Herein we present a 55-years-old male with end-stage hypertrophic cardiomyopathy and implantable cardioverter defibrillator that developed life threatening ventricular arrhythmia after the administration of flecainide. The patient experienced many appropriate shocks until the arrhythmia was successfully terminated.

In 2004, a 28-year old male presented with a traumatic dissecting pseudoaneurysm of the distal left cervical internal carotid artery was followed conservatively for 12 years with cross-sectional imaging. The patient was originally diagnosed with an acute left internal carotid artery (ICA) dissection, with significant luminal narrowing. Follow-up imaging revealed the dissection was not completely healed and a small pseudoaneurysm, about 4mm in size, was formed in the distal left cervical ICA. During the twelve-year observation period, the patient’s pseudoaneurysm expanded from 4.0mm to 9.0mm and the patient presented with ptosis, aniscoria, and myosis. Flow diverter embolization resulted in radiographic cure of the pseudoaneurysm and resolution of the Horner’s syndrome.

Summary Vulvar carcinoma is rare as a gynecologic malignant tumor, and among vulvar carcinoma, basal cell carcinoma is extremely rare. We encountered 2 cases of basal cell carcinoma that developed in the vulva. Case 1: A patient was an 81 year-old female. The patient presented with a chief complaint of sensation of mass in the left side of the vulva. The mass in the left side of the vulva was 1 cm in size and diagnosed as basal cell carcinoma based on biopsy results. Systemic examination showed no distal metastasis and local resection was performed. Case 2: A patient was an 84-year-old female. The patient presented with a chief complaint of atypical genital bleeding. Mass of 3 cm in size was present in the left side of the vulva, and biopsy of that site was performed and basal cell carcinoma was diagnosed. Systemic examination showed no distal metastasis, and local resection was performed. Postoperative course was uneventful and recurrence has not occurred in both cases. In differential diagnosis of external genitalia lesion, basal cell carcinoma should be put in mind and if abnormal lesion is observed, biopsy should be actively performed aiming at early detection, and appropriate operative procedure should be selected.

Background and Objective: While there has been an increase in the number of laparoscopic surgery in Japan, few studies have reported about scars from wounds by laparoscopic surgery. Silicone gel sheets are widely used as part of multidisciplinary treatment for hypertrophic scars and keloids, and their usefulness has been reported. The present study examined the efficacy and safety of a silicone gel sheet (Lady Care3) for laparoscopic surgical wounds. Subjects and methods: Subjects were 15 cases who underwent laparoscopic surgery during the period from March 2017 to March 2018. Silicone gel sheets (Lady Care3) were applied to the wounds (umbilicus, lower abdomen) for one week to six months postoperatively. The JSW Scar Scale was used in evaluating the wounds. The wounds were evaluated visually and through interviews before the application of silicone gel sheets, at three months following surgery, and six months following surgery. Results: The JSW Scar Scale scores for the umbilicus surgical wound were 7.4±2.4 before application, 2.7±1.6 at three months following surgery, and 0.9±0.7 at six months following surgery. Those for the lower abdomen surgical wounds were 4.7±2.3, 0.8±1.1, and 0.3±0.5, respectively. Three cases reported pruritus; however, all were mild, and it was tolerable to continue to use silicone gel sheets in those cases. Conclusion: Significant decreases were observed in the JSW Scar Scale scores from an early postoperative stage, and no serious adverse events were observed. Therefore, the present study suggested that the silicone gel sheet (Lady Care3) is safe and efficacious.

Described is the case of a 29-year-old male with Y. enterocolitica subclinical colitis causing an infected venolymphatic malformation, presenting as a large septic left temporal swelling. The patient was given IV antibiotics and over the course of a week the swelling significantly decreased in size and the patient’s diarrhoea subsided; thus, the decision was made to not operate. Most extraintestinal case reports of Y. enterocolitica occur in immunosuppressed patients. Our case demonstrates a situation where even a young and healthy individual can develop seeding sepsis outside of the intestinal tract.

Even though the humankind is familiar to disease outbreaks and pandemics, one of the few that has negatively impacted not only public health, but economy, finances among other vital government sectors is the COVID-19 caused by the SARS-CoV-2. These Viral family are common pathogens that can cause a variety of clinical entities, from respiratory symptoms to gastrointestinal ones ranging from mild to death threating cases. Many countries worldwide had already reported numerous index and imported cases and the death toll continues to trend up most dramatically in European and Asian countries. For this reason, one of the main strategies to control and contain the widespread dissemination of the virus are social isolation and even lockdown. In spite this measure, the number of cases continues to trend up with the lethality rate and the burden of the disease slowly increasing. Even though this disease presents a challenge, not only in diagnosis, but in specific etiological treatment, many researchers are developing many SARS-CoV-2 specific drugs and agents to decrease the alarming numbers of mortality and death toll. Given those treatments are novel, most of them have increasingly growing information regarding effectiveness and safety. In this article, we will try to compilate all the current novel therapies that are currently being developed for this on-growing pandemic.

Topical benzocaine spray is a local anesthetic agent that is commonly used during transesophageal echocardiography (TEE). This agent is believed to be safe because it has very low systemic absorption. We report a case of life-threatening methemoglobinemia following very minimal dose of benzocaine spray.

The temperature distribution and thickness design of the human infectious disease COVID-19 protective clothing are studied in this paper. Based on the data provided by China mathematical modeling competition in 2018. We establish the temperature distribution model and skin layer heat conduction and burn model. The interface continuous conditional difference method, differential iterative method, least squares method and the chasing method are used to solve the given temperature distribution on the the human infectious disease COVID-19 protective clothing in the environment, and analyze the human infectious disease COVID-19 protective clothing meeting the actual needs.

Neoadjuvant chemotherapy is the standard of care in inoperable locally advanced breast cancer (LABC), as it helps in reducing tumor burden and facilitating surgical resection. We describe a 56-year-old post-menopausal woman who presented with a huge, right breast mass extending from the clavicle to the mid abdomen. A chest-abdomen-pelvis computed tomography showed the mass invading the pectoralis muscles and right axillary lymph node with no evidence of distant metastasis. A needle core biopsy revealed an infiltrating ductal carcinoma (Scarff-Bloom- Richardson grade 3). A multidisciplinary collaboration was undertaken, and the patient was started on docetaxel; however, after three cycles of docetaxel, she showed no improvement and was readmitted for palliative mastectomy with skin grafting. A post-operative histopathology examination of the excised tumor revealed an invasive micropapillary carcinoma. A multidisciplinary approach is the cornerstone for the treatment of LABC. In the case of chemoresistance, very few treatment options are available.

Background: A breast adenomyoepithelioma is an uncommon tumor characterized by the presence of epithelial and myoepithelial cells. Case Report: We describe a 47-year-old woman who presented with a right breast mass of four-year duration. An examination of the breasts revealed two masses in the right inner quadrant of the right breast measuring 1 x 1 cm and 2 x 2 cm in dimension. A mammogram favored a lesion highly suspicious of malignancy, suggesting further examination. An ultrasound examination confirmed the mammography and a biopsy was subsequently performed. A biopsy revealed findings suggestive of duct adenoma. The tumor was excised, and the specimen was sent for histopathological examination. The histopathological findings were consistent with adenomyoepithelioma. The patient was discharged one day after surgery and did not present any complaints. Conclusion: Although most adenomyoepitheliomas have a benign course, it is essential for clinicians to identify these tumors, as the radiologic and cytologic characteristics can mimic malignant lesions. A definitive diagnosis can be made after a histopathologic examination, and tumor excision may be helpful in preventing recurrence or malignant change.

Introduction: Our preliminary trial revealed the correlation between cognitive ability and active ability, blood vessel age, and stress. From this result, a method to eliminate stress and favorably influence blood vessels and activity capacity was examined. We developed a method where elderly participants danced to familiar music while executing brain training tasks. Methods: Verified method is a brain training developed from music therapy and dance. As brain training, the effectiveness of training tasks such as dual-task (performing two tasks simultaneously) and n-back task (recall task for items shown n steps earlier) have been verified. Additionally, methods developed in this study utilized "ostinato", a rendition often used in music such as folk music. This method repeats a short phrase multiple time. As it has a trait which makes it easy to retain and recall, a repeated melody which speeds up is easily retained in memory. Analysis in that is a comparison between intervention and control. Cognitive tests and stress checks were compared with a paired One-way analysis of variance. Result: Data of 102 people were analyzed. In comparison to the control group, cognitive function was improved and distress was reduced in the intervention group. Scores of cognitive test items: immediate memory and recall delayed memory were significantly improved (p < 0.05). Conclusion: The brain training dance to familiar music improved cognitive abilities. This activity can relieve stress. Following this study, we want to evolve the brain training dance that elderly in various conditions can do and increase the volume of fun activities available to the elderly.

Background: HIV is commonly associated with positive antiphospholipid antibodies and lupus anticoagulant (LA) assay, but association with clinical evidence of thrombosis is not well established. To our knowledge, we are the first to describe concurrent Pulmonary Embolism (PE), ischemic stroke due to paradoxical embolism, and renal infarction occurring in the presence of Patent Foramen Ovale (PFO) and HIV-related Antiphospholipid syndrome (APS). Clinical Presentation: This article reports a 60-year-old male with pertinent past medical history of HIV presented to the ER with left-sided weakness, slurred speech and left facial droop. Patient was highly suspected of ischemic stroke and given tPA. The CT angiogram (CTA) head and neck was negative, but revealed bilateral PE, later confirmed by CTA chest. This was determined to be an unprovoked PE. CTA chest also revealed large left renal infarction, later confirmed by renal radioisotope scan. Repeated EKG showed atrial flutter, and TTE with bubble study revealed a 3 mm PFO. Hypercoagulability work-up revealed LA. Conclusion: Clinical significance of aPL antibodies, positive LA assay in HIV infection remains unclear. Yet, several casereports, including our own, describe major thrombotic events, including PE, CVA and renal infarction. We can conclude, that screening for APS in HIV patients, especially those with intracardiac shunts, followed by proper anticoagulation, may prevent life-threatening thrombotic events.

Abstract Painting and Impressionism comes in the beautify of human creation. This affects the visual variation of elements and the way we view our social correlation. The demonstration of visual elements affects the way we view a visual composition. Painting enhances human intelligence and this affects the way we relate and correlate ideas like mind mapping. It affects how we think and the visual elements that determined the world around us. It is a constant study of the profound elements of the visual arts and neuroscience. Perhaps neuroscience is the greatest gift to support the visual elements and cognitive hierarchy. Neuroscience and the visual world around us enhance ourselves through vision. Creative prodigies are known to be able to correlate all three applications neuroscience, the visual arts, and mathematics. The brainpower that enhances the visual cognitive price of human intelligence.

Context Pancreaticocolonic fistula is a rare and potentially critical complication of necrotizing pancreatitis. We report a complex case of multiple Pancreaticocolonic fistulas that was successfully treated with extended left hemicolectomy. Case report A forty-three-years-old male patient, presented in our emergency department with epigastric pain, vomiting, diarrhea and weight loss for 4 weeks duration, with past history of acute gall stone pancreatitis 10 weeks earlier. Contrast enhanced computed tomography abdomen showed multiple Walled-off Pancreatic Necrosis in the peripancreatic, right paracolic and left paracolic regions up to left inguinal region with extensive Pneumoretroperitoneum. The periduodenal collection caused duodenal compression. Laparotomy done for pancreatic necrosectomy, relieving the duodenal compression, and drainage of all collections. We noticed multiple Pancreaticocolonic fistulas, 5 in numbers, between the transverse and descending colon and their neighboring collections, extended left hemicolectomy done. Multiple abdominal drains had been put for continuous postoperative irrigation. The patient discharged home but after 3 months of a hectic post-operative course. Discussion To the best of our knowledge this is the first case to be reported in the literature with multiple walled-off pancreatic necrosis associated with multiple Pancreaticocolonic fistulas (5 in Number) in both transverse and descending colon. Conclusion Necrotizing pancreatitis is a devastating disease, the presence of Pneumoretroperitoneum does not essentially only point to infected necrosis, but the possibility of Pancreaticocolonic fistula should always be kept in mind and searched for the diagnosis of pancreaticocolonic fistulas.

This QIP highlights the importance of commitment to the "continuous education and training" in hospitals and raised the knowledge and the scientific level of staff with different categories in the basics and principles of "TQM, Patient safety, IPC and Environmental safety" to "create one team for one goal speaks the same language and thinks the same thinking”. Additionally, inevitability of involving staff in finding the solution and listening to their opinions to satisfy them. Selecting the best team to study and proposes appropriate solution and implement it through a clear action plan is vital. The Problem is arisen and is discovered when internal auditing revealed a false sensation of security and appearance of informal groups. The spirit of quality and patient safety with implementation of policies and procedures become far away from daily workload of hospital categories. Among six months with sharing of 789 out of 814 hospital staff and a team of 15 members chosen by "GRPI" model, the "SMART" goal was specifically "innovating Simple Move to Improve Continuous Education and Training of quality and Patient safety among hospital staff using a new method instead of lectures proved to be not suitable for time workload and work shifts as well as to create one team for one goal, the hospital overcome all obstacles and achieved success. The team used "FOCUS-PDCA", practiced Team, Data collection and analysis quality tools, for decision making, through action plan formed of four phases, putting in mind results of preliminary and final staff questionnaires and exams. Neutralization of informal groups, elimination lack of commitment and resolving the false sensation of security to prepare the hospital for reaccreditation occurred in conjunction with improving staff skill development and morale was achieved. Usage the new method in departmental education is recommended. It can help patient education and new employee orientation. Enhancing the internal marketing and celebrating the annual WHO awareness days and sharing in exhibitions to get benefits from it.