patients

TEmphysematous pyelonephritis (EPN) is a rare but potentially life-threatening necrotizing renal parenchymal infection characterised by the production of intra-parenchymal gas. The approach and the management of emphysematous has changed dramatically over the last two decades with the advent of computed tomography (CT)-based diagnosis and advances in antibiotic therapy as well as multidisciplinary intensive care of sepsis leading to an overall decline in mortality rates to 20-25%. The previously standard treatment for EPN which included nephrectomy of the affected kidney has been replaced by minimally invasive and nephron sparing surgery with better patient outcomes. We present our case series of 12 patients with EPN over a short period of two years treated at our tertiary care centre in South Western India.

Emergency medical care in palliative patients during the COVID-19 pandemic, it is important to provide a consistent treatment for stable patients that should be consistent with the goals and benefits, the perspective of these patients, but avoiding palliative patients with a poor prognosis that is unlikely to survive. Cancer is the second leading cause of death in the world around 8.8 million deaths a year. Worldwide, about 7-10 million patients are diagnosed with cancer each year, recently there has been a significant increase in the number of cases diagnosed with cancer. About 70% of cancer deaths are in low- and middle-income countries. The goals of emergency medical care based on the criteria of BLS and ACLS, that is should be done “Do not do resuscitation, do not intubate but continue medical treatment excluding endotracheal intubation without prospects for the patient, but offering BLS only treatment concentrated symptomatic. ED is often the only place that can provide the necessary medical interventions (e.g., intravenous fluids or pain management medications. Medications as well as immediate access to advanced diagnostic tests when needed such as CT, RM and other diagnostic and treatment procedures.

Trans-radial uterine artery embolization (UAE) is acknowledged as a non- invasive, cost-effective and safe procedure for the treatment of symptomatic fibroids. However, it is associated with the recurrence of symptoms like abnormal uterine bleeding and pressure symptom in some patients. This is a comparative study of our data with other international data, in the context of percentage reduction in fibroid size, accompanying controlling factors, short and long term follow up data analysis of the first two years was done. Careful pre-procedural counseling of future possibility of fibroid recurrence and means of management should be stressed. Materials and methods: A retrospective cohort study at the Security Forces Hospital in Riyadh, Saudi Arabia, was conducted. The study was done from 1st November 2017-31st October 2019, on symptomatic patients diagnosed with fibroids, who refused surgical treatment. The outcomes included: fibroid site, size and anatomical position, patients’ symptoms, general condition, and early and delayed complications. These data were compared with those from other international studies. Results: The study involved 23 patients (mean age: 39 years). The average percentage reduction in fibroid volume was 49%. There were no major complications and no recurrence of symptoms during the covered period. Data analysis revealed a poor correlation between the overall percentage reduction of fibroid size with fibroid number, age of patients’, and body mass indices. Conclusion: Despite poor correlation, we provided preliminary data of the first two years out of the total five-year projected period of the study where it showed effectiveness and relative safety of radial - UAE for fibroid.

Introduction: Chronic endometritis (CE) is a common cause of infertility in asymptomatic patients and its diagnosis and treatments improved assisted reproduction technique outcome in most of the specialized centers. Diagnosis of CE in endometrial biopsy by Hematoxylin and Eosin (H&E) stain is hard to identify chronic inflammatory cells from the stroma and the use of plasma cells-specific stains is helpful. Aim of the work: Evaluation of the use of CD138 in the identification of plasma cells in endometrial biopsy of patients with previous IVF trial failure. Material and methods: Hysteroscopic and curettage endometrial biopsies from fifty-five females with previous IVF trial failure were stained with H&E and CD138 immunostaining for detection of plasma cells. Results: Plasma cells were identified in 52.7% of cases by H&E and in 6/55 by CD138 immunostaining. CD138 is more sensitive in detecting plasma cells in endometrial biopsy than H&E stain. There was a significant statistical correlation between CE and abnormal uterine bleeding, abortion and primary infertility (p > 0.5). Conclusion: Diagnosis of CE is helpful in infertility patients with IVF trial failure to improve the outcome of the maneuver. CD138 is more sensitive for plasma cells specially in endometrial biopsies than H&E.

Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their live donor. We evaluated outcomes following PXM renal transplant despite failure to convert to negative flow cytometric crossmatch (FCXM) after desensitization. Patients that underwent desensitization before PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who received a transplant despite failure to convert to negative FCXM were identified as the not converted group. Patients who converted to negative FCXM after desensitization comprised the converted group control arm. 108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66). Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p=0.91. Patients with eGFR < 30mL/min at 3 years did not differ significantly (28% vs. 14%, p=0.15). Biopsy-proven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.

The article describes the interaction of anorexic patients, hospitalized in the Regional Pilot Psychiatric Service for the treatment of Anorexia in the Molinette Hospital of Turin, with the reading volunteering group. On the basis of said interaction, the Creative Self is searched for in patients and shows into be present in different ways. It seems anyway enhanced by the presence in the reading group.

Cystoisosporiasis (formerly isosporiasis) is caused by Cystoisospora belli (erstwhile named Isospora belli) is encountered globally, particularly in tropical and subtropical regions. Cystoisosporiasis is a human intestinal disease whose etiology is the parasite Cystoisospora belli with infection frequent in immunocompromised subjects, principally HIV-infected and AIDS patients. This coccidium parasite infects the epithelial cells and lining of the villi of the small and large intestines. C. belli is the least frequent of the three intestinal coccidia, viz: Cryptosporidium, microsporidium and C. belli which perturb humans. The clinical presentation of cystoisosporiasis gives a semblance of inflammatory bowel disease and irritable bowel syndrome, as well as other gastrointestinal symptoms, nausea, vomiting and diarhoea found in COVID-19, AIDS and HIV-infected patients. Research has not presented comorbid features of COVID-19 and cystoisosporiasis. The oocytes of C. belli are visualizable microscopically on wet mounts via bright-field, differential interference contrast (DIC) and epifluorescence. Trimethoprin sulfamethoxazole constitute the normal treatment of choice. C. belli,HIV-infected/AIDS and COVID-19 patients have clinicopathological correlates necessary to elucidate comorbidities and mechanisms of the diseases.

This article presents an overview of information regarding Acanthamoeba keratitis per epidemiology, host-pathogen interactions, clinical manifestations, risk factors, environmental implications, diagnosis, treatment and management as well as COVID-19 characteristics which may be taken into cognizance for suspected infected patients, researchers and ophthalmologic practitioners. Acanthamoeba spp. is pathogenetically ubiquitous in nature. Acanthamoeba keratitis is considerably an ocular-threatening and debilitating keratitis that exhibits contumacious characteristics which hinder or impede treatment or management. At inception, Acanthamoeba generally depicts atypical clinical features which are frequently misdiagnosed as other microbial keratitis. Fundamentally, it constitutes a rare corneal infection of which the aetiologic agent is the protozoon Acanthamoeba spp. in contact lens wearers, presenting features of severe ophthalmic distress, blurred vision, blepharospasm, ocular excoriation, extraneous entity sensation and photophobia culminating in aberrant visual functionality. These are perspicuously due to retarded prompt and adequate treatment and management. Personal and environmental hygiene, especially on the hands, face and ocular areas as advised for the COVID-19 protocol could prevent contamination and dissemination of Acanthamoeba keratitis infection. The differentiating relatedness of Acanthamoeba keratitis, COVID-19 ophthalmologic infections and other ocular problems may not have been clearly elucidated.

Objective: to determine the incidence of HBV and HCV in pediatric ward. Sitting: 2ed March teaching hospital, sebha Libya. Materials and Methods: this was a prospective hospital base study of pediatric cases admitted to 2ed March teaching hospital during a period from March 2018 to February 2019. Pediatric cases were studied for the incidence of HBsAg and HCV Ab by ELISA, Rapid technique. The positive result was confirmed with line immuno-assay. Results: the study showed positive HBsAg in 12 patients and HCV in 2 cases out 25 cases represented with acute hepatitis from a total of 1763 pediatric cases were submitted in this study, with incidence rate of 0.68% and 0.11% respectively. Conclusion: the incidence of HBV and HCV are low in Sebha, therefore active program need to be applied to control the spread of infection among the population.

A histopathological review preliminary of 429 patients diagnosed with tumours of the uterine corpus (TUC) cancer between 1984- 2010 in the Vigo University Hospital Complex (Spain) were evaluated prospectively for over 5 years. Of these 403 (93.9%) were epithelial tumours: 355 (82.7%) were adenocarcinomas of the endometrioid type, 5 (1.1%) mucinous adenocarcinoma, 10 (2.3%) serous adenocarcinoma, 17 (3.9%) clear cell carcinomas, 11 (2.5%) mixed adenocarcinoma, 4 (0.9%) undifferentiated carcinomas and 1 (0.2%) squamous cell carcinomas. A total 20 (4, 6%) were mesenchymal tumours: 4 (0.9%) endometrial stromal sarcoma, 7 (1.6%) Leiomyosarcoma, 9 (2%) Mixed endometrial stromal and smooth muscle tumour. A total 1 (0.2%) were mixed epithelial and mesenchymal tumours: (0.2%) Adenosarcoma 1. And 5 (1.1%) were Metastases from extragenital primary tumour (3 carcinomas of the breast, 1 stomach and 1 colon). The mean age at diagnosis from total series were 65, 4 years (range 28-101 years). Age was clearly related to histologic type: Endometrial stromal sarcoma 46.0 years, Leiomyosarcomas 57.1 years, Adenocarcinomas of the endometrioid type 65.4 years, Clear cell carcinomas 70.1 years and mixed endometrial stromal and smooth muscle tumours 71.2 years. Five-year disease-free survival rates for the entire group were: Endometrial stromal sarcoma 50%, Leiomyosarcomas 28.6%, Adenocarcinomas of the endometrioid type 83.7%, Clear cell carcinomas 64.7% and mixed endometrial stromal and smooth muscle tumours 44.4%. The 5-year disease-free survival rates of patients with Adenocarcinomas of the endometrioid type tumors were 91.4% for grade 1 tumors, 77.5% for grade 2, and 72.7% for grade 3. In conclusion, we describe 5-year histological and disease-free survival data from a series of 429 patients with TUC, observing similar percentages to those described in the medical literature. The only difference we find with other published series is a slightly lower percentage of serous carcinomas (ESC) that the Western countries but similar to the 3% of all ESC in Japan. Our investigation is focus at the moment on construct genealogical trees for the possible identification of hereditary syndromes and to carry out germline mutation analysis.

Background: Low back pain has recently been reported as the leading cause for disability worldwide. The diagnostic value of imaging has been estimated low. Led by own positive experience, however, we hypothesized that MRI can detect signs of facet joint pain. Methods: 15 patients and 15 controls were retrospectively assessed by two readers. They compared de-identified T2 weighted lumbar spine MRI scans. Facet joint size, shape, angle, joint space signal and degeneration were rated. Pain aetiology was proven with the diagnostic gold standard of medial branch blocks. Results: Facet joint angles and joint diameters were significantly larger in symptomatic patients, who also showed significantly higher grades of degeneration but no difference in joint space distances or shape or signal intensity. The readers were able to correctly identify symptomatic patients with good interrater reliability (kappa 0.5, sensitivity and specificity 0.87-0.93), positive (LR+= 6.7-7.2) and negative likelihood ratios (LR-=0.15). Conclusion: Contrary to recent publications, we could demonstrate differences between asymptomatic and symptomatic subjects showing the latter to have larger joints and more signs of degeneration. One can conclude from the strong LR+ and LR- values that MRI is a useful investigation to rule in or rule out facet pain.

Purpose: The purpose of the study is to access the prevalence of accessory right inferior hepatic veins and their relevant significance in liver transplantation. Materials and Methods: A retrospective study was done in which the CT of 82 potential liver transplant candidates between January 2012 and March 2013 were reviewed. The presence of the accessory right inferior hepatic vein was examined; the diameters of the accessory inferior hepatic veins and the distance between the point where they open into the inferior vena cava on the coronal plane and to the right hepatic vein-inferior vena cava junction was measured. Results: Out of 82 patients, 42 (51%) had accessory right inferior hepatic veins. Right accessory inferior hepatic veins larger than 3 mm were detected in 23 (28%) patients. The distance of these veins to the right hepatic vein-inferior vena cava junction was more than 4 cm in 13 (15%) patients. Conclusion: The precise preoperative knowledge of accessory right inferior hepatic veins is essential in living donor liver transplantation.

Background: Pyogenic liver abscesses (PLA) are frequent in immunosuppressed patients. We review the characteristics of patients with PLA at a tertiary academic Spanish hospital in Asturias. Methods: A retrospective observational study for 10 years, between 2006-2015. Epidemiological, clinical, analytical characteristics, treatment and hospital stay of the patients with PLA were analyzed. Results: 99 patients, 62 (62.6%) men, with age ≥65 years (72.7%). The most frequent etiology was: Biliary (40%), postsurgical (15%) and intestinal origin (11%). The most frequent clinical signs were fever, showing significant differences, abdominal pain (p=0.001) and nausea (p=0.02) between biliary PLA and the rest of the PLA. Microbiological results were confirmed in 63% (62 cases). All were treated with antibiotic therapy, along with percutaneous drainage (44.4% (44 cases)); and surgical drainage (12.1% (12 cases)). The overall mean stay was 23.1 days without significant differences between those treated with percutaneous drainage or surgical drainage. Conclusion: PLA predominate in patients ≥65 years. Biliary PLA are the most frequent, diagnosed at an older age than the intestinal PLA (p=0.005). - The treatment is based on systemic antibiotherapy and percutaneous drainage, especially in PLA only >5cm (p=0.019). - There are no significant differences in average stay of patients treated with percutaneous drainage or surgical drainage.

Background: Transcatheter arterial embolization can be used for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic treatment. Our aim to identify the clinical and technical factors that influenced the outcome of transcatheter embolization for therapy of upper gastrointestinal bleeding after failed surgery or after failed endoscopic treatment in high risk surgical patients. Methods: We performed a prospective study to analysis of the 15 patients who underwent Transcatheter arterial embolization for nonvariceal upper gastrointestinal bleeding at Alshifa hospital from January 2015 to March 2019. The following variables were recorded: demographic data, time from bleeding start to TAE, units of packed red cells before TAE and units of packed plasma before Transcatheter arterial embolization and we analysis 30 days rebleeding rates and mortality. Results: Patients treated with Transcatheter arterial embolization (median age: 62 years, range: 14–79 years).The technical success rate of the embolization procedure was 100%. Time from bleeding start to TAE was 2.1 (1-4) days , units of packed red cells before Transcatheter arterial embolization was 12.8 (4-22) packed and units of packed plasma was 3.2 (2-5) packed. Following 30 days after embolization, 2 (13%) patients had repeated bleeding and 3 (20.0%) patients died. Conclusion: In our experience, arterial embolization is a safe and effective treatment method for upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

Acute pulmonary damage and vascular coagulopathy appear to be frequent in patients with SARS-CoV-2 infection relation to corona-virus. The inflammatory process accompanying the infection and excessive coagulation state is one of the most important causes of patient loss.

Background: Even with current standard treatment after variceal bleeding which includes combination of nonselective b-blockers and repeated endoscopic variceal ligation, the risk of rebleeding and mortality are high. Statins exhibit an antifibrotic effect and improves HVPG. We evaluated whether addition of simvastatin to carvedilol plus EVL therapy reduces variceal rebleeds or death in patients with cirrhosis. Method: Patients with a variceal bleed 5 to 10 days before were randomly assigned to groups A [carvedilol (n = 69)] or group B [carvedilol (maximum dose - 12.5mg), and simvastatin (40mg/day) (n = 65)]. Primary end points were variceal rebleeding or death. Secondary end points were new complications of portal hypertension and serious adverse effects of drugs. Results: During a mean follow-up of 49.05 ± 25.74 weeks, composite end point i.e. rebleeding or death developed in 23 patients (33.3%) in group A and 12 patients (18.5%) in group B [HR for simvastatin = 0.512; 95% CI: 0.254 – 1.030; p = 0.06]. In subgroup analysis by excluding patients of Child C class, 18 patients (34.6%) in group A and 7 patients (13.6%) in group B developed composite end point [HR for simvastatin = 0.369; 95% CI: 0.154 – 0.887; p = 0.026]. 17.4% and 15.4% patients in group A and B developed additional secondary complication [HR = 0.86; 95% CI: 0.345-2.161; p = 0.75). No simvastatin induced significant adverse effects were found. Conclusion: Addition of simvastatin to carvedilol and EVL may reduce the rebleeding and death in patients with less advance liver disease.

Purpose: The purpose of this study was to evaluate biological dose in single-field optimization (SFO) and multi-field optimization (MFO) intensity-modulated proton therapy (IMPT) plans for brain tumor patients that used a fixed relative biological effectiveness (FRBE) and those that used a variable RBE (VRBE). Materials and methods: SFO and MFO IMPT plans were planned by the Varian Eclipse treatment planning system for three brain tumor patients. Dose and linear energy transfer (LET) distributions for each plan were recomputed using an in-house fast Monte Carlo dose calculator system, and then biological dose distributions were calculated with a FRBE of 1.1 or with a previously published VRBE model. We then compared biological dose distributions obtained by the VRBE with those obtained by the FRBE. Results: Doses obtained by the VRBE for the gross tumor volume and clinical target volume in all plans were 1%-2% larger than those obtained by the FRBE. The minimum dose obtained by the VRBE for the brainstem in the SFO IMPT of one patient was 140% larger than that obtained by the FRBE, but the difference was only 5.3 cGy (RBE). The difference in maximum dose for the optic chiasm in the MFO IMPT of another patient was less than 3.2%, but the dose difference was 149.2 cGy (RBE). We also found that no major differences were seen between the biological dose differences in the SFO IMPT plans and those in the MFO IMPT plans. Conclusion: We could observe biological dose differences between the FRBE and the VRBE in the SFO and the MFO IMPT plans for brain tumor patients.

Objective: To determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) to differentiate Benign and Malignant Parotid Gland Tumors taking histopathology as gold standard. Design: Cross sectional study. Place and duration of study: Department of Diagnostic Radiology, Lahore General Hospital, Lahore from January till July 2014. Methodology: 200 patients of age between 5 to 80 years of either gender with parotid gland swelling, having radiological evidence and clinical suspicion of parotid tumour like fixation to underlying skin, pain, facial palsy and cervical lymphadenopathy were taken. T1 and T2 plain and contrast enhanced 1.5 Tesla MRI unit using standard imaging coil was then carried out. Imaging was further evaluated for the presence or absence of benign or malignant parotid gland tumours using histopathology as a Gold standard. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MRI were taken against the gold standard. Results: There were 170 males and 30 females having mean age of 40.27±15.04 and 40.12±12.15 years respectively. Sensitivity, specificity, positive predictive value and negative predictive value of MRI were 90.4%, 89.33%, 93.39% and 84.41% respectively. The diagnostic accuracy of MRI to differentiate benign and malignant parotid gland tumours was 90%. These results were taken against surgery histopathology as a gold standard. Conclusion: MRI is highly accurate in differentiating malignant & benign tumours of parotid glands and can be used as an adjunct to histopathology for pre-operative evaluation of the parotid gland tumours.

Background: Biopsy findings of percentage of positive biopsy cores, percentage of cancer volume, and maximum involvement of biopsy cores have been shown to have prognostic value and correlate with magnetic resonance imaging (MRI) findings of extracapsular extension and seminal vesicle invasion. The relationship of these prognostic biopsy factors to MRI findings of the presence of a dominant lesion, has not yet been investigated. Methods: Sixty-five patients with intermediate risk prostate cancer were included in a retrospective cohort. MRI was acquired using either 1.5 Tesla (T) with endorectal coil or a 3 T MRI unit. Findings of extracapsular extension, seminal vesicle invasion, and presence and number of dominant lesions were noted. T-test and Cox regression statistical analyses were performed. Results: Patients with one or more dominant lesions on MRI had a significantly higher mean percentage of positive biopsy cores (56.7% vs 39.8%, p=0.004), percentage of cancer volume (23.5% vs 14.5%, p=0.011) and maximum involvement of biopsy cores (62.9% vs 47.3%, p=0.027) than those without a dominant lesion on MRI. On multivariate analysis, only percentage of positive biopsy cores remained a statistically significant predictor for a dominant lesion on MRI (Hazard Ratio 1.06 [95% CI 1.01-1.12; p=0.02]), whereas prostate-specific antigen, clinical T-stage, Gleason score, percentage of cancer volume, and maximum involvement of biopsy cores were not significant predictors of a dominant lesion on MRI. Receiver-operator characteristic analysis was done and a cutoff value of >=50% was chosen for percentage of positive biopsy cores, >=15% for percentage of cancer volume, >=50% for maximum involvement of biopsy cores. Conclusion: Percentage of positive biopsy cores was found to be a significant predictor for the presence of a dominant lesion on MRI. This finding is hypothesis-generating and should be confirmed with a prospective trial.

Meigs’ syndrome is a rare condition characterized by the presence of a benign fibroma of the ovary, ascites and pleural effusion. Other benign cysts of the ovary (such as struma ovarii, mucinous cystadenoma, serous cystadenoma and teratomas), leiomyoma of the uterus, and secondary metastatic tumours to ovary if associated with hydro thorax and ascites are referred to as ‘Pseudo-Meigs” syndrome. It very uncommon and diagnosis is made difficult by symptoms that usually mimic disseminated malignancy or tuberculosis. The gold standard treatment is laparotomy and, by definition of the syndrome, after tumor removal, the symptoms resolves and the patients become asymptomatic. We presented an 18 years old girl with giant ovarian serous cystadenoma with associated pseudo-meigs syndrome, successfully managed in a low resources setting.