There is a lack of research that investigates the risk factors of cycling in low- and middle-income countries. We present descriptive epidemiology of crashes that involved at least one fatal cyclist, over a three-year period (2016-2018) in Delhi, India. Next, we used an unmatched case-control approach to identify road design risk factors of cycle fatalities. Cases were road segments with at least one cycle fatality, and controls were those with none. We developed logistic regression models with cases and controls as binary outcomes to estimate the odds ratio of site characteristics. There were 167 crashes involving at least one cyclist fatality over the study period. Fatal cyclists were almost all males. They were less likely to be children or young adults and less likely to be residents of high-income localities, compared to the general population. One in ten crashes included more than one occupant on a cycle and 5% of fatal victims were pillion riders. Seventy percent crashes occurred at midblock, and majority were backend collisions. Regression shows that road width, traffic speed, and volume of heavy vehicles have strong positive effects on the fatality risk of cyclists. These results can inform strategies to design interventions for safety of cyclists.

Xeroderma pigmentosum is a rare autosomal recessive genodermatoses characterized by a deficiency in nucleotide excision repair. Erythropoietic protoporphyria is a rare inherited metabolic disease caused by the perturbation of heme. Xeroderma pigmentosum-erythropoietic protoporphyria is exceedingly rare. Hereby, we firstly report a young Chinese patient of xeroderma pigmentosum Group A with erythropoietic protoporphyria carrying an XPA Met214AsnfsTer7 frameshift mutation and a homozygous splicing mutation, c.315-48T>C, in the proband\'s intron3 of FECH.

UNASSIGNED: Adrenaline, stress cardiomyopathy, allergic reactions, and Kounis syndrome (Adrenaline, Takotsubo, Anaphylaxis, Kounis Complex, ATAK) constitute a complex clinical syndrome often associated with endogenous or exogenous adrenaline. Due to its rapid onset, severity, and treatment challenges, it warrants significant attention from clinicians. This article reports a case of Type II Kounis syndrome combined with stress cardiomyopathy (ATAK) triggered by a latamoxef-induced allergy.
UNASSIGNED: A 67-year-old male patient with an acute exacerbation of chronic obstructive pulmonary disease was admitted to the respiratory department for treatment. The day before discharge, after receiving a latamoxef infusion for 27 min, the patient developed wheezing, dyspnea, chills, profuse sweating, and an elevated body temperature, necessitating transfer to the ICU for monitoring and treatment. The ECG suggested a suspected myocardial infarction, while bedside echocardiography showed a left ventricular ejection fraction of 40%, segmental dysfunction of the left ventricle, and apical rounding. Emergency coronary angiography revealed 50% segmental eccentric stenosis in the mid-segment of the left anterior descending branch and right coronary artery. The final diagnosis was Type II Kounis Syndrome combined with stress cardiomyopathy due to a latamoxef-induced allergy, i.e., ATAK. Despite aggressive treatment, the patient succumbed to severe cardiogenic shock on the third day in the ICU.
UNASSIGNED: ATAK is a critical condition that progresses rapidly. For patients experiencing severe allergic reactions, monitoring biomarkers such as Troponin and ECG changes is crucial for timely recognition. If a patient is diagnosed with Kounis syndrome, caution should be exercised in using adrenaline to prevent ATAK.

Anhedonia and motivational impairments are cardinal features of depression, against which conventional antidepressants demonstrate limited efficacy. Preclinical investigations and extant clinical trial data substantiate the promise of opioid receptor modulators in addressing anhedonia, depression, and anxiety. While synthetic opioid agents like dezocine are conventionally employed for analgesia, their distinctive pharmacological profile has engendered interest in their potential antidepressant properties and translational applications. Herein, we present a case in which persistent bupropion treatment was ineffective. However, the incidental administration of a single low-dose intravenous injection of dezocine resulted in a rapid and sustained amelioration of depressive symptoms, particularly anhedonia and motivational deficits. Our findings posit a potentially novel role for the \"legacy drug\" dezocine.

UNASSIGNED: Organ donation after euthanasia (ODE) has been performed over 100 times in the Netherlands, primarily involving patients suffering from a neurodegenerative or psychiatric disease. In recent years, the number of euthanasia cases related to dementia has increased in the Netherlands, with some patients living with dementia expressing a wish for organ donation after euthanasia.
UNASSIGNED: We describe a unique case of a 67-year-old female diagnosed with primary progressive aphasia as part of frontotemporal dementia who requested and underwent organ donation after euthanasia.
UNASSIGNED: The patient had expressed her explicit wishes for both euthanasia and organ donation, which were discussed with her family physician, the Euthanasia Expertise Center (EE), and an organ donation coordinator. The patient was informed that to proceed with ODE, she should still be capable of voicing a voluntary and well-considered request for organ donation. The legally required euthanasia assessment procedure was carefully completed before ODE. Multiple healthcare professionals assessed the patient\'s competence, voluntariness, and unbearable suffering. Thereafter the patient\'s ODE request was granted, and both lungs and kidneys were successfully donated and transplanted. Post hoc analysis confirmed that all due diligence criteria for euthanasia were met, and the patient\'s relatives received an anonymous letter of gratitude from one of the organ recipients.
UNASSIGNED: This unique case demonstrates that ODE is feasible from medical, ethical, and legal perspectives in patients living with dementia. This case highlights several aspects essential to enable an ODE request by a patient living with dementia to be granted, such as the role of the physician performing euthanasia, the relevance of the decision-making capacity of the patient, the presence of an advance directive, and the involvement of and support by relatives and caregivers. However, several unresolved ethical issues surrounding ODE in patients with dementia, especially in patients with advanced stages of dementia, warrant further exploration, including the timing of discussing organ donation after the initial euthanasia request.

Herbal teas have been ingrained in traditional practices, particularly in traditional Chinese medicine, for many years. Despite their global popularity and widespread use, there is a notable absence of comprehensive studies elucidating the mechanism of action and potential adverse effects associated with these medicinal herbs. We present the case of a male in his early 50s who consumed an herbal tea called \"Tapee tea\" which is marketed to alleviate musculoskeletal pain and is available for purchase on various online platforms. He presented to the hospital due to melanotic stools and was subsequently diagnosed with a large duodenal peptic ulcer which was further complicated by hemorrhagic shock and cardiopulmonary arrest. Our aim is to create awareness for the public to exercise caution before purchasing products regarded as \"natural\" supplements. Healthcare professionals, including physicians and mid-level providers, should adopt a comprehensive approach to patient assessment, including history-taking that includes medication reconciliation of over-the-counter dietary supplements when constructing a differential diagnosis. This approach ensures a well-informed and vigilant stance towards the potential risks associated with herbal product consumption.

Hematohidrosis (bloody sweat) is a symptom of trophic damage to the vascular wall, in which sweat mixes with blood and seeps onto undamaged areas of the skin in the form of red or pink liquid (depending on the ratio of sweat to blood). In our study we have analyzed 25 case reports of hematohidrosis in children, reported throughout the world using PubMed, ResearchGate with detailed description and opened access. We took into consideration: age of the patient, sex, location of bloody excretion, cause or trigger, treatment and its effectiveness. Our clinical case present a 9-year-old girl complained of a periodic bleeding from the intact skin of the face, neck, thighs (without visible damage to the skin) manifested by red or pink liquid, nosebleeds, and bloody discharge from the mucous membrane of the eyes. The secretions were of varying intensity and lasted up to several hours. Most of all episodes are associated with a strong emotional exertion. One of the theories of hematohidrosis pathogenesis is evident vasoconstriction of the blood vessels surrounding the sweat glands, provoked by hyperactivation of the sympathetic nervous system, which is followed by their excessive vasodilation up to rupture and blood entering the sweat gland ducts. Capillary endothelial cells are known to contain β2-adrenoceptors, which, through the modulation of nitric oxide release, cause endothelium-dependent vasodilation. Blocking β-adrenoceptors (for example, propranolol) prevents excessive vasodilation of blood vessels and, accordingly, their rupture and blood flow to the sweat gland. We managed to find out that the patient\'s bloody sweat was a manifestation of a separate pathological phenomenon, and not one of the symptoms of another disease. A properly formed treatment complex and the great trust of the parents enabled to stabilize the child\'s condition, and later to cure her. Currently, hematohidrosis is recognized as an independent disease that requires in-depth study of the triggering mechanisms of development, pathogenetic and clinical features.
Hematidrozė (prakaitas su krauju) yra trofinio ląstelės sienelės sužalojimo simptomas, kai prakaitas susimaišo su krauju ir prasisunkia į nesužalotas odos vietas raudono ar rausvo skysčio pavidalu (spalva priklauso nuo prakaito ir kraujo santykio).Šiame tyrime buvo išnagrinėtos 25 visame pasaulyje atliktos atvejų analizės, kai hematidrozė pasireiškė vaikystėje. Buvo panaudotos PubMed ir ResearchGate duomenų bazės, remtasi detaliais aprašais ir atvira prieiga. Atsižvelgėme į šiuos aspektus: paciento amžius, lytis, kraujingų išskyrų vieta, priežastis ar sukėlėjas, gydymas ir jo efektyvumas.Mūsų klinikinis atvejis pristato 9 metų mergaitę, kuri skundėsi nuolatos besikartojančiu kraujavimu iš nesužalotos odos veido, kaklo ir šlaunų srityje (ant odos nebuvo jokių matomų sužalojimo požymių). Veržėsi raudonas arba rausvas skystis, bėgo kraujas iš nosies. Be to, iš gleivinės akių membranos veržėsi kraujingos išskyros. Šių išskyrų intensyvumas buvo įvairus, ir epizodai trukdavo po keletą valandų. Beveik po visų protrūkių buvo stiprus emocinis išsekimas. Viena iš hematidrozės patogenezės teorijų yra aiškiai matoma kraujagyslių, supančių prakaito liaukas, vazokonstrikcija, kurią sukelia simpatinės nervų sistemos hiperaktyvavimas. Tada būna perteklinė vazodilatacija. Kraujagyslės sutrūkinėja, ir kraujas patenka į prakaito liaukų latakus. Žinoma, kad kapiliarinės endotelinės ląstelės turi β2 adrenoreceptorius, kurie, moduliuodami azoto oksido išskyrimą, sukelia nuo endotelio priklausomą vazodilataciją. β adrenoreceptorių blokavimas (pavyzdžiui, panaudojant propranololį) neleidžia įvykti perteklinei kraujagyslių vazodilatacijai, ir todėl jos nesutrūkinėja. Tad kraujo tėkmė į prakaito liaukas yra nutraukiama.Mums pavyko nustatyti, kad pacientės kraujingas prakaitas buvo atskiro patologinio reiškinio apraiška, o ne vienas iš kitos ligos simptomų. Tinkamai sudarytas gydymo kompleksas bei parodytas didžiulis pacientės tėvų pasitikėjimas leido stabilizuoti mergaitės būklę ir galiausiai ją pagydyti. Šiuo metu hematidrozė yra laikoma nepriklausoma liga, kuriai reikia išsamių tyrimų, norint išsiaiškinti, kokie mechanizmai ją sukelia ir skatina, bei kokios yra šios ligos patogeninės ir klinikinės savybės.

Minimally invasive percutaneous nephrolithotomy (mini-PCNL) maintains a stone clearance rate similar to standard PCNL while reducing blood loss. Bleeding is a complex and serious complication that can arise after PCNL surgery. Pseudoaneurysm (PA) is an uncommon type of delayed bleeding problem, which affects less than 1% of patients after PCNL. The most effective treatment for severe post-PCNL hemorrhage is super-selective renal angiographic embolization (SRAE), but it can fail in some patients and require additional surgical intervention. This report details the case of a male patient, 55 years old, who experienced severe bleeding four times and had three SRAE procedures and one laparoscopic procedure after PCNL. The presence of a renal artery pseudoaneurysm was not initially identified during the first two attempts of angiography due to arterial spasm and a small, undeveloped lesion. This case report is intended to enhance awareness of tiny pseudoaneurysms, emphasizing the importance of avoiding oversight to improve the success rate of embolization.

暂无摘要。

UNASSIGNED: Clavicular osteomyelitis, unlike the metaphysis of long bones, is a rare condition that poses a challenge for orthopedic surgeons in terms of diagnosis. The unique location of the clavicle makes it crucial to diagnose and effectively manage these non-traumatic clavicular lesions promptly. Localized pain and swelling are common symptoms experienced by patients with clavicular osteomyelitis.
METHODS: A 9-year-old boy presented with swelling and pain in the left clavicular area for 6 months. There was no fever or history of trauma. Physical examination revealed a tender, 2 cm by 3 cm swelling over the left clavicular area, with no abnormal findings in other body systems. This case was treated with surgical debridement and PO cloxacillin, and his condition improved.
UNASSIGNED: To achieve an accurate diagnosis, a thorough analysis of the patient\'s clinical presentation, along with blood workups, radiologic studies, bacteriological studies, and histopathological studies, is essential. Treatment options for clavicular osteomyelitis may involve surgery, medical intervention, or a combination of both. Existing literature suggests that the cure rate does not significantly differ between patients who receive medical treatment and those who undergo surgery for clavicular osteomyelitis.
CONCLUSIONS: In evaluating non-traumatic clavicular lesions, considering chronic osteomyelitis as a potential diagnosis is important. The final diagnosis is determined through analysis of the clinical presentation, laboratory and radiographic tests, and confirmation with assistance from local culture and biopsy.