Background: Beta-blockers are widely used for the treatment of arrhythmia, hypertension, and congestive heart failure. Major trauma causes significant blood loss and subsequent tachycardia and hypotension. Although beta-blockers may induce negative compensatory sympathetic responses to hemorrhagic shock, the effects of beta-blocker use before major trauma on posttrauma outcomes are controversial. Aim: We examined the association between the use of beta-blockers before major trauma and posttrauma outcomes using a nationwide population-based database. Methods: The data for this nationwide population-based retrospective cohort study were obtained from the National Health Insurance Research Database in Taiwan. A total of 2245 beta-blocker users were assigned to the study cohort, and another 8980 patients matched for age, sex, comorbidity, and medication use by inverse probability of treatment weighting formed the comparison cohort. The major outcome assessed was all-cause mortality during a 30-day follow-up period in major trauma patients with or without pretrauma beta-blocker use. Results: Our study included 2245 patients who used beta-blockers before major trauma. Individuals who used beta-blockers did not have a significantly higher cumulative risk of mortality than individuals who did not use beta-blockers (beta-blockers users: 17.19%, nonbeta-blockers users: 16.70%, P = 0.662). Conclusion: Pretrauma beta-blocker users did not have a higher mortality rate after a major trauma even after adjusting for several comorbidities and medications in a nationwide population database.

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Condyloma acuminatum is one of the most commonly occurring sexually transmitted diseases, caused by the human papillomavirus. We report the case of a male with intraurethral condyloma acuminata treated through electrocauterization. He presented to our genitourinary outpatient department with several days of painless gross hematuria. Patient history indicated 3 years of ongoing hemodialysis and a prior ureteroscopy. Multiple intraurethral tumors and bulbar urethral strictures were found by cystoscopy. Eventually, the patient underwent transurethral resection with electrocauterization. The patient recovered well, and there was no evidence of recurrence at the 1-year follow-up consultation. While there are many different methods for the treatment of intraurethral condyloma acuminata, panurethral condyloma acuminata are rare and difficult to treat. Here, we report a case of panurethral condyloma acuminata where urethroscopy with electrocauterization, without the use of the cutting mode, was performed with rapid, safe, and effective results.

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Background: The calcaneus bone (heel bone) has angles called the Bohler's angle (BA) and the Gissane angle (GA). Estimation of the normal values of these angles can help in their surgical reduction and in restoring the function of the bone in calcaneal fractures. Aim: Our aim is to evaluate the normal limits of BA and GA from lateral view radiographs of the foot of patients presenting to a tertiary care center and also assess the distribution of these parameters with respect to age, sex, and side of the body and also compare them with literature. Methods: A retrospective study was done on 100 randomly selected patients with intact calcaneus bone attending the Department of Orthopedics of our Tertiary Care Hospital between January 2020 and March 2020. Lateral plain radiographs of both feet are obtained and the angles are calculated by two observers using a goniometer and pencil. Mean BA and GA were calculated and their relationship with age, sex, and side of the body were assessed. The SPSS (Statistical Package for Social Sciences. IBM corp, Armonk, NY, USA) software was used. Unpaired t-test for correlation between the mean of angles with gender and with side of the body and one-way ANOVA test was done for correlation between the mean of angles with age. Results: The mean value of BA in our study was 30.03° ±5.09° (range: 20.2°–42.3°) and mean GA was 123.57° ±7.53° (range: 101.5°–135.3°). No statistically significant variations were found for sex (BA: P = 0.2108; GA: P = 0.2172), age groups (BA: P = 0.6003; GA: P = 0.2275), and side of body (BA: P = 0.1819; GA: P = 0.0602). Conclusion: Variations of statistical significance were present between the results of our study with that of other studies in the past. The values obtained from our study can be used as a reference standard for use by orthopedic surgeons in the treatment of calcaneal fractures for Chennai population.

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Background: People with mental illness often experienced sleep disturbances. Physical activity and psychological factors may be associated with sleep quality among people with mental illness. Aim: The purpose of this study was to assess the association between physical activity (PA), psychological distress, perceived stress, and sleep quality in people with mental illness. Methods: Sixty-seven people with schizophrenia, major depressive disorder, and dysthymia were enrolled in the study group. All participants completed the International PA Questionnaire, Kessler psychological distress Scale, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index (PSQI). Results: The results revealed that moderate metabolic equivalent task (MET)-minutes/week (min/wk) and psychological distress accounted for 39% of the variance in subjective sleep quality. Walking MET-min/wk and psychological distress accounted for 24% of the variance in the use of sleep medication. Vigorous MET-min/wk, psychological distress, and perceived stress accounted for 42% of the variance in daytime dysfunction over the previous month. Psychological distress was a significant related factor for sleep duration (adjusted R^[2] = 0.20) and sleep disturbances (adjusted R^[2] = 0.33), respectively. A majority of the participants (n = 58, 87%) used sleep medication and most (91%) of them had PSQI ≥5, which was suggestive of sleep problems. Conclusion: Our results indicated that PA, psychological distress, and perceived stress could have impact on different aspects of sleep quality. More research is needed to explore the association between these variables on sleep quality in people with mental illness.

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Background: Owig to the extensive use of mechanical ventilation, risks of acute lung injury are significant in the intensive care unit. Broccoli extract-sulforaphane (SFN) has been investigated as bioactive polyphenol in chronic lung diseases. Aim: The present study aimed to evaluate the preventive effect of SFN in a rat model of ventilator-induced lung injury. Methods: SFN supplement was administrated 30 min before intubation with the dosage of 3 mg/kg. Then, rats were assigned to receive ventilation with a high tidal volume of 40 mL/kg for 6 h, and low ventilation of 6 mL/kg served as controls. Results: The severity of pulmonary edema was mitigated in the SFN-pretreated group with decreased weight ratios of wet to dry lung and total lung to the body, respectively. From bronchoalveolar lavage, SFN treatment suppressed both leukocytes counts and cytokines production. Following ventilator-exerted oxidative burst with the rescue of glutathione level was identified in SFN-pretreated group. Besides, SFN-reduced cell apoptosis was confirmed by terminal deoxynucleotidyl transferase dUTP nick end labeling assay and cleavage of caspase-3. Western blotting from lung tissues revealed the upregulation of hemeoxygenase-1 with decreased nuclear factor κB and p38 phosphorylation in SFN-treated group. Conclusion: Our results elucidated the prophylaxis of broccoli extract-SFN could attenuate ventilator-induced oxidative stress, inflammation reaction, and pulmonary edema.

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Obstructive sleep apnea (OSA) is a serious sleep disorder. The complications of OSA are respiratory and cardiovascular events, including bradycardia, tachycardia, and even cardiac arrest. A 57-year-old female with OSA was vulnerable to vagal stimulation, developing severe bradycardia and asystole during general anesthesia while undergoing intubation with a conventional direct laryngoscope. This asystole case highlights the fact that anesthetized patients with OSA may experience increased parasympathetic activity (vagal tone) and vagal stimulation with consequent severe bradycardia and asystole. Atropine is recommended to resolve such conditions.

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Spontaneous pyogenic spondylodiscitis (SPS) is an uncommon disease. The most common causative organism of SPS is Staphylococcus aureus, followed by Gram-negative bacilli in 4%–30% of the cases. Polymicrobial SPS is very rare, with only a few cases reported in the literature. We report a case of polymicrobial SPS in a 43-year-old male who was recently diagnosed with autoimmune hepatitis with cirrhosis of the liver and presented with a 1-month history of progressive low backache with radiation to both the legs. Initially, he was managed as a case of Pott's spine with antitubercular therapy on the basis of immunocompromised status with positive ascitic fluid Mycobacterium tuberculosis polymerase chain reaction. However, due to lack of clinical and radiological response after 6 weeks, he underwent computed tomography-guided biopsy of the affected region. The culture from the biopsy specimen yielded Klebsiella oxytoca and Proteus vulgaris. He was managed with culture-sensitive antimicrobials. To the best of our knowledge, this is the first case of polymicrobial SPS caused by K. oxytoca, P. vulgaris, and M. tuberculosis.

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Large paraesophageal hiatal hernia, which is a type III hiatal hernia, involves the combined herniation of both the esophagogastric junction and fundus. Different symptoms are noted in patient with hiatal hernia, the most common being gastroesophageal reflux disease-related symptoms. Herein, we present two cases of large paraesophageal hiatal hernia with symptoms mimicking cardiopulmonary disease, which were successfully treated by laparoscopic hernia repair.

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