Articles

Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L.Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.

Hydatid cysts primarily affect the liver and secondary involvement may be seen in almost any anatomic location. We describe the unusual pericardial location of the Echinococcus cysts in an asymptomatic patient with suggestive cardiac magnetic resonance imaging.

Polychlorinated dibenzo-p-dioxins, dibenzofurans and dioxin-like polychlorinated biphenyls are persistent organic pollutants (POPs), which in recent years received huge attention due to their extreme stability, high potential toxicity and bioaccumulation in food chains. The main source of human exposure to these compounds is discovered in foods of animal origin, especially foods rich in fat. The target of the present study was to set up an analytical method for the determination of PCDDs/PCDFs and DL-PCB in vegetable oils, sunflower meals, sunflower seeds, rapeseeds and milk powder. The first step consisted of a semi-automatic Soxhlet extraction for 3 hours, by using a mixture of Hexane: Acetone – 80:20, followed by acid digestion with 55% acid silica and filtration. After concentration, the extract is purified on a multilayer column (silica gel, silica-KOH, silica-H2SO4 anhydrous Na2SO4) followed by an alumina column separation in two fractions (first fraction containing PCDDs/PCDFs and second containing only PCBs). The purified extract was then analyzed by GC/MS/MS. The newly developed approach in our lab was capable to reduce the overall time of sample preparation to seven hours/ per sample. Since the method shows good mean recoveries for all labeled congeners spiked in the samples (for PCDDs/PCDFs – 80% - 110%, for DL-PCBs – 70% - 85%), we assumed the absence of overestimation or underestimation in the analyzed samples.

The terms urotherapy and urotherapist are often mentioned in the literature, but their origins and meanings are less well-known. Objective: To describe the background and development of the concept of urotherapy in pediatric care and the profession of urotherapist.Methods: Data has been searched for in Medline PubMed and selection has been limited to papers important for the purpose.Results: Understanding of urinary bladder function was developed in the 1970’s, mainly due to new urodynamic methods opened up for possible treatment options. Standard urotherapy is a concept developed in the 1980’s and aims to treat dysfunction by helping the patient to learn to understand bladder function and then practice certain techniques in order to normalize it. To succeed, guidance and support are needed from a skilled urotherapist. In Scandinavian and German-speaking countries, quality-assured training for urotherapists at the university level is available.Conclusion: Urotherapy standard therapy is a non-invasive treatment recommended as the first-choice treatment for lower urinary tract disorders. However, we must have requirements as to what knowledge a urotherapist needs to have, and training has to be certified and be at the university level.

Background: Ovarian fibroma is a very unusual epithelial tumor representing less than 1% of all ovarian tumors. It can be asymptomatic and discovered during surgery or be associated with a pleural effusion preferentially located on the right side and a more or less abundant free ascites in the framework of the so-called Meigs syndrome. The challenge of management then lies in distinguishing benign from malignant since clinically, radiologically, and biologically everything points towards malignant which requires radical surgical treatment. We report here the case of a 69-year-old postmenopausal patient with a clinical form of Meigs' syndrome that strongly suggested ovarian cancer.Case presentation: We hereby report here the case of a 69-year-old patient, menopausal, gravida 4 para 3 with 3 live children delivered vaginally and one miscarriage. She presented with ascites, hydrothorax, and a solid tumor of the ovary. Serum CA 125 and HE 4 levels were very high. ROMA score was highly suggestive of malignancy. A hysterectomy with adnexectomy was performed. It was only the histological evidence of ovarian fibroma and the rapid resolution of its effusions that confirmed Meigs syndrome.Conclusion: Meigs syndrome is an anatomical-clinical entity that associates a benign tumor of the ovary, ascites, and hydrothorax. Highly elevated CA 125 and HE-4 tumor markers often point clinicians toward a malignant tumor and compel radical surgical treatment. This case report reminds us once again that only histology confirms the diagnosis of cancer.

Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment.Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful.Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.

Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP).Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05.Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI.Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.

Cancer is a disease that implies several different genotypic and phenotypic traits in its whole process of development: tumorigenesis.

Introduction: Percutaneous kidney biopsy is a necessary tool to diagnose many kidney diseases. However, major complications were reported in adults, including bleeding in the kidney or around it, creation of arteriovenous fistula, wound infection, damage to adjacent organs, or even loss of the kidney. Such complications can rapidly develop serious consequences. Exploring risk factors might help in preventing them.Objective: The current study aims to evaluate and explore the complications that happened after percutaneous kidney biopsy in children and associated risk factors.Methodology: A retrospective record-based study was conducted by reviewing the medical records of children with post-ultrasound-guided percutaneous kidney biopsy complications at King Saud Medical City, a tertiary hospital in Riyadh, Saudi Arabia during the period from May 2014 to June 2021. Data were extracted using pre-structured data collection sheet. Data collected included children’s age, gender, primary disease, laboratory findings, and kidney complications with needed management. Results: The study identified 76 children who had undergone 86 ultrasound-guided percutaneous kidney biopsies in the study period and fulfil the inclusion criteria. Children’s ages ranged from 1 years to 15 years with a mean age of 7.3 ± 4.0 years old. Most of the study children had nephrotic syndrome (61.6%; 53), followed by glomerulonephritis (25.6%; 22). Thirty-five (40.7%) children developed at least one of the complications. The most-reported complication was microscopic haematuria (32.6%; 28), followed by gross haematuria (3.5%; 3), Flank pain was reported among 3 (3.5%) children also and hematoma (1 child), only 2 children (3.9%) among those who had no complications recorded Haemoglobin drop > 2 g/dl compared to 3 of those who had complications with no statistical significance (p = .365). Prothrombin time was significantly higher among children who had renal complications than others who had not (11.7 ± 1.8 vs. 10.8 ± 1.2 seconds; p = .022).Conclusion: Suggestive by the low need to intervene in complications, ultrasound-guided percutaneous kidney biopsy is a relatively safe procedure in children. Even in the most commonly observed complication, i.e. hemorrhagic ones, blood transfusion is rarely needed.

Introduction: Diabetes mellitus and diabetic nephropathy are the most common causes of end-stage renal disease (ESRD) in developed countries, accounting for about 30% of these cases. Up to 40% of patients with type 2 diabetes with micro albumin uria progress to overt nephropathy and develop ESRD after one to two decades. Albumin uria is the most important indicator of diabetic nephropathy and its progression. Also, hyperuricemia has been suggested as a risk factor for kidney damage, this study was designed to determine the relationship between serum uric acid level and proteinuria in patients with type 2 diabetes.Materials and methods: In this descriptive-analytical and cross-sectional study, data collection was performed among patients with type 2 diabetes referred to the diabetic Center in Gorgan from the years 2015 to 2018. The data collection tool was a two-part questionnaire including demographic and anthropometric characteristics and information about the disease. Serum levels of Uric Acid, Blood Urea Nitrogen (BUN), Creatinine (Cr), Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1C) were measured in all patients. 24-hour urine collection was performed for proteinuria, albuminuria, urinary volume, and Cr volume. Patients’ GFR was also calculated using the CKD-EPI formula. Patients were re-evaluated 1 year after the initial evaluation in terms of measured factors and the relationship between serum uric acid and albuminuria, proteinuria, kidney function, and other serum factors were evaluated.Results: Among 823 diabetic patients that were referred to the nephrology center in this study, 90 patients were included. 34 (37.8%) of these patients were men. The age range of patients was between 32 years to 70 years with a mean of 56.31 and a standard deviation of 7.84 years. According to the Pearson correlation coefficient, a direct correlation was observed between uric acid with proteinuria and creatinine levels, and an inverse correlation was observed between uric acid and GFR. But we didn’t find any correlation between uric acid and microalbuminuria.Conclusion: According to the results of this study, the relationship between uric acid level and the severity of nephropathy (based on proteinuria) is proven. It seems that maintaining serum uric acid levels in patients with type 2 diabetes within the normal range and treatment with serum uric acid-lowering drugs may be possible to reduce the progression of diabetic nephropathy and proteinuria.