Splenectomy being one commonly performed surgeries throughout the world is well known to have many complications. Heterogeneity exists in presentation, some being hematological or chest infections. Due to advancement of medical science, complications have reduced. Yet still some exist despite precautions and vaguely recorded in literature. We aim to study the incidence of complications of splenectomy in elective & emergency settings during perioperative period to demonstrate the present status and discuss the future changes in preventing or treating complications.
OBJECTIVE Electrotherapy is the electrical stimulation of tissues for therapeutic purposes which uses a specific wavelength and frequency from the electromagnetic spectrum to produce the desired physiological and chemical changes in the body. Insusceptibility to get malaria infection among patients treated with electrotherapy was locally observed, therefore the study was aimed to detect the potential effect of electrotherapy on acquiring of malaria infection to assess the management of the disease endemic in Khartoum state. METHODS This is descriptive cross-sectional study, all patients (101) attending and submitting to electrotherapy unit in the hospitals were enrolled, and their clinical reports were collected. Among these patients 55 were male and 46 were female and were divided into three categories according to the number of sessions, age and gender. The data were analyzed using SPSS software. RESULTS The study involved both sexes (55 males and 46 females), and the percentage of males not infected with malaria after electrotherapy sessions (84%) was higher than that of females (67%) out of the total number. Interestingly one of the patients undergoing electrotherapy sessions had been diagnosed with severe malaria with mental disturbance, the symptoms of the severe malaria decreased from him, and his condition improved after submitting to electrotherapy sessions. The exposing percentage of patients who did not acquire malaria after electrotherapy sessions was approximately 80% with P-value (<0.001) compared to those infected with malaria after electrotherapy sessions. CONCLUSION The study results suggest the potential hypothesis of existence of effect of electrotherapy on acquiring malaria infection, the study recommended to carry out further experimental in-vitro and in-vivo studies to prove and explain the mechanism of effect in order to assist in treatment and management of the disease.
Monkeypox virus (MPXV) is a zoonotic disease, with endemic circulation and it’s not considered a sexually transmitted infection. Recently, it has been reported a particularly high incidence among men who have sex with men (MSM). We report the first case of a male HIV-negative patient with HIV Pre-Exposition Prophylaxis (PrEP), and a simultaneous coinfection of Monkeypox Virus, Covid19 and Syphilis.
Fat embolism is the presence of fat particles within the microcirculation, while FES is the systemic manifestation of fat emboli within the microcirculation. FES commonly presents with ards, altered mental status, and dermatological manifestations which occur commonly after traumatic long-bone fractures, though the incidence reported by varies studies range from 1%-33%. Here we discuss the two young patients presented with cerebral fat embolism syndrome. Cerebral FES may manifest from minimal changes in mentation to deep coma. Early suspicion in patients with no traumatic neuro parenchymal injury and MRI of brain will be helpful for the early diagnosis.
Venous thromboembolism is one of the most frequently encountered condition for which patients need intensive care admission often. Most of the time patients presents with shock and hemodynamic instability if it is massive pulmonary embolism. Incidence of Vte is comparable to western population in India, studies conducted by Ayyapan et all say it around 20/10,000 admission. Studies showed higher mortality of around 50% in high risk (massive) and mortality of around 14% in intermediate risk (sub-massive) PE which necessitating more aggressive approach in high-risk groups. Rapid administration of systemic thrombolytic agents is indicated in massive pulmonary embolism patients who presents with hemodynamic instability but systemic thrombolytic therapy is associated with risk of major bleeding around 20% and haemorrhagic stroke of 2% to 5% . During systemic thrombolysis shunting of thrombolytic agents away from clot into the systemic circulation which makes it failed lysis sometimes along with major bleeding.
INTRODUCTION PVD, one of the major macrovascular complications of T2DM, usually begins at an earlier age and remains subclinical for a long duration. So early detection of PVD will help to assess its true prevalence and hence prevention of overt manifestation. OBJECTIVES To assess the true prevalence of PVD in T2 DM from Eastern India and its correlation with clinical and biochemical parameters METHODS It was a cross sectional study with consecutive diabetes patients attending OPD from 2015 January to 2016 July. Each was subjected to meticulous history, measurement of ABPI by handheld Doppler and various laboratory parameters. Patients having known vascular disease due to other causes were excluded. RESULTS Out of 103 patients, PVD was present in around 25% cases with positive association with age, male gender, and high body weight. Hypertension, hyperglycemic state (PPBS, HbA1C), total cholesterol, triglyceride and LDL independently increases the risk of PVD. Though low levels of HDL are a well-recognized risk factor for PVD, this was not reflected in study. CONCLUSION The true prevalence of PVD is higher in DM and ABPI can detect subclinical PVD much before its progression and overt manifestations
OBJECTIVE The study aims to determine the risk factors for endometrial hyperplasia and endometrial cancer in patient with abnormal uterine bleeding and thus early diagnostic investigations to detect the disease and limit its development. DESIGN Primary data were collected from an infectious disease clinic outpatient setting using the PSQ-18 short form. The data were collected between February and March 2021. The study population included (a) non-institutionalized individuals, (b) individuals aged 18 years and older, (c) individuals living with HIV/AIDS, and (d) individuals who had had a provider visit in the past 12 months at an infectious disease clinic. METHODS Multiple regression was used to assess the relationship between the dependent and independent variables using a cross-sectional quantitative analysis. RESULTS The study revealed a statistically significant relationship between PPR and perceived quality of care from the perspective of patients living with HIV before and during the SARS-CoV-2 pandemic. CONCLUSION The study results indicated that overall provider-patient relationship (PPR), communication, accessibility, and convenience were related to perceived quality of care. The study findings also revealed that PPRs can uniquely impact perceived quality of care. Provider accessibility was also found to uniquely impact a patient’s perceived quality of care. Finally, the study results demonstrated that HIV patients who have a good relationship with healthcare providers and a high level of satisfaction tend to perceive high-quality healthcare.
BACKGROUND The incidence of rosacea in adolescents and young adults with acne vulgaris has been increasing; however, the underlying factors and clinical symptoms have not been clearly described. AIM To investigate the factors underlying the recent increase in the prevalence of rosacea with acne vulgaris, with a focus on changes in social and medical factors over the past decade. METHODS A case series of rosacea conducted from April 2022 to May 2023. Characteristics and clinical symptoms of rosacea with acne vulgaris in adolescents and young adults were investigated. As a countermeasure against rosacea, two-color (blue and red) light-emitting diodes (LED) were irradiated. RESULTS Of the total 84 patients with rosacea, 34 (40.8%) had rosacea with acne vulgaris. All patients had onset before the age of 30 years, particularly in the teenage years (25 cases). All patients with rosacea and acne vulgaris developed rosacea during benzoyl peroxide and/or adapalene (BPO/adapalene) therapy, with a higher incidence in females than in males. During the study period, 863 patients with acne vulgaris were identified in the author’s clinic, and 34 (3.9%) had rosacea and acne vulgaris. Among the 863 patients with acne vulgaris, 437 (50.6%) were using BPO/adapalene, whereas all (100%) patients with rosacea and acne vulgaris were using BPO/adapalene (p = 0.0083). Among the female patients with acne vulgaris, 265 used BPO/adapalene, and 29 (10.9%) developed rosacea. Contrastingly, 172 males used BPO/adapalene, and 5 (2.9%) developed rosacea, which was a lower rate than that in females (p = 0.0051). CONCLUSION In the present study, all patients with rosacea and acne vulgaris had an age of onset of less than 30 years, and most were teenage females. All patients developed rosacea during BPO/adapalene therapy for acne vulgaris and wore masks for at least 6 hours per day. Rosacea in patients with acne vulgaris may be induced by BPO/adapalene and prolonged mask-wearing. Preventing rosacea development during acne vulgaris treatment is important, especially in female adolescents; mask-wearing should be avoided as much as possible, and additional LED therapy may help prevent rosacea during BPO/adapalene therapy.
Periapical cysts are inflammatory cysts that developed due to caries and trauma of the involved tooth. Usually, the tooth becomes nonvital with pain, swelling, and sinus formation. On radiographic examination these cyst shows radiolucency around the apex of the involved tooth. On aspiration straw colored inflammatory fluid with or without pus comes out suggestive of a radicular cyst. Surgical removal with curettage of the lesion, apicoectomy, and root canal treatment should be performed to treat the lesion. Excised cavity can be augmented with PRP (Platelet rich plasma) or PRF (Platelet rich fibrin) for better healing of the lesion. This case series reported 3 such cases and their treatment with follow-up.
Chat Generative Pre-Trained Transformer 3 (ChatGPT3) is an open artificial intelligence (AI) platform that utilizes deep learning to produce human-like text, which could greatly reduce the time spent on literature search, data analysis and research writing in future, and ensures academic standards of writing. This study aims to evaluate the information provided by open artificial intelligence, Chat Generative Pre-Trained Transformed 3 (ChatGPT3) and its use in orthopedic surgery research writing. Serial of five prompted questions on surgical management of knee osteoarthritis (OA) were asked from ChatGPT3. The answers were reviewed and scrutinized for how updated, accurate and succinctly presented the information was in text and referencing. The information ChatGPT3 provided was accurate, albeit surface-level. It lacked analytical abilities, missed vital studies, and all references links were incorrect. It seems that while the algorithm has access to all information on the internet until 2021, it lacked the analytical ability to dissect for important limitations about knee OA, which would not be conducive to potentiating creative ideas and solutions in orthopedic surgery. ChatGTP3 only promotes convergent thinking and prevent innovation and therefore should be limited within the scope of research or at least reviewed under the guidance of experts.
SUMMARY:This is a descriptive summary of the case of a patient with Axenfeld-Rieger syndrome associated with a congenital malformation of the iris and consequent pupillary morphological alteration of an atypical characteristic reported. This anomaly is unique in scientific literature and exhibits a peculiarity that we have called pseudoacorea: Hidden pupil. Other associated abnormal clinical findings were posterior embryotoxon, astigmatism, amblyopia, and exotropia. Diagnosis was achieved by instilling ocular mydriatics into the cul-de-sac that revealed this peculiarity. It is necessary to make a differential diagnosis with other pupillary pathologies such as corectopia, acorea and microcoria. Early detection of pathology and surgical management is necessary, since it would lead to a better visual prognosis for both amblyopia and strabismus.BACKGROUND:Among the malformations of the pupil, we can find polycoria (more than one pupil), dyscoria (abnormal pupil shape), corectopia (abnormal pupil position) and acorea (absence of pupil). In addition, morphologically normal pupils can denote other anomalies such as the microcoria described by Holth in 1923. Acorea is a rare anomaly, congenital or acquired, characterized by an absolute absence of the pupil both at rest and in mydriasis. In our case we prefer to differentiate it and name it pseudoacorea, since although there is a total absence of the pupil at rest thanks to the application of ocular mydriatics, a micropupil with discoric and corectopic characteristics is achieved. It is worth noting that we have not detected in the scientific literature any case described as the one that we will develop here.CONCLUSION:The case of a patient with Axenfeld-Rieger syndrome associated with a congenital malformation of the iris and consequent atypical pupillary morphological alteration is presented. This anomaly is unique in the scientific literature and presents a peculiarity that we have called pseudoacorea: Hidden pupil. Early detection of pathology and surgical management is necessary, since it would lead to a better visual prognosis for both amblyopia and strabismus.
Left ventricular free wall rupture (LVFWR) is an uncommon yet catastrophic complication of myocardial infarction (MI). The protean manifestation of LVFWR and the challenging imaging in patients in extremis and the critical time-window for surgical intervention pose considerable challenges. Here in, we report a case where multiparametric CT was utilised to elucidate the diagnosis, define coronary anatomy and aid strategy in emergency cardiothoracic surgery for LVFWR.
OBJECTIVE:Hallucinations is a core characteristic symptom in Lewy Body Dementia (DLB) and Parkinson's Dementia (PDD). It may also appear at the late stages of Alzheimer's disease (AD). They are not easily managed, and they are associated with cognitive decline, earlier institutionalization, increased mortality, and increased caregivers' burden.DESIGN/SETTING:This is a cross-over RCT. The participants were randomly assigned in 6 different groups of 10 patients each.PARTICIPANTS:60 dementia patients (different types and stages of dementia).INTERVENTIONS:The three non-pharmacological interventions used are: A) Validation therapy (VT) in a Psycho-educational program, B) Reminiscence therapy (RT) and C) Music therapy (MT). Each intervention lasted for 5 days and there was an interval of two days, as a wash-out period (all the interventions had a duration of 3 weeks).MEASUREMENTS:The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaire at baseline and after each intervention.RESULTS:The most effective combination for the reduction of the hallucinations is: VT/Psycho-educational program (p = 0.005), MT (p = 0.007) and RT (p = 0.022). The same combination applies for the caregivers' distress: VT/Psychoeducational program (p = 0.010) - MT (p = 0.023) - RT (p = 0.036).CONCLUSION:VT/Psycho-educational program followed by MT, followed by RT is an effective combination of non-pharmacological interventions that can reduce hallucinations in patients with dementia and caregivers' burden. Non-pharmacological interventions should be further examined as an effective alternative for the reduction of the hallucinations in dementia.
Introduction: Small lesions involving or compressing dural sinuses are frequent but secondary intracranial hypertension is not very common, with few examples reported in the literature. This event may be explained in the setting of anatomic variants in pattern of venous sinus circulation.
Langerhans Cell Histiocytosis (LCH), also known as Histiocytosis X (HX), is a group of hyperplastic cellular diseases of unknown causes. LCH could affect bones, lungs, central nervous system, liver, thymus, skin, and also lymph nodes. The diagnosis of LCH is difficult to enforce and rarely found in adults, with just about 5 cases per million per year. The present study reports the case of a young woman with LCH with multisystem involvement, including that of the bone, orbit, pulmonary system and central nervous system. The patient received chemotherapy for 6 months and exhibited rapid improvement in the involved systems. The last PET/CT showed metabolic activity in the right iliac bone. One year after completion of the therapy, the patient returned to the hospital showing deteriorating health. The clinical case is interesting not only because of the registered clinical, morphological, and imaging data of histiocytosis but also because of the unclear prognostic and diagnostic importance of this phenomenon.
Background: Dilated cardiomyopathy with heart failure is a common cause of morbidity and mortality in patients with Becker muscular dystrophy. An early diagnosis, treatment and a close follow-up are crucial in improving quality of life and prognosis. Neuro-hormonal therapy may improve symptoms and cardiac dysfunction and reduce mortality risk. Little is known about the use of sacubitril/valsartan for heart failure in patients with Becker muscular dystrophy and dilated cardiomyopathy. Methods: We present a case series of four patients with Becker muscular dystrophy cardiomyopathy followed in a dedicated cardiologic neuromuscular program and treated with sacubitril/valsartan because of severe left ventricular dysfunction with heart failure symptoms. Results: In our experience sacubitril/valsartan was effective in improving symptoms and functional capacity, in reducing hospital admission for HF and, when early introduced, it promoted positive reverse heart remodeling. Despite a fragile population, sacubitril/valsartan was safe, without episodes of hypotension or renal function worsening. Conclusion: Sacubitril/valsartan may be considered an effective and safe pharmacological option in patients with Becker muscular dystrophy and dilated cardiomyopathy with reduced ejection fraction.
Background: Mycotic aneurysms are a rare subset of intracranial aneurysms caused by bacterial, viral or fungal sources. Rupture of an intracranial mycotic aneurysm is a life-threatening event untreated with a mortality range up to 80%. Case description: Here, we report the case of a 21-year-old second year female medical student who suffered from a ruptured mycotic aneurysm of the middle cerebral artery with subarachnoid haemorrhage. After surgical resection of the aneurysm, intensive monitoring and treatment of cerebral vasospasm were performed. Further diagnostics for the focus of infection, including laboratory parameters, transoesophageal echocardiography and otolaryngoscopic diagnostic, showed normal findings without any sign of endocarditis, vasculitis or otolaryngitis. After 3 weeks, the patient was discharged in a very well condition. Conclusion: Aseptic mycotic aneurysm is a rare subtype with posing significant therapeutic challenge. Surgical resection of those aneurysms might be safe and effective treatment.
Intravenous Bisphosphonates (BPs) are used to treat cancer-related conditions, including hyperkalemia of malignancy, Skeletal-Related Events (SREs) associated with bone, and for management of lytic lesions in the setting of multiple myeloma. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is a severe complication of BPs, which affects the patient's quality of life. In the treatment of BRONJ, soft tissue coverage for coverage of the debrided bone is essential. In severe soft tissue deficiency, the use of local or distant soft tissue flap is necessary this case report; a massive BRONJ was described in which a submental flap was used to cover the mandibular bone.
Background: Appendicular Endometriosis represents less than 1% of all pelvic endometriosis cases. It manifests with pain in right iliac fossa and bear resemblance to acute appendicitis. Definitive diagnosis is possible only after histopathological examination of excised appendix. Case presentation: We report a rare case of Appendicular Endometriosis (AE) in a 38 years old non-married female, otherwise healthy, came to emergency room with less than 24 hours lower abdominal pain associated with nausea but no vomiting. All other systemic review was unremarkable. Patient has no positive medical or surgical history. Blood investigations were normal and abdominal ultrasound US showed edematous wall thickening of the appendix with 12 mm distended lumen. Laparoscopic appendicectomy was performed with incidental finding of blood-tinged fluid in the pelvis and multiple prominent fibroids of the uterus, the appendix was inflamed, and appendectomy done. Postoperative recovery course was uneventful. The final histopathological examination confirmed endometriosis of appendix. Conclusion: AE is a rare entity and almost always diagnosed after histopathological examination. it should be included in the differential diagnosis of acute abdominal pain, especially when women of childbearing age present with clinical symptoms of acute appendicitis.
