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 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

Inferior vena cava (IVC) involvement by intraluminal extension of tumor is infrequent, occuring in 4% to 10% of patients with renal cell carcinoma (RCC) [1-5]. Based on the cephalic extension of the thrombus, Mayo [6] described a classification of inferior vena cava thrombi in 4 categories, which has implications on surgical complexity, estimated blood loss (EBL) and peri-operative complications, but not cancer-specific survival [2,7]. Level III IVC thrombus is classified as being located in the retro-hepatic IVC below the diaphragm. Total resection of this tumor is the best chance of cure when no distant metastases are present [4,8]. Actually, open radical nephrectomy with concomitant thrombectomy is still the standard treatment. This procedure is technically challenging and involves a large incision and prolonged convalescence [9]. Recently, the feasibility of robotic IVC thrombectomy has been demonstrated, with potential lower EBL and shorter hospitalization and convalescence [7,10-14]. This surgery requires thorough knowledge of surgical anatomy, detailed pre-operative preparation and meticulous robotic technique [7]. The key point in the surgical management is the correct assessment of the extension of the endocaval thrombus, what is mainly based on radiological examinations [8]. Although Ultrasonography (US) and computerized tomography (CT) are useful in demonstrating the extent of the thrombus, CT is not always accurate in delineating the superior margin of the tumor in the IVC. More precisely, magnetic resonance imaging (MRI) can demonstrate a tumor thrombus and its extension, besides signs of wall invasion, being extremely useful to surgical procedure planning [8,15]. Vena cavography is not additive to US, CT, and MRI, and it increases the risk of contrast-associated renal injury [4,8]. However, new modern image technologies has emerged to help surgical planning, as three-dimensional visualization technique (3DVT) based on routine CT or MRI processed image data [16-20]. Recently, a comparative study showed advantage of 3DVT in management of complex renal tumor during laparoscopic partial nephrectomy [20]. This modality is able to demonstrate anatomy relations, allowing the surgeon to observe the relationship between targeted tumor and peripheral structure before surgery and perform virtual manipulation. This kind of preoperative accurate assessment can enhance surgeons confidence of surgical procedure and decrease surgical risk and incidence of complications [20]. There is no report in the literature of the use of this type of technology in cases of IVC tumor thrombus. We present the use of 3D holographic interactive reconstruction in a single case of robotic radical nephrectomy with level III IVC thrombectomy.

Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency. 

Objectives: This study aimed to compare the quality and quantity of bone at intraoral autogenous graft donor sites in type II diabetes mellitus (DM) patients versus healthy controls using cone-beam computed tomography (CBCT). Materials and methods: This case-control study was conducted on CBCT scans of 50 DM patients and 50 healthy controls between 20-70 years. Maximum height, width, length, and volume of harvestable bone at the symphysis, ramus, palate, and tuberosity were measured bilaterally. The Hounsfield unit (HU) was also calculated to assess bone quality. The two groups were compared regarding the quality and quantity of harvestable bone using an independent t-test. The effect of confounders was analyzed by the regression model (alpha = 0.05). Results: DM patients had significantly lower harvestable bone volume at the symphysis, ramus, and tuberosity than healthy controls (p < 0.001) but this difference was not significant at the palate (p = 0.957). Also, bone quality was significantly lower at the symphysis, ramus, palate, and tuberosity in DM patients (p < 0.001). Conclusion: Diabetic patients had significantly lower bone quality and quantity at intraoral graft donor sites than healthy controls. Mandibular symphysis had higher bone volume and density than ramus, palate, and tuberosity for graft harvesting in diabetic patients.

Background: Acute rheumatic fever (ARF) is a systemic inflammatory disease resulting from an abnormal immune response to group A β-hemolytic streptococci. ARF is a major public health problem in developing countries, particularly in Senegal. The aim of this study was to evaluate the mutation penetrance and genetic diversity of exon 2 of the HLA-DRB1 gene in Senegalese patients with ARF. Results: DNA was extracted from the blood of patients with ARF. Exon 2 of the HLA-DRB1 gene was amplified by polymerase chain reaction and sequenced using the Sanger method. Bioinformatics software and databases (polyphen-2, SIFT and ProVean) were used to assess the pathogenicity of missense mutations. The results revealed a high level of polymorphism in exon 2 of the HLA-DRB1 gene, with 73 non-synonymous mutations between codons 21 and 89, which lie in the hypervariable region encoded by exon 2. Of the 73 variants tested, 44% were pathogenic, indicating their potential involvement in ARF onset. Conclusion: Our results indicate that the HLA-DRB1 mutations involvement in the onset of rheumatic fever.

Aim of the study: Conduct long-term monitoring of recovered patients with pulmonary TB and study the frequency of relapses of pulmonary TB and factors contributing to their development in the Republic of Tajikistan.Material and research methods: Of the total number of patients with pulmonary TB, 820 people in 2010-2011 after successful treatment, were transferred for further dispensary observation to PHC facilities, whose health status we monitored for 10 years (including 2020). Of the 820 patients, we were able to track the health status for 10 years in 622 patients (320 men and 302 women, age groups 19-44 years old - 330 people and 45-69 years old - 292 people). The rest - for various reasons were lost from further dispensary observation. All patients in PHC facilities annually during the period of dispensary observation underwent clinical, instrumental, laboratory, and X-ray examinations to exclude the recurrence of TB. Data for each patient were tracked using the National TB Registry OpenMRS data.Research results: The elimination of preventive anti-relapse measures in people with residual post-tuberculosis changes in the lungs led to an increase in the number of relapses of the disease. The analysis of the conducted studies shows that the incidence of relapses of pulmonary TB does not depend on the regions and the severity of TB burden, they often develop with insufficient follow-up after the end of treatment and inadequate preventive measures in dispensaries patients.The study of the reasons for the development of relapses makes it possible to timely identify a group of patients who need anti-relapse measures and prolongation of dispensary observation.Conclusion: Thus, the results of this observation revealed the occurrence of relapses within 10 years in 19.3% of cases. A retrospective analysis of the initial forms of the disease showed that relapses of pulmonary tuberculosis occurred more often in patients who had had fibrous-cavernous pulmonary tuberculosis, than in patients who had disseminated pulmonary TB, and less often after suffering infiltrative pulmonary TB. Relapses of the disease occurred more often in men aged 19-44 years. The results obtained indicate the development of relapses of pulmonary tuberculosis has a statistically significant dependence on the form of the initial disease, the presence of RPTCL, comorbid diseases such as HIV, diabetes mellitus, COPD, and the regularity of taking anti-TB drugs. At the same time, it turned out that the social status of all patients with relapses corresponds to the level of poverty, which should also be taken into account.

Meigs’ syndrome is a rare condition characterized by the presence of a benign fibroma of the ovary, ascites and pleural effusion. Other benign cysts of the ovary (such as struma ovarii, mucinous cystadenoma, serous cystadenoma and teratomas), leiomyoma of the uterus, and secondary metastatic tumours to ovary if associated with hydro thorax and ascites are referred to as ‘Pseudo-Meigs” syndrome. It very uncommon and diagnosis is made difficult by symptoms that usually mimic disseminated malignancy or tuberculosis. The gold standard treatment is laparotomy and, by definition of the syndrome, after tumor removal, the symptoms resolves and the patients become asymptomatic. We presented an 18 years old girl with giant ovarian serous cystadenoma with associated pseudo-meigs syndrome, successfully managed in a low resources setting.

Cancer prognosis reflects a complex biological process measured by multiple types of omics data. Deep learning frameworks have been proposed to integrate multi-omics data and predict patient outcomes in different cancer types, potentially revolutionizing cancer prognosis with superior performance. This minireview summarizes the advances in the strategies for multi-omics data integration and the performance of different deep learning models in prognosis prediction of diverse cancer types using multi-omics data published in the past 18 months. The challenges and limitations of deep learning models for predicting cancer outcomes based on multi-omics data are discussed.

Robust anti-microbial surfaces that are non-toxic to users have widespread application in medical, industrial, and domestic arenas. Magnesium hydroxide has recently gained attention as an anti-microbial compound that is non-toxic, biocompatible, and environmentally friendly. Here we demonstrate melt compound and thermally embossed methods for coating polypropylene with Mg(OH)2 nanoplatelets and copper-infused Mg(OH)2 nanoplatelets. Polypropylene articles coated with Mg(OH)2 nanoplatelets and copper-infused Mg(OH)2 nanoplatelets exhibit a log 8 kill of E.coli within 24 hours. In addition, Mg(OH)2 NPs suspension, at 0.25% reduced SARSCoV-2 virus titers in the solution by 2.5 x 103 PFU/mL or 29.4%, while the Cu-infused Mg(OH)2 NPs suspension, at 0.25% reduced titers by 8.1 x 103 PFU/mL or 95.3%. Fluorescence microscopy revealed that reactive oxygen species (ROS) are produced in bacteria in response to Mg(OH)2 and Cu-infused Mg(OH)2 nanoplatelets which appears to be an important but not the sole mode of anti-microbial action of the nanoplatelets. Plastics with anti-microbial surfaces from where biocides are non-leachable are highly desirable. This work provides a general fabrication strategy for developing anti-microbial plastic surfaces.

Cerebrotendinous Xanthamatosis (CTX) is a rare autosomal recessive disorder caused by a mutation in the CYP27A1 gene leading to impaired metabolism of cholesterol and accumulation of cholestenol and the cholesterol in various tissues such as the brain, eyes, lungs and bones and reduced formation of cheno-deoxycholic acid (CDCA). The clinical presentation is diverse, starting in the early neonatal period and progressing till adulthood unless treated early. A common neurological manifestation is a spino-cerebellar ataxia followed by spastic paraparesis. Tendon xanthoma is a classical finding that usually helps in clinching the diagnosis but may not be present in all cases. Brain MRI also reveals characteristic abnormalities with cerebellar atrophy and hyper-intensities in the dentate nucleus and surrounding cerebellar white matter on T1weighted images. It is a rare cause of treatable ataxia in young individuals. Treatment is by replacement by CDCA or Urso-deoxycholic acid (UDCA). Supplemented with statins these individuals also have premature atherosclerosis causing death due to athero-sclerotic coronary artery disease. Here a rare case of symptomatic heterologous CYP27A1 mutation is reported with syndrome of spino-cerebellar ataxia treated with UDCA.