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Warfarin ought to be utilized for an extended duration in individuals with a predisposition to thromboembolism, such as those with atrial fibrillation or aortic valve replacement. While the primary complication of long-term warfarin usage is the potential for bleeding, there are also infrequent complications like vascular and tracheal calcification. We present a case of a patient who experienced diffuse tracheal calcification as a result of long-term warfarin usage. A 74-year-old female patient, who had been receiving chronic warfarin treatment for atrial fibrillation, required intubation and was admitted to the intensive care unit due to aspiration pneumonia. As the patient was unable to be extubated during the hospital stay, she became a candidate for Percutaneous dilution tracheostomy (PDT). It was discovered during the PDT procedure that all available spaces of the trachea above the sternum were calcified, preventing the passage of the trach needle. The presence of tracheal calcification was confirmed by both a radiologist and ultrasound examination. Currently, individuals are compelled to employ oral anticoagulants, like warfarin, in order to avert thromboembolic diseases. Nevertheless, the protracted utilization of warfarin is linked with infrequent adverse outcomes, such as disseminated calcification. Consequently, meticulous scrutiny of these side effects is requisite for patients with enduring warfarin consumption.

Background: The present study was conducted in Jul 2019 and Jan 2020 in two wildlife parks of the Nowshera district, Khyber Pakhtunkhwa, Pakistan, where the endangered Punjab urial (Ovis vignei punjabiensis) is successfully bred in captivity. We determined diversity of internal and external parasites that take advantage of the situation of congestion, resulting in massive mortalities of wild animals in captivity. Methods: Internal parasites of living urial were determined by direct wet smear and flotation methods, while dead urial was necropsied for any pertaining observation. Results: All examined fecal samples were found infected with gastrointestinal parasites, which had significant difference in the total abundance in winter and summer. S. papillosus and H.contortus, and a single protozoan, Eimeria spp. were the dominant parasites in fecal samples. Ticks collected from urial enclosures and dead animals were of single species H. anatolicum. Theileria spp. was observed in blood, while hydatid cysts were found in lungs and liver of necropsied urial. Conclusion: The study indicates that internal parasites such as Haemonchus contortus and Strongyloides papillosus, while external parasites as Hyalomma anatolicum ticks played major role in the population decline. Strict veterinary control of infectious diseases, provision of hygienic and supplementary diet, and proper maintenance of urial population are necessary measures for the control of mortalities.

Introduction: Mercury, in different form can induce adverse effects on various organs especially central nervous system. The aim of this study was to determine concentration of mercury in inhalation and urine of the exposed worker and to investigate the prevalence of probable neurobehavioral disorders. Material and Method: The present case-control study was conducted among workers of a unit in a petroleum industry. The study population consisted of 52 workers as case and 63 workers as control groups. The mercury concentration in air and urine was measured according to NIOSH 6009 standard and using the cold vapor atomic absorption spectrophotometer (CV-AAS). Demographic data and neurobehavioral disorders were collected using a self-reported questionnaire. Pearson correlation coefficient, multiple regression tests and SPSS v24 were used to analyze the data. Result: Air concentration of mercury was 0.062 ± 0.0014 mg/m3 which was higher than the recommended threshold by NIOSH and ACGIH. In addition, there was a significant difference between urinary concentration of mercury in the case (37.73 ± 13.01 µg/g cratinine) and control (5.93 ± 4.76 µg/g cratinine) groups (p=0.03 6). Based on the multivariate logistic regression model, significant relationships were found between memory loss, sleep disturbance, and urine mercurial concentrations and, between memory loss, moody, muscle weakness and air mercurial concentration. Conclusion: The values of Hg in blood and urine workers who worked in investigated unit were significantly higher than recommended threshold values. In addition, the Hg concentration in urine was related to some of neurobehavioral disorders.