Non-surgical Techniques for Combined Rheumatic Severe Aortic and Mitral Stenosis – Case Series and Brief Review of Literature
Published on: 13th May, 2024
Rheumatic heart disease persists as a significant concern in developing regions, often resulting in multivalvular heart conditions. Treatment options are limited, though percutaneous transvenous mitral commissurotomy effectively addresses rheumatic mitral stenosis. Non-surgical interventions for aortic stenosis include balloon aortic valvotomy and Transcatheter aortic valve replacement (TAVR), tailored to patient factors like age and comorbidities.We describe two cases of Rheumatic multivalvular disease which were managed non-surgical. The first case is a pioneering procedure performed on a young patient combined percutaneous transvenous mitral commissurotomy with balloon aortic valvotomy, guided by 4-dimensional transoesophageal echocardiography (4D TEE). This represents the first documented instance in medical literature, showcasing the potential of integrated interventions and advanced imaging techniques. In the second challenging case involving a heavily calcified, retrovirus, and Hepatitis B positive 55-year-old, a staged approach was adopted, involving percutaneous transvenous mitral commissurotomy followed by Transcatheter aortic valve replacement (TAVR). Despite complexities, this sequential strategy demonstrates the adaptability of transcatheter techniques in managing complex valvular pathologies. These cases highlight the evolving landscape of interventional cardiology and underscore the importance of tailored, multidisciplinary approaches in optimizing outcomes for patients with rheumatic heart disease and multivalvular involvement, especially in resource-limited settings. Further exploration and dissemination of such innovative strategies hold promise for enhancing cardiac care quality and expanding treatment options globally.
Perception of Brazilian adolescents about cancer prevention
Published on: 31st December, 2021
OCLC Number/Unique Identifier: 9382541827
Cancer, as a disease, has found a place in the social imaginary. Individuals construct ideas based on pre-established discourses—be they medical, media, or popular—which often hinder its prevention. Educational interventions have tended to focus on spreading information about the disease, ignoring its social connotations. The objective of the present study is to investigate the concept of cancer prevention in 980 adolescents, aged between 12 and 18 years, attending primary and secondary school in three public schools and one private school in the metropolitan region of São Paulo and the municipality of Dom Viçoso, Minas Gerais. The notion of prevention implies the dominant feeling of performing medical examinations from a symptom, against the idea of preventing, even when there is no clinical manifestation of the body. The majority of students emphasize the advantages of early diagnosis and that the decisive factor for the cure corresponds to the moment of detection: "cancer must be discovered in time". This is a solid belief within the body of knowledge about the disease that can be used as a starting point in prevention messages.However, even when the importance of early detection of cancer is understood as an essential element for its cure, care practices do not accompany the set of principles that regulate prevention or its demands.
An uncommon gastrointestinal bleeding in a patient with portal vein thrombosis: a case report and literature review
Published on: 5th May, 2023
Portal vein thrombosis (PVT) is a rare condition that may congest bowel venous drainage and cause mesenteric ischemia. In acute settings, gastrointestinal bleeding (GIB) is rare, and acute abdominal pain is the most common clinical presentation. A 24-year-old man who presented with acute abdominal pain and a single episode of hematemesis is reported. Workups revealed evidence of thrombosis in the portal vein, but upper endoscopy was incapable to detect the source of the bleeding. We discuss the possible scenarios for the GIB in this case and review similar reports in the literature.
Genetic identification of three exhumed human remains at a hospital in Ghana: a forensic case report
Published on: 7th January, 2022
OCLC Number/Unique Identifier: 9395224000
DNA identification is very important in cases of high decomposition of dead bodies, in which the bodies cannot be identified by physical means.To compare the results of DNA typing, it is necessary to have related subjects with which to perform comparative analyses. Such tests are normally performed by comparing DNA profiles from people known to be immediate family members of the presumptive victim, such as parents or children because they share half of their genetic material with the unidentified.We report on how DNA analysis was used to solve a case of mixed-up bodies at a local mortuary in Ghana, West Africa. Two families and three buried human remains were in contention in this case. The first body (E9) was buried three months before exhumation. The second body (E11) was buried two and a half months before exhumation whiles the third body (E10) was buried a month before exhumation. Exhibit E5 was taken from an alleged child of the deceased, E11. Toenails of the exhumed bodies were sampled by a pathologist and used for DNA extractions using the QIAamp DNA Investigator Kit. Profiles from relatives were generated for comparison purposes. All samples gave a quality amount of genomic DNA after quantification. DNA was amplified with a GlobalFiler PCR amplification kit. Profiles from relatives were generated for comparison purposes.The human remains (exhibit E11) cannot be excluded as the biological father of the child (exhibit E5) because they share common alleles at all 23 genetic loci. The applicable combined paternity index was 17218125604.492 assuming a prior probability of 0.5. The probability of paternity is 99.99999999%. Based on this relationship testing, one of the bodies was successfully identified and handed over to the family for re-burial.
Menstruating primary umbilicus cutaneous endometriosis: A case report and review of literature
Published on: 5th May, 2021
OCLC Number/Unique Identifier: 9041187527
Primary umbilical cutaneous endometriosis is a rare umbilical endometrioma that affects women who are within the reproductive age group. It may be associated with infertility and severe dysmenorrhea and can be difficult to diagnosed in an asymptomatic patient.
We report a case of a 38-year-old nulliparous with seven years history of infertility and severe dysmenorrhea. Her hormonal profile assay and hysterosalpingogram results were normal while her husband semen analysis was also within normal range. She complained of monthly bleeding from a painful rubbery multilobate cutaneous nodule on the umbilicus of one year duration. She was diagnosed of cutaneous endometriosis. The diagnosis was confirmed histologically and she had surgical excision with good outcome.
Vulvar lipoma: A rare tumour
Published on: 5th May, 2021
OCLC Number/Unique Identifier: 9030351429
A 26 year nulliparous woman presented to the OPD with complaint of painless swelling in the vulva for the last 1.5 years which gradually increased in size causing difficulty in walking.
Pure Erythroid Leukemia: The Sole Acute Erythroid Leukemia
Published on: 11th July, 2017
OCLC Number/Unique Identifier: 7317598453
Pure Erythroid Leukemia (PEL) is an aggressive and exceedingly rare form of acute leukemia. In the 2008 WHO classification PEL was one of the subtypes of acute erythroid leukemia the other subtype being erythroleukemia (erythroid/ myeloid). In the 2016 WHO classification update, erythroleukemia was merged into myelodysplastic syndrome and PEL now is the only type of acute erythroid leukemia.106 cases of acute myeloid leukemia were diagnosed in 28 months in children’s hospital Lahore and PEL constituted 0.94%. Diagnosis of PEL is made by the bone marrow morphology showing predominant Immature erythroid precursors (proerythroblastic or undifferentiated), Periodic Acid- Schiff staining and immunophenotyping. In PEL no specific genetic mutations have been described but complex karyotypes and TP53 mutations are frequently noted. Future collaborative studies to identify the molecular defects will contribute to the development of targeted therapies that might improve the prognosis.
Maximal stability limits in adolescents with Tourette syndrome
Published on: 30th January, 2021
OCLC Number/Unique Identifier: 8984615786
We explored if adolescents with Gilles de la Tourette syndrome (GTS) had functional postural control impairments and how these deficits are linked to a disturbance in the processing and integration of sensory information. We evaluated the displacements of the center of pressure (COP) during maximal leaning in four directions (forward, backward, rightward, leftward) and under three sensory conditions (eyes open, eyes closed, eyes closed standing on foam). GTS adolescents showed deficits in postural stability and in lateral postural adjustments but they had similar maximal COP excursion than the control group. The postural performance of the GTS group was poorer in the eyes open condition (time to phase 1 onset, max-mean COP). Moreover, they displayed a poorer ability to maintain the maximum leaning position under the eyes open condition during mediolateral leaning tasks. By contrast, during forward leaning, they showed larger min-max ranges than control subjects while standing on the foam with the eyes closed. Together, these findings support the idea that GTS produces subclinical postural control deficits. Importantly, our results suggest that postural control disorders in GTS are highly sensitive to voluntary postural leaning tasks which have high demand for multimodal sensory integration.
Dynamic knee valgus in anterior cruciate ligament non-contact injury and reinjury in professional female athletes. Determinant or not?
Published on: 15th November, 2022
Dynamic Knee Valgus (DKV) is correlated with both, Anterior Cruciate Ligament (ACL) injury and hip and ankle disorders in female athletes and has a more significant prevalence compared with male athletes because of numerous factors. The aim of this study is to determine if the connexion between DKV, landing errors, and non-contact ACL injury and re-injury in high-performance, adult, female team sport athletes can be eliminated by changing the frontal plane movement pattern and the landing errors during the rehabilitation process (RHB), a process which was focussed on dynamic knee stability with multidimensional single-leg jump landing training, on 3D knee balance improvement and multistimulus perturbation challenges and tasks,+ eccentric & concentric exercise, strength & conditioning, aerobic training that lasted from 26 - 44 weeks.Assessing and eliminating-reducing DKV during the RHB is mandatory in lowering the re-rupture rates in female professional athletes after ACL surgery and in preventing opposite knee trauma.
Clinical picture of pulmonary plague observed in the paediatric wards of antananarivo
Published on: 13th May, 2021
OCLC Number/Unique Identifier: 9272358036
Introduction: In Madagascar, plague is a highly contagious acute endemic infectious disease. The diagnosis of the most severe form of pneumonic plague remains difficult in children, hence the objectives of the present study; which is to identify the clinical signs of this clinical form in children and to describe its epidemiological and evolutionary profile.
Methods: A retrospective case-control study was conducted in four pediatric wards in Antananarivo during the urban pneumonic plague outbreak from September 2017 to January 2018.
Those cases were defined as children aged 0-15 years old suspected of having plague with positive RDT and PCR, and they were defined as children aged 0-15 years old with negative RDT and PCR.
Results: Fifty-two cases of pneumonic plague were identified, half of which (50%) were under 24 months of age.
A male predominance was noted with a sex ratio of 1.23 and 86.54% of the patients were from urban areas.
Several clinical signs were found but none was specific for pneumonic plague: cough (59.62% p: 0.5), dyspnea (3.85% p: 0.16), chest pain (3.85% p: 0.26%), hemoptysis (7.69% p: 0.17), vomiting (9.62% p: 0.14), diarrhea (11.54% p: 0.45), altered general condition (38.46% p: 0.24%).
Two deaths were noted (3.8%).
Conclusion: No specific clinical warning signs have been identified in childhood pneumonic plague. In the event of an epidemic of urban pneumonic plague, any bacterial pneumonia should at least initially include active treatment against Yersinia pestis.
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