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An innovative method for determining the structural zones in the large static steel ingots has been described. It is based on the mathematical interpretation of some functions obtained due to simulation of temperature field and thermal gradient field for solidifying massive ingot. The method is associated with the extrema of an analyzed function and with its points of inflection. Particularly, the CET transformation is predicted as a time-consuming transition from the columnar- into equiaxed structure. The equations dealing with heat transfer balance for the continuous casting are presented and used for the simulation of temperature field in the solidifying virtual static brass ingot. The developed method for the prediction of structural zones formation is applied to determine these zones in the solidifying brass static ingot. Some differences / similarities between structure formation during solidification of the steel static ingot and virtual brass static ingot are studied. The developed method allows to predict the following structural zones: fine columnar grains zone, (FC), columnar grains zone, (C), equiaxed grains zone, (E). The FCCT-transformation and CET-transformation are forecast as sharp transitions of the analyzed structures. Similarities between steel static ingot morphology and that predicted for the virtual brass static ingot are described.

The study presents investigations of an influence of various direct current densities on microstructure, residual stresses, texture, microhardness and corrosion resistance of the nickel coatings electrodeposited from modified Watt’s baths. The properties of obtained coatings were compared to the nano-crystalline composite Ni/Al2O3 coatings prepared under the same plating conditions. The similarities and differences of the obtained coatings microstructures visible on both their surfaces and cross sections and determined properties were presented. The differences in the growth character of the Ni matrix and in the microstructural properties were observed. All electrodeposited Ni and Ni/Al2O3 coatings were compact and well adhering to the steel substrates. The thickness and the microhardness of the Ni and Ni/Al2O3 deposits increased significantly with the current density in the range 2 - 6 A/dm2. Residual stresses are tensile and they reduced as the current density increased. The composite coatings revealed better protection from the corrosion of steel substrate than pure nickel in solution 1 M NaCl.

Magnesium alloys are the lightest structural materials, which makes them particularly suitable for use in the aircraft and automotive industry. However, due to hexagonal close-packed crystal structure, resulting in insufficient number of independent slip systems, magnesium alloys exhibit poor formability at room temperature. Conventional methods of work hardening of magnesium alloys requires the temperature about 300°C, which favours simultaneously processes of thermal recovery and grain growth, but decreases beneficial microstructure strengthening effect. Thus, it is a crucial to undertake development of a technology for semi-finished magnesium alloys elements, which will ensure better mechanical properties of the final products by forming desirable microstructure. In the paper we present the development of crystallographic texture of the Mg-based alloy (Mg-AZ31) in the form of pipe extruded at 430°C and subjected to pilger rolling at relatively low temperature.

A vertical cut at the mid-depth of the 15-ton forging steel ingot has been performed by curtesy of the CELSA - Huta Ostrowiec plant. Some metallographic studies were able to reveal not only the chilled undersized grains under the ingot surface but columnar grains and large equiaxed grains as well. Additionally, the structural zone within which the competition between columnar and equiaxed structure formation was confirmed by metallography study, was also revealed. Therefore, it seemed justified to reproduce some of the observed structural zones by means of numerical calculation of the temperature field. The formation of the chilled grains zone is the result of unconstrained rapid solidification and was not subject of simulation. Contrary to the equiaxed structure formation, the columnar structure or columnar branched structure formation occurs under steep thermal gradient. Thus, the performed simulation is able to separate both discussed structural zones and indicate their localization along the ingot radius as well as their appearance in term of solidification time.

The article presents the results of residual stress analysis in selected metal-metal joints manufactured by conventional welding and explosive merging. The X-ray diffraction technique applied for advanced stress-texture measurements and data processing revealed directions and values of the principal stresses and their configuration on the surface of the examined structural elements. The obtained stress topography of the joint intersections indicates a possible path of potential cracking formed during the exploitation process and thus it becomes a very useful tool in the diagnostics of structural elements.

Industries that rely on additive manufacturing of metallic parts, especially biomedical companies, require material science-based knowledge of how process parameters and methods affect the properties of manufactured elements, but such phenomena are incompletely understood. In this study, we investigated the influence of selective laser melting (SLM) process parameters and additional heat treatment on mechanical properties. The research included structural analysis of residual stress, microstructure, and scleronomic hardness in low-depth measurements. Tensile tests with specimen deformation analysis using digital image correlation (DIC) were performed as well. Experiment results showed it was possible to observe the porosity growth mechanism and its influence on the material strength. Specimens manufactured with 20% lower energy density had almost half the elongation, which was directly connected with the porosity growth during energy density reduction. Hot isostatic pressing (HIP) treatment allowed for a significant reduction of porosity and helped achieve properties similar to specimens manufactured using different levels of energy density. [ABSTRACT FROM AUTHOR]

The paper, which is a summary and supplement of previous works and research, presents the results of numerical and physical modeling of the GX2CrNiMoCuN25-6-3 duplex cast steel thin-walled castings production. To obtain thin-walled castings with wall in the thinnest place even below 1 mm was used the centrifugal casting technology and gravity casting. The analyzed technology (centrifugal casting) enables making elements with high surface quality with reduced consumption of batch materials and, as a result, reducing the costs of making a unitary casting. The idea behind the production of cast steel with the use of centrifugal technology was to find a remedy for the problems associated with unsatisfactory castability of the tested alloy. The technological evaluation of the cast construction was carried out using the Nova Flow & Solid CV 4.3r8 software. Numerical simulations of crystallization and cooling were carried out for a casting without a gating system and sinkhead located in a mold in accordance with the pouring position. It was assumed that the analyzed cast will be made in the sand form with dimensions 250×250×120 mm. [ABSTRACT FROM AUTHOR]

Two MgLiAl alloys of composition 4.5% Li and 1.5% Al (in wt.%) composed of α phase and of 9% Li, 1.5% Al composed of α (hcp) + β (bcc) phases were subjected to twist channel angular pressing (TCAP) deformation. Such deformation of α + β alloys caused less effective grain refinement than that of single α phase alloy. However, with increasing number of passes, grain size of single α phase alloy increased and that of β phase in two phase α + β alloy also grew, which suggested the effect of dynamic recrystallization. TEM studies allowed identifying particles of Li2MgAl phase of size of few μm. {001}<100> texture was observed in extruded alloy. Texture studies of extruded and TCAPed single phase hcp alloy indicated texture with {101 - 0} plane perpendicular to the extrusion direction and {0002} plane parallel to the extrusion direction. Duplex α + β alloys showed poor texture development. [ABSTRACT FROM AUTHOR]

The study presents investigations of an influence of various direct current densities on microstructure, residual stresses, texture, microhardness and corrosion resistance of the nickel coatings electrodeposited from modified Watt's baths. The properties of obtained coatings were compared to the nano-crystalline composite Ni/Al2O3 coatings prepared under the same plating conditions. The similarities and differences of the obtained coatings microstructures visible on both their surfaces and cross sections and determined properties were presented. The differences in the growth character of the Ni matrix and in the microstructural properties were observed. All electrodeposited Ni and Ni/Al2O3 coatings were compact and well adhering to the steel substrates. The thickness and the microhardness of the Ni and Ni/Al2O3 deposits increased significantly with the current density in the range 2 - 6 A/dm2. Residual stresses are tensile and they reduced as the current density increased. The composite coatings revealed better protection from the corrosion of steel substrate than pure nickel in solution 1 M NaCl. [ABSTRACT FROM AUTHOR]

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Cholecystokinin (CCK) released in the CNS inhibits the analgesic action of exogenous opioids and may antagonize analgesia resulting from the activation of an endogenous pain inhibitory system. The aim of this study was to analyse the central action of PD 140.548 N-methyl-D-glucamine -- a peptide antagonist of a specific peripheral type CCK receptor -- on animal behaviour, catecholamines (CA) and cortisol concentration, as well as clinical symptoms of visceral pain induced by duodenal distension (DD). A 5 rain distension of the duodenum wall, using a 10 cm long balloon filled with 40 and/or 80 ml of water (DD 40 and/or DD 80) at animal body temperature, produced a significant increase in plasma CA and cortisol levels, an increase in the heart rate, hyperventilation and other clinical symptoms (inhibition of rumen motility, bleating, teeth grinding, prostration, urination, defecation) that may be related to pain, proportionally to the degree of intestinal distension. Intracerebroventricular administration of PD 140.548 at the dose of 1 or/and 2 mg in toto 10 min before applying DD 40 completely blocked the increase in blood plasma cortisol, epinephrine (E), norepinephrine (NE) and dopamine (DA) concentration. It is suggested that the central inhibitory action of CCK antagonist on the cortisol and catecholamine release produced by visceral pain is due to the inhibition of peripheral CCK1 type receptors in the central centrifugal descending pain facilitatory system in sheep perhaps via the hypothalamic-pituitary-adrenal axis. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: A.P. is an owner of Poff Medical Consulting and Communications, LLC, which performs consulting and public speaking services related to ketogenic metabolic therapy. A.P. is a scientific advisor to Pruvit Ventures, LLC, which sells exogenous ketone products. A.P. is an owner of Metabolic Health Initiative, LLC which is a medical education company in the field of metabolic health and metabolism-based therapies. A.P. is an inventor on and receives royalties from the following patent: “Targeting Cancer with Metabolic Therapy and Hyperbaric Oxygen” (Patent Number: 9801903). D.P.D. is an inventor of patents on the use of exogenous ketones, advisor for Levels Health, and co-owner of Ketone Technologies LLC, which does consulting and public speaking events. C.E.C. receives royalties from books, consulting, and lectures on nutrition and exercise, and serves on the scientific advisory board of Simply Good Foods/Atkins. M.K. is employed by Dietary Therapies LLC. The other authors declare no competing interests., (© 2024. The Author(s).)

Prostate cancer (CaP) represents a significant cause of cancer-related mortality on a global scale. Low- and middle-income countries (LMIC), particularly those in sub-Saharan Africa (SSA), face a disproportionate burden of this disease. Underlying genetic factors as well as barriers to early diagnosis and treatment lead to overall worse outcomes for CaP patients in SSA compared with the United States (U.S.). The number of available therapies for CaP has exploded over the last decade. Discussion of the potential impact these therapies could have on the current management of patients with metastatic CaP in SSA may help to prioritize goals for making drugs available to more patients. We review U.S. Food and Drug Administration (FDA)-approved treatments for metastatic CaP while acknowledging that many of these treatment regimens may not be feasible in SSA given barriers to medication access, significant follow-up required, and limited technological advancements needed to diagnose and treat. The purpose of this manuscript is to aid readers who may be unfamiliar with the currently approved regimens for CaP in the U.S. to provide information that may aid in prioritization of the available therapies for this cancer in SSA. Given our review of both the treatment of CaP in SSA and current treatment options available in the U.S., abiraterone has demonstrated remarkable benefits in advanced CaP and has been well-tolerated. Abiraterone and prednisone combination therapy has demonstrated significant survival benefit to patients in multiple phase three trials and given it was the first of the newer generation hormone therapies to become available, generic options are available allowing for a cost-effective option for patients. Studies have demonstrated similar efficacy when administering low-dose abiraterone taken with a low-fat meal (compared to full dose taken when fasting), which can lead to cost-savings if the drug is at a lower dose. In conclusion, abiraterone and prednisone can be clinically meaningful for patients in SSA and has a favorable and manageable side effect profile. Additional treatment options also have meaningful benefits; however, the absolute benefit of abiraterone as well as the ease of administration would favor pursuing options to make this or similar newer-generation hormone therapy available to patients in SSA., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-23-2289/coif). P.V. reports that receiving grants or contracts from UICC for his department, as well as payment or honoraria from Roche, Novartis, and MSD, support for attending meetings and/or travel from Roche and MSD, and holding unpaid leadership or fiduciary role in WHO’s GBCI and ICF Foundation. T.M. reports that receiving grants or contracts from Merck, Sotio, and Curium as institutional funding for trial, as well as consulting fees from Blue Earth Diagnostics and IMPACT Network, payment for educational event from Aptitude Health, and serving on the advisory board of Exelexis. The other authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: Botulinum toxin A (BTX-A) is a widely utilized protein derived from the bacterium Clostridium botulinum, known for its effectiveness in treating various medical conditions involving muscle spasticity, involuntary muscle movements, and pain disorders. Beyond its therapeutic applications, BTX-A is also commonly used in cosmetic procedures to address dynamic wrinkles, hyperhidrosis, sebum production, pore size, and overall skin texture. While the use of neurotoxins like BTX-A for treating conditions such as UVB-induced hyperpigmentation, specifically melasma, is an emerging area of interest, it is not yet a widely recognized treatment for this dermatologic condition. This literature review serves to provide a consolidated overview of the current therapeutic implications of BTX-A treatment for melasma and explore its proposed mechanisms of action., Objective: This review aims to provide a comprehensive analysis of the current evidence base for the efficacy of BTX-A treatment on melasma., Methods: To gain a comprehensive understanding on the current theories regarding BTX-A treatment on melasma, a literature review was conducted on all the available information using PubMed. A combination of keywords was used to maximize the search results, including "botulinum toxin," "melasma," "melanogenesis," "neurotoxin," "cholinergic system," "BTX-A," and "UV-induced melasma." The search was not restricted by date, allowing for the inclusion of articles offering historical context and those providing the most recent findings. Ninety-eight articles were reviewed to provide a consolidated update on the effectiveness of botulinum toxin A in reducing the appearance of melasma and potential mechanisms of action involved in doing so., Conclusion: Melasma is a challenging dermatologic condition due to its chronicity and various intrinsic and extrinsic factors that influence its pathogenesis. While current treatment options for melasma include topical, oral, and light-based therapies, recent studies suggest that BTX-A may hold potential as a viable treatment modality for melasma. Despite the mechanism of action remaining unclear, it is hypothesized that BTX-A inhibition of Ach receptors on melanocytes could play a role in the reduction of melanogenesis. BTX-A treatment in melasma-affected skin demonstrates statistically significant reduction in hyperpigmented lesions associated with melasma., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Cosmetic dermatology is a growing field as more patients are seeking treatments for esthetic concerns. Traditionally, practitioners and patients utilize their own perceptions, current beauty standards, and manual observation to determine their satisfaction with cosmetic interventions. Artificial intelligence (AI) can be introduced into cosmetic dermatology to provide objective data-driven recommendations to both dermatologists and patients., Objective: The purpose of this paper is to compose a unified review that illustrates the various facets of artificial intelligence and formulate a hypothesis regarding the new implications of artificial intelligence in cosmetic dermatology specifically., Methods: A comprehensive search on PubMed was conducted to identify the available information related to AI in cosmetic dermatology. The search was conducted using a combination of keywords including "cosmetic dermatology" and "artificial intelligence.", Results: The current literature indicates that AI models offer personalized, efficient, and result-driven outputs that can enhance cosmetic outcomes, patient satisfaction, and overall experience., Conclusion: Artificial intelligence integration in cosmetic dermatology shows a promising future, offering the ability to analyze vast data sets and deliver a tailored patient experience. By incorporating AI into cosmetic dermatology, there is an opportunity to balance evidence-based decision-making with the artistic human touch of cosmetic dermatologists., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Purpose: The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers., Methods: A multisite cross-sectional survey study of cancer care was conducted with oncology staff at Princess Marina Hospital (PMH), Nyangabgwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH) from February to April 2021. At each POC, a focal person (experienced nurse working in oncology) identified relevant oncology staff and confirmed service availability., Results: Only PMH and NRH had a broad array of diagnostic, surgical, and treatment services. In addition, PMH was the only center with a a dedicated inpatient oncology service, a multidisciplinary committee to review patients, and a palliative care team. To support the only national cancer screening program, for cervical cancer, all POCs offered Pap tests. Mammography, available at PMH and NRH, was used solely for diagnosis. Patients from POCs requiring radiation therapy were referred to Gaborone Private Hospital at government expense. For perceived service availability, 51 staff, mainly oncologists, physicians, and nurses, were surveyed (66% based at PMH). Perceptions of services revealed a few concerns, for example, numerous staff considered hysterectomies for cervical cancer available when they were only performed at PMH., Conclusion: Despite Botswana's efforts to increase the proximity of cancer services to patients, there are marked gaps, particularly at the two district-level POCs, SMH and LMH. In the future, SMH and LMH could provide selected services for specific prevalent cancers on-site, as well as follow-up and palliative care.

Background: Cryolipolysis, also known as fat freezing, is a nonsurgical technique specialized for localized fat reduction. Utilizing targeted cold exposure to adipose tissue, cryolipolysis devices induce cellular apoptosis in adipocytes while sparing surrounding tissues, resulting in the selective disruption of fat cells and subsequent removal of damaged cells by macrophages. A reduction of the fat layer produces a noninvasive cosmetic benefit that provides an accessible alternative to liposuction. Objective and subjective measurements have demonstrated significant reduction in fat volume and high patient satisfaction rates. Cryolipolysis has been proven to be safe with minimal adverse effects. However, further research is needed to fully understand the mechanism of cryolipolysis and its efficacy in different treatment areas. This paper aims to provide a comprehensive overview of cryolipolysis, including its mechanism of action, indications, contraindications, adverse effects, results and outcomes, safety profile, and areas requiring further research., Methods: Our primary phase of literature review consisted of a PubMed search looking for all published literature around cryolipolysis. We employed a review approach that examined over 30 papers with the key search terms of "cryolipolysis," "fat-freezing," "cosmetic dermatology," "body contouring," "adverse effects," "adipocyte apoptosis," "Coolsculpting®," "cold panniculitis," and "localized fat reduction." We then analyzed each paper, extracting relevant information to gain a multidimensional understanding of cryolipolysis to provide a comprehensive review., Conclusion: Cryolipolysis, with its ability to target and reduce localized adipose tissue, has emerged as a promising nonsurgical technique in the field of body contouring. It offers patients a valuable option for achieving their desired fat reduction without the need for a lengthy recovery period or major surgery. Cryolipolysis has shown to reduce the number of adipocytes in the treated area, a phenomenon that can be objectively quantified through various means, including fat caliper measurements, ultrasound assessments, and 3D imaging, or subjectively observed through patient satisfaction rates, clinical observations, and investigator assessments. In addition to its effectiveness in reducing localized adipose tissue, cryolipolysis also holds potential in the area of skin tightening. Preliminary studies suggest that cryolipolysis may have a positive impact on skin elasticity and tightening. Further investigation of this mechanism is needed to provide a better understanding of its potential in achieving optimal cosmetic outcomes for patients. By combining the benefits of fat reduction and skin tightening, cryolipolysis has the potential to offer a comprehensive nonsurgical solution for body contouring., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Typical or atypical presentations of rare diseases may be confounded by co-morbidities in critically-ill patients. It is imperative to diagnose and treat appropriately, despite this difficulty. Scleroderma renal crisis mimics many other conditions, and can be potentially fatal if not caught early enough. Particularly, in critically-ill patients with multiple pathologies, it can be difficult to distinguish scleroderma renal crisis from other diseases, such as thrombotic thrombocytopenic purpura (TTP), hypertensive emergency, posterior reversible encephalopathy syndrome (PRES), or atypical hemolytic uremic syndrome (HUS). Herein, a patient who presented with encephalopathy and seizures was initially treated for thrombotic thrombocytopenic purpura, but was ultimately diagnosed with scleroderma renal crisis. Given her numerous laboratory abnormalities, such as thrombocytopenia, hemolytic anemia, kidney and liver dysfunction, and elevated inflammatory markers, various differentials were considered. During her hospitalization, she suffered a cardiac arrest, seizures, nosocomial infections and worsening kidney disease requiring dialysis, making the final diagnosis of scleroderma renal crisis a diagnosis of exclusion. Subsequently, the management of a patient with multiple co-morbidities and confounding laboratory abnormalities difficult to treat. This article highlights these intricacies and formulates the thought process behind the diagnosis of Scleroderma Renal Crisis., Competing Interests: Disclosure of interest The authors report no conflict of interest. Ethical review is not necessary, because this is a case report. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (© 2023 Greater Baltimore Medical Center.)

Autoimmune Hepatitis (AIH) is a progressive form of chronic hepatitis, with periods of remissions and exacerbations. Diagnosis includes abnormally high levels of immunoglobulins and multiple autoantibodies. Clinical presentation is variable, with a spectrum extending from asymptomatic cases to fulminant liver failure. Symptoms include abdominal pain, malaise, fatigue, and small joint arthralgia. We present a case of a 36-year-old male with a past medical history of alcohol dependence and acute pancreatitis who was diagnosed with AIH. There is limited data regarding patients with concomitant AIH and pancreatitis. Our patient presented with AIH with secondary acute on chronic pancreatitis, in the absence of additional autoimmune manifestations. The mechanism of AIH remains poorly understood; however, there is an association between the HLA gene and AIH. Genetic studies have shown HLA-DRB1*0301 and HLA-DRB1*0401 as primary and secondary genotypes susceptible to AIH, as well as genetic variants with CARD10 and SH2B3. Products secondary to metabolism of ETOH such as alcohol dehydrogenase, malondialdehyde, and acetaldehyde, can lead to development of autoantibodies. Additional research is indicated to evaluate the relationship between AIH and acute pancreatitis., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

BACKGROUND Refractory hypokalemia has been rarely demonstrated in patients with acute monocytic leukemia (AMoL). Hypokalemia develops in these patients owing to renal tubular dysfunction, secondary to lysozyme enzymes that are released by monocytes in AMoL. Additionally, renin-like substances are produced from monocytes and can lead to hypokalemia and metabolic alkalosis. There is also an entity called spurious hypokalemia, in which high numbers of metabolically active cells in blood samples increase sodium-potassium ATPase activity, resulting in influx of potassium. Additional research is warranted regarding this specific demographic to create standardized treatment approaches to electrolyte repletion. CASE REPORT In this case report, we demonstrate a rare case of an 82-year-old woman with AMoL, complicated by refractory hypokalemia, who presented with concerns of fatigue. The patient's initial laboratory results were significant for leukocytosis with monocytosis and severe hypokalemia. Refractory hypokalemia was noted, despite administration of aggressive repletions. During her hospitalization, AMoL was diagnosed and an extensive workup was performed to evaluate the underlying cause of hypokalemia. Ultimately, the patient died on day 4 of hospitalization. We describe the correlation between severe refractory hypokalemia and leukocytosis and provide a literature review of multiple etiologies of refractory hypokalemia in patients with AMoL. CONCLUSIONS We evaluated the numerous pathophysiologic mechanisms responsible for refractory hypokalemia in patients with AMoL. Our therapeutic outcomes were limited owing to the patient's early death. It is of high importance to evaluate the underlying cause of hypokalemia in these patients and to treat accordingly with caution.

Background: Acne scarring is disfiguring and psychologically taxing on patients. Many energy-based modalities have emerged and been studied for the treatment of acne scarring; however, there is a paucity of these studies in skin phototypes IV-VI., Objective: To review the medical literature and discuss the most significant studies regarding safety and efficacy of energy-based devices (ablative lasers, non-ablative lasers, and radiofrequency microneedling) in the treatment of ethnic skin (skin phototypes IV-VI)., Methods: A literature search was conducted using the PubMed database and bibliographies of relevant articles., Results: Ablative and non-ablative lasers have proven to be effective for treatment of acne scars in ethnic skin. The risk of developing adverse effects such as post-inflammatory hyperpigmentation is contingent upon several factors including skin phototype, laser device, fluence, and moreso density settings. Non-ablative fractional lasers have been considered first line for the treatment of acne scars in skin of color due to their better safety profile; however, they are less efficacious and require more treatments compared to ablative lasers. Studies regarding efficacy and safety of radiofrequency microneedling for treatment of acne scarring in skin of color are limited, but are promising., Conclusion: Ablative lasers, non-ablative lasers, and radiofrequency microneedling are all useful treatments for acne scarring in ethnic skin when appropriate settings are used. Further head-to-head studies are needed to evaluate their efficacy and safety in darker skin phototypes V-VI., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Sickle Cell Disease (SSD) can present with acute painful crises, most commonly manifesting as diffuse bony pain; however, rare presentations of acute coronary syndrome, acute papillary necrosis, or multi-organ failure may also present in these patients. TTP has been rarely described in conjunction with sickle cell pain crisis (SS crisis). In both TTP and sickle cell crises, widespread platelet activation is present with thrombocytopenia as a result. Thrombocytopenia can be utilized as a poor prognostic indicator in patients with SS crisis. Multi-organ failure may appear similar to TTP and patients may benefit from similar therapy. Here, we present a 27-year-old female with a history of SSD who presented with a painful crisis who was found to have worsening renal failure and thrombocytopenia and was treated empirically with therapeutic plasma exchange (TPE), later discovered to have SS crisis with multi-organ failure with unremarkable ADAMSTS13 values. Given the high fatality risk of TTP, the benefits outweighed the risks for empiric TPE therapy, and our patient benefited from the treatment, as patients with both TTP and/or SS crisis multi-organ failure have demonstrated improvement following this treatment. Given the severity of multi-organ failure in SSD patients, additional research is warranted for improvement in the diagnosis and management of these patients., Competing Interests: Conflict of interest The authors report no conflict of interest. Ethical review is not necessary, because this is a case report. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (© 2023 Greater Baltimore Medical Center.)

Cardiovascular disease, COPD, and diabetes (DM) are associated with increased complications with COVID-19. A correlation between COVID-19 and diabetic ketoacidosis (DKA) or Hyperosmolar Hyperglycemic Syndrome (HHS) has been suggested; however, the precise mechanism remains unclear. We present a case series of six patients with COVID-19 infections who were found to have DKA, HHS, or mixed picture. Wedescribe an association between COVID-19 and hyperglycemic emergencies. Six patients (50% male, 50% female, mean age 47.667 ± 18.747) were identified from November 2021 to February 2022. Comorbidities included DM (83.3%), HTN (50%), as well as ESRD, A-Fib, ISLD, HIV, and dementia (each 16.7%). Common review of systems included nausea and vomiting (50%), abdominal pain (33.3%), dyspnea (33.3%), and decreased appetite (33.3%). Additional findings were dysarthria, facial droop, generalized weakness, productive cough, myalgias, and increased urinary frequency (16.7%). Patients were diagnosed with DKA (50%), mixed process (33.3%), andHHS(16.7%). In terms of COVID-19 symptoms, most patients were asymptomatic (83.3%), with one patient developing hypoxia. The survival rate was 100%. Infections can incite DKA/HHS; yet, COVID-19 may have factors that amplify this process, in the setting of pancreatic beta-cell dysfunction from the virus itself. This may contribute to why diabetic patients have a ten times higher risk of death if they develop COVID-19. This virus binds to ACE2 receptors in the pancreas and damages the islets, ultimately decreasing insulin release. Here, we introduce cases of DKA/HHS in the setting of COVID-19, to understand the relationship between how COVID-19 infections may exacerbate diabetic complications., Competing Interests: Conflicts of interest No conflict of interest to disclose., (© 2023 Greater Baltimore Medical Center.)