Objective: To delineate the explore potential etiological contributions to subcutaneous panniculitis-like T-cell lymphoma (SPTCL) in adults with sickle cell disease. Sickle cell disease (SCD) is an inherited hematologic disorder where standard treatment may enhance risk of the development of rare comorbidities like SPTCL. Methods: We reviewed the scientific literature and only found one case report detailing the development of SPTCL in an adult with SCD. Results: We reviewed 1 case reports and the general literature on hematolymphoid disorders. We discovered that there are several potential mechanisms to explain SPTCL in SCD but no conclusive evidence to support either. We reported radiographic, serological, immune, and hematological finding from the previous case. Conclusions: SPTCL is a complex disorder with a likely multifactoral etiology. The development of the disease in adults with SCD is rare but possible as evidenced by a published case report. We advocate for additional attention to the intersection of these two diseases for the purpose of better understanding their etiology and epidemiology. More research is needed.
A healthy and balanced diet is one of the main key components of a healthy lifestyle. It is a guarantee for long-term health promotion and prevention of a numberofdiseases. The survey included a study of nutritional attitudes in the new and unknown coronavirus disease during isolation and quarantine. For this purpose, 77 medical students aged 20 to 25 were sun/eyed with a direct postal questionnaire. The lack of scientific data on treatment, vaccine, immunity, behavior poses a number of challenges in lifestyle and particularly in nutrition. The study shows that high health literacy and culture allow students to create their own model of nutrition in this complex epidemiological environment, as there is still no research proving or dismissing the link between a healthy and balanced diet and coronavirus disease. We believe that this may be the subject of research by scientists from around the world, which will enrich the knowledge in this field. © 2021 Medical Information Center. All rights reserved.
Cytokines IL-6, IL-8 and MCP-1 play an important role in a number of inflammatory diseases. Curcumin is known to have strong antioxidant, anti-inflammatory and anti-tumor effects. Observations in patients with severe COVID-19 show an immune response called 'cytokine storm' characterized by fatal hypercytokinemia associated with multiple organ failure. In this aspect, studies focusing on the effect of inhibitors of natural origin on inflammatory response are of interest The aim of the present study was to analyze the effect of curcumin on the secretory levels of pro-inflammatory cytokines from peripheral blood mononuclear cells pre-treated with lipopolysaccharide to induce inflammation. For this purpose, the protein levels of cytokines IL-6, IL-8 and MCP-1 were measured in supernatant using specific kits based on the ELISA method (eBioscience, San Diego, USA). Statistically significant decrease in the secretory levels of cytokines IL-6, IL-8 and MCP-1 was observed and was recorded as early as the second hour after incubation with LPS and curcumin. The levels of MCP-1 secreted by cells treated with both substances were noted to be even lower than those of the control cells at 18 hours, and this dependence was maintained at 24 hours. The decrease in the secretory levels of cytokines IL-6, IL-8 and MCP-1 due to the action of curcumin on peripheral blood mononuclear cells pre-treated with LPS indicates that curcumin inhibits the synthesis and secretion of the studied inflammatory cytokines. © 2021 Medical Information Center. All rights reserved.
Studies conducted in many countries, inci Bulgaria, demonstrate the antimicrobial activity of Salvia officinalis against different pathogens including coronaviruses SARS-CoV u IBV The effect is due to its biologically active compounds The medicinal plant has a millennial history of application in pulmonology and today is used in medicines for respiratory diseases There is a significant opportunity that Salvia officinalis could contribute to the solution of contemporary challenges facing our healthcare systems like the Coronavirus disease (COVID-19) pandemic (caused by the coronavirus SARS-CoV-2, according to WHO (22)) through its appropriate use in prophylactic and therapeutic applications © 2020 Medical Information Center All rights reserved
The article is a review of the present COVID-19 crisis and its influence over remuneration of physicians, working time and conditions, aggression against medical professionals and public opinion in 12 countries of EU and two European countries: Albania and Kosovo. Various managerial approaches have been implemented by governments and professional organisations, yet they share common features such as reduced working time, bonus payments and various compensations in kind, mostly additional time-off and rest/shift regimes. The pandemic launched serious debate on the status of health systems in all countries which led to urgent legal amendments in some countries. Special attention is paid to the measures, undertaken in Bulgaria and the professional organizations reaction, health managers and the state. © 2020 Medical Information Center. All rights reserved.
Studies conducted in various countries, including Bulgaria, prove the antimicrobial/antiviral action of Salvia officinalis in a number of pathogens, including SARS-CoV coronavimses. The effect is due to its biologically active substances. The medicinal plant has a history of millennial application in the field of pulmonology and is used today in medicines for respiratory diseases. During the March-June 2020 period, a positive effect was observed in the treatment of viral diseases, including COVID-19 at home in about 20 patients∗ with two preparations containing Salvia officinalis and other medicinal plants-Immuno Pam Plus with antiviral effect, as well as Broncho Pam with application in pulmonology Zn (Zinc) and Se (Selenium) were included in the therapies, combined with antipyretic dmgs containing paracetamol and acetylsalicylic acid with preventive effect against blood clots. This article presents a detailed description of 4 typical clinical cases with different manifestations, ranging from mild symptoms to pneumonia in a patient with COPD and analyzes the therapeutic methods taken and their results. In the latter case antibiotics were added. © 2020 Medical Information Center. All rights reserved.
A case was posted in internet by a distressed mother in the year 2008 who has a son with possible congenital hypothyroidism and possibly some underlying syndrome like Prader Willi Syndrome, was only picked up by 1 year of age. Her family moved from Middle East to India and then finally to Canada. The mother wondered how much damage could this delay in diagnosis make to his mental development. The story of course, raises several questions and the “borderline hypothyroidism” may not be the son’s immediate underlying pathology where one is compelled to worry about Prader Willie Syndrome and the likes instead! But borderline hypothyroidism (mother is probably referring to ‘subclinical hypothyroidism’) may be one of those aspects which must be addressed immediately in her son’s management. Her son is now getting the services that he needed as they have moved to Canada. But, for someone who is posting comments on an internet, it remains unacceptable that this borderline hypothyroidism was not picked up by Newborn Screening, be it in Middle East or in India. We cannot afford to keep missing congenital hypothyroidisms in the second decade of 21 st Century. It has been proven amply by now that the Holy Grail of present day Pediatrics is Early Detection and Early Intervention [1,2]. To do so, we must ask ourselves the following questions, examining the existing evidence and weighing our interventional options with fine judgments based on the available evidence, as follows: Does congenital hypothyroidism cause developmental problems?
Bone lymphomas can be classified as primary (PBL), or secondary (SBL).PBL is a rare entity, accounting for approximately 7% of malignant bone tumors, 5% of extra nodal lymphomas and <1% of all non-Hodgkin lymphomas.We present here a case of multifocal bone lymphoma in a 72-year old female patient, who was admitted to our clinic for further investigation of persistent back pain, anorexia, weight loss and fatigue.There were no palpable lymph nodes, no hepatosplenomegaly or neurological signs.Her laboratory tests showed a moderate elevation of LDH, ESR and beta-2 microglobulin.In CT and MRI scan a complete fracture of the left hip and multiple vertebral lesions were revealed.Bone biopsy of the left hip showed a Diffuse Large B-cell Lymphoma.She was treated with combined chemotherapy (R-CHOP regimen) plus radiation, followed by bracing with cervical immobilization and cimentoplasty of lumbar vertebrae.She achieved complete response and she is alive at last follow-up.
Background: Based on relation of pathological effects of stress on the body and its reflex on blood pressure, the high level of stress undergone by medical students becomes a concern about quality of medical training and its health.The aim is to verify the possible influence of stress during exam periods on the blood pressure of medical students. Method:The systemic arterial pressure (SAP) of 109 medical students of an institution was measured and analyzed in the period from March to September 2016, using the standardization recommended by the American Heart Association, in 3 time intervals: school holidays, classes without exams, and classes with exams. Results:The authors verified that the systolic arterial pressure and cardiac frequency values checked on exam days were statistically higher (mean of 121.60 mmHg and 85 bpm, respectively) than when measured on class days or during vacations.Whereas the systolic arterial pressure and cardiac frequency values measured on class days were significantly lower than those on the other days (mean of 112.75 mmHg and 74.86 bpm, respectively). Conclusion:The authors statistically verified that stress during exam periods had an influence on the arterial blood pressure of medical students, bringing into focus the need for teaching institutions to provide these students with psychosocial and pedagogical support.
Background: LA volumes and functions are reported to be independent predictors of cardiovascular events in general and diabetic population.The aim of this is to evaluate the effects of prediabetes on LA volumes and functions and parameters that effect LA volumes and functions in patients with prediabetes.Methods: 114 patients (83 female, mean age 48.6 ± 7.4 years) with prediabetes and 70 controls (46 female, mean age 46.5 ± 9.4 years) were included in the study.LA volumes (indexed maximal LA volume-V max , pre-atrial contraction volume-V olp , minimal LA volume-V min ) and functions (passive emptying volume-fraction (PEV-PEF), active emptying volume-fraction (AEV-AEF), total emptying volume-fraction (TEV-TEF) were evaluated with 2dimentional echocardiography and indexed to body surface area.Results: LA diameter, indexed V max , V olp , V min , AEV, and TEV were found to be significantly higher in preDM group compared with control group (P<0.05).There were significant positive correlation between all three LA volumes and body mass index (BMI), triglyceride, HbA1c, fasting glucose, high sensitive C-reactive protein, mitral A wave and deceleration time.Additionally, there were positive correlation between AEV, TEV and BMI.Multivariate analysis showed that the BMI had statistically significant effect on LA diameter, indexed V max , indexed V olp , indexed PEV and indexed TEV whereas prediabetes had statistically significant effect on indexed V max , indexed V olp and indexed V min .HT had only statistically significant effect on indexed V max . Conclusion:BMI and prediabetes have significant effect on LA volumes, but BMI is the only factor that has significant effect on LA functions.On the basis of these findings, we speculate that impairment of LA volumes and functions may be present before overt DM begins and this finding was mainly due to prediabetes and BMI.
Benign Cystic Teratoma (Dermoid cyst) is the most common Germ cell tumor; it rarely grows larger than 10 cm in diameter and usually occurs in young women with peak incidence between the ages of 20 and 40 years. We report a case of an unusually massive benign cystic teratoma measuring 25 × 25 × 15 cm and weighing approx. 7 kg, removed from a 53 year old post-menopausal female, multiparous woman who had been carrying the cyst over a period of two years. She underwent an exploratory laparotomy with ovarian mass resection total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological diagnosis confirmed the tumor to be a benign cystic teratoma.
Purpose: To analyze the outcomes of patients in whom we performed a SG depending on the calibrating bougie.Methods: Retrospective review of patients who underwent SG.Baseline characteristics were analyzed, and outcomes compared between groups.In order to identify the contribution of each predictor in the %EWL, a linear regression univariate and multivariate model was constructed.Results: 168 LSG were performed (120 women), mean age 42.9 years and BMI 51.1.Mortality rate of 0.3% and morbidity rate of 4.7%.No differences in terms of complications between both groups (5.8% vs 3.2%, p=0.735), while %EWL was statistically superior in the 40fr group (67.4±17.9vs 58.1±15.6 at 24 months, p=0.012).Age, larger bougie size and arthropathy influenced negatively on the %EWL.In the multivariate analysis, the introduction of the variable "surgeon" produced a reduction of the effect of the bougie size in weight loss at 24 months (mean difference between groups is 7.5; 95% CI (3.4 -18.3); p=0.173).Conclusions: There are differences regarding %EWL in the medium term favoring the use of a 40Fr bougie against the 58 Fr one, with no differences in terms of complications.As well as the bougie, the surgeon plays an important role in the %EWL.
During ESD, the submucosal layer beneath the tumor was visually confirmed and dissected, and the tumor was completely resected and no adverse events were reported (Figure 2a and 2b). Figure 2: 2a: The submucosal layer beneath the tumor is dissected during endoscopic submucosal dissection, under direct vision. 2b: The submucosal layer beneath the tumor completely resected during endoscopic submucosal dissection, under direct vision.
Benign multicystic peritoneal mesothelioma (BMPM) is a rare tumor of slow growth, with low malignant potential and which is part of the differential diagnosis of pelvic cysts.We described a case report: 55 years old woman, asymptomatic, with ultrasonographic findings of multicystic pelvic image, submitted to exploratory laparotomy and, at the inventory of the cavity, multiple cysts were present, adhered to the omentum.Omentectomy and resection of the cysts was performed followed by complete hysterectomy and bilateral oophorectomy and salpingectomy.Macroscopic examination of the surgical specimen revealed a cystic lesion with translucent content and histological features compatible with BMPM.In the immediate postoperative period, the patient developed vasomotor symptoms secondary to hypoestrogenism, which ceased spontaneously.She underwent a new surgical approach for recurrence after two years.Since the pathogenesis and etiology of BMPM are not well defined, it is very important to describe clinical practices, to better understand the diagnosis, prognosis and management of this disease.
Autosomal recessive polycystic kidney disease (ARPKD) is a developmental disease that affects 1 in 1000040000 live births worldwide. It manifests in the form of disturbed celullar proliferation/ apoptosis that affects the epithelium of the renal collecting ducts and the biliary ducts. Disturbed cellular polarity plays a major role in the disease development, rendering the cyst epithelium secretory rather than absorptive [1]. The main molecular changes of ARPKD are lossof function mutations of Fibrocystin, defective Focal Adhesion Kinase (FAK) activation, and defective β1 Na+/K+ ATPase expression [2].
The Gold Headed Cane is awarded to the graduating medical student at the University of California San Francisco School of Medicine who embodies the qualities of the “true physician”. In May, 2016, I donated the Gold Headed Cane that I received upon graduation 40 years ago to the 2016 recipient. As part of the Gold Headed Cane ceremony, I was asked to reflect on my career in medicine. Good evening! I have always thought of the Gold Headed Cane (GHC) as a metaphor, a beacon of medical professionalism. Throughout my career, I have pursued that beacon by listening to my inner GHC.
Electronic health record (EHR) problem lists are extremely important, and yet they are often incomplete and out of date. We compared the EHR problem list to a self-reported problem list obtained via a tablet-administered questionnaire to identify potential synergy. We conducted a retrospective review comparing the EHR problem list to the patients’ self-reported problem list during the year of 2011. To confirm the accuracy of patient self-reports, we also analyzed medication lists, and laboratory results for two selected conditions, hypercholesterolemia and diabetes mellitus. Overall, 1472 patients at the Massachusetts General Hospital (MGH) used the tablet questionnaire. Of these, 843 (57.27%) had no problem reported in the EHR and some problem reported on the tablet (“Tablet Only”); 42 patients (2.85%) had no problem reported on the tablet or in the EHR (“None”); 17 patients (1.15%) had some problem reported in the EHR and no problem reported on the tablet (“LMR Only”); and 570 patients (38.72%) had some problem reported both on the tablet and in the LMR (“Both”). Overall, we studied 59 conditions, of which twelve had enough patients to run Chi Square analysis. Of the 12 conditions analyzed, 10 were significant, and 9 out of 10 conditions favored the tablet-administered questionnaire. Medication lists and laboratory results were reviewed to confirm the presence of the selected conditions. We reviewed the EHR problem list one year after the study was initiated to update the conditions under study. The additional data corroborated 107 additional self-reported conditions in 97 patients. In summary, a self-administered tablet questionnaire is an acceptable method for collecting the medical history. When combined with the EHR problem list, self-reported medical history is optimal for obtaining the most accurate problem list possible.
Abdominal US described a dilation of the left intrahepatic biliary tree and mild dilation of the main biliary duct (7 mm) with the presence of a tubuliform structure inside of about 5 mm. The CT scan confirmed the presence of a tubular structure inside of the choledocus till the left hepatic duct. A magnetic resonance cholangiopancreatography (MRCP) stated the suspect of biliary parasitosis. Thus, we performed ERCP (endoscopic retrograde cholangiopancreatography). The major papilla’s orifice was enlarged. The cholangiography showed an unusual, braid-like defect in the main biliary duct (Figure 1). After the sphyncterotomy, we pull out the foreign body throught the papilla with Dormia’s cage (video). An about 20 cm-long warm was extracted (Figure 2).
Achondroplasia is the commonest form of dwarfism and possesses multiple anesthetic challenges ranging from securing intravenous line, monitoring and calculating drug dosage to abnormalities of the airway, spine, thoracic cage, and obesity, cardiopulmonary and neurological system.Multiple case reports describing neuraxial anaesthesia, particularly in obstetrics patients are available but there are limited literature on airway management and general anaesthesia.We came across an achondroplastic dwarf for hip replacement with spine deformity where neuraxial anaesthesia was impossible and her difficult airway and chronic lung disease imposed serious anesthetic challenges.We describe the importance of awake fiberoptic intubation (FOI) for airway management and general anaesthesia in this patient with difficult airway and spine and restrictive lung disease for total hip replacement.
