Von Willebrand’s disease diagnosed after hemorrhage following hysteroscopic myoma resection and endometrial band excision

Von Willebrand factor, the largest human plasma protein, is an adhesive multimeric glycoprotein that mediates platelet adhesion to both the subendothelial matrix and endothelial surfaces and acts as a carrier for coagulation factor VIII in the circulation. Von Willebrand disease (vWD) is the most common inherited bleeding condition that involves extended or excessive bleeding and is caused by the deficiency or defect of vWF. In this case report, we present vWD diagnosed after hemorrhage following hysteroscopic myoma resection and endometrial band excision. The importance of a detailed medical history is emphasized as even health care workers cannot spontaneously give this information. Further tests are recommended in patients who have a history of prolonged bleeding as bleeding time and other routine coagulation tests done preoperatively cannot always make a definite diagnosis

A common genetic variation of melanoma inhibitory activity-2 labels a subtype of pancreatic adenocarcinoma with high endoplasmic reticulum stress levels.

HNF1 homeoboxA(HNF1A)-mediated gene expression constitutes an essential component of the secretory pathway in the exocrine pancreas. Melanoma inhibitory activity 2 (MIA2), a protein facilitating protein secretion, is an HNF1A target. Protein secretion is precisely coordinated by the endoplasmic reticulum (ER) stress/unfolded protein response (UPR) system. Here, we demonstrate that HNFA and MIA2 are expressed in a subset of human PDAC tissues and that HNF1A induced MIA2 in vitro. We identified a common germline variant of MIA2 (c.A617G:p.I141M) associated with a secretory defect of the MIA2 protein in PDAC cells. Patients carrying MIA2(I141M) survived longer after tumor resection but the survival benefit was restricted to those patients who received adjuvant chemotherapy. The MIA2(I141M) variant was associated with high expression of ER stress/UPR genes - in particular those of the ERN1/XBP arm - in human PDAC samples. Accordingly, PDAC cell lines expressing the MIA2(I141M) variant expressed high levels of ERN1 and were more sensitive to gemcitabine. These findings define an interaction between the common MIA2(I141M) variant and the ER stress/UPR system and specify a subgroup of PDAC patients who are more likely to benefit from adjuvant chemotherapy

Optimal premium allocation under stop-loss insurance using exposure curves

Determining the retention level in the stop-loss insurance risk premium for both insurer and reinsurer is an important factor in pricing. This paper aims to set optimal reinsurance with respect to the joint behavior of the insurer and the reinsurer under stop-loss contracts. The dependence between the costs of insurer and reinsurer is expressed as a function of retention (d) and maximum-cap (m) levels. Based on the maximum degree of correlation, the optimal levels for d and m are derived under certain claim distributions (Pareto, Gamma and Inverse Gamma). Accordingly, the risk premium and exposure curves for both parties are based on the selected distributions. Quantification of the premium share over derived exposure curves based on the optimized retention and maximum levels and the maximum loss risk is obtained using VaR and CVaR as risk measures

Long Term Follow-Up Results of Fibromyalgia Patients

DergiPark: 379042tmsjAims: Fibromyalgia is a chronic musculoskeletal syndrome of which the main symptoms are chronic widespread pain, debility and fatigue. This is an ailment that is seen 1-2% in general population, mostly in women. Most of the fibromyalgia patients are consulting to health care providers, have examinations made and getting chronic pain treatments. However, there is no sufficient data in the literature concerning long term follow-up of the fibromyalgia patients. Therefore in our study, we aimed to evaluate long term follow-up results of the patients formerly diagnosed as fibromyalgia. For this purpose, we aimed to evaluate our patients’ latest status, to diagnose whether any pain to continue, to determine if there is any autoimmune inflammatory disease developing and to assess whether they have taken a treatment or not. Methods: Seventy four female patients diagnosed fibromyalgia between the years 2003-2008 were taken to our study (Mean of age: 44.5+11.3). In the year of 2015, all of the patients are reached out and questioned about their complaints and treatments. In our study, chi-square test is used in the comparison of the categorical data (Fisher Exact test if necessary) and unpaired t test is used in the comparison of constant variables.Results: Sixty one of the patients (82.4%) remarked that their widespread pain complaints continued. Only 12 patients (16.2%) remarked that they are under follow-up of a rheumatology or physiotherapy and rehabilitation clinic because of their widespread pain or a rheumatologic disease. The percentage of patients who get treatment regularly because of the widespread pain was found 21.6% (16 patients). During the period of follow-up none of the patients developed any autoimmune inflammatory disease.Conclusion: In the group which the fibromyalgia complaints continue; scores of numbness, lassitude and somatization were found significantly high. Despite that regular treatment ratio was relatively low and the ratio of follow-through to treatment was higher in the smoker and well educated grou

Assessment of Lateral Epicondylitis Videos on YouTube

Objective:The aim of the present study was to assess the quality, reliability and educational value of health-related information videos about lateral epicondylitis on YouTube.Method:The study conducted a search on YouTube on April 1, 2021 using the search term ‘‘lateral epicondylitis’’. Based on relevance to this keyword, the first 50 videos were recorded for assessment. The videos were assessed by two orthopedic surgeons. Video length in seconds, view counts, number of likes, number of dislikes, video category (animation or not), video content, days since upload, and source of upload (uploader) were recorded. All videos were analyzed for length, view counts, number of likes and source of upload. Quality of the videos was assessed using the global quality score (GQS) (score range: 0-4), Journal of the American Medical Association (JAMA) score (0-5), and DISCERN (15-75) score. The data were statistically analyzed according to these scoring systems.Results:Like rate had no significant correlation with GQS, DISCERN, and JAMA scores. There was a significant positive correlation between view rate and GQS scores (p=0.038). View rate had no significant correlation with DISCERN (p=0.453) and JAMA scores (p=0.946). There was a significant positive correlation between video power index and GQS scores (p=0.036). Video power index had no significant correlation with DISCERN (p=0.442) and JAMA scores (p=0.938). According to the source of upload, there was a significant difference in JAMA and DISCERN scores between physicians and non-physicians. GQS did not significantly differ (p=0.15) according to the source of upload.Conclusion:The analysis of the first 50 videos relevant to lateral epicondylitis on YouTube revealed that videos were uploaded mainly by healthcare professionals. Overall, the 50 videos had an average level of adequacy

Covid-19 financial consequences in United States hospitals

Introduction: Since the wake of the coronavirus pandemic, United States (U.S.) hospitals have struggled to stay financially afloat amid the constant battle with unprecedented circumstances and financial consequences from the pandemic. The purpose of this research was to analyze the financial consequences of COVID-19 for U.S. hospitals to determine the impact on the number of inpatient cases, length of stay (LOS), surgeries performed, and operating expenses. The hypothesis was that U.S. hospitals were financially affected by the consequences of COVID-19, having more inpatient cases, increased LOS, fewer surgeries performed, and higher operating expenses. Methodology: The methodology for this qualitative study was a literature review following systematic reviews and a semi-structured interview. The references used for this research were located using Marshall University’s EbscoHost, CINAHL, ProQuest, and PubMed research databases. The inclusion criteria were articles published in the English language and studies conducted in the United States between 2012 and 2022. Results: The results of this study show that the inequalities in the distribution of CARES Act funding increased financial vulnerability for many hospital markets across the country. The results also show that, in all U.S. children’s hospitals, the number of inpatient stays was lower since the onset of the pandemic, as well as the number of emergency department visits and surgeries. Additionally, study findings show that the pandemic resulted in significant net income losses for all U.S. hospitals. Discussion: This investigation indicated that Covid-19 has caused a huge financial burden in U.S hospitals, causing an increase of LOS, more impatient cases, fewer surgeries, and higher operating expenses. Conclusion: Study findings point to the need for increased funding for U.S. hospitals to more effectively manage the number of inpatient cases, LOS, surgeries performed, and operating expenses, ensuring future sustainability and better health outcomes. Although previous findings indicated that CARES Act funding improved U.S. hospital outcomes amid the pandemic, our study followed a greater number of hospitals, both urban and rural, than those in studies conducted previously. Future researchers should consider investigating the impact of COVID-19 financial consequences on U.S. hospitals from beginning to end since the pandemic is still ongoing

A comparison of dexmedetomidine, moxonidine and alpha-methyldopa effects on acute, lethal cocaine toxicity

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 μg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality. © 2015, Iranian Red Crescent Medical Journal

A Case of Lennox-Gastaut Syndrome Who Developed Tonic Status Epilepticus Induced by Intravenous Diazepam

Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy characterized by several types of seizures, special EEG patterns, and cognitive deterioration with resistance to therapy and poor prognosis. It is a well known phenomenon that some antiepileptic drugs (AED) have a worsening effect on some seizure types, especially in the generalized epilepsies of childhood. However, its underlying pathogenetic mechanisms are not fully understood. In this paper, a case with LGS who developed tonic status epilepticus induced by diazepame given intravenously is reported and the topic of seizure aggravation caused by AED and LGS is discussed

İsviçre esmeri ineklerde geçiş döneminde vitamin, iz element uygulamalarının fertiliteye etkisinin araştırılması

This study examined the effects of injectable vitamin and trace element combination during the transition period on clinical-biochemical parameters and reproductive performance in Brown Swiss dairy cows. Sixty multiparous cows were randomly allocated two groups as trace element-vitamin treated (n=30) and control (n=30). Animals received four injections at the beginning of the dry period, 21 days before parturition, the day of parturition, and postpartum 30±5 days. Energy, protein, hepatic metabolism markers, blood mineral levels concentrations were measured at -7±4 days antepartum, 3±2 days, and 30±5 days postpartum. Genital tract examinations were performed at 30±5 day postpartum. Treated cows showed lower glucose, total protein, urea, and greater NEFA concentration -7±4 days relative to calving. Effect of vitamin and trace element on serum calcium and phosphorus levels were significant. The total pregnancy rate was 95.8% and 59.09%, in treatment and control groups respectively at 150 days postpartum (P<0.05). In conclusion, trace element and vitamin supplementation increased pregnancy rate significantly and treatment positively affected energy, ion metabolism, and hepatic function.Bu çalışmada geçiş dönemi boyunca vitamin ve iz element enjeksiyonlarının, klinik-biyokimyasal parametreler, periparturent dönem sorunları ile fertilite parametrelerinin üzerine etkisinin araştırılması amaçlandı. Altmış inek, iz element ve vitamin enjeksiyonu yapılanlar (n=30) ve kontrol grubu (n=30) olarak rastgele iki gruba ayrıldı. Vitamin ve iz element enjeksiyonları kuru döneme girişte, doğumdan 21 gün önce, doğumun gerçekleştiği gün ve doğumu izleyen (30±5). günlerde gerçekleştirildi. Enerji, protein, karaciğer metabolizması belirteçleri ile mineral düzeyleri doğum öncesi 7±4. gün, doğum sonrası 3±2. gün ve 30±5. günlerde ölçüldü. Genital organ muayeneleri doğum sonrası 30±5. günde gerçekleştirildi. Uygulama grubundaki inekler kontrol grubundakilere kıyasla doğum öncesi 7±4 günde daha düşük glikoz, toplam protein, üre ve daha yüksek NEFA konsantrasyonu gösterdi. Vitamin ve iz element uygulamasının serum kalsiyum ve fosfor düzeylerine etkisi önemli düzeydeydi. Doğum sonrası 150. günde toplam gebelik oranı uygulama ve kontrol gruplarında sırasıyla % 95.8 ve % 59.09 olarak saptandı (P<0.05). Sonuç olarak, iz element ve vitamin uygulanan ineklerde toplam gebelik oranının belirgin olarak arttığı ve uygulamaların enerji, iyon metabolizması ve karaciğer fonksiyonlarını olumlu etkilediği belirlendi

Giant left anterior descending coronary artery aneurysm in a patient with Behçet’s disease

Coronary artery involvement is quite rare in the course of Behçet’s disease. Complications secondary to coronary artery aneurysms, including rupture, dissection, and myocardial ischemia, may be fatal. In young patients without cardiovascular risk factors, systemic inflammatory vasculitis syndromes should be investigated in case of acute coronary syndrome secondary to dilated coronary arteries. In this report, we present our management strategy in a 31-year-old male patient with Bechet’s disease