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Introduction: This case report presents a rare instance of hypervirulent Klebsiella pneumoniae invasive syndrome (KPIS) without hepatic involvement. It highlights an atypical presentation as this syndrome is characterized by liver abscesses. Case Presentation: A 54-year-old female of South Asian descent presented to the emergency department with abdominal pain, fever, chills, nausea, and vomiting. Lab investigations showed hyperglycaemia, leukocytosis, and elevated procalcitonin. Imaging revealed bilateral acute pyelonephritis with early abscess formation in the left kidney, bilateral pleural effusions, diffuse multi-lobar consolidations, minimal ascites, and left renal vein thrombosis. The patient was treated as a case of septic shock secondary to hypervirulent K. pneumoniae with complications evolving into acute pyelonephritis and endogenous endophthalmitis. K. pneumoniae, known for its polysaccharide capsule, can lead to severe complications in immunocompromised patients, such as endogenous endophthalmitis, liver abscess, and pyelonephritis. Endophthalmitis, a critical ocular emergency, can result in permanent vision loss. The patient’s ocular outcomes remain uncertain due to a lack of follow-up, but prompt interdisciplinary intervention led to the resolution of other comorbidities. Conclusion: This case highlights the importance of considering hypervirulent K. pneumoniae as a cause of severe infection without liver abscess. It also underscores the importance of immediate multidisciplinary management to address the systemic complications associated with this infection and the importance of connecting different symptoms to one aetiology.

Aims Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is an inflammatory brain disorder characterised by a new onset of obsessive-compulsive disorder, triggered by streptococcal infection likely inducing molecular mimicry of antistreptococcal antibody action within brain tissue. PANDAS is perhaps considered controversial in the field of psychiatry due to debates over the validity of the diagnosis, controversy surrounding aggressive antibiotic and immunomodulatory treatment and limited well-controlled case studies. Methods A 13-year-old boy, X, presented with new onset worsening confusion, on a background of autism, to a child psychiatric clinic in the Lake District. During the summer, he developed a fixation with Harry Potter and began to act on confabulating beliefs that his mother is (and always has been) Lord Voldemort. X's behaviour became increasingly violent and aggressive and he now only spoke in ‘parseltongue’, refusing to communicate with anyone in any other way. A new personality change was identified as his usual routine behaviours and fixations had dissipated, such as a decrease in his ritualistic behaviours, a loss of his usual inquisitive nature, and an increased fascination with wearing sunglasses due to beliefs that the sun was poisoned by his mother, ‘Lord Voldemort’. Additionally, X's eating habits had markedly changed and now refused all forms of food. Clinically, X also developed a new and sustained tic and was tremulous in clinics, despite no evidence of focal neurological signs. Due to the relatively acute onset of symptoms, an organic cause was queried, which eventually led to the presumed diagnosis of PANDAS. Results Extensive investigations, such as an MRI of the brain, autoantibody testing for anti-AQP4, MOG-Ab, and other serological testing, showed no specific cause could be identified other than evident inflammatory changes in the brain. A ‘three-pronged’ treatment approach was adopted: increased psychotherapeutic intervention, antibiotic treatment and IV immunoglobulin therapy. Conclusion This case illustrates the importance of recognition of PANDAS and, more pertinently, an appreciation of the biological aspect of the biopsychosocial approach to psychiatry. From the minimal evidence available, there is a suggestion of a relatively good prognosis for patients with suspected PANDAS when intervened timely; however, repeated infections or a chronic course of illness is more difficult to treat. PANDAS remains a diagnostic challenge and perhaps a mystery, with complicated impacts on not only the patient and their families but also the psychiatrist and wider teams involved in the management of care.

Background: Gastroparesis is a serious condition that can be caused by diabetes, surgery or infection, or can be idiopathic. When there is no mechanical obstruction, gastroparesis is characterized by delayed stomach emptying. Itopride, a prokinetic drug, inhibits acetylcholinesterase activity in addition to antagonizing dopamine D2 receptors. Methods: This prospective, multicentre study is based on real-world data from 988 patients with a diagnosis of diabetic gastroparesis for index (PAGI-SYM2) evaluation at baseline and week 4 of treatment for upper gastrointestinal disorder symptoms. Results: Upper gastrointestinal symptom severity scores improved significantly after 4 weeks of treatment (p

Abstract Solid‐state lithium batteries (SSLBs) have received considerable attention due to their advantages in thermal stability, energy density, and safety. Solid electrolyte (SE) is a key component in developing high‐performance SSLBs. An in‐depth understanding of the intrinsic bulk and interfacial properties is imperative to achieve SEs with competitive performance. This review first introduces the traditional electrochemical approaches to evaluating the fundamental parameters of SEs, including the ionic and electronic conductivities, activation barrier, electrochemical stability, and diffusion coefficient. After that, the characterization techniques to evaluate the structural and chemical stability of SEs are reviewed. Further, emerging interdisciplinary visualization techniques for SEs and interfaces are highlighted, including synchrotron X‐ray tomography, ultrasonic scanning imaging, time‐of‐flight secondary‐ion mass spectrometry, and three‐dimensional stress mapping, which improve the understanding of electrochemical performance and failure mechanisms. In addition, the application of machine learning to accelerate the screening and development of novel SEs is introduced. This review article aims to provide an overview of advanced characterization from a broad physical chemistry view, inspiring innovative and interdisciplinary studies in solid‐state batteries.

Objective: To evaluate the surgical outcomes of delayed microsurgical clipping for ruptured intracranial aneurysms (RICAs) of anterior circulation. Methods: This retrospective, cross-sectional study assessed the surgical outcomes of 50 patients who underwent surgical clipping for "ruptured aneurysms" with subarachnoid haemorrhage after the 21st post-bleed day, from May 01, 2022, till May 01, 2023, at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan. Results: The mean age of patients was 49.66 ± 6.231 years with a female preponderance of 54%. Out of 50 cases, 21 were midline aneurysms (42%), followed by left-sided laterality in 16 cases (32%). Aneurysm of the anterior communicating artery was the most common accounting for 42% of the patients. Forty-nine patients returned home after first postoperative week without deficits, with a success rate of 98%. Seizures, surgical site infection and cerebrospinal fluid leak were noted in 6%, 4% and 2% patients, respectively. Conclusion: Delayed clipping in RICAs after the 21st post-bleed day is advocated, especially in resource-constrained settings. Meticulous surgical technique and asepsis are responsible for great postoperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: Multiple techniques have been used to treat trigeminal neuralgia (TGN), including pharmacotherapy, radiosurgery, rhizotomy and microvascular decompression (MVD). Blood vessels are considered to be the most common cause of offense and compression to trigeminal nerve. We aimed to determine the causes of classic TGN and efficacy of MVD. Methods: This retrospective, cross-sectional study assessed the data of 53 patients, who underwent MVD at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, from May, 2022 to December, 2023. Information regarding patient demographics, clinical presentation, Barrow Neurological Institute Facial Pain Score (BNI-FPS), intra-operative findings, and postoperative complications were analyzed. Results: The mean age at presentation was 44.33±11.71 years. Unilateral facial pain was the consistent clinical presentation among all patients, with right-sided involvement in 67.92% patients. All patients had involvement of at least two divisions of trigeminal nerve; maxillary and mandibular nerve in 84.91% and 71.70% cases, respectively. BNI-FPS Grade-IVb was found among 49.09% patients on presentation. Arachnoid adhesions, superior cerebellar artery and superior petrosal vein were the most common causes of compression in 71.70%, 50.94% and 43.40% cases, respectively. About 94% patients were discharged home on first post-operative day without complications and with BNI-FPS Grade-I. Conclusions: Microvascular decompression is highly advocated in classic cases of TGN. In the absence of grossly visible offending vascular structure, arachnoid adhesions should be the thorough focus of address. [ABSTRACT FROM AUTHOR]

Context: In this study, we observed using serial injections of parenteral testosterone whether we can alter the degree of hypospadias. Aims: The aim was to study the effect of testosterone on different parts of the phallus in hypospadias and to see if we can alter the degree of hypospadias. Settings and Design: This was a prospective observational study. Subjects and Methods: Forty-five boys with proximal and mid-penile hypospadias below the age of puberty who did not have prior testosterone injection or surgery were recruited in this study for the duration of 1 year and given testosterone injection intramuscularly and measurement taken using Vernier caliper at regular interval followed by surgery. The follow-up was at the 1st, 3rd, and 6th months of surgery. Results: Of 45 patients who received intramuscular testosterone injections, 40 showed some degree of response. Of these 40 patients, 23 showed a significant improvement in phallic size, whereas 17 showed a clinically insignificant response only. Of these 23 patients, 14 improved from a mid-penile to a distal penile hypospadias, whereas 7 improved from proximal penile to mid-penile hypospadias, and 2 showed an exceptionally good response and improved from proximal penile to distal penile hypospadias, whereas 5 patients exhibited no response at all. Conclusion: Through this study, we can conclude that intramuscular testosterone can be effective in some patients with proximal and mid-penile hypospadias to convert them into either mid- or distal penile hypospadias by the differential response of different parts of the phallus, and this may favorably alter the type of procedure required for the hypospadias repair.

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.