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Studies in children with eosinophilic esophagitis (EoE) have reported esophageal strictures but none have examined risk factors associated with strictures. Aim: To assess risk factors associated with strictures in children with EoE. Methods: In this retrospective study, children with EoE seen over 20 years were separated into two groups; with and without strictures. Physical features, CBC, endoscopic findings, and biopsy of the distal and mid-esophagus were captured. Statistical significance with p - value and multivariate logistic regression was done. Results: Total patients 222 and 20 (9.1%) had strictures. Mean age of stricture patients 12.7 years (range 7-18) and non-stricture 9.3 years (range 1-17) (p = 0.006). Among stricture patients following were prevalent and significant; dysphagia (stricture 100% vs. non-stricture 41.6%, p = 0.0005) and food impaction (70.04% vs. 4%, p = 0.0005); EGD: rings and exudates were strongly associated with stricture, 45.0% vs. 4.5%, p = 0.0005 and 60% vs. 30.7%, p = 0.008, respectively. Abdominal pain was lower in the stricture group (5% vs. 31.2%, p = 0.017). Eosinophil counts were numerically more in the stricture group but not significant. Multivariate logistic regression confirmed that strictures are likely to occur among patients with dysphagia (p = 0.02, OR = 11.7, 95% LCL 2.0) and food impaction (p = 0.0001, OR = 80.9, 95% LCL 15.4), respectively, adjusted for age and gender. Conclusion: EoE children with dysphagia or food impaction have a higher chance of having an esophageal stricture. These EoE children 12 years or over with exudates or rings on endoscopy, should be treated and carefully monitored, to reduce the risk of stricture formation.

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.

Aims: There is no study in the literature about ischemia-modified albumin (IMA) and hepatocyte growth factor (HGF) levels in amniotic fluid for Down syndrome cases. The aim of this study was to investigate the changes of IMA and HGF in Down syndrome cases at 16-20 weeks of gestation compared to normal fetuses.Methods: For this prospective case-control study, following reaching the number of 20 women (study group) who had the prenatal diagnosis of Down syndrome, maternal and gestational age-matched pregnant women with normal constitutional karyotype were selected for the control group (n = 74) from the stored amniotic fluid samples. Results: Mean women and gestational ages were comparable between the two groups. Amniotic fluid IMA (1.32 ± 0.13 vs. 1.11 ± 0.11 ABSU, respectively, p < 0.001) and HGF (2743.53 ± 1389.28 vs. 2160.12 ± 654.63 pg/mL, respectively, p = 0.008). Levels were significantly higher in pregnant women having Down syndrome fetuses compared with women having normal fetuses. The amniotic fluid IMA levels for the diagnosis of Down syndrome, and the sensitivity and specificity were calculated as 95.0% and 71.6% for the limit value 1.171 cm3, respectively. Conclusion: In cases with suspected Down syndrome, the diagnosis of Down Syndrome may be made in approximately 1 hour with high sensitivity and specificity by measuring the IMA level in the amniotic fluid sample taken for fetal karyotyping.

Distinguishing between fibroadenomas and phyllodes tumors is a challenge in breast surgery, despite advances in both radiology and pathology. In this case report, we analyze a patient presenting with a breast mass with multiple core needle biopsy results consistent with fibroadenoma, who underwent enucleation and was found to have phyllodes tumor on final pathology, thereby requiring surgical re-excision. This case report highlights the importance of patient clinical presentation in differentiating fibroadenomas and phyllodes tumors and explores how to achieve appropriate margins upon surgical re-excision after prior enucleation of phyllodes tumor via ultrasound localization of a seroma.

Introduction: Despite the benefits of Cardiac Rehabilitation (CR), local and national CR referral and participation rates remain low when compared to established cardiovascular therapies, especially amongst racial/ethnic groups. Objectives: This study investigated the effects of the implementation of a CR program and electronic order set (EOS) in a large health system on CR referral and participation rates among a diverse group of patients with Coronary Heart Disease (CHD). Methods: A total of 360 patients from UCSD Health who presented with ACS were prospectively evaluated during initial hospitalization and 6- and 12-weeks post-discharge. The multivariable logistic regression model assessed referral and participation rates by week 1 and -12 post-discharge, adjusting for gender, age, race, ethnicity, geography, and referring physician subspecialty. Results: UCSD CR program implementation led referral rates to increase at week 1 (Pre- 38.6% and Post-54.9%, p = 0.003) and week-12 (Pre- 54.1% and Post- 59.8%, p = 0.386). Post-CR referrals were more likely at week-1 (OR: 1.93, 95% CI 1.27-2.95) and week-12 (OR: 1.26, 95% CI 0.79-2.00). EOS implementation increased referral rates at week-1 (Pre- 40.3% and Post- 58.7%, p < 0.001) and week-12 (Pre- 54.9% and Post- 60.4%, p = 0.394) with referrals more likely at week-1 (OR: 2.1, 95% CI 1.35-3.29) and week-12 (OR: 1.25, 95% CI 0.795-1.98). Participation in CR following EOS was more likely at both week-1 and week-12. Multivariable analysis revealed disparities in referral based on race, geographic location, and referring physician subspecialty. Conclusion: A CR program and EOS implementation were shown to increase referral rates with long-term potential for increasing referral and participation rates. Condensed abstract: This prospective study investigated the implementation of a Cardiac Rehabilitation (CR) program and Electronic Order Set (EOS) within the same health system on CR referral and participation rates. 360 patients with ACS were evaluated over 12 weeks. UCSD CR program and EOS implementation led referral rates to increase at week-1 and -12. CR participation was more likely to increase at week-1 and -12 following EOS. Multivariable analysis revealed disparities in referrals disproportionally affecting racial and ethnic minority groups and rural communities. CR and EOS implementation may increase CR referral rates for diverse patients with CHD.

The pandemic the new Coronavirus infection has brought changes in the health status of a large number of our citizens. The consequence of this has been a higher rate of employees seeking medical care and subsequent sick leave. Crisis phenomena in the economic and social life of society are associated with the consequences of the pandemic, moreover, the stress burden on the population increases with the consequences of the pandemic. All this affects the level of performance. The transferred COVID-19 has increased the number of patients with complaints of pain in joints and muscles, with the phenomena of cardiovascular pathology, as well as in breathing, increased frequency of asthma attacks, etc. That is, complications affected a wide range of diseases [1-4]. All this is the consequence, including neurological pathology, which is closely related to stress. According to surveys of several large industrial enterprises, 31.7% of those seeking medical help report anxiety, sleep problems, and a feeling of fatigue [5]. Exacerbation of chronic diseases was recorded in more than 50% of patients with COVID-19. The figures show that more than 1/3 of the population is chronically unwell, and more often than usual they apply for sick leave, which inevitably leads to a decrease in economic indicators [6-10].

Coastal areas are subjected to both natural and man-made actions, leading to a deterioration of coastal structures. Climate change has had a heavy impact on these areas in recent years. An important consequence of these actions is sea level rise. This phenomenon is the most important cause of coastal erosion, a serious problem with ecological, economic, and human health consequences. The countermeasures to contrast this phenomenon and the degradation of the entire coastal system, are represented by engineering interventions. These basically consist of approaches for adaptation to sea level rise, namely protection, retreat, and accommodation. Variations and site adaptation of these actions can involve procedures of no intervention; advancement; protection; retreat; accommodation; and ecosystem-based adaptation. While these procedures have provided coastal benefits and protection, in the long run, they may cause further coastal disruption and further aggravate the situation. Such interventions, therefore, require an accurate assessment of the advantages and disadvantages. However, it is certainly necessary to proceed with actions aimed at mitigating climate change, respecting the rules in a sustainable way.

Crohn's disease is a chronic syndrome of the gastrointestinal tract that produces idiopathic inflammation. Approximately half of the patients develop abscesses and/or fistulas throughout their history that are located, mainly, in the perianal region. Current treatments are based on individualized plans that generally use combined pharmacology for symptomatic relief based on glucocorticoids, immunosuppressants or immunomodulators, antibiotics, anti-inflammatories, probiotics, and antibodies, or surgical therapies such as intestinal resections or ostomizations (colostomy and ileostomy) that tend to cause notable side effects in a considerable percentage of patients and a significant decrease in their quality of life.Perianal fistulas consist of abnormal tracts, inflammatory tunnels, or chronic tracts of granular tissue that connect two surfaces lined with epithelium, have an external hole in the skin that borders the anus, and an internal hole located inside it around the anal canal, rectus and sphincters. Treatment is a complex process that requires a multidisciplinary approach and the combination of several treatments. In the short term, the goal is to drain abscesses, reduce inflammatory and infectious processes, guard the fistulous tract with seton or lax lines, facilitate patency, and hinder new formations. In the long term, a total cure and the avoidance of complications that require surgery or the creation of intestinal stomas are pursued.For this reason, new effective remedies with fewer adverse effects continue to be investigated, one of the most promising being the use of mesenchymal stem cells for the regeneration and cure of perianal fistulas and the remission of symptoms. The present bibliographic review delves into this new therapy and analyzes the current state of the situation regarding its efficacy and safety.

At present Corona virus is the most burning topic across the world. At present there is no drug available to cure 100%. So many companies are trying to make it possible as soon as they can. The basic characteristics of the product is “Non-Toxic made of sugars Carbohydrates”. A Galectin is a protein that recognizes carbohydrates and modulates intracellular and extracellular interactions primarily related to the immune system. In some cases Galectins act as a glue bringing molecules together. The major focus of the research is on extracellular interactions.

Background: Hypertension is the leading cause of cardiovascular diseases and premature deaths. Hypertension plays a striking role in mortality and morbidity in case of Coronavirus Disease 2019 (COVID-19) infection; however, numerous studies have reported contradictory findings. Objective: To assess the relationship of hypertensive disease and mortality of COVID-19 infection and to assess the sex and age differentials on the association. Methods: We have conducted a systematic review of published literatures that identified the relationship between hypertension and mortality of COVID-19 infections. Nineteen articles were selected following structured inclusion and exclusion criteria for systematic review and analyses. A total of 21,684 hospital admitted COVID-19 patients were included in this review and meta-analysis from 19 studies. The studies covered the six months of the pandemic from December 2019 to May 2020. Results: In the pooled analysis, the median age of patients was 58 years, and the proportion of male patients was 58.8%. In contrast, we estimated 33.26% of hypertensive and 19.16% of diabetes mellitus patients in the studies. Hypertension was found to be associated with COVID-19 mortality (“Risk ratio (RR) = 1.45, [95% confidence interval (CI): 1.35 - 1.55]; I2 = 77.1%, p - value < 0.001”). The association in the meta-regression was affected by sex (p - value = 0.050). The association was found to be stronger in the studies with males ≥ 55% and age ≥ 55 years (“RR = 1.65, [95% CI: 1.52 - 1.78]; I2 = 77.1%, p - value < 0.001”) compared to male < 55% or age < 55 years (“RR = 1.11, [95% CI: 0.94 - 1.28]; I2 = 72.2%, p - value < 0.001”). Conclusion: Hypertension was significantly strong associated with COVID-19 mortality which may account for the contradiction in the many studies. The association between hypertension and mortality was affected by sex and there were significantly higher fatalities among older male patients.