physical status of the patient, an anticipated difficult procedure, or an unanticipated complication. Aims: The aim was to study various factors affecting the selection of anesthesia techniques in patients undergoing endoscopy. This was a cross-sectional descriptive study in a tertiary care hospital. Methods: All patients who underwent upper gastrointestinal endoscopic procedures (n = 373) from January 2017 to December 2018 were included in the study. Patients were divided into groups on the basis of the anesthesia technique employed as MS – Group I (n = 343) and GA – Group II (n = 30). Data were collected for patient related and procedure related factors such as age, sex, physical status of the patient, complexity of the endoscopic procedures, anesthesia duration, drugs used, complications and recovery profile, which were analyzed for the two groups as per the entries made in the GE suite and central anesthesia registry. Statistical analysis was done using SPSS software Version 22.0 (IBM Corp., Armonk, NY, USA). Categorical variables were tested using Chi-square test and means were compared using t-test. Conclusions: MS was preferred in patients with lesser grades of physical status and in less complex GE procedures as compared to GA.

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The timely diagnosis and optimal therapy of the pituitary apoplexy is challenging. We report a case about our treatment experience for the acute stage of pituitary apoplexy complicated with sinusitis. It is the strong predictor for the acute stage of pituitary apoplexy when magnetic resonance imaging(MRI) presented the both signs simultaneously, the pituitary ring sign and the sphnoid sinus mucosal thickening. Once the diagnosis of pituitary apoplexy is established, hypocortisolism and hyponatremia should be considered intensely. Surgical decompression via transsphnoid approach has favorable prognosis for the visual involvement of the pituitary apoplexy. Effective antibiotic for sphenoid sinusitis before surgery may could minimize the postoperative risk of intracranial infection. Otherwise, the sign of the sphenoid sinus mucosal thickening is not a contraindication for the transnasal transsphnoidal surgery.

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