The patients infected with the human immunodeficiency virus are not a homogeneous group and are generally living longer on human active antiretroviral therapy. They are amenable to the colorectal diseases in the general population for which colorectal surgery is safe and effective. Surgical intervention is obligatory in life-threatening surgical correctable disease, but aggressive surgical intervention must be undertaken with caution and adequate perioperative care is required. A close liaison between the human immunodeficiency virus/acquired immune deficiency syndrome physician and the surgeon will decrease negative laparotomies and exclude preterminal cases. The knowledge of anorectal sexually transmitted diseases is important, and the symptomatic improvement of anorectal pathology in acquired immune deficiency syndrome may render delayed wound healing an acceptable complication.
Megameatus intact prepuce is an unusual variety of the distal hypospadias, characterized by a widely splayed (fishmouth) coronal or subcoronal meatus, a deep glanular groove with normal prepuce, and no chordee. Physically, the glans penis has disunion with an abnormally large meatus associated with a deep glans cleft. Because the foreskin is intact, the condition is frequently overlooked; as a result, the patient seeks medical attention later, when the purpose is to address other urogenital issues. Cosmetic remodeling should be performed to avoid affecting a child’s psychological state. We present 2 cases of the mentioned condition (circumcised and uncircumcised) with blunderbuss external urethral meatuses, admitted to our pediatric surgery department. Both patients underwent tubularized incised plate urethroplasty along with spongioplasty and a vascularized dartos flap over the urethroplasty for fistula prevention. The cosmetic and functional results were satisfactory.
Monkeypox (MPX) has become a global health emergency, as declared by the World Health Organization (WHO). Primary symptoms include fever, headache, and rashes. There has been considerable concern about primary cutaneous symptoms and lesions, but other rare manifestations have been avoided. Neurological manifestations like headaches, malaise, myalgia, anorexia, and altered consciousness have also been reported. The Center for Disease Control and Prevention (CDC) has recently reported 2 cases of encephalomyelitis, which has caught the attention of the world’s health community. There is not enough evidence to explain the transmission of MPX to the central nervous system in humans. Previous studies on monkeypox-infected animals have reported probable transmission routes. Neuropsychiatric effects of MPX have also not been investigated. In this letter, we have highlighted various neurological aspects of MPX. This letter stresses the need to understand the biological mechanisms underlying these complications, so better measures can be taken to deal with them.
Introduction: Metanephric adenomas (MAs) of the kidney are rare benign epithelial lesions in the kidney that have been described in the literature, mainly through case reports, representing ~0.2% of renal masses. No prior case reports have been published from Nepal. We report one such case with MA presented to our center. Case presentation: A 25-year-old lady presented with complaints of recurrent hematuria for the past 6 months. Ultrasound of the abdomen revealed left gross hydronephrosis and reduced left renal parenchyma. A contrast-enhanced computerized scan of the abdomen and pelvis showed a heterogeneously enhancing soft tissue density lesion 65 mm×57 mm at the left renal pelvis extending into mid calyx and distally to proximal ureter, ~34 mm distal to pelviureteric junction causing moderate hydronephrosis, likely urothelial cell carcinoma. Urine cytology was negative for malignancy. Laparoscopic left nephroureterectomy with bladder cuff excision lymphadenectomy was done. The histopathology report came out to be consistent with MA and the lymph nodes were negative for malignancy. Immunohistochemistry study showed that the cells were positive for PAX8. During follow-up, she did not have hematuria and her postoperative period was uneventful. Discussion: From this report, we want to highlight the need to consider MA as a differential diagnosis of renal mass and differentiate MA from upper tract urothelial carcinoma, renal cell carcinoma, Wilms tumor, and papillary adenomas. Conclusion: MA is a rare renal lesion that may present as upper tract urothelial carcinoma. MA should be evaluated through histology and immunohistochemistry studies.
Dear Editor, Heatwaves are a type of weather phenomena that occur during the summer and monsoon seasons in Bangladesh. However, the definition of a heatwave is not standardized and can differ depending on the country and location. Heatwaves have a detrimental impact on human health, leading to conditions such as heat exhaustion, dehydration, and heat stroke. They are also having a complex effect on human economies as they can lower productivity, especially among informal sector and outdoor workers. Outdoor workers, including those in agriculture, are particularly susceptible to the high temperatures during heatwaves. They can quickly become dehydrated and experience symptoms such as heat stroke, fatigue, and cramps, which limit their ability to work for extended periods1. In fact, workers are unable to remain in one place for more than 6 hours if the temperature exceeds 35 °C, resulting in a significant reduction in productive working hours2. The fact remains that, heatwaves can be a cause for public health disasters. Recently Bangladesh has undergone the highest temperature in 5 decades—41.7 °C in Chuadanga3,4. With rising temperatures across the country, individuals who spend prolonged periods of time outdoors under direct sunlight are at a higher risk of experiencing heat stroke. When the body temperature rises, there is an increased likelihood of occurring heat stroke. According to a labor force survey conducted in 2010, ∼89% of the total jobs in the labor market in Bangladesh are in the informal sector5. These workers typically work outdoors and are not in air-conditioned rooms. They are more vulnerable. In 2022, Western Europe experienced a heatwave that resulted in more than 20,000 deaths6. It is worth noting that heatwaves are not a new phenomenon in Europe. The major heatwave that hit Athens in 1987 resulted in more than 2000 deaths7, and in 2003, a heatwave caused more than 70,000 excess deaths across Europe, with France being particularly affected8. In Bangladesh, at least 3800 people died from excess heat. The fact that at least two-thirds of those who perished were aged 65 or older demonstrates that the elderly are particularly susceptible to heat waves. Illnesses associated with heat are also a serious problem; however, due to the lack of health data, it is considerably more difficult to estimate or assess these disorders9. In Bangladesh, mitigating the effects of heatwaves on public health requires collaborative efforts from both communities and governments. One key strategy is to safeguard vulnerable populations and enhance access to cooling. This can be accomplished by providing air-conditioned spaces, distributing fans or other cooling devices, and improving access to safe drinking water to prevent dehydration. Furthermore, it is crucial for communities to cooperate in raising awareness about the risks of extreme heat and how to protect oneself during a heatwave. Public education campaigns can be launched, and health workers and first responders can be trained to recognize signs of heat-related illnesses. Information on how to stay cool and hydrated during a heatwave should also be provided. By taking steps to address the impact of heatwaves on public health, needless fatalities can be avoided, and the well-being and safety of all community members can be ensured during extreme weather events in Bangladesh. Ethical approval Not applicable. Consent Not applicable. Sources of funding None. Author contribution M.O.: manuscript: writing first draft; S.J.: study concept and design, manuscript: review and editing; H.M.A.: supervision, study concept and design, manuscript: review and editing; A.A.: manuscript: review and editing. Conflicts of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor Safayet Jamil. Data availability statement Not applicable. Provenance and peer review Not applicable.
Acquired immune-deficiency syndrome (AIDS) is becoming an increasing problem to the surgeon. The impact of HIV/AIDS on surgical practice include the undoubted risk to which the surgeon will expose him or herself, the atypical conditions that may be encountered and the outcome and long term benefit of the surgical treatment in view of disease progression. The two factors most associated with surgical outcome and poor wound healing were AIDS and poor performance status (ASA score). This article questions whether gastrointestinal surgical procedures can be safe and effective therapeutic measures in HIV/AIDS patients and if surgical outcome is worthy of the surgeon's ethical responsibility to treat. As HIV/AIDS patients are not a homogeneous group, with careful patient selection, emergency laparotomy for peritonitis confers worthwhile palliation. However, aggressive surgical intervention must be undertaken with caution and adequate peri-operative care is required. Symptomatic improvement of anorectal pathology may make delayed wound healing an acceptable complication. Alternatives to surgery can be contemplated for diagnosis, prophylaxis or palliation.
Introduction and importance: Chondronecrosis is a rare life-threatening complication of endotracheal intubation. Only few cases have been reported in the literature. Here, we present a case report and discuss the diagnosis of the condition, the causative factors, treatment through a literature review.Case presentation: We present a case of a patient with a history of severe brain injury, who developed a cricoid chondronecrosis after prolonged intubation. The complication was suspected when decannulation led to upper airway obstruction and was confirmed by laryngoscopy and computed tomography.Clinical discussion: The diagnosis is suspected in patients with upper airway dyspnea and a prior history of intubation. Multiple anatomical and host-related factors may contribute to the pathogenesis of this unusual entity. In addition to history and presenting symptoms, CT imaging can demonstrate some specific abnormalies.To date, there is no consensus on the best treatment for this condition.Conclusion: Cricoid chondronecrosis carry a high morbidity and therefore a timeous diagnosis and management of these injuries is essential to prevent fatalities.
Objectives: The aim of our study is to evaluate the organisms growing into the pus cultures of diabetic foot patients and to further document their sensitivity and resistance toward antibiotics. Methods: This study was conducted among admitted patients in the department of Medicine and Orthopedics, of a tertiary care hospital, including patients with known diabetes mellitus for the last 5 years, with a foot ulcer of any grade and a positive culture for bacterial growth. Cultures showing fungal growth were excluded. Results: There were 139 participants in our study with a mean age of 55.27 years, and mean HbA1c levels of 9.51%, 101 (72.66%) patients were males and 38 (27.33%) females. According to the Wagner classification; there were 48 (34.53%) patients in grade 2, 27 (19.42%) patients in grade 3, 54 (38.84%) patients in grade 4, and 10 (7.19%) patients in grade 5. The most frequently isolated bacteria were Staphylococcus aureus (43.16%), methicillin-resistant staphylococcal aureus (5.03%), Enterococcus species (5.75%), Streptococcus species (7.91%), Pseudomonas aeruginosa (20.14%), Escherichia coli (24.46%), Klebsiella pneumonia 7 (5.03%), Proteus vulgaris 6 (4.31%), Proteus mirabilis 3 (2.15%), Enterobacter species 7 (5.03%), Morganella morganii 2 (1.43%), and Acinetobacter 7 (5.03%). Amikacin was the most susceptible antibiotic to the majority of the microorganisms, followed by gentamicin, piperacillin/tazobactam, vancomycin chloramphenicol, and clindamycin. Among the resistant antibiotics, penicillins and cephalosporins were the notable ones. Conclusions: This study will decipher the bacteriological profiles among patients of diabetic foot ulcers according to their susceptibility and might be helpful to provide effective treatment.
Neurosurgical training in Sudan is organized by Sudan's Medical Specialization Board since 2003. Since its establishment, the program has graduated 54 Neurosurgeons; 12 of them are female Neurosurgeons. Candidates are required to complete their Internship year after receiving their MBBS degree to be legible to sit for the Neurosurgery Entry Exam (Neurosurgical MD first part exam). Successful candidates spend 6 years in the training program in which they rotate around 6 Neurosurgical centers. 18 months are spent doing elective shifts (3 mo each) and 54 months neurosurgical shifts (6 mo each). They are also required to complete compulsory courses in biostatistics, ethics, and medical professionalism. The thesis dissertation is also required as partial fulfillment before the candidate sits for the Exit exam (Neurosurgical MD second part exam). The pandemic has disturbed this process and affected neurosurgical training in the entire world; however, the toll it took on low-income countries, such as Sudan whose health care system was already suffering far exceeds that of other countries. Neurosurgical care is unequal worldwide, with up to 5 billion people from low and middle-income countries not having access to safe and affordable neurosurgery a year1. The Neurosurgical training in Sudan was already compromised due to a scarcity of resources to perform surgeries, an inadequate number of Neurosurgeons in the country to train residents, and preexisting problems in the infrastructure of the healthcare system. On top of these preexisting problems, the pandemic came with more problems to navigate and restrictions that played a role in compromising the Neurosurgical training of residents in the country (Fig. 1).Figure 1: Ice berg model of impact of COVID-19 on neurosurgical training in Sudan.The restrictions imposed by the COVID-19 pandemic have challenged previous models of neurosurgical training bringing forth the necessity to adopt emerging technological solutions2. In order to maintain social distancing and due to the lockdown many of the neurosurgical activities were canceled or spaced out. Teaching, academic meetings, lectures, and conferences were either canceled, decreased in frequency, or converted to online sessions thus compromising the in-person experience Neurosurgical trainees used to have before the pandemic. In addition to that, the number of in-patients also decreased as hospitals were trying to accommodate fewer patients, therefore, decreasing the number of cases inwards and decreasing the exposure of residents. While e-education has been a great tool to compensate for the lack of activities and keep the training process ongoing, for trainees in Sudan, a new set of obstacles came to life. The internet services in Sudan are not only expensive but also not stable enough. That coupled with the lack of training or knowledge to properly use online mediums to host and deliver lectures online. While a solution for the theoretical aspect for education was found. No alternative was found to compensate for the practical aspect as many of the elective surgeries were canceled. Despite the fact that emergency cases outnumber elective cases in Africa, surgery cancellations were noticeable3. In the early days of the COVID pandemic, the World Bank estimated that the cancellation of surgeries in Sub-Saharan Africa has reached 520,459 cases3. Moreover, the reasons behind the high rate of cancellation of surgeries could vary, including the restricted mobility during the lockdown, the fear of contracting COVID, and the closing of some health facilities4. The cancellation of surgeries took a huge toll on doctors in African countries like Sudan due to the low income from the governmental institutes. Fresh graduate doctor receives about 16,000 Sudanese Pounds which equals US$36.05 per month, which is below the poverty threshold (US$57 per month). Normally they get more financial benefits from the surgeries; therefore, their finances have decreased significantly during the pandemic5. This added insult to injury when it came to the preexisting problem of staff shortage in Sudan's health care system, even before COVID. One of the reasons contributing to staff shortages is the migration of doctors from Sudan, especially to the Gulf countries, to escape from the different difficulties in Sudan. The continuous infections, hospital admissions, and deaths from COVID-19, as so far, more than 40 Sudanese health professionals died due to COVID infection6, has reduced the number of the available doctors to provide patients with health services. Sudan's health care system is beset with challenges, including a lack of personal protective equipment and basic pharmaceuticals. Doctors and other medical personnel were confronted with the pandemic without the necessary equipment or even protective precautions for themselves and their patients3. Even before the pandemic, Sudan's health system was struggling to keep up with the daily influx of Neurosurgical patients. The large number of patient presenting to the fragile system, in comparison to available services, resources, and staff, has resulted in a complete imbalance and loss of flow within these facilities. Problems faced included overcrowding of rooms, contributing to the increase if nosocomial infections therefore posing a threat to the patients in the ward by subjecting them to the possibility of postoperative infections. Oncologists in Sudan were unable to strike a compromise between safeguarding themselves, their employees, and their patients while also performing necessary surgeries. As a result, several oncological surgeries and appointments were also postponed7,8. The impact of the pandemic on the educational system will definitely continue for the next few years9. This includes exams that were postponed during the pandemic, the pregraduate and postgraduate exams. Regarding the pregraduate exams, universities were not able to regularly organize lectures and exams along with putting students and tutors at direct risk to contract COVID infection. Therefore, there was an obvious delay in completing the curriculum in many Sudanese medical colleges, which reflected the critical shorting of staff during the pandemic. Postgraduate exams were deferred too, as an example, membership of the royal college of surgeons part A which was planned to take place in January 2022 was postponed to an unknown date10. Objective structured clinical examination (OSCE) exams have been affected significantly due to the pandemic, organizing OSCE exams became more challenging considering the person-to-person interaction that is needed most of the time, yet, many organizations worldwide have adopted online OSCE exams to carry on with the educational process, but then again doctors in Sudan do not have the appropriate facilities required to keep up with these changes. The COVID-19 pandemic was perceived in different ways by the people of Sudan which also contributed to the difficulty faced when it came to controlling the disease. To a small but significant segment of the Sudanese population, COVID-19 is a political game that was created by political parties in bids to secure the country's economic stability. Others argue that COVID-19 has been eradicated from the country and that the illness is simply a flu misdiagnosed as COVID-1911. Ethical approval None. Sources of funding None. Author contribution None. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None.
Covid-19 maintains influencing various areas of life in distinct geographic regions. Kurdistan Region has experienced the influences of this disease regarding the process of education. The authorities have been keen to contain these influences and took several measures towards this end. Universities were temporarily closed at the early stages of the outbreak of the Coronavirus1–3. With their opening afterwards, the educational process witnessed a shift. Instead of classical face-to-face education, digital learning became the dominant norm for a period. The process of education at the college of medicine in the University of Zakho became a hybrid process of these 2 modes temporarily4. The present article aims at illustrating the potential non-reporting of the Covid-19 cases by medical students at the University of Zakho during the fall term 2021/2022. Face-to-face reopening of universities in the Kurdistan Region started with a public concern about the spread of the Covid-19. The Ministry of Higher Education and Scientific Research issued health guidelines in relation with the reopening process of the universities. A major point of concern was associated with the commitment of students to the implementation of the health guidelines5. Administrative units at the University of Zakho instructed medical students to closely follow the health guidelines for the sake of the containment of the Covid-19. They implemented a mechanism that allowed students who tested positive for this disease to take temporary study leave. None of the students submitted to the administrative units a request for the study leave due to the infection during the fall term 2021/2022 (IA Naqid, personal communication, February 25, 2022). According to this procedure, this article argues that the students potentially did not report cases of Covid-19 during this period. Several variables provide an explanatory power for this circumstance. The very nature of the Covid-19 constitutes one of them. The old generally present strong symptoms of the disease. In association with the young medical students at the University of Zakho, symptoms of Covid-19 could very well be mild6. The campus of the university witnessed the launch of campaigns concerning the administration of the vaccination against the disease. These campaigns could have encouraged the staff of the college, the lecturers, and the students to take the vaccine against the Covid-19. The rate of the disease was accordingly influenced. A third illustrating factor regarding the absence of reported cases by the medical students at the University of Zakho was the necessary knowledge that they had about the Covid-19. The students were mainly armed with information about the symptoms of the disease, its effects, and its prevention. This background appeared to have motivated them to behave reasonably about Covid-19. The students were mainly committed to the implementation of protective procedures against the disease. They wore medical masks, practiced physical distancing, and followed hygienic measures. It also deserves to be mentioned that the general rate of Covid-19 in the Kurdistan Region during the last months of 2021 was low. This was positively linked with the rate of the disease in universities given the inevitable interaction between students and the wider population of the region7. The outbreak of the Coronavirus has influenced the educational process in universities in Kurdistan Region. In response to this circumstance, the authorities in the region took measures to allow education to proceed smoothly. In the case of the medical students at the University of Zakho, the fall term 2021/2022 seemed to be a successful experience in relation with the containment of the disease. This article attempted to illustrate this experience to contribute to the knowledge on the containment of Covid-19. It demonstrated that an availability of recommended guidelines combined with a personal commitment to their effective implementation has a positive correlation with the containment of Covid-19. Ethical approval None. Sources of funding None. Authors contribution Solo author. Conflicts of interest disclosure The author declares that there is no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Ahmed Ameen Mosa.
Introduction: Perforated peptic ulcer (PPU) is the fatal complication of peptic ulcer disease and is associated with increased morbidity and mortality of patients. Psychological stress significantly increases the risk of developing PPU. This coronavirus disease 2019 (COVID-19) pandemic causes fear and uncertainty, increasing psychological stress and perceived stress. This study aims to analyze the effect of COVID-19 pandemic high psychological stress as a risk factor for developing PPU. Methods: A cross-sectional study was conducted on all adult patients diagnosed and that underwent surgery for PPU from July 2017 to March 2021. The nonpandemic group consists of patients who underwent PPU surgery from July 2017 to February 2020 and the pandemic group from March 2020 to March 2021. Perceived stress is collected from the patient during the follow-up visit using an Indonesian version of the Perceived Stress Scale (PSS-10) questionnaire. Results: A total of 53 patients with PPU underwent surgery in our hospital. Twenty-five patients from the nonpandemic period and 28 patients during the pandemic period. There was a significant increase in postoperative complication or morbidity rate (78.5% vs. 52%; prevalence ratio: 1.51, 95% confidence interval: 0.99–2.31; P =0.041) in pandemic group. Stress level were also higher in the pandemic group compared with the nonpandemic group (42.1% vs. 5.6%; prevalence ratio: 7.58; 95% confidence interval: 1.05–54.69; P =0.006). Conclusions: COVID-19 pandemic impacts psychological stress, consequently increasing the risk of PPU and increasing morbidity.
Background: Preoperative fasting is compulsory before anesthesia to lower the risk of pulmonary aspiration. However, it is usually prolonged beyond the recommended time affecting the patient’s comfort and has several deleterious effects. Objective: To assess the adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia. Materials and methods: A multicenter cross-sectional study was conducted on 422 adult patients who underwent elective surgery at Addis Ababa public hospitals from February 20, to May 10, 2021. The collected data were entered into SPSS, version 24 for analysis. Spearman correlation and independent t test were used to assess the relationship between preoperative fasting time and explanatory variables, as appropriate. P value <0.05 was considered as statistically significant. Results: Majority (97.4%) of patients were instructed to fast from midnight regardless of the food type and schedule. Majority (98.1%) of the participants did not adhere to the preoperative fasting guidelines. The mean preoperative fasting time was 14.26±2.35 hours (range: 8–22 h) for solid foods and 13.89±2.37 hours (range: 8–21 h) for clear fluids. More than half (64%) of the participants felt preoperative discomfort, and factors contributing were thirst, hunger, mouth dryness, lengthy waiting of prior surgery, and tiredness. There was a moderate positive correlation between preoperative fasting time and severity of patient discomfort ( P <0.001). There was also a strong positive correlation between total fasting time and the sequence of patient’s schedule ( P <0.001). Conclusions: Preoperative fasting for solids and clear liquids was longer than the recommended international fasting guidelines. Preoperative fasting duration had an association with preoperative discomforting factors. Incorrect orders of instructions and changing sequences of schedule challenged the preoperative fasting adherence. Thus, preoperative fasting instructions should be clear, individualized; and health professionals need to communicate when surgery is delayed or changed.
Introduction: Cutaneous melanoma (CM) is a cancer of melanocytes that has a poor prognosis and can metastasize to any organ. Presentation of case: Here, we report a unique case of a 59-year-old Syrian male with a nodular melanoma (NM) that grew and varied rapidly on a large superficial spreading melanoma (SSM), which was a pigmented lesion that lasted for 24 years on his trunk. The lesion developed on a part of his body that had not been exposed to the sun or any artificial sources of ultraviolet radiation. His personal and family history of melanoma and nonmelanoma skin cancer were negative. The histopathologic evaluation, along with the immunohistochemistry examination, confirmed the diagnosis. Clinical discussion: SSM and NM are the most common subtypes of CM. NM has a more rapid growth rate and more aggression compared to SSM, and it tends to be more invasive, ulcerated, and fatal than SSM. Conclusion: Despite the advanced stage of the NM and the large size of the lesion, no metastasis or lymphadenopathy had been found during the patient’s follow-up.
Introduction: The novel coronavirus (COVID-19) causes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which rapidly became a worldwide pandemic. During the pandemic, accurate utilization of medical resources is required while maintaining the safety and well-being of patients and medical staff. This study assessed the safety profile of performing emergency surgical procedures for COVID-19 negative patients confirmed by reverse transcription-polymerase chain reaction (RT-PCR) preoperatively while positive patients were transferred to be managed at a designated COVID-19 hospital. Methods: This retrospective descriptive study included COVID-19 negative patients who underwent urologic and general surgery procedures for 3 months from March to May 2020. Demographic characteristics, operative and postoperative hospital course, and postoperative COVID-19 status were evaluated. Results: During the 3 months, 865 preoperatively COVID-19 negative patients were evaluated. All patients had uneventful postoperative courses except 2 patients who developed SARS-COV-2 infection postoperatively and were managed conservatively at an isolation facility. The first patient developed bronchospasms and fever upon intubation for laparoscopic appendectomy, with RT-PCR yielding a positive result, while the second developed symptomatic COVID-19 infection 18 days after emergency ureteroscopy. Conclusion: Routine screening for COVID-19 using RT-PCR before emergency surgeries provide an acceptable safety profile and cost-effectiveness. COVID-19 negative patients can be managed safely with standard precautions, while positive patients should be managed at designated hospitals.
Objectives: This study aims to evaluate the reliability of endometrial curettage in determining tumor grade and type in patients of endometrial cancer, and to study correlations between histologic and clinical findings. Methods: A retrospective cohort study was conducted between January 2014 and December 2020 at obstetrics and gynecology university hospital. A total of 75 cases of endometrial curettage with total hysterectomy using H&E stains were studied. Inter-rater reliability test was done. Results: The most common category in this study was endometrioid carcinoma in the sixth decade with second grade and first stage. Sensitivity was 93%. Positive predictive value was 93%. Conclusion: Endometrial curettage is a reliable investigation in evaluating endometrial cancer. Determining tumor grade and type are possible on the initial report of endometrial curettage thus, using it for therapeutic management for patients of endometrial cancer.
Introduction: Schwannoma is a gradually growing encapsulated benign tumor arising from the Schwan cells of the peripheral nerve sheath. This study aims to report a rare case of tongue cellular schwannoma. Case presentation: A 15-year-old boy presented with a swelling of the posterior part of the tongue that had started 2 years prior. On examination, a large mass was seen in the posterior part of the tongue. It was smooth, mobile, and nontender on palpation. A contrast computed tomography scan of the neck revealed an irregular, ill-defined, thick-walled cystic lesion. Magnetic resonance imaging demonstrated a well-circumscribed, enhancing mass measuring about 5×4.56×4.59 cm and causing compression upon the oropharyngeal airway. Histopathologic examination revealed a cellular schwannoma. Discussion: Histologically, all schwannoma tumors are encapsulated. Under the capsule, there are 2 specific patterns associated together, but they can be easily differentiated from each other. The first one is made up of firmly aggregated Schwan cells arranged in rows with palisade and enlarged nuclei which are known as Antoni type-A. The second one is the Antoni type-B that consists of weakly packed Schwann cells. Conclusion: Tongue schwannoma is regarded as a solitary encapsulated benign tumor that may cause complications like difficulty in phonation. The primary treatment modality usually is transoral excision.
Introduction: Vagal paraganglioma (VP) is a rare tumor of the vagus nerve (VII). This study aims to present a rare case of VP extending to the brain. Case report: A 35-year-old woman presents with neck swelling for 1 year. On examination, there was an ill-defined hard mass involving the left side of the anterior neck, fixed in all directions. A neck ultrasound revealed an irregular mass attached to both carotid arteries. A computed tomography scan showed a large lobulated, intensely enhanced mass encasing left carotid carotid vessels. Total resection under general anesthesia was done. Histopathologic examination revealed VP. Discussion: VP is the rarest form of paraganglioma and accounts for <5% of all head and neck paragangliomas. The average age of diagnosis for these patients is reported to be 45 years. VP poses a therapeutic challenge due to its anatomic location, and surgery is often associated with a significant rate of postoperative morbidities, particularly loss or impaired vagus nerve function. Conclusion: VP is a rare tumor of the head and neck, even rarer in young adults. A standard management approach is absent for these cases.
Introduction and importance: The simultaneous development of Kasabach-Merritt syndrome (KMS) and focal nodular hyperplasia (FNH) in the same individual is rare. This study aims to report the coexistence of KMS and FNH in a 32-year-old female. Case presentation: A 32-year-old woman presented to the gastroenterology clinic complaining of heavy menses, fatigue, and hematuria. Physical examination revealed multiple ecchymoses on the skin. Abdominal computed tomography scan revealed a large hepatic lesion with features of atypical hemangioma. Complete blood count showed normochromic, normocytic red blood cells, and thrombocytopenia. Surgery was decided based on a clinical diagnosis of KMS resulting from a giant liver hemangioma. Histopathologic diagnosis of the resected lesion was FNH. Clinical discussion: KMS, which refers to a giant hemangioma associated with thrombocytopenia, was initially described by Kasabach and Merritt. It occurs in nearly 1% of hemangiomas and primarily affects infants. KMS is a life-threatening condition that could be fatal if adequate, timely treatment is not administered. FNH is a benign hepatocellular neoplasm with a predilection for females. Conclusion: KMS and FNH are 2 distinct conditions that can rarely co-exist in the same patient. Corticosteroids, radiotherapy, and surgical resection are the primary modalities of treatment.
An essential nutrient, vitamin B12 acts as coenzymes for the conversion of homocysteine (HCY), a sulfur-containing amino acid to a methionine. High HCY is an indication of vitamin B12 or folic acid deficiency, commonly involving the cardiovascular system and resulting in damage to major organs. The normal level of HCY is <15 µmol/L. When the level crosses 50 µmol/L, known as hyperhomocysteinemia (HHCY). Whenever excess HCY accumulates in the blood, causes disruption of the arterial lining by the process of inflammation and reactive oxygen species. Evidence of blood coagulation and vascular calcification have been found also1. Damaging of arteries can give rise to complications such as atherosclerosis, coronary artery disease, stroke, fibrillation2. Homocysteine is regarded as an independent risk factor for developing cardiovascular disease. Patient with end-stage renal disease or acute kidney injury has compromised renal excretory function. As a result, HCY piles up in the blood and gives rise to cardiovascular complications—a global cause of mortality in renal failure patients3. Traditional risk factors such as diabetes, smoking, obesity are not sufficient to explain the high death rate due to cardiac problems in renal failure patients. Thus, a nontraditional biomarker, HCY is being used nowadays. Obese women with high HCY are at a high risk of developing chronic renal failure, where reducing weight has proved a positive impact4. Abnormal HCY and DNA methylation are interrelated. High HCY results in demethylation of DNA, which is responsible for psoriasis—a multifactorial chronic inflammatory disorder of the skin. Mortality from myocardial infarction, stroke is commonly found in psoriatic patients. HCY is known to have atherogenic properties5. Along with oxidative stress, inflammatory cells and cytokines play an important role to develop plaques and resulting in cardiovascular complications6,7. A choice of treatment might be artificial narrowband ultraviolet ray B for these patients to reduce cardiovascular events8. Coronary artery disease has been reported as the primary cause of death in type 2 diabetes mellitus (DM), which finally developed into acute myocardial infarction and can also lead to macrovascular and microvascular complications. Elevated HCY interrupts the blood-retinal barrier and is associated with age-related macular degeneration9,10. The relation between thyroid antibodies and HCY in hypothyroid and hyperthyroid is been clear. HCY is impaired in defective thyroid function. Thyroid peroxidase antibody influences HCY to cause cardiac events in graves' disease11. HHCY in subclinical hypothyroidism and autoimmune thyroiditis increase the tendency of atherosclerosis and coronary artery disease by stimulating chemokines and lowering circulating anti-oxidants12. Homocystinuria, a rare genetic disorder presents with valvular disease and atherosclerosis. Decreasing HCY can potentially reduce cardiovascular risk13. HCY is toxic to our neurons and leads to Alzheimer disease, Parkinson disease, stroke. HCY promotes reactive oxygen species and blood clotting. In traumatic brain injury blood-brain barrier integration is disrupted and inflammatory cells get infiltrated, gradually plaque formation is the outcome14. Levodopa is the treatment of choice for Parkinson disease. In these patients, dietary supplementation with vitamins and folic acid can markedly reduce the level of HCY15. High HCY also promotes brain atrophy. In modern days, the significant role of HCY has widely been practiced as a biomarker not only for prognostic purposes but also for diagnosis and treatment. The positive response is found in treating patients with coronary artery atherosclerosis16. Complete metabolism of HCY requires folic acid, vitamin B6, and vitamin B12. Folic acid degrades HCY and prevents deleterious effects on arterial walls. This also improves endothelial function. Therefore, complimentary folic acid with or without vitamin B12 can improve vascular activity and counter mortality and morbidity from cardiovascular complications17. Ethical approval None. Sources of funding None. Author contribution All authors contributed equally to the manuscript. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Md Moshiur Rahman.
