The coronavirus pandemic has caused major changes in society around the world, especially in healthcare systems. Patients with various medical ailments and conditions who were scheduled to undergo elective treatments before the pandemic arrived, wonder now if they still should follow through with it.
Frequency specific microcurrent (FSM) has been used to treat myofascial pain syndrome [1,2] fibromyalgia associated with spine trauma [3], delayed onset muscle soreness [4], acute and chronic neuropathic pain [5] and chronic scarring in burn patients [6]. In this case, its use was modified to include not only the treatment of neuropathic pain but the treatment of neural adhesions in a patient with a ten year history of pain at rest and painful restricted range of motion following an ulnar nerve anterior transposition surgery in 2001. Eleven standard physical therapy sessions including augmented soft tissue mobilization using plastic tools, and muscle strengthening exercises and stretching failed to resolve symptoms. Three sessions of frequency specific microcurrent produced complete resolution of pain and symptoms. Patient remained symptoms free at one-year follow up.
Introduction: Desmoplastic Malignant Mesothelioma (DMM) is a rare histological subtype of sarcomatoid malignant mesothelioma arising most frequently in the pleura or peritoneum and less frequently in the lung parenchyma.
Patient concerns: A 52-year-old female with no apparent asbestos exposure was referred for consultation in our center after 1 month of cough and no concomitant symptoms of chest.
Diagnosis: Chest computed Tomography (CT) revealed a localized mass measuring 4.5 x 3.9 cm in the right lung middle lobe with inhomogeneous enhancement following injection of contrast, and without pleural lesions, considered a primary intrapulmonary desmoplastic mesothelioma.
Interventions: Surgical intervention was performed.
Outcomes: Following complete tumor resection, the patient declined to receive chemotherapy or radiotherapy. The final diagnosis of intrapulmonary desmoplastic mesothelioma was confirmed by pathological and immunohistochemical examination. In addition, no local tumor recurrence was observed within 10 months of follow-up.
Conclusion: Even elderly female patients with localized pulmonary masses without significant pleural lesions should not excluded the possibility of malignant mesothelioma in the lungs.
Background: Primary lymphedema occurs as a result of genetic abnormalities of the lymph system. Currently, complex decongestive therapy is accepted as the standard treatment of the lymphedema. In this case presentation, we described the management of bilateral primary lower extremity lymphedema and the use of complex decongestive therapy.
Case Report: A 62 years old female patient had stage III primary lymphedema on her left lower extremity and stage II primary lymphedema on her right lower extremity. The patient, who had morbid obesity, also had untreatable sleep apnea, urinary incontinence, umbilical hernia and hypertension controlled by drugs. She had stage 4 gonarthrosis according to Kellgren – Lawrence classification in her both knees. The patient received complex decongestive therapy as an outpatient.
After 27 sessions of complex decongestive therapy, edema reduced in both lower extremities. Before the treatment started, the patient couldn’t go up and down stairs, get out and had difficulty mobility in the home. But after the treatment, the patient could go up and down 16 stairs by holding the railing, get out by two walking sticks and had less difficulty mobility in the home. However, due to gonarthrosis in her knees, her pain did not diminish.
Conclusion: Complex decongestive therapy is effective in the management of bilateral primary lower extremity lymphedema, which progressed with multiple health conditions.
Purpose: To investigate the suture-tourniquet technique for haemostasis in patients with acute thrombosis of native arteriovenous fistula (AVF) whom underwent manual aspiration thrombectomy using large-bore venous sheaths and high dose heparin.
Methods: Between January 2016 and May 2018, patients with acute AVF thrombosis performed successful manual aspiration thrombectomy by using large bore venous sheaths and high dose heparin were included in this retrospective study. Success rate for haemostasis, procedural complications clinical and imaging follow up was reported descriptively.
Results: A total of 52 patients with 64 procedures met the inclusion criteria. In 60(94%) of 64 procedures, successful haemostasis was achieved with suture-tourniquet technique. In 2(3.1%) of the 64 procedures, the suture broke while turning the tourniquet and haematoma occurred in another 3 procedures (4.7%) although suture-tourniquet technique was applied appropriately. Manual compression was performed in these patients. There were 3 major complications unrelated the suture-tourniquet technique.
Conclusion: The suture tourniquet technique can achieve haemostasis rapidly and can be safely used with low complication rates without fistulae thrombosis after large-bore venous sheath removal following treatment of AVF thrombosis.
Moataz M El Semary*, Nawal A Abou Shady, Hayam Mahmoud Sayed and Mohamed El Said Al Awaady
Published on: 27th April, 2018
Aim: The aim of this study was to evaluate the ankle-knee-hip interaction during sit-to-walk (STW) movement and clinical functional abilities of the lower limbs in Parkinson’s patients.
Methods: Twenty male patients, ages ranged from 55 to 70 years, stage ΙΙ & ΙΙΙ according to modified Hoehn and Yahr (1997) classification of disabilities and ten male healthy elderly subjects, ages ranged from 55 to 70 years, participated in this study. All subjects were assessed for; clinical functional abilities of the lower limbs, ground reaction force (GRF) & spatiotemporal data and range of motion (ROM) of hip, knee and ankle joints during STW movement.
Results: The results showed very significant differences in the GRF among the normal subjects and Parkinson’s patients during STW movement. There were significant differences in hip, knee and ankle joints ROM during STW. There were significant differences in spatiotemporal findings during STW movement. The Parkinson’s disease patients did not merge the two tasks of STW while the elderly subjects merged it. There was impairment in clinical functional abilities of the lower limbs in Parkinson’s patients.
Conclusion: A continuum of STW performance and clinical functional abilities whereby the healthy elderly people performed the task more efficiently than PD patients.
Bleeding diatheses due to platelet-related disorders can present challenges to treating clinicians especially in the context of peri- and post-partum patients in the obstetric setting. TARS is an inherited disorder characterised by reduced bone marrow platelet production, skeletal deformities affecting radii and other limbs; cardiac, renal, and other heterogeneous anomalies may occur. It is caused by co-inheritance of a microdeletion and a nucleotide polymorphism in the RBM8A gene on chromosome 1.
Bleeding phenotype is more severe than platelet numbers might predict especially in infants but improves with age. There is minimal literature regarding impact in pregnancy and puerperium.
We describe management of three pregnancies in the haematology-obstetrics clinic. As platelet counts normally decrease through pregnancy, close monitoring is required in TAR syndrome. No major bleeding was seen antenatally but two required platelet transfusion during labour. No other treatment definitely improves bleeding, although case reports of steroids claim variable success.
Tranexamic acid may be helpful, and thrombopoietin agonists represent a potential future option.
Vitamin D has immunomodulatory and antifibrotic properties, and therefore used for treatment of many of chronic liver disease [1]. Although there are many reports on the relationship between serum 25-hydroxyvitamin D3 levels and chronic liver diseases, but the relationship between hepatitis B virus e antigen (HBeAg) and vitamin D level is still unclear.
The modification and prevention of vitamin D deficiency needs an accurate illustration of the current position in each region. Vitamin D level in patients with HBV is relatively an important issue, which has been studied in many researches. As different papers published in national and international journals.
Background: Pseudomonas aeruginosa is one of the top five pathogens causing healthcare-associated infections. Biofilm formation is nowadays a major problem. Aim: The aim of this study was to examine the prevalence of virulence genes in clinical isolates of Pseudomonas aeruginosa at Suez Canal University Hospitals with respect to the site of infection and microbial resistance of the strains.
Materials and methods: A cross-sectional descriptive study was carried out on 47 Pseudomonas aeruginosa strains collected from hospitalized patients from December 2015 to August 2017. To detect biofilm formation, we used Tissue Culture Plate Method. The virulence genes (toxA, algD, nan1, pslA and pelA) were amplified using PCR technique.
Results: The highest sensitivity was to Imipenem and Ciprofloxacin (85.1% and 68.1% respectively).With respect to the virulence genes, toxA gene was detected in 45 isolates (95.7%), algD gene in 42 isolates (89.4%), pslA in 42 isolates (89.4%) %), pelA cted in 41 isolates (87.2%) and nan1gene was detected in 19 isolates (40.45%).
Conclusions and Recommendations: We conclude that there is relationship between virulence genes and biofilm formation in Pseudomonas aeruginosa. We recommend the expansion of work on a larger sample size in a longer period of time.
The incidence of HBV infections among the pregnant in Europe falls within the range of 1% - 7%, whereas it is 1.7% - 4.3% for HCV.
The aim was to assess the course of pregnancy among women infected with HBV or HCV, and the condition of neonates in the fifth minute after the birth.
The study included 157 pregnant individuals infected with HBV, 53 infected with HCV, and 330 healthy pregnant women. None of the women infected with HBV and HCV as well as from the control group were infected with HIV, and none of them took intoxicants.
Weight of neonates delivered by healthy women was higher as compared with children born by women infected with HBV or HCV (3,517 vs. 3,347 and 3,366). The Apgar score of neonates delivered by women with HBV and HCV infections was lower as compared with the children born by healthy women (9.4 vs. 9.3 vs. 9.7; p < 0.05). Premature births occurred more often in HBV and HCV-infected women than in the control group (14.6% and 24.5% vs. 6.96%; p < 0.05). Miscarriages were significantly more common among the pregnant with HCV infections as compared with the pregnant who were healthy (9.4% vs. 1.8%; p < 0.05). In comparison with the healthy individuals, this group of patients experienced pruritus (10.5% vs. 4.2%; p < 0.05), oedemas (9.4% vs. 2.4%; p < 0.05), and hypertension (9.4% vs. 1.5%; p < 0.05) more often.
An increase in HBV loads was observed between the 6th and 28th – 32nd week of pregnancy among the infected with HBV, and then, a decrease was observed in the 6th months after the delivery.
The pregnant infected with HBV without HBsAg (-) and the infected with HCV are subject to common incidence of premature births. Women infected with HCV often experience oedemas, hypertension, and pruritus.
Background: Egypt has the highest prevalence of HCV in the world as more than 10% of population suffers from HCV infection. High prevalence of HCV in Egypt represents a great risk to the whole population that requires aggressive mass awareness regarding routes of infection and means of prevention.
Aim: To determine the knowledge and practices of university students in 5 different faculties in Suez Canal University regarding HCV infection and means of prevention.
Materials and method: A cross sectional study was conducted in five university faculties in Suez Canal University.
Results: The study included 698 students from the faculties of Medicine, Pharmacy, Dentistry, Nursing and Education in Suez Canal University in Ismailia city in Egypt. There was a statistically significant difference regarding the knowledge about the diagnosis, complications and routes of transmission total knowledge score for HCV among the different faculties.
Conclusion and Recommendations: Knowledge and practices of university students in Suez Canal University is partial to weak especially in students of non-biological sciences who have less close contact with patients
Objective: To determine the prevalence of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in labor and delivery units in one of the epicentres of the West Coast.
Study Design: This was a retrospective chart review of patients admitted to labor and delivery from April 15, 2020-May 15, 2020 after implementation of a universal testing policy on Labor and Delivery.
Results: The prevalence of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the admitted labor and delivery population was 2.5%, of whom 87.5% were asymptomatic.
Conclusion: We present additional data on the prevalence of asymptomatic SARS-CoV-2 in pregnant patients on the West Coast, which is much lower compared to other locales, possibly as a result of aggressive ‘shelter in place’ policy. Universal screening is insufficient to detect asymptomatic SARS-CoV-2 and thus rapid, universal testing should be prioritized for labor and delivery units for the protection of patients and staff, and to better allocate appropriate resources.
Key points:
1. 2.5% of 320 patients tested positive for SARS-CoV-2.
2. 87.5% of positive patients were asymptomatic.
3. Universal testing on labor and delivery is necessary.
4. ‘Shelter-in-place’ policies reduced SARS-CoV-2.
Uterine sections from 6 patients with incidental nodal lymphangioleiomyomatosis (LAM) were examined for LAM lesions by screening these sections with cathepsin K immunohistochemistry (IHC) stains. The hysterectomy specimens were all concurrent with the lymph node dissections in which the nodal LAM was discovered. In 4 of 6 patients microscopic lesions of pre-LAM were identified and confirmed by IHC staining for HMB-45 and beta-catenin. All lesions were grossly inapparent and also inapparent by routine hematoxylin and eosin stains. Three variants of pre-LAM lesions were identified. None of the pre-LAM lesions had an associated lymphatic proliferation. It is proposed that these pre-LAM lesions gave rise to the incidental nodal LAM lesions. Furthermore, it is suggested that the absence of an associated lymphatic proliferation associated with these lesions may be a factor in the attenuated potential for spread and the only rare association of these nodal lesions with pulmonary LAM.
Background: The purpose of this study was to establish a new, reliable and reproducible reference line for assessing bladder neck descent using 2-dimensional transperineal ultrasound. Therefore, we created a novel line, named Symphysis-Levator Line (SLL) and defined it as the connecting line between the hyperechogenic, dorsocaudal edge of the symphysis pubis and the hyperechogenic anterior margin of the puborectalis muscle, posterior to the anorectal junction.
Methods: A retrospective study was performed including 111 patients, who underwent a transperineal ultrasound as part of an urogynecological examination in the department of Urogynecology at the University Medical Center of the Johannes Gutenberg University Mainz. We calculated the bladder neck decent using the SLL and compared our results with the measurements assessed using a horizontal line through the infero-posterior margin of the symphysis pubis, as previously described by Dietz (Horizontal Symphysis Line, HSL). In addition, we calculated the intra- and interobserver reliability of the two methods and examined the influence of various patient characteristics on the obtained values.
Results: Both methods demonstrated a high intra- and interobserver reliability. Even though the HSL produced slightly higher numerical values for the bladder neck descent, the novel SLL was more precise. Our data support that the 2-point fixation of the SLL on two anatomical structures ensures the stability of the reference plane during the functional changes of the pelvic floor.
Conclusion: The Symphysis-Levator Line could be a useful tool for urogynecologists in the future.
Luteinizing Hormone (LH) like exposure in the mid cycle for inducing the oocyte maturation is the very crucial step in the success of ICSI treatment. Introduction of LH surge endogenously by GnRH-agonist for final oocyte maturation induction, may be more physiological compared with the administration of HCG. Since GnRH agonist would induce FSH surge also along with LH surge, as happens in natural cycle. However, the effects of giving HCG trigger for inducing only LH surge and giving GnRH agonist trigger for inducing both LH and FSH surge, in patients treated for ICSI with GnRH antagonists need more research. Sub fertile patients planned for ICSI, meeting the requirement of inclusion criteria, were started with recombinant FSH from day 2 of menstrual cycle. GnRH antagonists were started from day 6 of stimulation. FSH dose was adjusted according to the individual response. Trigger was planned when the lead follicle reaches 24 mm. For triggering, 100 patients were randomized to receive Recombinant HCG trigger and Triptorelin acetate trigger. Oocyte retrieval was done 36 hours after Recombinant hCG Trigger and 35 hours after Triptorelin acetate trigger. The oocyte maturity rate was assessed by the number of metaphase II oocytes retrieved.
Aim and objectives: Endometrial Window of Implantation (WOI) is open in the midsecretory phase wherein the markers of invasion and cell adhesion are manifested .The primary objective was to find out the predictive value of Endometrial thickness and profile as a prognostic factors for embryo transfers during ART.
Materials and Methods: Endometrial thickness assessment was performed with grey scale ultrasound on the day of transfer just before thawing the embryos in patients undergoing Frozen embryo transfer cycle after endometrial preparation.
Results: The mean age and standard deviation of study population was is 33.26+5.95.Out of 69 patients there was clinical pregnancy in 33 patients , miscarriage in 10 patients and ongoing pregnacy in 23 patients. So the implantation rate was 47.83% (33/69), early miscarriage rate (pregnancy ending before 12 weeks) was 14.49%(10/69) and the ongoing pregnancy rate was 33.33% (23/69). Endometrial thickness < 6 mm had comparable implantation rates but low ongoing pregnancy rates.
Conclusion: The ultrasound morphological and vascular grading of endometrial thickness and vascularity is useful to synchronise Day 5 embryo transfer and window and implantation thereby minimizing the loss of good embryos in nonreceptive endometrium.
Introduction: Uterine rupture is one of the peripartum complications, which cause nearly about one out of thirteen maternal deaths. This study aimed to assess the prevalence and associated factors of mortality among women with uterine rupture in referral hospitals of Lubumbashi, in the south east part of the Democratic Republic of Congo.
Methods: Institution based cross sectional study was conducted from December 1st, 2012 to 31st, 2016 on uterine rupture. During the study selected 158 women were included by using exhaustive sampling method. Data were checked, coded and analyzed into STATA version 12. Chi-square test was used to identify the predictors of maternal and perinatal mortalities in women with uterine rupture and 95% Confidence Interval of odds ratio at p - value less than 0.05 was taken as a significance level.
Results: The overall prevalence of uterine rupture was 0.49%. The average age of the patients was 29.5 ± 6.2 years and 71.52% of them were between 20 and 34 years old; more than 60% had a parity ≥4 (average parity: 4.7 ± 2.5). 81.17% of the cases had a fully ruptured uterus and 51.17% of the uterine ruptures were located in the lower segment. Repair of the pregnant ruptured uterus was performed in 93.04% of the cases and hysterectomy in 5.06%. Maternal and perinatal mortalities were 8.86% and 72.04% respectively. Regarding maternal mortality, no parameter showed a significant association with maternal death. As for perinatal mortality, parity ≥4, complete rupture and segmento-corporeal lesion were significantly associated with perinatal death (p < 0.05).
Conclusion: Uterine rupture remains one of the causes of maternal and perinatal mortality in Lubumbashi. The place occupied by uterine ruptures in obstetric activity requires joint and urgent action by all stakeholders in the health system in order to combat this scourge, witness to poor quality obstetric care.
Typhoid fever is a systemic infection caused by Salmonella enterica serotype typhi. It is of major concern in tropical regions of the world. Highest episodes of typhoid fever occur in Asia i.e.93%. Early diagnosis of the disease is mandatory to lower the mortality rate associated with it as well as to prevent the emergence of antimicrobial drug resistance by Salmonella typhi. Research work was conducted in Immunology Department of the Children’s Hospital, Lahore for the period of one year including a total of 60 patients suspected of having typhoid fever. Serum samples of these patients were tested for typhidot IgG and IgM antibodies as well as for the antibodies against TO and TH antigens using Widal test. Of the total 60 patients, 10 (16.7%) were positive for both typhidot IgG and IgM, 16 (26.7%) were positive for typhidot IgM, 3 (5%) were Positive for typhidot IgG and 31 (51.66%) were negative for both typhidot IgG and IgM. Reading the results of Widal test, 8 (13.33%) were positive for Widal TO and TH antigens, 3 (5%) were positive for Widal TO antigen, 19 (31.7%) were positive for Widal TH antigen and 30 (50%) were negative for Widal TO and TH antigens. IgM is positive at the early stage of acute typhoid fever, IgM along with IgG positive means the middle stage of acute illness. The detection of only IgG cannot discriminate between acute and convalescent phases as it can stay in the serum for at least 2 years or more. The typhidot test is much helpful for the rapid diagnosis of typhoid fever as compared to Widal test which is still being used in some set ups in poor countries, although has become mostly obsolete. By testing the rise of IgM and IgG antibodies against Salmonella typhi, we can detect the infection at early and late stages, respectively
Objectives: Tension-free vaginal tapes are the gold standard of the surgical treatment of stress urinary incontinence (SUI); however, long-term recurrence of SUI after this surgery has been a matter of problem. Here, we attempted to determine the incidence of its recurrence and to identify the risk factors of 4-year-recurrence of SUI after this surgery.
Methods: Of all patients undergoing this surgery (n = 341, 2015-2019), 71 patients were met the study inclusion criteria. Of 71, SUI recurred in 8 patients, with the recurrence rate being 11.3%. The following three were identified to be independent risk factors: older age, history of delivery of macrosomic baby (>4 kg), and the presence of mixed urinary incontinence. The frequency of recurrence in cases with mixed incontinence amounted for 19.5%. Recurrence was 22 and 50% for women with macrosomic delivery once and more than twice, respectively.
Conclusion: Advanced age, macrosomic delivery and mixed urinary incontinence have shown to be independent risk factors of recurrence of SUI after tension-free vaginal tape-obturator at 4 years.
Key message: Stress urinary incontinence can recur so investigate possible risk factors is a priority. Our paper relates recurrence with: advanced age, fetal macrosomia and mixed incontinence.
MMK Mbula*, HNT Situakibanza, GL Mananga, B Longo Mbenza, JRR Makulo, MM Longokolo, MN Mandina, NN Mayasi, MM Mbula, B Bepouka, GL Mvumbi, EN Amaela, DN Tshilumba, O Odio, BM Ekila, A Nkodila and BT Buasa
Background and aim: Metabolic abnormalities are common in HIV/AIDS. Increasingly, lipid ratios are used as screening tools for dyslipidaemia in these medical conditions. The aim of this study was to assess the ability of 4 lipid ratios to predict cardiovascular risks.
Methods: This is a cross-sectional and analytical study included 105 HIV+ patients followed in Kinshasa University Teaching Hospital (KUTH). Four indices [Atherogenic Index of Plasma (AIP), Castelli Risk Index (CRI) I and II, Atherogenic coefficient (AC)] were compared. Statistical analyzis consisted of measuring frequencies and means, Student’s t-tests, ANOVA and Ficher’s exact test, and the calculation of the Kappa value.
Results: Lipid ratios predicted respectively the risk in 62% (AIP), 28.6% (CRI-I) and 23.8% (CRI-II). CRI-I and II were elevated, especially in women. The AIP appeared to be a better predictor than CRI-I and II to assess dyslipidaemia in general and the high-risk frequency. The cholesterol detected risk in 66.7% (Low HDL-C), 50% (High LDL-C), 38.9% (High TC and/or TG).
The atherogenic risk was higher with age, advanced WHO stage, HIV-TB, HBV-HCV co-infections, smoking and alcohol intake. Haemoglobin (Hb) and CD4 counts were low when the risk was high. Age ≥ 50 years, stage 4 (WHO), CD4s+ ≤ 200 cells/µL were independent factors associated with atherogenic risk.
Conclusion: Lipid ratios can be used as reliable tools for assessing cardiovascular risk of naïve HIV-infected patients who received HAART.
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