Paraproteins have been reported to cause interference in a sort of chemistry assays conducted by current automated chemistry analyzers. However, the nature of interference differs across different methodologies and reactions. Total bilirubin and direct bilirubin assays might yield spurious result when the sample contains excess amounts of paraproteins, which are neither reliable nor reproducible when repeated tests are applied once the interference occurs. Herein, we present the case of a 78-year-old female diagnosed with kappa light chain multiple myeloma with disease progression. On admission, she had acute hepatitis and a bizarre result with direct bilirubin level higher than total bilirubin level was noted. After further investigation, excess amounts of immunoglobulin G (IgG) were the most likely cause which led to the interference of direct bilirubin assay and caused unreliable results. This case highlights the significance of the fact that patients with excess IgG might have unreliable results of direct bilirubin assay which could mislead clinical judgment. Moreover, clinicians should be more careful and should base therapeutic decisions on the patient's clinical condition when faced with patients in a similar condition.

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Severe traumatic injury continues to present challenges to health-care systems worldwide, and posttraumatic bleeding remains a leading cause of potentially preventable death among injured patients. Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided patient blood management has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health-care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. This document aims to provide practice algorithm on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources.

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Background: The aim was to determine the activity of plasminogen activator inhibitor-1 (PAI-1) and levels of circulating ceruloplasmin (CP) in men with iron-deficiency (ID) anemia and heart failure with preserved ejection fraction (HFpEF) with concomitant prostate cancer and their dynamics after intravenous iron hydroxide sucrose supplementation. Methods: Dynamic observation and treatment was performed in 53 men with ID anemia and HFpEF with concomitant prostate adenocarcinoma. Serum PAI-1 activity levels were determined using a modified colorimetric method of tissue-type plasminogen activator determination. Serum CP levels were evaluated by immunoblot assay. Results: After 10 days of treatment in the group of patients treated with intravenous iron (III) hydroxide sucrose, the median PAI-1 activity level decreased by 9.2% (P < 0.001), in Group II, this indicator was not significantly different. After 10 days of treatment, it was estimated decreased median CP level by 35% (P < 0.001), in comparison with standard therapy – on 14.4% (P < 0.001). Conclusion: The infusion of intravenous iron (III) hydroxide sucrose in men with ID anemia and HFpEF with concomitant prostate cancer contributed to a significant decrease of PAI-1 activity level and CP level.

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Idiopathic thrombocytopenic purpura (ITP) is the most common immune-related thrombocytopenia during pregnancy. Here, we present a case of ITP with acute flare-up during pregnancy. Worsening thrombocytopenia dropped the platelet count to 11,000/dL. Steroid treatment, intravenous immunoglobulin (IVIG) infusion, and anti-CD20 antibody therapy were all unsuccessful. Fortunately, no further critical maternal or fetal complications developed. Transient neonatal thrombocytosis was noted after delivery but was corrected with IVIG.

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Background: Comprehensive facial assessment can be attained by analyzing population facial profiles and comparing racial variations. To date, there are no databases of Taiwanese facial profiles. Furthermore, facial profiles vary widely among different countries and races. Understanding these differences may facilitate facial profile analyses and surgical planning for facial plastic surgeons. Therefore, in this study, we collected the facial profile parameters of Taiwanese and Fijian people and then analyzed the differences between the two populations. Methods: We recruited 94 Taiwanese individuals at Fu Jen University from December 2014 to November 2015. During a volunteer medical mission to Fiji in November 2017, we enrolled 13 Fijians. Right lateral standard facial photographs were taken to analyze facial profile parameters, including nasofrontal angle (NFA), nasolabial angle, nasofacial angle (NfA), nasomental angle (NMA), mentocervical angle (MCA), glabella-subnasale-pogonion angle, glabella-nasal tip-pogonion angle, superior labial angle, inferior labial angle, and pogonial angle. These parameters were compared between both males and females in Taiwan and Fiji. Results: We observed no significant difference in any of the facial profile parameters between males and females in both Taiwan and Fiji. Compared with Fijian individuals, Taiwanese females have a sharper NfA, and Taiwanese males have a more obtuse NFA, NMA, and MCA, as well as a sharper NfA. Conclusion: Fijian females may have a more outstanding nose than Taiwanese females. Meanwhile, Fijian males may feature a more prominent glabella, a more outstanding nose, and a sharper chin compared with Taiwanese males. In conclusion, the Fijian population has more prominent facial convexity than the Taiwanese population.

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Background: Sentinel lymph node (SLN) remains one of the most important indicators of axillary lymph node status, defining the prognosis of breast cancer (BC) patients. The present study was done to map axillary SLN using dual method of intraoperative axillary ultrasound-guided (USG) and methylene blue dye, in patients receiving neoadjuvant chemotherapy (NAT) for locally advanced BC. Methods: A prospective interventional cross-sectional study was conducted on 36 core-needle biopsy-proven cases of locally advanced breast carcinoma (Stage IIb and Stage III) who received NAT. The SLNs as identified by the bluest staining node (dye method) and the node with a needle inserted in it through axillary USG method were dissected and sent for frozen section in normal saline. It was followed by complete axillary dissection and final histopathology reporting. Diagnostic test was used for calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: After NAT, 26/29 patients with pre-NAT staging of N1 and 5/7 patients with pre-NAT staging of N2 showed significant downstaging of the nodal status after NAT (P < 0.001). We found that the dual method showed similar sensitivity to the dye method and the USG method (94.74%). But, the specificity, PPV, and NPV of the dual method although similar to the dye method (76.47%, 81.82%, and 92.86%, respectively) were lower than that of the USG method (82.35%, 85.71%, and 93.33%, respectively). Conclusion: In conclusion, dual method (dye and USG) is a good attempt in increasing the SLN detection but it is not a powerful test in the application of avoiding axillary lymph node dissection. The comparable sensitivity but lower specificity in determining the SLN restricts its use, and warrants future studies with contrast-enhanced USG to decrease the false negatives.

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Peripheral odontogenic neoplasms have similarities with other peripheral tumoral and nontumoral lesions. It is difficult to obtain proper diagnosis clinically and it is mostly based on the histopathologic features. Moreover, differential diagnosis of oral lesions differs between children and adults, and as a result, reports of such cases help better diagnose the lesions in this age group. Peripheral odontoma (PO), unlike central types, is uncommon. However, they have the same features as their intraosseous counterparts histopathologically. Here, we report the case of PO in a pediatric patient which was present from his infancy.

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Background: Cardiovascular implantable electronic devices (CIED) are life-saving devices, but may lead to puncture-related complications during implantation. Aim: The aim of this study was to compare the success and complications of the subclavian venous puncture under the guidance of fluoroscopy, venography, and Doppler. Methods: This was a prospective observational study conducted for one year at a tertiary health center in North India. We studied the clinical profile, success, and complications in three puncture techniques for CIED lead implantation in 75 adult patients of >18 years of age, randomized in three equal groups of 25 participants. Results: The mean age was 66.6 ± 15.6 years, with the majority being males. The left-sided approach for lead implantation was common (84%). Pacemakers were most commonly implanted CIED devices. The overall success of punctures was 100% each in Doppler and venography group, and 92% in the fluoroscopic-guided venous puncture group. Success in the first attempt was observed in 48% in the Doppler group and 24% each in the fluoroscopic and venographic group. There were total of 12 complications, the most common were arterial puncture (10.7%), followed by major hematoma (4%), and pneumothorax (1.3%). The fluoroscopic group had maximum complications (83%), followed by the venography group. Significantly higher arterial punctures occurred in the fluoroscopic venous puncture group. Conclusion: There were 100% success in the Doppler and venographic groups and only 92% success in the fluoroscopic venous puncture group. Maximum complications were seen in the fluoroscopic group, with significantly higher arterial punctures seen in the fluoroscopic venous puncture group.

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