A case of oncocytic papillary cystadenoma in a 72-year old woman, a rare tumor of laryngeal seromucinous glands of unclear nature is presented. The patient had a history of chronic inflammation of laryngeal mucosa and both her age and tumor location were typical. The lesion was resected transorally without complications. Histological findings are shown in the present study. The controversial status of oncocytic papillary cystadenoma as either a true neoplasm or a combination of metaplastic and hyperplastic changes, its resemblance to Warthin’s tumor and optimal approach to treatment are discussed.

This case report presents in-vivo findings on the spatial and temporal relationship between focal Ab-amyloid deposition, cerebral micro-haemorrhages and superficial siderosis. A 65-year-old woman underwent 11C-PiB PET scans that revealed an atypical focal and asymmetrical pattern of Ab-amyloid deposition and MRI scans that revealed cerebral micro-haemorrhages and superficial siderosis. Almost all micro-haemorrhages were associated with focal Ab-amyloid deposition. Follow-up 11C-PiB PET and MRI scans showed progression of the disease. We speculate that Abamyloid deposition affects the structural integrity of arterioles, thereby predisposing them to micro haemorrhages. In support of this hypothesis, progression of MRI lesions was observed only in areas associated with Ab-amyloid deposition.

Background: The measures are being put in place for the management of Hepatitis B virus (HBV) infection in Hargeisa, Somaliland among pregnant women remain the most vulnerable to develop chronic hepatitis. Routine screening in pregnant women is therefore necessary for effective control. However, the performance of the commonly used the HBsAg sero test strips has been available. Also, identifying the risk factors of transmission in pregnant women is importance for the implementation of preventive measures. Hence, the goal of this study was to determining seroprevalence and associated risk factors with HBV infection among pregnant women. Material & Methods: The study area was carried out at Hargeisa group hospital in Somaliland from May 2018 up to December 2018. The researcher was collected research pregnancy woman data through questionnaire & used diagnostics methods such as Hepatitis B surface antigen (HBsAg) test, antibodies test (HBsAb) by used anti-card test and ELIZA system. In order to find specific full information’s about patients & relationship the associated risk factors with hepatitis B in pregnancy. Data processed and analyzed by used both words and SPSS package. The sample size investigated was 80 patients. Of these, 28 were excluded; among the reasons for exclusion were prior HBV vaccination and known HBsAg sero-positive status. Aims of Study: The study was designed & aimed to determine seroprevalence and associated factors of HBV infection among pregnant women. To assess and establish if there is significant relationship between blood transfusion and hepatitis B virus at Hargeisa group hospital (HGH). Results and Discussion: The results in the current study shown that the pregnancy with hepatitis BV and it relation with appeared some symptoms in our study was 24(46.15%) of patients appeared they have cirrhosis symptom, 12(23.08%) of patients answered they have liver failure, while 9(17.31%) of patients appeared yellowish of eyes & skin and 5(9.62%) showed hepatic cancer. Overall, HBV prevalence: HBsAg was detected in fifteen 15(31.3%) of the participants while all fifteen (100%) had total HBcAb (both IgM and IgG). Of the HBsAg sero-positive women, 26(42.7%) were positive for HBeAg; eight (13.3%) were positive for HBeAb and four 4(9%) were negative for both HBeAg and HBeAb which was close similar with other previous studies. On the other hand, We found identify statistically significant p-values < 0.05 and high relationship between HBV and some demographic and clinical risk factors such as blood transfusions, levels of knowledge about HBV infection in addition to age and marital status. Conclusion: The results of this study showed that the seroprevalence of HBV infections in pregnant women and it relationship with blood transfusion in Hargeisa Group Hospital, Hargeisa, Somaliland is high. However, further studies are needed to assess the role of other demographic and clinical risk. Urgent action is required to improve hepatitis B infection control measures to reduce dependence on blood transfusions and make new policies for treatment of anemia in HGH

The nurse in Poland may have a secondary level of education (secondary school or post-secondary) or high level (BSc and MSc). She can have a specialization of one the parts of medicine. After the MSc studies she can take the doctor’s degree. But we must take as a fact that with the high level of education and specialization she can be the Court Expert i.e. in nursing anesthesiology, intensive therapy, nursing first aid, palliative medicine as well as in many other cases. As about nursing we should remember that woman and man can practice this specific profession [1].

A 61-year-old Brazilian black woman consulted with a nephrologist due to proteinuria identified on a routine urine test. She has a personal history of thymoma resection five years ago, followed by multiple episodes of pulmonary infections including mycobacteriosis, recurrent mucocutaneous candidiasis, and paraneoplastic pemphigus. Physical examination showed no edema or hypertension and laboratory tests identified proteinuria of 2.43 g/day without hematuria, serum creatinine of 0.69 mg/dl, urea 34 mg/dl, serum albumin of 2.4 g/dl, hemoglobin 10.9 g/dl, platelets 292,000/mm3, leukocytes 4950/mm3, lymphocytes 594/mm3 and neutrophils 3910/mm3. The hemolysis tests were negative and serum iron was low. Analysis of glicemia and serum lipids levels were normal as well as serum complement and imunoglobulins, except for an IgM level of 283 mg/dl (normal values 40 to 230 mg/dl) and undetectable IgE. Serologies for Syphilis, HIV, hepatitis B, C and antibodies for autoimmune diseases were negative. 

Granulomatosis with polyangiitis (GPA), a form of ANCA-associated vasculitis (AAV), is a rare disease with an often-occult presentation. It is more common in 4th and 5th decades of life but can be seen in all ages. This case report details a 76-year-old female presenting with abdominal pain, generalized weakness, and malaise, who was found to have pulmonary nodules on chest imaging. Biopsy of the lung nodule showed organizing pneumonia. Initially, antibiotics were used to treat the patient. However, she developed acute renal failure a few days after presentation and found to have positive serum C-ANCA as well as elevated ANCA-PR3 serologies. A subsequent kidney biopsy demonstrated pauci-immune necrotizing and crescentic glomerulonephritis that was consistent with GPA and the patient was started immediately on combination immunosuppressive therapy, plasmapheresis, and hemodialysis. GPA’s clinical and radiological presentation can mimic other common conditions such as pneumonia, malignancy, bacterial sinusitis, pulmonary tuberculosis, sarcoidosis, and urinary tract infection. Because of this, a high level of suspicion is required for early diagnosis and treatment to alter the high mortality rate in this disease entity. All forms of ANCA-associated vasculitis (AAV) should be in the differential diagnosis for all patients presenting with multiorgan system involvement particularly in individuals with pulmonary and renal manifesations.

A 39-year-old woman, with a not significant past medical history, entered the Emergency Department complaining about nausea, vomiting, constipation, anorexia, deep asthenia, and diffuse muscle aches with cramps. She referred sporadic diarrhea (one episode) the day before and a worsening headache in the past three days; she also complained about polyuria and polydipsia not investigated for one year. The clinical examination was not significant, apart from the evidence of skin and mucosal dryness, tachycardia, and diffuse abdominal pain. The laboratory tests revealed hypokalemia and elevated beta-human chorionic gonadotropin (β-hCG) plasma levels. An ultrasound abdominal imaging was consistent with kidney lithiasis. Suspecting a hyperemesis gravidarum in a patient with kidney lithiasis, a rehydrating therapy was administered as long as potassium reintegration. During the hospital stay, the patient became drowsy. A haemogasanalysis revealed very high calcium values: 3,379 mmol/L (n.v. 1,120-1,320 mmol/L). Lab tests confirmed very high levels of calcium 21,1 mg/dL (n.v. 9-10,5 mg/dL), as long as increased parathormone (PTH) > 3000 pg/mL (normal values 14-65 pg/mL), and hypokalemia (3,2 mEq/L n.v. 3,50 – 4,50). Ultrasound exam of the neck revealed the presence of a left parathyroid nodule measuring 2,5 x 1,6 cm. Before having time to start an appropriate therapy, the patient died.

Objectives: To describe a patient with facial-onset sensory-motor neuronopathy (FOSMN) that later developed Huntington’s disease (HD). Case report: A 62-year-old woman complained of progressive dysphagia 8 years before referral. At initial evaluation, there was excessive salivation, dysphagia, and sensory-motor trigeminal impairment. Denervation was noted on the upper limbs and the tongue. Blink reflexes were abolished. Genetic study of amyotrophic lateral sclerosis (ALS)-related genes was normal. She was diagnosed with FOSMN syndrome. Her clinical state progressively worsened with corneal anesthesia, severe denutrition, right arm and axial weakness. Seven years after referral, she was unable walk and developed generalized chorea. Abnormal huntingtin gene repeat expansion confirmed the diagnosis of HD. She died 16 years after onset of dysphagia. Conclusion: Cases with both HD and ALS have already been reported but not FOSMN and HD, to our knowledge. Some FOSMN cases have been linked to ALS-related gene mutations and HD phenocopies have been associated with C9ORF72 repeat expansions. Recently, huntingtin repeat expansions were described in the ALS population. Although a chance association cannot be excluded, data from the literature are in favor of a pathogenic relationship between FOSMN and HD in this particular case. We suggest that huntingtin gene be more systematically studied in patients with FOSMN.

A 38-year-old woman with no past medical history presented to the emergency room with dyspnea, fever and upper left abdominal pain.

Intrasellar meningioma (IM) is a rare occurrence that is difficult to distinguish preoperatively from the most common non-functioning pituitary adenoma. Here we describe a case of psammomatous IM occurring in a 68-year-old woman, presented with visual defects. On magnetic resonance imaging (MRI) she was found to have an intrasellar mass with suprasellar extension that was approached with transsphenoidal surgery. Subtle radiological hints, namely dural tail sign, intralesional calcifications and a marked and homogenous early enhancement of IM on MRI after gadolinium administration, may aid clinicians in achieving an accurate pre-operative diagnosis and choosing the proper surgical approach. The clinical and neuroradiological features of IM described in the literature has been reviewed.

Background: Pre-eclampsia and eclampsia have remained a major global public health threat in contributing significantly to maternal and perinatal morbidity and mortality. Based on the inverse relationship between serum 1,25(OH)2D3 levels and plasma renin activity found previously, it is speculated that 1,25(OH)2D3 might be a negative endocrine regulator of renin production in vivo. During pregnancy, vitamin D may play a role in implantation and placental function potentially due to angiogenic, immunomodulatory, and antiinflammatory effects. Vitamin Ddeficiency can affect the health of both mother and fetus by increasing the production of inflammatory cytokines and stimulating the activity of T-regulating cells. Vitamin D is emerging as a promising agent for pre-eclampsia prevention. Aims and objectives: The objective of this study is to compare the vitamin D levels in pre-eclamptic and healthy non-pre-eclamptic pregnant women in labor and find out the relationship between vitamin D levels and pre-eclampsia. Methodology: The present cross-sectional study was carried out on pregnant women with pre-eclampsia in labor. For each case with pre-eclampsia, one uncomplicated, normotensive pregnant woman in labor was taken as control. On admission to the labor room detailed history, physical examination followed by thorough obstetrics and systemic examination was done. Required investigations were done including vitamin D and calcium levels. Maternal and fetal condition was monitored during labor/cesarean section, mode of delivery, maternal and fetal outcomes were recorded. After delivery, 2cc of cord blood was collected in a serum tube and sent for vitamin D levels. Data was collected and analyzed statistically using Epi-info version 7.1.Results: It was observed that the patients in both groups were comparable with respect to demographic and obstetrics characteristics except for significantly high BP in group I. Vitamin Ddeficiency (i.e. < 20 ng/ml) was significantly more in group I as compared to group II and the difference was highly significant (p < 0.0001). Similarly, the mean maternal calcium levels were significantly lower in group I in comparison to group II (p < 0.0001) i.e. the mean maternal calcium level in group I and group II were 8.03 ± 0.94 and 9.19 ± 0.67 respectively. It was also observed that the level of 25-OH-D in neonates of preeclamptic women was significantly lower than for those of the normal pregnant women (p < 0.0001). Conclusion: Vitamin D deficiency is highly prevalent in all parts of the world. Pregnant women and neonates are highly vulnerable to vitamin D deficiency. Preeclampsia is indeed associated with lower vitamin D levels and the pathophysiology of pre-eclampsia involves vitamin D and calcium metabolism through their role in immunomodulation, angiogenesis and anti-inflammatory effects. From the present study, it was observed that vitamin D and calcium levels were significantly lowered in women with pre-eclampsia as compared to those of the normotensive pregnant women. So early detection of vitamin D and calcium deficiencies may be helpful in preventing occurrence of PET and its complications.

Background: Cervical choriocarcinoma is a malignant trophoblastic neoplasm that arises from pluripotent gonadal germ cells. Various manifestations are expected including vaginal bleeding and symptoms related to metastasis. Here, we report a case of primary choriocarcinoma in a post-menopausal woman. Case presentation: A 67-year-old woman presented with vaginal bleeding and lower abdominal pain. Ultrasound and laboratory results were normal except for a β-hCG titer of 14850 IU/L. Hysteroscopy revealed a polyp in the posterior wall of the cervix. hysterectomy and bilateral salpingo-oophorectomy were performed due to suspected choriocarcinoma. The β-hCG titer decreased immediately after surgery. However, the β-hCG titer increased again one month after surgery and treatment was continued with weekly methotrexate administration. Conclusion: Manifestations such as vaginal bleeding is very important in post-menopausal women. Although there are no specific guidelines for the treatment of choriocarcinoma in these patients, hysterectomy following chemotherapy based on response to treatment and β-hCG titration is favorable.

A case of post-operative agranulocytosis which occurred in a 66-year-old woman following surgery for endometrial carcinoma is reported. The agranulocytosis had a rapid onset, being detected on the first post-operative day. The causative agent, cefazolin was given to the patient intraoperatively. The agranulocytosis persisted until the 22nd postoperative day. A bone marrow biopsy performed on post-operative day four showed a left-shifted myeloid maturation pattern but not a maturation arrest. The pathogenesis of drug-induced neutropenia/agranulocytosis is discussed. It is postulated that reversible binding of cefazolin to albumin accounts for the prolonged duration of agranulocytosis.

Cardiac angiosarcomas are rare malignant neoplasms with an aggressive clinical course. These are characterized by the absence of specific clinical findings, rapid growth with frequent metastasis at the time of diagnosis, correlated with poor prognosis, and reduced response to treatment. But with early diagnosis, more possibilities for treatment and survival can be provided. We report the case of a young woman diagnosed with right atrial angiosarcoma locally advanced with bone metastases detected by 18F-FDG PET/CT, which revealed distant disease extent at diagnosis, consequently, chemotherapy was started.

Introduction: Induction of labour is a common obstetric intervention, occurring in approximately 25% of term pregnancies in developing countries. Pharmacological and mechanical methods commonly used are prostaglandin preparations (PGE1 and PGE2) and various intracervical catheters (single or double balloon), respectively.Material and methods: Study was conducted in Siliguri District Hospital, Siliguri, Darjeeling, west Bengal. 100 antenatal woman admitted in obstetrics ward with pog more than 37 weeks were taken for study after applying inclusion and exclusion criteria. 50 were induced with cerviprime gel and 50 with intracervical foley catheter. Statistical analysis done.Results: Mean interval between treatment initiation and delivery was not statistically significant, tachysystole was more common in group B women, rate of LSCS and NVD was similar in both groups.Conclusion: It can be concluded from the present study that Foley’s catheter (mechanical) and prostaglandin E2 gel [pharmacological] both are effective agents for preinduction cervical ripening which substantially improve the bishops score and increase the chances of successful labour induction. There is no significant difference in their efficacy, mode of delivery and perinatal outcome.

Median arcuate ligament syndrome is a rare entity. This clinical condition develops by compression of the root of a celiac artery with the median arcuate ligament. The typical triad of this syndrome is the following; abdominal discomfort and pain, especially after a meal, and weight loss. In diagnosis, other causes should be ruled out and compression must be demonstrated by any type of imaging method. The main principle of treatment is cutting down the median arcuate ligament. A 54-year-old woman presented with untreatable recurrent abdominal pain and was diagnosed with median arcuate ligament syndrome by imaging with angiographic computed tomography. This patient was operated on. We performed laparoscopic division of median arcuate ligament with the retrograde surgical dissection technique. The patient was discharged from the hospital without any complaint on the third day after surgery. She was still symptom-free after 12 months.The laparoscopic retrograde dissection approach is a safe and feasible treatment modality for median arcuate ligament syndrome.

Background/Introduction: WHO recommended ‘ready to use therapeutic food’ (RUTF) for community-based management (CMAM) of severely malnourished children (SMC). This is often rejected by children. The objective is to identify and map the locally produced and socio-culturally acceptable food items to treat SMC. Methods: Through community participation, eight varieties of MAHAN Local therapeutic foods (LTFs) were prepared by tribal females at our center as per WHO norms with a shelf life of 4 weeks. LTFs with micronutrients were given at the feeding centers in the villages under supervision 3 - 4 times a day. Results: Multiple, palatable, culturally acceptable, safe, feasible with local womanpower, and cost-effective recipes were developed. Hence, our LTFs are qualitatively superior to other therapeutic foods. This mapping exercise provides a ready reference to other government or non-government organizations for CMAM. Conclusion: MAHAN-LTF is a multiple, palatable, generalizable, and sustainable therapeutic food and are being used in other tribal blocks of India.

Background: Persistent contrast staining is highly associated with stent thrombosis. Case summary: A 75-year-old woman presented with new-onset effort angina. A coronary angiogram revealed a 90% blockage of the distal left main trunk (LMT) and a 99% blockage of the ostial left anterior descending coronary artery (LAD). A 3.0 × 18-mm CYPHER™ the stent had previously been implanted into the dominant proximal circumflex artery (LCx) in 2009 because of unstable angina. The patient developed pulseless ST elevation myocardial infarction after the withdrawal of antiplatelet therapy before a scheduled CABG. The patient recovered with VA-ECMO and PCI using aspiration thrombectomy and urgent CABG.Discussion: This case highlighted that a preoperative patient may develop thrombosis at a previous stent site with peri-stent contrast staining and withdrawal of an antiplatelet regimen in certain settings poses an imminent risk for preoperative deterioration. A bridging strategy using intravenous PY12 inhibitor before CABG should be considered in this setting. The revascularization strategy should be selected based on coronary anatomy, hemodynamic status and baseline risk for CABG. A hybrid revascularization approach should be considered in this patient population.

Background: Leiomyomas beyond the uterus are defined by benign smooth muscle cell tumors outside of the uterus. Intravenous leiomyomatosis is a rare type of uterine leiomyoma and is characterized by the formation and growth of benign leiomyoma tissue within the vascular wall. Herein, we present a case of Intravenous leiomyomatosis successfully treated by surgical removal and a review of actual medical recommendations.Case presentation: A 49 - year-old woman, maghrébin, G3 P2, no family history of uterine myomas mentioned, having systemic arterial hypertension, presented to our department with hypogastric pain and abnormal uterine bleeding in the prior five months resulting in anemia which required iron supplementation. On physical examination the vital signs were normal. A palpable mass in the hypogastrium was noted. The rest of the exam was unremarkable. Pelvic ultrasound showed a huge uterus with multiple heterogeneous leiomyomas, including at least one intracavity. Computed tomography scans and magnetic resonance imaging were not done initially due to the unaffordability of the patient. The initial diagnosis was leiomyoma. The decision to perform a total abdominal hysterectomy and bilateral salpingo-oophorectomy was taken. The abdomen was opened by a midline vertical incision. During surgery, multiple subserosal, intramural and submucosal fibroids ranging from 2 cm × 3 cm to 10 cm × 10 cm were seen. On pathological examination, the uterus measured 19 cm in the largest diameter and weighed 1.3 kg. The cut section showed white nodular myometrial masses. Microscopically, intravascular growth of benign smooth muscle cells is found within venous channels lined by endothelium. The diagnosis of Intravenous leiomyomatosis of the uterus without malignant transformation was retained. The patient was monitored for 14 months and subsequent computed tomography did not reveal any evidence of tumor recurrence. The follow-up will be performed annually till the age of menopause.Conclusion: Intravenous leiomyomatosis is a benign, rare and potentially lethal pathology. It especially affects premenopausal women with a history of uterine myoma, whether operated on or not. They require close and prolonged follow-up because of the high risk of recurrence.

Ms X is a 40-year-old gravida 12, para 2+9 woman, who was admitted for an elective caesarean section at 38 weeks gestation following the previous two caesarean sections. Ms X had abdominal distension and generalised abdominal tenderness in the postoperative period. On investigation, she was found to have an elevated white cell count (WCC), C - Reactive Protein (CRP) and creatinine with free fluid in the abdomen on imaging but there was no evidence of perforation of any visceral organ. Ms X was treated conservatively for sepsis, an Acute Kidney Injury (AKI) and post-operative ileus and her symptoms gradually resolved. This is a case of idiopathic ascites post caesarean delivery with no clear cause.