Acute coronary syndrome following arteriovenous fistula creation in a post CABG patient: A steal phenomenon from coronary artery to subclavian artery

A 70‐year‐old man with a history of coronary artery bypass grafting 15 years back and arteriovenous (AV) fistula creation in the left arm 1 month back presented with acute coronary syndrome (ACS). He had not received dialysis before his referral. We felt the most likely etiology for these complaints was increased cardiac oxygen demand from an increased cardiac output related to the newly formed left AV fistula. Coronary angiography was done to detect any significant stenosis in the native or grafted vessels. This revealed that the left subclavian artery was totally occluded in the ostioproximal segment and the coronary arteries did not have occlusions to explain the ACS setting. CT angiography confirmed the angiographic findings of the totally occluded left subclavian artery followed by a well‐developed and patent left internal mammary artery to left anterior descending artery. This led to the consideration of a steal syndrome from the coronary artery by the subclavian artery distal to the occlusion. A successful percutaneous endovascular intervention on the left subclavian artery occlusion was performed. Subsequently, the patient became asymptomatic and experienced a dramatic increase in left ventricular ejection fraction.     

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sports. However, while Jones fracture incidences are frequent in the sporting world, there is still a lack of consensus on how such fractures should be effectively managed. There are numerous treatment options for patients with fifth metatarsal Jones fractures. The role of nonoperative treatment remains controversial, with concerns about delayed union and nonunion. Surgical stabilization of metatarsal Jones fractures is therefore often recommended for athletes, as it is often associated with a low number of complications and a higher rate of union than nonoperative management. This review will focus on literature regarding the prevalence of Jones type fifth metatarsal fracture, alongside the efficacy of both conservative and surgical treatment within this population.     

Urrets-Zavalia Like Syndrome,as a Complication of Sickle Cell Disease

Introduction: We present a case of a sickle cell patient who presented with Urrets-Zavalia Syndrome (UZS) like characteristics without having undergone any surgical procedures.

Case report: A 41-year-old woman diagnosed with sickle cell thalassemia presented with glaucoma of the both eyes. Visual acuity was decreased in both eyes. Epithelial edema was observed in corneas of both eyes, most prominently in the left eye. Peripheral anterior synechiae were present bilaterally. Intraocular pressure was measured to be 26 mmHg in the right eye and 36 mmHg in the left eye. Fixed dilated pupils were observed in both eyes. Fluorescein angiography revealed ischemia of the iris in the right eye.

Conclusion: Physicians should keep a high suspicion of UZS in all patients with fixed dilated pupils, especially in sickle cell disease, regardless of having undergone ophthalmic surgeries or not.     

Adsorptive removal of lead from aqueous solutions by amine–functionalized magMCM-41 as a low–cost nanocomposite prepared from rice husk: Modeling and optimization by response surface methodology

Amorphous silica that was extracted from rice husk was used to synthesize the magMCM-41 mesoporous silica. This was then functionalized by the APTMS group in order to produce NH₂-magMCM-41 as a novel and low–cost adsorbent. The XRD, VSM, N₂ adsorption–desorption, FT–IR, TGA, SEM and TEM analyses were utilized to characterize the produced materials. In order to optimize the adsorption of the Pb(II) ions, the RSM (response surface methodology) was applied by using the synthesized adsorbent in aqueous solutions. A rotatable CCD (central composite design) was adopted to carry out the experiments and RSM was used to analyze them. Three independent factors namely, initial solution pH (3–7), adsorbent dosage (0.1–2 g L^?1), and initial Pb(II) concentration (15–150 mg L^?1) were used to investigate the removal procedure. According to the obtained results, the initial solution pH of 5.22, adsorbent dosage of 0.1 g L^?1, and initial Pb(II) concentration of 150 mg L^?1 were considered as the optimum conditions with 64.32% removal of Pb(II) and an adsorption capacity of 540.64 mg g^?1. The maximum removal efficiency of Pb(II) ions was found to be 96.76%. The Sips isotherm model represents a better correlation with equilibrium data. It was reported by the kinetic study that data taken from the experiments fitted better to the pseudo–second–order model compared to the pseudo–first–order and intraparticle diffusion models. Finally, according to the thermodynamic study, the removal process strongly depends on temperature, which indicates an exothermic behavior and spontaneous nature of the adsorption.     

Sexual compatibility among Iranian couples: a qualitative study

Sexual compatibility increases the stability of marriage and partners’ relationships and decreases sexually transmitted diseases. This qualitative study using a content analysis approach was conducted with 36 married men and women. Interviews were conducted for data collection. As the main theme of this study, “couple's sexual companionship” emerged as the main theme of sexual compatibility, that means couples’ participation for fulfilling each other sexual needs and solving problems arising from sexual discrepancies based on sexual understandings, sexual agreements and interests for continuing the sexual relationship with the aim of mutual sexual satisfaction. Sexual compatibility did not necessarily mean similarities, as during the marital life sexual discrepancies were inevitable. However, compatible couples encountered such a situation based on understandings, agreement and love. Active participation in sexual relationships, forgiveness and consideration, no huffing, mutual respect, flexibility and an occasional use of non-penetrative sexual relationships, sexual conversation with spouses, patience and development of the sexual relationship were the prominent feature of sexually compatible couples.