A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

Background: Parathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma. Case presentation: We report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had severe gastrointestinal symptoms and acute kidney injury. She had unexplained consistent hypokalemia until surgery. Neck ultrasound and CT scan revealed giant parathyroid cyst extending into the mediastinum. After initial medical management for parathyroid crisis, parathyroid cystic adenoma was surgically excised. Her serum calcium, intact parathyroid hormone, creatinine and potassium levels normalized after surgery. Conclusion: This case of parathyroid crisis, with very high serum calcium and parathyroid hormone levels, is a rare presentation of parathyroid adenoma with cystic degeneration. This case also highlights that Vitamin D replacement may unmask subclinical hyperparathyroidism. Consistent hypokalemia until surgery merits research into its association with hypercalcemia

24 GHz Wearable Antenna Design for Wireless Body Area Networks: An Investigation of On-Body Channel Characterisation and Zigbee Protocol at 24 GHz

User-centric networks drive the evolution of wireless communication, demanding constant connectivity and services across various domains. MM-wave (24 GHz ISM band) frequencies emerge as a promising solution for WBAN, overcoming challenges posed by the on-body radio channel and achieving reliable communication in diverse environments. This thesis uses multiple antennas to characterise the mm-wave (24 GHz) radio propagation channel for body-centric communication. The aim is to design compact antennas insensitive to human skin and structural deformation, exploring system-level modelling of Zigbee's PHY and MAC layers in the context of mm-wave (24 GHz) Body Area Networks (BWAN). The first part introduces innovative on-body antenna designs, incorporating split square-ring electromagnetic bandgap (EBG) structures and bow-tie slot antennas, demonstrating high insensitivity to body proximity and bending. The study also proposes Koch fractal antennas backed by EBG structures for improved performance and stable radiation patterns suitable for on-skin mounting. The second part analyses 24 GHz on-body communication system performance and path loss modelling, considering various antenna types. Measurement campaigns confirm the significance of antenna diversity and position in mm-wave propagation on the human body, predicting potential performance for 24 GHz ISM band WBAN systems. The third part evaluates Zigbee protocol performance in body-centric wireless communication within the 24 GHz channel model. Results show good radio link quality for physiological sensor nodes, with lower performance observed in NLOS and PLOS scenarios due to body tissue obstruction. Throughput performance highlights the importance of sensor positioning and MAC layer optimisation. This thesis advances 24 GHz ISM band WBANs through innovative antennas, introducing 24 GHz path loss modeling, and insights into Zigbee (physical layer and MAC) protocol. It drives future research in advanced designs, propagation modelling, and protocol enhancements, boosting on-body wireless communication capabilities

Integrated Fungicidal Management for Downy Mildew of Pumpkin (Pseudoperonosporacubensis)

Downy mildew of pumpkin is caused by the fungus (Pseudoperonosporacubensis), which is responsible for considerable damage to the cucurbits. This pathogen plays a major role for yield losses in pumpkin crop. Current study was intended to verify the effectiveness of different fungicides alone and in combination against downy mildew of pumpkin. Diseased samples were collected for inoculation from different farms of Okara district. A pumpkin variety (Mahadeev) was inoculated by spraying method grown at experimental area of the Department of Plant Pathology, University of Agriculture, Faisalabad under randomized complete block design (RCBD). Selected chemotherapeutic mixtures were sprayed for the control of (Pseudoperonasporacubensis) under field condition. The data were recorded and analyzed statistically. Ipovalicarb (s) + Propanib (P) revealed maximum efficacy against disease (60%) followed by Tebuconazole (s) + Metiram (p) (58%) and Matlaxyal (s) + Mancozeb (p) (55%), Cymoxinal (s) + Mancozeb (p) (52%), Difenconazole (s) +Mancozeb (p) (46%) and Chlorothalonil (p) + Fosytyle Al (39%) respectively. Thus, Ipovalicarb (s) + Propanib (P) can be used to manage the disease under field conditions

Congenital bilateral choanal atresi

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full-term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth. On examination, alternating cyanosis and normal colour was observed in the infant. The insertion of nasal catheters in both the nares revealed the diagnosis of bilateral CCA. For this rare condition, conservative management was followed with elective transnasal endoscopic repair to relieve the life threatening nasal obstruction at the tenth day of life

Development of skin hypopigmentation in a patient with metastatic papillary carcinoma thyroid treated with Sorafenib.

Background: Sorafenib can be considered as the effective option of treatment in patients with metastatic radioiodine refractory differentiated thyroid cancers. The cutaneous manifestations of Sorafenib include rash, desquamation, hand foot skin reactions, pruritus, alopecia and erythema. We report the first case of hypopigmentation related to sorafenib therapy. Case presentation: We report the case of a middle aged gentleman with metastatic papillary carcinoma of thyroid diagnosed in 2005. He was managed with total thyroidectomy, radioactive iodine and TSH suppressive therapy. Despite receiving radioactive iodine 530 mci cumulative dose, patient had persistant disease with lung metastasis. Therefore a TKI, sorafenib, was started. He developed hypopigmentation of the skin more prominent on face six weeks after starting sorafenib treatment.He also developed diarrhea, desquamation of hands and feet, hair loss over scalp, eye brows and moustache. Sorafenib treatment was discontinued. His diarrhea stopped in one week and after four weeks his skin became normalized whereas he regained his hairs in six weeks. Conclusion: To our knowledge, hypopigmentation in our patient appears to be the first reported of its kind in the literature to date. Sorafenib is used in Renal cell carcinoma, Hepatcellular carcinoma and radioactive iodine refractory thyroid carcinoma therefore it is very important to be aware of hypopigmentation as a potential side effect for both physicians and patients

Parotidectomy: A review of 112 patients treated at a teaching hospital in Pakistan

Objective:The Purpose of this study was to analyze the clinical presentation, histopathology and complications following parotid surgery. Methods: We retrospectively reviewed the charts of 112 Patients who underwent parotidectomy from January 2000 to February 2010. Data including age, sex, clinical signs and symptoms, histology and complication were collected from medical records. Results: Of the total, 82 (74%) had benign lesions, 30 (36%) had malignant tumors. The most common benign tumor was pleomorphic adenoma (57%), and the most common malignant tumor was mucoepidermoid carcinoma (16%). Analysis of the correlation between fine-needle aspiration cytology and final histology revealed that fine-needle aspiration sensitivity, specificity and accuracy to 86.6%, 97.6% and 94.6% respectively. The most common complication following parotidectomy was transient facial nerve palsy (18.7%). Conclusions: Superficial parotidectomy is associated with a decrease incidence of transient facial nerve dysfunction compared with that of total parotidectomy. High grade or advanced tumour is a predictor of poor outcome which may require adjuvant therapy

THE METAVERSE: A VIRTUAL WORLD IN THE PALM OF YOUR HAND

This paper explores the actual and future impact of the Metaverse as a virtual space. Thus, it focuses the probe on the technical challenges that face this everlasting emerging technology. Today, the Metaverse presents a digital environment to build collective architecture and historical heritage in a virtual space. In this digital world, the modeling and design methodology is based on individual archetypes that can puzzle new elements. Currently, traditional methods require change and adaptation in both the education and work market, especially due to the remote-work integration in the last few years. For example, many components are required to build a Virtual Reality (VR) laboratory or a VR museum. Virtual environments present us with novel opportunities to bring together the real world with a virtual extension or duplication. This technology will remove physical boundaries and design constraints and consequently will open a gate to a metaphysical world. Imagine a world with limitless space where gravity doesn’t exist, and water can float upward. There is no limit for art and architecture but even this magic has its limitation related to computer technology. Therefore, this paper surveys the state-of-the-art computational technologies and the ecosystems of the Metaverse. The paper covers the fields of Computer Vision, Human-Computer Interaction, Artificial Intelligence, Robotics, Internet of Things (IoT), Cloud Computing, and future mobile networks. In application, the Metaverse will allow users to have a fantastic experience being part of worldwide entertainment and socio-economic network

Harmonic scalpel versus electrocautery tonsillectomy: a comparative study in adult patients

OBJECTIVE: To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.METHODS: Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.RESULTS: The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes;

Extracranial Meningioma: an Unusual Presentation of a Mass Over Inner Canthus of Left Eye

ABSTRACT Meningiomas are commonly encountered as intracranial brain tumours, but extracranial meningiomas do occur although seen rarely. Here we present a case of extracranial meningioma presenting as a mass over the medial canthus of left eye and the glabella with extension into the left ethmoid sinuses, without any neurological symptoms or signs. The patient underwent surgical excision, plastic surgical reconstruction and adjuvant radiotherapy after 3-dimensional conformal treatment planning