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Appendiceal neuroendocrine tumors (NET) although rare, but the most common tumors of the gastrointestinal tract in children and adolescents. NET of the appendix is typically undiagnosed preoperatively, are usually not associated with specific neuroendocrine symptoms, and a high percentage are initially identified by pathologists. For well-differentiated tumors of ＜1 cm and complete (R0) resection, no follow-up is required. Unlikely, tumor size ＞2 cm or tumor with high-risk features confer a relevant risk of recurrence and further imaging and surgical procedures are warranted. No consensus, clear recommendation or management guidelines are available for the management of appendiceal NET in children. Herein, current article will provide an overview of literature and suggested guidelines for evaluation and management of childhood neuroendocrine tumors of appendix.

This report presents the clinical details and management of a 58-year-old Caucasian male with pericardial effusion and cardiac tamponade following outpatient inferior vena cava (IVC) filter removal. The patient was unresponsive and experienced cardiac arrest minutes after the procedure, requiring cardiopulmonary resuscitation. After return of spontaneous circulation he displayed somnolence, confusion and chest discomfort. Investigations revealed a large pericardial effusion, and an echocardiography confirmed cardiac tamponade. Prompt intervention involved pericardiocentesis, resulting in haemodynamic stabilisation and reduction in effusion size. The patient responded favourably with treatment. Differential diagnoses were considered and treatment options were discussed, highlighting the importance of timely recognition and appropriate intervention in managing pericardial effusion and cardiac tamponade. This report adds to the limited literature on pericardial effusion and cardiac tamponade following a scheduled outpatient IVC filter removal, emphasising the unique clinical presentation and successful management of this rare phenomenon.

Abstract In this paper, the Improved Applied Element Method (IAEM), which was originally developed as an effective analysis technique for large-scale bonded and unbonded prestressed structures, is utilized to carry out failure modeling of prestressed bridges under different hazard loads. A typical prestressed concrete girder bridge is analyzed under two hazardous loading scenarios. The first one is applying a detonation charge located in the middle of the central span, while the second scenario is a sudden failure of a column representing a truck or a vessel colliding with the bridge pier. For both scenarios, the collapse analyses of the bridge structure after damage are explored. In addition, the mechanism and severity of damage in the bridge pier and deck are investigated. Both material and geometric nonlinearities are considered in the analysis. Moreover, it considers contact-impact, re-contact, and inertia effects, and hence, it can track the collapse stages of the structure as well as debris movement until the complete collapse of the structure. The results show a strong capability for simulating the total performance of the bridges from early the stages of loading until the total collapse, with a clear graphic representation of the collapse phenomena.

This case report presents the management of a 53-year-old female with a complex psychiatric history who ingested multiple medications, resulting in severe cardiovascular compromise and subsequent respiratory failure. The patient’s ingestion included clonidine, fluoxetine, gabapentin, quetiapine and bupropion. Initial treatment involved supportive measures, including fluid resuscitation, bicarbonate infusion and correction of electrolyte imbalances. Despite these interventions, the patient remained haemodynamically unstable, requiring multiple vasopressors. Lipid emulsion therapy was initiated and led to a remarkable improvement in the patient’s cardiovascular status. However, she developed acute respiratory distress syndrome (ARDS) and required prolonged mechanical ventilation. Steroid therapy was initiated to manage the ARDS, and the patient was successfully extubated on day 6. The case highlights the potential effectiveness of lipid emulsion therapy in managing bupropion toxicity, but emphasises the need for further research to establish clear guidelines on dosing, timing and safety protocols. Adverse effects associated with lipid emulsion therapy must be carefully considered. Individualised decision-making and patient-centred care is crucial in optimising outcomes in cases of bupropion toxicity.

Key Clinical Message Nirmatrelvir‐ritonavir (Paxlovid) is a brand‐new oral antiviral medication for treating mild to severe COVID‐19. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for ritonavir‐nirmatrelvir on December 22, 2021, to treat COVID‐19. We describe a case of mild COVID‐19 infection who developed severe hyponatremia following the administration of Paxlovid. Clinical and laboratory evaluations suggest SIADH, likely secondary to Paxlovid. The potential side effects of this medication still require further study.

Organizing pneumonia (OP) is a form of interstitial lung disease that develops in response to acute lung injury. SARS-CoV-2 causes a wide range of lung and extrapulmonary disease, but there are few data suggesting an association between COVID-19 and OP. We describe a patient with COVID-19 pneumonia who developed severe progressive OP with significant morbidity.

The article tells about the strategy of Winter University of Urban Planning and the characteristics of Winter University of Urban Planning 2019, as well as the experts, pilots and participants of the workshop. The practice-oriented approach of the workshop and the value of the campus have made the Winter University a platform for interesting discussions and innovative proposals.

Thrombotic disease represents a rare manifestation of leprosy. In this study, we report the case of an external jugular vein thrombosis associated with tuberculoid leprosy in a 23-year-old male patient. The patient presented with a 3-month history of painful cord-like swelling on the left side of the neck and a nearly 3-week history of skin lesions on the left cheek and right leg. Physical examination revealed cord-like, tender swelling on the left lateral aspect of the neck overlying the sternocleidomastoid muscle, and a hypopigmented, hypoaesthetic 6×7 cm lesion with an irregular margin on the left cheek. A Doppler ultrasound examination of the jugular vein showed thrombosis of the left external jugular vein. Three-dimensional reconstruction of the computed tomography scan showed the enlarged and enhanced left external jugular vein, as well as 1 of its tributaries, and the thickened skin patch. A skin punch biopsy from the left cheek lesion revealed granulomatous inflammation with occasional peri-adnexal granulomas, consistent with the clinical impression of tuberculoid leprosy. A diagnosis of leprosy with external jugular vein thrombosis was established. Anticoagulation therapy was initiated, and the patient was referred to an infectious disease clinic for treatment with anti-leprosy medications.

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder that causes isolated thrombocytopenia. Many viruses have been identified as triggering the autoimmune process, including HIV, MCV, EBV, parvovirus, rubella and measles. However, ITP in association with coronavirus infection has not previously been reported. We describe the case of a healthy man who presented with severe ITP complicated by intracranial haemorrhage following upper respiratory tract infection. An infection screen revealed coronavirus infection.

The article tells about the strategy of Winter University of Urban Planning and the characteristics of Winter University of Urban Planning 2019, as well as the experts, pilots and participants of the workshop. The practice-oriented approach of the workshop and the value of the campus have made the Winter University a platform for interesting discussions and innovative proposals.

Uncontrolled hyperthyroidism has been associated with significant changes in cardiovascular hemodynamics. We report a case of a 39-year-old male who has been recently diagnosed with severe hyperthyroidism. He was undergoing dobutamine stress echocardiography (DSE) for evaluation of symptoms suggestive of stable angina. The exam was complicated by ST-segment elevation myocardial infarction- (STEMI-) required coronary angiography that showed mild coronary artery disease.

Ventricular arrhythmia storm is a state of cardiac instability characterized by multiple ventricular arrhythmias or multiple ICD therapies within a 24-hour duration. Management of this life-threatening state depends on the reversal of the cause besides either electrical or medical management of the arrhythmia. We report a case of a 54-year-old male who underwent a percutaneous coronary intervention following massive acute myocardial infarction. Afterwards, he developed frequent life-threatening ventricular arrhythmias that required multiple shocks and antiarrhythmic medications. Despite all these interventions, it was very difficult to control the electrical instability, but after overdrive ventricular pacing, the storm subsided and within a few days the case was stabilized. Overdrive pacing is an easy temporary modality to control the resistant arrhythmia following myocardial infarction.

Introduction: Pulmonary vein (PV) isolation is considered as a key to atrial fibrillation (AF) treatment. Cryoballoon ablation is an effective therapy for PV isolation for AF with minimal side effects and was approved by the US Food and Drug Administration (FDA) several years ago. Successful isolation of PVs during cryoablation depends on the balloon temperature and helps in early identification of noneffective cryoballoon applications. A lower balloon temperature has been associated with long-term success in isolation of PVs. Case Presentation: At the start of the procedure, the cryoconsole displayed “low refrigerant level”. After a few cycles of successful cryoballoon applications, for a fresh application for a new PV the optimal temperature was not obtained in spite of obtaining good grade of occlusion and ostial positioning for right inferior pulmonary vein (RIPV). Later, immediately after changing the refrigerant cylinder, suitable temperature was obtained. We faced this situation thrice in a span of eight months. Conclusion: Low refrigerant level may cause nonoptimal temperature during cryoablation, which can be resolved by premature change of a gas cylinder.

Multiple-target tracking has received tremendous attention due to its wide practical applicability in video processing and analysis applications. Most existing techniques, however, suffer from the well-known "multitarget occlusion" problem and/or immense computational cost due to its use of high-dimensional joint-state representations. In this paper, we present a distributed Bayesian framework using multiple collaborative cameras for robust and efficient multiple-target tracking in crowded environments with significant and persistent occlusion. When the targets are in close proximity or present multitarget occlusions in a particular camera view, camera collaboration between different views is activated in order to handle the multitarget occlusion problem in an innovative way. Specifically, we propose to model the camera collaboration likelihood density by using epipolar geometry with sequential Monte Carlo implementation. Experimental results have been demonstrated for both synthetic and real-world video data.

Background: Endometrial carcinoma is the most common gynecological malignancy in developed countries. About 80% of endometrial carcinomas are preceded by atypical endometrial hyperplasia. PTEN is a tumor suppressor gene involved in many vital intracellular biological processes. PTEN is altered in more than 45% of endometrial carcinomas. The aim of this study was to evaluate the value immunohistochemical expression of PTEN in normal, hyperplastic and neoplastic endometrial tissues. Methods: Ninety-two endometrial samples were enrolled in this study. They were classified into normal (n=6), hyperplastic (n=54) and neoplastic (n=32) endometrial tissues. Formalin-fixed and paraffin-embedded tissue blocks were prepared from each specimen. Tissue sections were immunohistochemically stained by anti-PTEN antibodies. Results: In our study; PTEN was strongly expressed in all normal and hyperplastic endometrial tissues without atypia. Staining intensity was decreased in atypical endometrial hyperplasia and endometrial carcinoma (p

Abstract Background Clomiphene Citrate is considered the gold-standard for induction of ovulation and has been used for several years to treat PCOS related infertility. Unfortunately, 15-40% of women with PCOS are resistant to Clomiphene Citrate. The study aimed to evaluate potential benefits of adding the active form of Coenzyme Q10 (Ubiquinol) to Clomiphene Citrate compared with Human Menopausal Gonadotropins (hMG) in Clomiphene Citrate resistant PCOS patients. 148 PCOS Patients with Clomiphene Citrate resistance were randomized into two groups (A and B). In group A, controlled ovarian stimulation was done by Clomiphene Citrate 150 mg daily (from 2nd till 6th day of cycle) together with Ubiquinol starting from 2nd day till day of hCG triggering in a dose of 100 mg orally once daily. In group B, hMG was given from 2nd day of the cycle in a dose ranging from 75 to 225 IU. Serial transvaginal ultrasonography was done starting on cycle day 8 and continued till size of leading follicle reaches 18 mm or more then ovulation triggering was done. Thereafter, patients were advised for a timed intercourse (TI) after 36 hours. A blood sample was withdrawn seven days after hCG triggering, for measurement of serum progesterone. If the Patient presented with a missed period for one week, a serum sample was sent for β-hCG. Results There were no statistically significant differences (P > 0.05) between studied groups regarding; number of cases reaching mature follicular size, number of stimulated cycles, endometrial thickness on the day of hCG triggering, mid-luteal serum progesterone, positive serum pregnancy test and clinical pregnancy rate. Conclusions Addition of Ubiquinol to Clomiphene Citrate improved ovarian responsiveness in Clomiphene Citrate resistant patients with results comparable to conventional hMG stimulation protocol.

Abstract Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of reproductive age women with a prevalence of 4-12%. The study aimed to investigate the potential benefit of adding thymoquinone to metformin in alleviating symptoms of polycystic ovarian syndrome. Two hundred seven overweight and obese PCOS patients were divided into two groups. Patients in group A received metformin 500 mg three times daily for 6 months. Patients in group B received a combination of metformin 500 mg and thymoquinone in the form of black cumin oil 500 mg capsules three times daily for 6 months. Follow-up was done after 3 and 6 months from the beginning of the study for evaluation of menstrual cycle pattern, body mass index, waist circumference, hip circumference, and waist:hip ratio, oral glucose tolerance test, glycosylated hemoglobin A1C, superoxide dismutase activity, and malondialdehyde concentration. Results Patients who received a combination of black cumin oil capsules and metformin, showed a significant decrease in number of patients suffering from amenorrhea or oligomenorrhea (P = 0.031), significant (P = 0.00) weight reduction (reduced BMI), and body fat redistribution (reduced W/H ratio), regaining oxidative balance with significant increase of SOD activity (P = 0.00) and decrease of MDA concentrations (P = 0.03). Regarding the number of prediabetic patients, there was no statistically significant difference (P = 0.89) when both groups were compared at the end of study period. Conclusions Black cumin oil supplementation constitutes a beneficial added value to metformin in ameliorating PCOS-related disorders with resumption of menstrual regularity, weight reduction, change of body fat distribution, and regaining oxidative balance.

Background: Letrozole is as effective as clomiphene citrate for induction of ovulation in patients with PCOS. Adequate endometrial development is required for pregnancy to occur, and pregnancy rates were found to be higher when the endometrium reached at least 10 mm thickness. Objective: To study the effect of estradiol valerate on the endometrial thickness and subsequently the pregnancy rate in PCOS cases receiving letrozole for induction of ovulation as compared to letrozole alone. Study design: A randomized controlled study. Setting was at the infertility clinic of the Cytogenetic and Endoscopy Unit, Zagazig University Hospital. Material and methods: The study included 273 patients who underwent ovulation induction and timed intercourse. Patients were divided into 2 groups: controlled ovarian stimulation was done in group 1 by letrozole with addition of estradiol valerate and in group 2 by letrozole alone. Results: As regard the clinical pregnancy rate, we found a statistically significant difference between the 2 studied groups, with documented clinical pregnancy in 34 patients in group 1 compared to only 16 patients in group 2. Conclusion: This study showed that the pregnancy rate achieved with letrozole/estradiol valerate combination was significantly higher than with letrozole alone. This was attributed to the improvement of endometrial thickness by estradiol valerate. Keywords: Endometrial thickness, Estradiol valerate, Letrozole, Ovulation induction

Background: Adequate and optimum endometrial development is required for a successful pregnancy to occur. Clomiphene citrate is well known for its negative impact on endometrial thickness. The long-acting phosphodiesterase 5 inhibitor, Tadalafil, was shown to improve endometrial growth in patients under Clomiphene citrate stimulation. Objective: To study the effect of Tadalafil on the endometrial thickness in Clomiphene citrate stimulated cycles as compared to clomiphene citrate alone and human menopausal gonadotropins. Study design: A randomized controlled study. Setting was at the infertility clinic of Cytogenetic and Endoscopy Unit, Zagazig University Hospital. Material and methods: The study included 236 patients who underwent a single cycle of ovulation induction and timed intercourse. Patients were divided into 3 groups: Controlled ovarian stimulation was done in group A by Clomiphene Citrate alone, in group B by Clomiphene Citrate with addition of Tadalafil and in group C by Human Menopausal Gonadotropins. Results: As regard the number of cases who got pregnant, we found that there was a statistically significant difference (P