BACKGROUND:Kommerell's diverticulum (KD) with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it (35% of case study). There are three types of aortic arch diverticulum. Even literature concerning the treatment options are limited.CASE SUMMARY:We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery. We conducted a total endovascular repair procedure, which is innovative and will spread more light in the medical world. Our patient has no past medical history and is a non-smoker and non-alcoholic. Patient presented with shortness of breath, chest pain and dizziness for six months. Blood tests were done and computerized tomography (CT) angiogram of the chest confirmed the diagnosis, illustrating showed a 3.9 cm KD. On Day 1, the CT angiogram showed mild dilatation of the thoracic aorta, adjacent esophagus, trachea was compressed and displaced. Surgery was planned as the treatment modality. Carotid-Subclavian artery bypass and endovascular aortic repair was conducted. We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery. Haemostasis was secured and wounds were closed. Protamine was administered and patient was shifted to intensive care unit. Post-operative, patient responded favorably and was discharged. Regular follow-up is done.CONCLUSION:The procedure we performed is novel. This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted, thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.
Inviting InnovationsIn 2005 Naidu et al [2] characterized an infantile neurodegenerative syndrome with pictures of acute clinical deterioration associated with asymmetric patchy leukoencephalopathy in neuroimaging studies along with cavities and vascular permeability, found initially on corpus callosum and centrum semiovale, and developing cystic degeneration; This entity was called Progressive Cavitational Leukoencephalopathy
she Abstract Clozapine, an atypical antipsychotic agent, is useful in the treatment of patients with psychotic symptoms. However, severe adverse effects, such as agranulocytosis, can restrict its indications. We present a case of a 42-year-old Caucasian woman with a 4-year history of persistent delusion disorder, who presented with fatigue and fever and was ultimately diagnosed with agranulocytosis due to clozapine. Clozapine-induced agranulocytosis is an uncommon condition, but potentially fatal in consequences. Each patient with an episode of agranulocytosis should be assessed individually, with special attention to risk factors. Upon that, the decision about clozapine rechallenge or withdrawal should be made.
Tricho-hepato-enteric syndrome is a rare autosomal recessive enteropathy that first presents as intractable diarrhea in neonates. Diarrhea persists throughout life and patients are dependent on parenteral nutrition for growth. Additional features include facial dysmorphism, trichorrhexis nodosa (woolly hair), intra-uterine growth restriction, hepatic disease, skin anomalies and a depressed immune system. Tricho-hepato-enteric syndrome is a life limiting disease with variability in its manifestations and severity. Mutations in two different genes, TTC37 or SKIV2L , cause the disorder. In this case report we present a neonate with a novel mutation in TTC37 that resulted in a severe phenotype associated with fulminate sepsis. The infant presented at one week of age with sudden onset of diarrhea and dehydration. Tricho-hepato-enteric syndrome was diagnosed by whole exome sequencing but was not initially considered because the infant lacked many of the diagnostic clinical features. Soon after presentation, the infant developed pneumoperitoneum and necrosis of entire bowel. The blood culture was positive for Clostridium perfringens. Autopsy showed bacteria in the parenchyma and vasculature of all major internal organs as well as within the bone marrow, connective tissue and skeletal muscle but there was minimal inflammatory response. The lack of migration of white blood cells to the sites of infection is likely due to the combined immunodeficiency reported in patients with tricho-hepato-enteric
It is well known that oxidative stress is a pathologic condition that compromises wound evolution, contributing to inflammatory environment maintaining and wound healing stagnation. This condition specially affects to aged people and to patients with important comorbidities, whereby healing capabilities are significantly impaired. In this work, a new therapeutic approach through a new antioxidant technology with natural components has been applied, in order to manage the oxidative stress, in 31 patients with complex chronic wounds of different etiologies, attended to the Sanitary West District in Almería (Spain). Wound assessments were performed at 4, 8 and 12 weeks and main endpoints included the evolution of wound healing (% of healing rate and Resvech 2.0 score) and pain relief. The treatment with antioxidant dressing produced a significant decrease of RESVECH 2.0 of 37.28%, 58.52% and 67.8% at 4, 8 and 12 weeks respectively and during the 12 week follow-up, 16/31 wounds totally healed (50%). In addition, a decrease in pain and biofilm presence in wounds were observed. In conclusion, the analyzed antioxidant approach could be a new therapeutic strategy directed to overcome the inflammatory phase in complex wounds and allow the progression over the healing process.
Figures 1 and 2 shows the trend of the sale of advanced therapeutic drugs for rheumatoid arthritis (RA) currently available commercially in Japan. After the release of infliximab in 2003, biological products were introduced to the market with great frequency, and biological products with different mechanisms of action and dosing regimens became available (the use of rituximab for RA is not approved in Japan, unlike in overseas countries). Ten years after the release of the first biological product in Japan, the sale of Janus kinase inhibitors was promoted, and biosimilars (BSs) were also actively marketed.
Gastrointestinal cancer can remain asymptomatic until advanced stages, when treatments tend to be less effective.Therefore, prognosis is poor.Cancer screening programs can help to improve prognosis and patient quality of life through early detection.Biomarkers could prove to be an alternative diagnostic tool and help to select more appropriate treatment.This review focuses on the use of predictive biomarkers in the early diagnosis of colorectal cancer, esophageal cancer, and gastric cancer.Molecular biomarkers based on DNA (methylation of DNA and circulating tumor DNA), RNA, circulating tumor cells, and proteins are being developed for this purpose.These markers have the potential to confirm the diagnosis of the disease in its early stages.
Since the coronavirus (SARS-CoV-2) pandemic began, frontline workers in general face the stress of uncertainty and fear in encountering infected individuals in the wider public. Frontline healthcare workers are at particular risk for increasing stress levels when treating and caring for COVID-19 patients. These healthcare professionals experience anxiety, psychological pressure and post-traumatic stress with their associated workloads [1-3]. Post-traumatic stress accompanying the COVID-19 outbreak in healthcare workers also elicits hyperarousal and decreased sleep quality [4]. Post-traumatic stress is known to induce somatization with gastrointestinal (GI) symptoms [5].
The incidence varies according to regions, with a predominance in pediatric patients. In adults, there has been an average age of onset at 50 years with a female predominance in a 1:7 with respect to the men [3]. An estimated worldwide incidence of 1.2 cases per million inhabitants. In Latin America, there is no standardized report that allows establishing epidemiological data, with an estimated survival of 38% one year after diagnosis [4] (Figure 1). However, this figure may be underestimated as it is a diagnosis of exclusion and due to the lack of specificity of the clinical picture.
