Myasthenia Gravis Mimicking Third Cranial Nerve Palsy: a Case Report

Background: The most common pituitary adenoma presentation is a visual field defect and inappropriate pituitary hormone secretion. The compression of the optic chiasma causes visual impairment. Large pituitary adenomas can rarely cause diplopia and ptosis secondary to adenoma's lateral extension into the cavernous sinus. Myasthenia gravis (MG) is an autoimmune disorder involving neuromuscular junctions. It is characterized by skeletal muscle fatigability, commonly involving extraocular muscles, face, and limbs. It is estimated that 75% of MG patients present with ptosis and diplopia. The association of MG with pituitary adenoma is very rare. Case Description: A 30-year-old lady presented with headache, diplopia, and ptosis of the left eye for two months. She was diagnosed with acromegaly secondary to pituitary adenoma. Ptosis is a rare presenting feature in pituitary adenoma. Her case was discussed in a multidisciplinary meeting, and the consensus was that her ptosis is likely secondary to pituitary adenoma, which was involving the left cavernous sinus. She underwent transsphenoidal resection of pituitary macro adenoma. Three weeks post-surgery, she developed bilateral ptosis, dysarthria, dysphonia, which was diagnosed as myasthenia gravis. Clinical implications: Ptosis is a rare manifestation of pituitary adenoma. Nonetheless, pituitary tumor patients presenting with ptosis should be evaluated for the neuromuscular disorder. A high index of suspicion is required for early diagnosis and prompt treatment of myasthenia gravis

Effects of co-infection on the clinical outcomes of Clostridium difficile infection

Background: Clostridium difficile (C. difficile) is a spore-forming, Gram-positive rod that is known to be associated with antibiotic use. It is one of the leading causes of nosocomial diarrhea in the industrialized world and therefore warrants further study of its nature. It isn\u27t clear if co-infection by other organisms can affect the outcome of C. difficile infection (CDI). Methods: A single center retrospective study was done and it used inclusion criteria of 18 years of age and being tested positive for CDI on FilmArray® multiplex gastro-intestinal (GI) panel. Exclusion criteria were a GI panel performed on an outpatient basis, recurrent CDI, and the presence of end-stage renal disease, cirrhosis, or a non-GI infection. The stool sample for all patients were collected within 48 h of presentation to the hospital. There were 235 of 2576 GI panels selected for a retrospective chart review based on the above criteria. Among these 235 patients, 38 had a co-infection (CDI+ another GI infection = group A or cases) and the rest had only CDI (group B or controls). Group A was compared with group B for CDI severity, its response to treatment, recurrence, and length of the hospital stay, using 0.05 as the alpha criterion. Results: Most patients with CDI were female and above the age of 60 years. Co infection did not increase the severity of CDI based both on the American College of Gastroenterology criteria (p 0.16) as well as Infectious Disease Society of America criteria (p 0.77). Co infection group also didn\u27t have significantly different CDI related treatment failure rate (p 0.23), or CDI recurrence rate (p 0.49). Co-infection was also not associated with lengthier hospital stay (p 0.41). Conclusion: Our study suggests that co-infection doesn\u27t affect the severity of CDI or can cause treatment failures. Additionally, there was no significant increase in hospital stay, or increase in CDI recurrence associated with co-infection. Therefore, if CDI is the leading clinical diagnosis and a patient is tested positive for co-infection in addition to CDI on FilmArray® multiplex GI panel, this co-infection shouldn\u27t change the management for CDI. Limitations of this study (including retrospective nature of the study, small sample size, single site study, not including all microbiome and non-inclusion of race) should also be taken into account, while considering the applicability of the results of this study

Ectopic Acromegaly Secondary to Bronchial Tumor; a Case Report of Rare Occurrence.

Introduction: Acromegaly is caused due to the unregulated and sustained overproduction of growth hormone (GH). The majority of the cases are caused by autonomous secretion of GH from anterior pituitary tumors. Nonetheless, in less than 1 % of the cases, the cause of autonomous secretion is secondary to ectopic growth hormone-releasing hormone (GHRH) production. Bronchial carcinoids are the most common cause of ectopic GHRH production. Case description:  A 32-year-old female presented to the clinic with a history of cough, hemoptysis, and undocumented weight loss for four years. Initial workup showed a large right main stem endobronchial mass. Transbronchial biopsy of the mass revealed a grade I neuroendocrine tumor (NET). During NET workup, a large sellar mass was incidentally found on cross-sectional imaging. The hormonal profile revealed markedly elevated insulin-like growth factor -1 (IGF-1) and mildly raised prolactin. The MRI Brain study revealed pituitary macroadenoma measuring 2 cm x 1.2 cm x 1.5 cm. The patient underwent bronchial carcinoid tumor resection, which led to normalization of serum IGF-1 and growth hormone response to an oral glucose tolerance test. Subsequent MRI brain revealed complete resolution of previously noted sellar mass. Practical implications:  This case highlights the importance of differentiating acromegaly secondary to pituitary adenoma and ectopic acromegaly. This case emphasizes the importance of keeping rare entities in the differential while assessing patients with pituitary macroadenoma

A Formal Model for Smart Living Room

we are living in an era full of technology and the most powerful feature behind this technology is the communication between two or more things. We achieved globalization with the power of digital computers and their ability to communicate. The next shape of computers for interactive remote processing is internet of things or wireless sensors network and for data storage it is cloud. These tiny computers with heterogeneous characteristics are very helpful in making environment smart and interactive in different ways.  In this paper, we are proposing an Ambient Intelligence architecture for safety and energy efficiency using sensors, further we are formalizing the architecture for its accuracy and reliability. The three major sensors are smoke sensor for safety, glass break detector sensor for security, motion sensor for energy efficiency. In addition, the working of all sensors is also formalized for its correctness

EPDM Based Double Slope Triangular Enclosure Solar Collector: A Novel Approach

Solar heating is one of the important utilities of solar energy both in domestic and industrial sectors. Evacuated tube heaters are a commonly used technology for domestic water heating. However, increasing cost of copper and nickel has resulted in huge initial cost for these types of heaters. Utilizing solar energy more economically for domestic use requires new concept which has low initial and operating costs together with ease of maintainability. As domestic heating requires only nominal heating temperature to the range of 60–90°C, therefore replacing nickel coated copper pipes with any cheap alternate can drastically reduce the cost of solar heater. We have proposed a new concept which utilizes double slope triangular chamber with EPDM based synthetic rubber pipes. This has reduced the initial and operating costs substantially. A detailed analytical study was carried out to design a novel solar heater. On the basis of analytical design, a prototype was manufactured. Results obtained from the experiments were found to be in good agreement with the analytical study. A maximum error of 10% was recorded at noon. However, results show that error is less than 5% in early and late hours

Dopamine-Agonist Induced Cerebrospinal Fluid Rhinorrhea; a Case Report

Introduction: Prolactinomas are the most common pituitary adenomas. Medical therapy with dopamine agonists (DA) is the mainstay of treatment and rarely requires surgical manipulation. Patients may rarely present with cerebrospinal fluid (CSF) rhinorrhea after starting therapy with DA in case of massive or invasive prolactinomas. Case Description: We present a case of a 29-year-old lady with invasive prolactinoma who presented with CSF rhinorrhea after a month of starting bromocriptine therapy with the development of meningitis and warranting early surgical repair. Practical Implications: Patients with macroprolactinoma should be closely monitored initially after starting on dopamine agonists to avoid life-threatening complications

Anti-counterfeit technologies

  Corresponding arrangement that covers and safeguards the unit dose of drug is called packaging .One of main reason of deaths , treatment failure , un cure cases and failure of health care set up is counterfeit drugs. Renowned medicines brands in addition to sky-scraping cost of medicine make pharmaceutical ideal for counterfeit medicines and in top of list include medicine for most commonly use disease and high price like medicine use in dyslipidemia, anticancer antihypertensive and other antidiabetic agents. This review article focus on the perfect ways and features present existing anti counterfeit technologies and various other parameters in upcoming and how to remove draw backs in existing technologies during packaging in pharmaceutical industry

Cytoskeleton-associated risk modifiers involved in early and rapid progression of sporadic Creutzfeldt-Jakob disease

A high priority in the prion field is to identify pre-symptomatic events and associated profile of molecular changes. Inthisstudy,wedemonstratethepre-symptomatic dysregulation of cytoskeleton assembly and its associated cofilin-1 pathway in strain and brain region-specific manners in MM1 and VV2 subtype-specific Creutzfeldt-Jakob disease at clinical and pre-clinical stage. At physiological level, PrPC interaction with cofilin-1 and phosphorylated form of cofilin (p-cofilin(Ser3)) was investigated in primary cultures of mouse cortex neurons (PCNs) of PrPC wildtype and knockout mice (PrP−/−). Short-interfering RNA downregulation of active form of cofilin-1 resulted in the redistribution/downregulation of PrPC, increase of activated form of microglia, accumulation of dense form of Factin, and upregulation of p-cofilin(Ser3). This upregulated p-cofilin(Ser3) showed redistribution of expression predominantly in the activated form of microglia in PCNs. At pathological level, cofilin-1 expression was significantly altered in cortex and cerebellum in both humans and mice at pre-clinical stage and at early symptomatic clinical stage of the disease. Further, to better understand the possible mechanism of dysregulation of cofilin-1, we also demonstrated alterations in upstream regulators; LIM kinase isoform 1 (LIMK1), slingshot phosphatase isoform 1 (SSH1), RhoA-associated kinase (Rock2), and amyloid precursor protein (APP) in sporadic Creutzfeldt-Jakob disease MM1 mice and in human MM1 and VV2 frontal cortex and cerebellum samples. In conclusion, our findings demonstrated for the first time a key pre-clinical response of cofilin-1 and the associated pathway in prion disease

Examining the Dynamics of Customers Behavioral Intentions: An Empirical Analysis of Factors Influencing Fin-Tech Adoption in the Banking Sector of Pakistan

Purpose: The main aim of this study was to investigate the factors that influence the customers’ behavioral intention to adopt financial technologies (Fin-tech) in the banking sector of Pakistan. These factors include perceived usefulness, perceived ease of use, attitude towards use, environmental concerns and demographic variable age was taken as moderator in this study. Design/Methodology/Approach: The primary data was collected from 600 customers of the banking sector located in the region of southern Punjab, Pakistan, using simple random sampling techniques from those who are using technologies for their financial activities. The five-point Likert scale was used for data collection and the Google form was used to collect the data as this is the most efficient way. Findings: The findings of this study reveal that many factors including perceived usefulness, perceived ease of use, attitude towards use, and environmental concerns play a positive and significant role in the adoption of financial technologies for their business activities for the customers of the banking sector. At the same time, age was taken as a moderator which significantly moderated the relationship between environmental concerns and behavioral intention to adopt fin-tech. Implications/Originality/Value: This study gave a detailed understanding of the factors influencing the adoption of Fin-Tech and is also helpful for the researchers, academician, business owners and policymakers for taking decision-makers about enhancing financial activities and getting more efficient and effective responses from the customers for adopting the financial technologies for their business activities and also generate a valuable business for their organizations

Case Report Disseminated Intravascular Coagulation as a Possible Cause of Acute Coronary Stent Thrombosis: A Case Report and Literature Review

Disseminated intravascular coagulation (DIC), as a cause of acute coronary stent thrombosis, has not yet been reported to our knowledge. We report a case of 64-year-old male, who presented with non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography revealed right coronary artery (RCA) stenosis and a drug eluting stent was deployed. Fifteen hours following the intervention, the patient developed an inferior wall ST elevation myocardial infarction. Repeat cardiac catheterization showed an acute in-stent thrombosis. Following thrombectomy, another stent was placed. The patient noted to have an acute drop in platelet count following the second intervention. Two hours following repeat intervention, the patient again developed chest pain and EKG showed recurrent ST-segment elevations in leads II, III, and aVF. Prior to repeat cardiac catheterization, the patient became unresponsive and developed cardiogenic shock. The patient was resuscitated and intubated, and repeat catheterization showed complete stent thrombosis. Intracoronary tissue plasminogen activator (tPA) was given. The platelet count further dropped. Additional studies confirmed the diagnosis of DIC. No further cardiac catheterization was done at this point. The patient then later had a cardiac arrest and unfortunately cardiopulmonary resuscitation could not revive him. Amongst the etiologies of acute stent thrombosis, DIC was deemed a possible cause