All Articles in march, 2021

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the most severe form of congenital malformation of the inner female reproductive tract. It is diagnosed as such when the uterus, the upper vagina and optionally the Fallopian tubes are absent. It accounts for approximately 1 in 5000 live-born females and has been classified in two subtypes: type 1 in the presence of isolated uterovaginal aplasia and type 2 when associated in various combinations with extragenital malformations of the kidneys, skeleton, heart and auditory system. Most cases of MRKH syndrome are sporadic, although a significant number of many familial cases have been reported to date. Despite numerous studies, the genetics of the syndrome remains largely unknown and appears to be heterogeneous: chromosomal abnormalities and some candidate gene variants appear to be associated with a few cases; others have been suggested but not yet confirmed. To date, mainly the GREB1L gene appears to be a serious candidate. Among the remaining hypotheses, the controversial contribution of partial duplications of the SHOX gene is still puzzling, as the deficiency of this gene is a major cause of skeletal adysplasia syndromes. We have attempted to resolve this controversy in a study of 60 MRKH cases. Our results tend to show that SHOX duplications can be the origin of a genetic mechanism responsible for MRKH syndrome.

It is the dart that penetrates deep into my soul, every time I see with my own eyes how the incidence of cancer has grown in recent years. I am a pathologist. I am dedicated to diagnosing the disease from the cellular and tissue point of view. The answer to the question that haunts me may seem easy, simple, but I am not satisfied with knowing that advances in technology make it possible to diagnose a greater number of entities, many of them in early stages [1]. Of course, this statement is true. However, in recent years we have verified a greater number of cases with aggressive phenotypes, a fact that makes us ask ourselves certain questions. The first one is: Why? We know that cancer is a multifactorial disease in which genetics and different environmental factors participate. Are we witnessing the concurrence of factors that facilitate the greatest degree of neoplasms? Are habits the cause of this paradigm shift? On the table for debate is the therapeutic success of new strategies, of new drugs, of new algorithms, but the morphology is also changing. This change is exacerbated in the times of pandemic that we have lived through [2]. Pathologists attend a number of cancer diagnoses that have grown exponentially, as has the histological grade, not the staging, of it. And the initial question remains in the air, why? The fear of going to the hospital, the fear of self-exploration, the diversion of media attention to topics that arouse greater interest ... may be having a harmful effect on the health of patients [3]. I do not tell anything new, at least nothing that cannot be assumed by analyzing what happens every day in this new world, a world that will soon have to face, if not already, a cut in resources, research and other parameters that will negatively influence the answers to the eternal question: Why? In the era of personalized medicine, the same one that has reached or is close to reaching great milestones in the survival of once-deadly diseases, the microscope shows a parallel reality and allows, at least, to be pessimistic, or at least realistic: suffering…

A clinical case of treatment of two severe intrabony defects on the aesthetic zone is reported and followed for one year. The biomaterial of choice was enamel matrix derivative (Emdogain®; Straumann™) alone with a preservation papilla flap and a minimally invasive surgical technique. After surgical treatment, the patient was kept in a supportive periodontal therapy programme with 6-month interval between appointments. In the one year after surgery appointment, clinical and radiographic changes were observed, showing periodontal health and stability. 

Background: The acaricidal action of Ozonized sunflower oil (OSO) has demonstrated in different clinical cases of different animal species, such as psoroptic rabbits and pig sarcoptic scabies and recently in demodesic goat. Objectives: This study evaluated the effectiveness of OSO as treatment for generalized demodicosis mange in dogs. Animals: Twenty dogs of different breeds, between six months and one year of age with generalized demodicosic mange that attended to Veterinary Clinic “José Luis Callejas” Havana, Cuba, during the year 2015, were included in the study. Methods: The demodicosis diagnostic was based on its clinical history, the mite’s presence by deep scraping and clinical signs. All cases had a history of receiving before conventional treatments without solution. OSO treatment was topically applied daily, every 12 hours, after shaving all affected areas. Monitoring of clinical signs, mite counting on scaling, pruritus and capillary regrowth (7, 14, 28, 56 and 84 days) were performed. Results: The results showed a significant reduction of mite counts, clinical signs and pruritus since the 7th day of application. The animals recovered the fur on more than 90% of the body surface. All the animals (100%) recovered from generalized demodesic mange in 84 days of treatment. Conclusion: The effectiveness and safety of OSO as election treatment of generalized demodicosis mange in dogs was demonstrated.

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.

 23-year-old man had a 2-year history of ketamine abuse and presented intermittent abdominal pain, urinary urgency and dysuria for one year. Two weeks ago, laboratory analysis showed within normal limits. This time, he visited our emergency department due to hematuria and bilateral flank pain. CT scan and MRI revealed bilateral hydronephrosis, hydroureter, irregular thickened wall of urinary bladder, and fusiform common bile duct with distal stenosis

A 58-year-old hypertensive man presented to our insti-tution with acute chest pain and dizziness. Electrocardiogram revealed inferior wall myocardial infarction with suspected right ventricular involvement (Figure 1A). Computed tomographic aortography (CTA) depicted ascending aortic dissection (AAD) with involvement of bilateral carotid, subclavian, and right common iliac arteries (Figure 1B). Replacements of aortic valve and ascending aorta with CABG (Ao-RSVG1-LAD and Ao-RSVG2-RCA) were conducted. 

The research was conducted in the Gross section of Veterinary Anatomy laboratory with the aim of preparation and comparing some skeleton bones of local domestic turkey and guinea fowl. Samples were purchased, sacrifice, feather and excess flesh were removed and boiled using water to produce the bones. The duration of process was recorded. Comparative biometry study was conducted on some selected bones (scapular, coracoid, furcular and tibiotarsus) and the bones were mounted using wooden stand, copper wire, and adhesive gum with the aim of enhancing avian teaching. Based on the processes of the research. It was recommended to use plastic materials in production of skeletal models to avoid deterioration of bones for proper teaching in veterinary anatomy.

Cervical cancer constitutes an issue in public health, becoming the leading cause of death by cancer in women between 20-40 years of age in Latin America. In Argentina 5000 new cases are diagnosed each year, where more than 56% are in advanced stages. The aim of the present current opinion or critical review article is to remark the importance of the prognostic significance of the Central Tumor Size in stages IIB and IIIB cervical cancer, as well as to propose a new FIGO Staging System for Cervical cancer and trying to find out a role for the different therapeutic strategies for those cases.

A 79 years old woman presented with one-day history of pain, redness, pain and swelling without discharge in her left ear, later her right ear started with the same symptoms as in her contralateral ear spreading around the scalp and the forehead (Figure 1), she denied fever, or other constitutional symptoms. 

From my desk I could be watching the wind blow or the horses running. Practicing Medicine in a rural setting has these advantages: from time to time you can take the time to admire the beauty that surrounds you in the form of an obligatory pause within a marathon working day, and rest helps refresh your mind of prejudices to continue with the inescapable task that awaits us after a few minutes, the only ones allowed to order our thoughts.

Acute and subacute ischemia of the lower limbs represents a major emergency with a high in-hospital mortality, complication, and leg amputation rates. Treatment options for acute limb ischemia include systemic anticoagulation, followed by various catheter based options including infusion of fibrinolytic agents (pharmacological thrombolysis), pharmacomechanical thrombolysis, catheter-mediated thrombus aspiration, mechanical thrombectomy, and any combination of the above or open surgical intervention (thromboembolectomy or surgical bypass). Minor and major bleeding complication during catheter directed thrombolysis (CDT) especially at access site are frequent. Bleeding complications require often an interruption or termination of CDT affecting clinical outcome of the patients. Recently we examined a new access site bleeding protection device during CDT.

Introduction: Obesity defined as increased fatty mass is progressively rising in recently, even though its affects begins to all systems in childhood and adolescence periods, the most important morbidity and mortality reason of obesity is its effects on the cardiovascular system. Researches point out endothelial dysfunction and atherosclerosis as the reason of the cardiovascular system disease in obesity. The studies conducted on childhood period related to this subject are highly limited and the results of these are also controversial. Therefore in our study the effects of obesity on endothelial functions in children and adolescents was assessed by flow mediated dilation (FMD) method. In addition to that, effects of epidemiological, biochemical, hormonal and clinical features of cases to FMD were investigated. Material and method: A total number of 104 cases were cover in this study. Obese group (group 1) was consisted of 59 children whose body mass index (BMI) was ≥ 95th percentile and mean age was 12 ± 2.8 years old. The control group (group 2) consisted of 45 children whose body mass index (BMI) was between 25th -84th percentil and mean age was 11.4 ± 2.9 years old. The detailed history, epidemiological data and physical examination were performed. The population classified three groups according to sport activities. 97th percentile and higher values were accepted as morbid obesity. The blood pressure was measured with a mercury sphygmomanometer with utilizing the proper size cuff in compliance with the criterion used by the “National High Blood Pressure Education Program Working Group”. The complete blood count and biochemistry tests (renal and liver function tests, electrolytes, lipids, hsCRP) of the cases were analysed with biochemistry Roche Cobas Integra 800 and hormon assays of the cases (thyroid function tests, diurnal cortisol, ACTH, 17 OHP, prolactin, DHEA-S) were analysed by ECLIA method on Roche Elecsys 2010 device in the laboratory of our hospital. IR-HOMA values > 2.5 in prepuberal and > 4 in pubertal were defined as the insulin resistance. Bone ages of cases were evaluated with left hand wrist X-ray by using Greulich and Pyle Bone Age Atlas. flow mediated dilation (FMD) was used to assess the endothelial functions of all cases. The brachial artery was evaluated with SPG 12 MHz surface probes by using GE voluson ultrasound system in this method. FMD was expresses as percent (%) increase according to the basal vein dimension. 7% mean value was taken as the limit in the comparisons. Results: The ratio of male and female was 20/39 in group 1 and 14/31 in group 2. 32.3% of the cases in group 1 and 47.6% of the cases in group 2 were prepubertal. The waist and hip circumferences ratio of the group 1 (0.86 ± 0.05) was significantly higher than group 2 (0.80 ± 0.07). While there was no difference between groups 1 and 2 in terms of the birth weight, using duration period of vitamin D and beginning time to additional nutrition, breastfeeding duration of group 1 (10.6 ± 7.8 months) was significantly shorter than group 2 (14 ± 7.4 months). BMIs of the mothers in group 1 were statistically higher than the mothers in group 2 (27.5 ± 4.8 kg/m² and 24.3 ± 3.2 kg/m² respectively. The mean of IR-HOMA was 4 ± 2.9 in group 1 and 1.9 ± 0.8 in group 2 and there was the insulin resistance in 51% of the obese cases. The dyslipidemia was diagnosed in 38.5% of the cases in group 1. The systolic and diastolic blood pressures in group 1 (117 ± 12.2 mmHg and 73.7 ± 9.4 mmHg respectively) were significantly higher than in group 2 (107.5 ± 9.1 mmHg and 68.2 ± 7.1 mmHg respectively). Hypertension was determined in 25% of the cases included in group 1. The minimum values of FMD in groups 1 and 2 were 1.01% and 3.1% respectively. The maximum values of FMD in groups 1 and 2 were 9.7% and 15% respectively. The mean values of FMD was %5 ± 2.3 in group 1 and %8.1 ± 3.5 in group 2. Compared with group 2, group 1 demonstrated significantly impaired FMD. There was no association between FMD and the birth weight, breastfeeding duration, physical exercises in two groups. A negative correlation was found between FMD and BMI (p < 0.01, r = -0.402). The correlation was determined between FMD and BMI of the mother (p = 0.017, r = -0.305) and the presence of obese individuals in the family (p = 0.021, r =-0.413). It was found that a significant negative correlation between FMD and waist-hip circumference ratio (p = 0.003, r = -0.421). When each groups were assessed in terms of biochemical and hormonal characteristics, there was low negative correlation between FMD and uric acid level and strong negative correlation between FMD and ALT level were determined in group 1. Conclusion: In our study showed that the obesity begins in the childhood period may cause to the endothelial dysfunction. For this reason, according to our opinion, recognition prior indicators of endothelial dysfunction in early time may be helpful both to take the precautions required and to prevent cardiovascular complications in childhood and influences to the adult period. The rising sizes of the waist and hip circumferences, positive family history for obesity and obesity of the parents were determined as the most important parameters negative affecting FMD. Unlike the literature, the association between endothelial dysfunction and GGT level the indicator of the hepatosteatosis in obese children was also found as well as FMD and ALT have also a close association independent from BMI in this study. Thus, a different point of view was formed since ALT may possibly have a predictor value in the assessment of the endothelial functions and it is also found as a highlighted risk factors for the endothelial dysfunction in this study. Because of this reason, it can be recommended that when the liver function tests carry out in obese children it does not show only hepatosteatosis but also can be used as an early indicator of the cardiovascular complications of obesity. Another important subject to be emphasize that the ALT level in the childhood period may be an early cardiovascular risk indicator in both obese and nonobese children.