Damage to the hypothalamus may result from direct surgical injury or from hemorrhage and ischemia caused by the procedure. Patients with hypothalamus damage can be comatose and exhibit hyperthermia. Here, we present a patient whose hypothalamus was directly damaged by a drainage catheter. His clinical manifestations included diabetes insipidus, hyperthermia and adrenocorticotropic hormone (ACTH) deficiency. The patient was a 48-year-old male and had a body weight of 95 kg. He was admitted to the hospital on August 31, 2019 for memory impairment and nonspecific dizziness that persisted for four months. A magnetic resonance image of the head showed an intraventricular mass attached to the anterior third of the septum pellucidum and Monro’s foramen and enlargement of the left lateral ventricle. This intraventricular cystic tumor was 1.9 cm in diameter, without gadolinium enhancement. The tumor resection was performed without complications and with less bleeding than expected. The patient developed central diabetes insipidus within just two hours after the operation and presented with hyperthermia within six hours after the operation. ACTH deficiency was evident on day 1 after surgery. selleck inhibitor After we removed the catheter 19 hours after the operation, the patient never developed polyuria or high fever again. Two months later, his ACTH level was normal and never needed to take prednisone again. This unusual complication should be taken into account in patients who need external ventricular drains. Much attention should be paid to ensure that the length of the drainage catheter beneath the brain surface does not exceed 5 cm.Sepsis is associated with life-threatening organ dysfunction. Drastic treatment methods such as antimicrobials and surgical control have been used to manage sepsis. However, there are currently no other sepsis-specific treatments capable of improving mortality rates. Plasma exchange (PE) for the removal of toxic substances and the replacement of consumed bioprotective proteins has been advocated as a potential treatment for sepsis. Although the evidence for the efficacy of PE for sepsis is quite limited, in a recent finding, sepsis patients treated with PE showed improvement in fluid balance and organ damage. Continuous PE with dialysis (cPED), which is a modified version of PE, is a novel blood purification method. cPED is a combination of selective PE and hemodialysis and operates slowly in a simple circuit that can potentially provide powerful supportive care for patients with multiple organ failure. In this report, we present two cases of treatment with cPED in patients with severe sepsis and organ damage. Both patients were discharged alive without any adverse events from cPED. cPED improved fluid balance as well as laboratory parameters that had reflected multiple organ failure. This suggests a possible reduction in side effects such as leakage of bio-essential proteins and citric acid reactions to large doses of fresh frozen plasma. The clinical course of these two patients may be useful for setting outcomes in future clinical studies regarding the effectiveness of cPED for severe sepsis.Background Cognitive impairment is a global public health problem in the elderly population. There is increasing evidence that diabetes mellitus predisposes to cognitive impairment. Early diagnosis and management of cognitive impairment can delay the onset of dementia, thereby improving self-care and quality of life of diabetic patients. This study intends to assess cognitive impairment, and the factors influencing cognitive impairment among older adults with diabetes mellitus in Puducherry. Methods A community-based cross-sectional study was conducted in field practice areas of a Government Medical College in Puducherry between April and June 2019. After obtaining ethical approval, 240 registered diabetic patients aged 55 years and above were randomly selected. Data on demographic profile and clinical variables were collected using a semi-structured questionnaire. Cognitive function was assessed using the Hindi Mental State Examination (HMSE) tool, and participants who scored below 26 were considered to have cognitive impairment. Results Among 240 participants, 67.9% were aged 60 years and above, 62.5% were females, and 83.8% were unemployed. The proportion of cognitive impairment among older adults with diabetes was 30.0% (95% confidence interval (CI) 24.5-36.03). The mean ± standard deviation of the HMSE Score was 26.13 ± 3.8, and the median score was 27. Female gender (P= 0.02, adjusted prevalence ratio (aPR) = 5.31, 95% CI 1.34-21), widowhood status (P= 0.005, aPR= 2.71, 95% CI 1.34-5.46), illiteracy (P less then 0.001, aPR= 3.55, 95% CI 1.78-7.07), and presence of probable symptomatic hypoglycemia (P=0.02, aPR= 2.18, 95% CI 1.13-4.20) were significant predictors of cognitive impairment in the study population by multivariate analysis. Conclusion Almost one-third of older adults with diabetes were found to be at risk of cognitive impairment. Older diabetic patients with identified risk factors may be prioritized for a screening of cognitive impairment at the primary care level.Objectives The purpose of the study was to evaluate the impact of country self-citation rate (SCR) among medical specialties in Saudi Arabia, and to assess the impact of self-citations on the country’s total cites world ranking in different specialties. Methods SCImago Journal & Country Rank (SJR) was used to collect data related to all medical specialties in Saudi Arabia for the period 1996-2019. The country SCR for the specialties was correlated with several bibliometric parameters and examined statistically. The specialties that showed a drop in Saudi Arabia’s total cites world ranking following the exclusion of self-citations were identified. Results The median country SCR for 46 specialties in Saudi Arabia was 9.5% (range 4.6-23.1%). The two specialties with the highest country SCR were Public Health (23.1%) and Family Practice (22.9%). Country SCR was significantly higher in the non-clinical specialties compared to clinical specialties (15.3% vs. 9.6%). It did not correlate significantly with any of the examined productivity indices.