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Abstract Background Cirrhotic cardiomyopathy, an intricate and multifaceted complication of end-stage liver disease, manifests as systolic and diastolic dysfunction in patients without previously diagnosed cardiac disease. Our study aims to investigate the prevalence of systolic and diastolic function in patients with cirrhotic cardiomyopathy in our region. Methods We conducted a cross-sectional study on 68 patients with established cirrhosis, and no overt cardiac manifestations, who consequently underwent 2D echocardiography to quantify systolic and diastolic dysfunction, as defined by the 2019 Cirrhotic Cardiomyopathy Consortium. The severity of cirrhosis was determined using various validated scoring systems. Results A total of 19 out of 68 (28%) had systolic dysfunction, while 6/68 (9%) had evidence of diastolic dysfunction. Overall prevalence of cirrhotic cardiomyopathy was 23/68 (34%), and the presence of hepatitis C was strongly associated with systolic dysfunction with p-value of 0.007. However, it was not significantly associated with diastolic dysfunction, p-value = 0.59. Logistic regression analysis did not show any significant association between cardiac dysfunction and the severity of liver cirrhosis, as assessed by Child–Pugh, MELD, ALBI, PALBI, portal hypertension, and FIB-4 score (R 2 = 3.66, F (13, 39) = 1.33, p = 0.234). Conclusion Our study reveals a remarkable prevalence of cirrhotic cardiomyopathy, which despite being a frequently occurring phenomenon often goes unrecognized. Lack of correlation with the severity of liver cirrhosis, based on currently available scoring system, suggests either a still poorly understood pathological mechanism or requires the development of a new validated reliable scoring system through multi-center longitudinal studies.

Abstract Background Kleeblattschädel skull, also known as the cloverleaf is a complex synostosis which presents with an enlarged tri-lobar skull resulting temporal bulging and a flat posterior skull, a rare find in the population. This pansynostosis is associated with other congenital syndromes which include Crouzon, Pfeifer, and Carpenter’s. The genetic disorder Pfeiffer syndrome results from skull bones’ premature fusion characterized by deformities of the hand and feet. The author reports a 10-month-old girl who presented with a tri-lobar skull and wide toes which is a significant finding of Pfeiffer syndrome. Case presentation A 10-month-old girl presents with congenital obstructive hydrocephalus due to cloverleaf skull with horizontally enlarged head and large fontanelles. The child also had mid-facial hypoplasia and pre-axial bilateral lower limb polydactyly. Wide toes were also observed, an indicator of Pfeiffer’s Syndrome. Computed tomography (CAT) scans grossly abnormal craniofacial appearances, with premature closure of the sagittal suture giving a cloverleaf skull appearance. There was also a significant thinning of the brain parenchyma. Conclusion Premature closure of sutures leads to a forced growth in a plane perpendicular to the closed suture. Cloverleaf deformity can present with multiple syndromes such as Pfeiffer’s. This leads to gross alteration of the skull with potential underlying morbidity.

Abstract Background Fungal infections of the CNS are almost always a clinical surprise. Aspergillus species although ubiquitous are more frequently observed in immuno-compromised individuals upon inhalation of conidia. Most of the fungal infections which happen in humans are opportunistic, mostly due to immunocompromised host. Case description We present the case of a 14-year-old boy who presented to the Emergency Department of Aga Khan University Hospital, Karachi, with complaints of right-sided weakness of the body. This was a rapid-onset condition which was associated with gait disturbances and multiple episodes of vomiting. MRI head showed encapsulated Space Occupying Lesion with puss in the left frontal lobe with surrounding edema. The patient was planned for a craniotomy to remove an intracerebral abscess. Histopathology report revealed the presence of chronic granulomatous inflammation with necrosis and numerous septate hyphae. A fungus culture was run which confirmed the presence of heavy colonies of Aspergillus flavus. Conclusion Fungal infections of the central nervous system are almost always a clinical surprise, have a subtle presentation and mistaken often as meningitis, brain abscess, or tumor. Any suspected lesion once removed should be sent for biopsy to rule out the presence of any fungal infection.

Abstract Background Surgery in a prone position is necessary when access to posterior anatomical structures is needed. A procedure in this position is associated with complications such as injuries to the eyes, peripheral nerves, and pressure points and swelling of the tongue. We report a rare complication of isolated lower lip swelling following neck dissection in the prone position. Case presentation A 25-year-old male patient presented to the clinic with complaint of neck pain for the past 2 months. A cervical spine MRI was done which showed the presence of a cavernoma. C2 laminectomy was performed for resection of the tumor in prone position with the head fixed on a three-point Mayfield clamp. Postoperatively, isolated swelling of the lower lip was observed. The patient was managed conservatively. Conclusion Cervical spine surgeries done in prone positions carry an increased risk of postoperative vision loss and swellings including those of the oropharynx and in the periorbital region. Possible risk factors for such conditions include anemia, hypotension, long duration of surgery, and significant intraoperative hydration.

New Hermite-Hadamard type inequalities are established. Some corresponding examples are also discussed in detail., Competing Interests: Authors declare that they have no competing interests.

The objective of this paper is to establish some new refinements of fractional Hermite-Hadamard inequalities via a harmonically convex function with a kernel containing the generalized Mittag-Leffler function.

In this paper, we introduce and study a new class of generalized functions, called generalized geometrically convex functions. We establish several basic inequalities related to generalized geometrically convex functions. We also derive several new inequalities of the Hermite-Hadamard type for generalized geometrically convex functions. Several special cases are discussed, which can be deduced from our main results.

In this paper, we derive a new extension of Hermite-Hadamard's inequality via k -Riemann-Liouville fractional integrals. Two new k -fractional integral identities are also derived. Then, using these identities as an auxiliary result, we obtain some new k -fractional bounds which involve k -Appell's hypergeometric functions. These bounds can be viewed as new k -fractional estimations of trapezoidal and mid-point type inequalities. These results are obtained for the functions which have the harmonic convexity property. We also discuss some special cases which can be deduced from the main results of the paper.

In this article, a new general integral identity involving generalized fractional integral operators is established. With the help of this identity new Hermite-Hadamard type inequalities are obtained for functions whose absolute values of derivatives are convex. As a consequence, the main results of this paper generalize the existing Hermite-Hadamard type inequalities involving the Riemann-Liouville fractional integral.