Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Barrett, N. Keates, E. Kyrodimou, H. Wilson
https://ift.tt/2HvVI1c
Τετάρτη 18 Απριλίου 2018
A florid paranasal sinus reaction from a systemic disease
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Barrett, N. Keates, E. Kyrodimou, H. Wilson
https://ift.tt/2HvVI1c
Editorial Board
Source:Clinical Immunology, Volume 191
https://ift.tt/2JVh6LA
Caffeine inhibits STAT1 signaling and downregulates inflammatory pathways involved in autoimmunity
Source:Clinical Immunology
Author(s): Merve Iris, Pei-Suen Tsou, Amr H. Sawalha
Caffeine is a widely consumed pharmacologically active product. We focused on characterizing immunomodulatory effects of caffeine on peripheral blood mononuclear cells. Caffeine at high doses showed a robust downregulatory effect on cytokine activity and genes related to several autoimmune diseases including lupus and rheumatoid arthritis. Dose-dependent validation experiments showed downregulation at the mRNA levels of key inflammatory genes including STAT1, TNF, and PPARG. TNF and PPARG were suppressed even with the lowest caffeine dose tested, which corresponds to the serum concentration of caffeine after administration of one cup of coffee. Cytokine levels of IL-8, MIP-1β, IL-6, IFN-γ, GM-CSF, TNF, IL-2, IL-4, MCP-1, and IL-10 were decreased significantly with caffeine treatment. Upstream regulator analysis suggests that caffeine inhibits STAT1 signaling, which was confirmed by showing reduced phosphorylated STAT1 after caffeine treatment. Further studies exploring disease-modulating potential of caffeine in autoimmune diseases and further exploring the mechanisms involved are warranted.
https://ift.tt/2JZq2zM
Laryngo-Rhino-Otologie 2018; S 02 Article in Thieme eJournals: Table of contents | Congress
Laryngo-Rhino-Otologie 2018; S 02
Article in Thieme eJournals:
Table of contents | Congress
https://ift.tt/2HJJH5X
A Case of Septicemia due to Nonocclusive Mesenteric Ischemia Occurring in Induction Chemotherapy
In nonocclusive mesenteric ischemia (NOMI), mesenteric ischemia and intestinal necrosis occur despite the absence of organic blockage in mesenteric blood vessels. As abdominal pain is often absent and few characteristic findings are seen in blood biochemistry, imaging diagnosis or other examinations, discovery is often delayed. With a mortality rate of 56–79%, NOMI is a very serious disease. However, few reports have described this pathology in association with chemotherapy regimens such as those used for malignant head and neck tumors. We encountered a case of NOMI during induction therapy combining cisplatin, docetaxel, and 5-fluorouracil. The patient was a 74-year-old man receiving chemotherapy for T2N2bM0 stage IVA oropharyngeal carcinoma. Febrile neutropenia appeared on treatment day 8. An antibacterial agent and a granulocyte colony-stimulating factor were administered, but septic shock developed and he was transferred to the intensive care unit. Abdominal distension was present and contrast-enhanced computed tomography of the abdomen suggested NOMI. Emergency surgery on day 9 resected the necrotized small intestine and created a single-hole ileostomy. The patient subsequently recovered with 2 weeks of continuous hemodiafiltration and other intensive therapies. Otolaryngological surgeons seldom encounter intestinal diseases, which are thus easily overlooked. The present case report may help in achieving early diagnosis.
https://ift.tt/2HKPYyb
Hydroxyapatite Calvaria Graft Repair In Experimental Diabetes Mellitus In Rats
Among the systemic conditions that impact negatively on the planning and execution of surgical procedures, diabetes mellitus (DM) is the primary clinical condition responsible for complications. This study investigated bone formation in critical defects surgically filled with hydroxyapatite (HA) in diabetic rats. A descriptive, randomized sample and blinded analysis were conducted to test bone regeneration in critical bone defects surgically performed in rat calvaria. Twenty adult male Wistar rats were randomly divided into two groups: control, normoglycemic animals (CG); and test, streptozotocin-induced hyperglycemic animals (TG).
https://ift.tt/2HB5NKs
Onlay grafting with bovine bone mineral block for horizontal reconstruction of severely atrophic alveolar ridges in anterior maxillae: A 6-year prospective study
The aim of this prospective study was to evaluate the efficacy and long-term outcomes of onlay grafting with bovine bone mineral block for reconstruction of horizontal alveolar ridge defects in anterior maxillae.
https://ift.tt/2vq0dWi
Electroconvulsive therapy for depression in a patient with an inspire hypoglossal nerve stimulator device for obstructive sleep apnea: A case report
Obstructive sleep apnea (OSA) is a common disorder that affects 5–10% of the US adult population [1]. Affected patients report significant reduction in quality of life due to poor sleep quality, excessive daytime fatigue, and disruption of partner's sleep quality due to chronic snoring. In addition, moderate to severe OSA is highly associated with hypertension, insulin resistance, dyslipidemia, vascular disease, and cardiac dysrhythmias [1], and is an independent risk factor for all-cause mortality [2].
https://ift.tt/2qJ3avD
The fork in the road: A laryngeal filter airway foreign body
Upper aero-digestive tract foreign body management can be complicated and life threatening in both adult and pediatric populations. The variation seen with foreign bodies including shape, material, and duration of ingestion can impact clinical decision making and management. The objective of this report is to demonstrate a complicated case of upper airway obstruction by a plastic fork.
https://ift.tt/2Hbp7yt
Meat reintroduction in a patient with alpha-gal allergy
A 56-year-old woman presented to a drug allergy clinic for evaluation of a possible allergic reaction to acetaminophen. Two months before presentation the patient took 1000mg acetaminophen for pain relief and five hours later awoke with pruritic hives that resolved with diphenhydramine. Two weeks later, she took acetaminophen and developed pruritic hives four hours later, this time with vomiting, cramping, pruritic mouth, and sensation of throat closure. These symptoms resolved with diphenhydramine.
https://ift.tt/2Haq7Tn
Leaving the nest: improving food allergy management on college campuses
The transition from adolescence to young adulthood marks a developmental period where responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well-positioned to provide integrated support for students with food allergies.
https://ift.tt/2HvZtnn
Rhinitis and Sinusitis in the Geriatric Population
Rhinitis and sinusitis are common medical conditions that affect the geriatric population and have a significant impact on their quality of life. Because few studies examine differences in the clinical management between the geriatric and general adult population, therapies should be based on current guidelines. Special considerations should be made when treating these patients in regards to multiple comorbidities and the potential for drug interactions from polypharmacy. Further research on the pathogenesis of sinusitis in the geriatric population may provide specific differences in the clinical management in this population.
https://ift.tt/2Hax9rp
Pneumolabyrinth, intracochlear and vestibular fluid loss after cochlear implantation
The present case was a 38-year-old male who presented with progressive hearing loss, resulting in profound bilateral hearing loss. He had a past history of childhood medulloblastoma, which was treated with posterior fossa craniotomy and radiotherapy. A ventriculoperitoneal (VP) shunt was put in place to manage the hydrocephalus. Cochlear implantation (CI) was carried out on his right ear by a standard procedure. At CI activation, the electric impedance of the electrode was very high, and computed tomography revealed that there was no area of liquid density, suggesting depletion of the perilymph in the cochlea and vestibule.
https://ift.tt/2EZufj8
Low frequency of soya allergy in peanut‐allergic children: Relevance to allergen labelling on medicines
Allergy, EarlyView.
https://ift.tt/2JXysra
Osteopenia and Multiple Fractures in an Infant With Harlequin Ichthyosis
This case report describes the occurrence of osteopenia and multiple fractures in an infant with harlequin ichthyosis.
https://ift.tt/2vxV0Mj
https://ift.tt/2vxV0Mj
Error in Data
In the recent article by Ashchyan et al, there were errors in the Abstract, Results, and Discussion. The correct number (percentage) of patients with comorbidities is 238 (66.9%). The article has been corrected online.
https://ift.tt/2HKPJ6v
https://ift.tt/2HKPJ6v
Association of Marital Status With T Stage and Management of Early-Stage Melanoma
This population-based study evaluates the association between marital status and T stage at the time of presentation and the decision for sentinel lymph node biopsy in patients with early-stage melanoma included in the Surveillance, Epidemiology, and End Results database.
https://ift.tt/2EXvtLC
https://ift.tt/2EXvtLC
Warty Fingers and Toes in a Child With Congenital Lymphedema
This case report describes the occurrence of warty fingers and toes in a child with congenital lymphedema.
https://ift.tt/2HKPxnN
https://ift.tt/2HKPxnN
Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists
This medical record review evaluates biopsy reports from skin cancer screening examinations to compare dermatologist vs physician assistant accuracy in diagnosing skin cancer in a large health care system.
https://ift.tt/2EYbYCH
https://ift.tt/2EYbYCH
Skin Examination Patterns and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis
This cross-sectional pooled analysis analyzes the association between skin examination practices and diagnosis with thin nodular or superficial spreading melanoma.
https://ift.tt/2HKPoRh
https://ift.tt/2HKPoRh
Erythematous Plaque on the Inferior Eyelid
A 40-year-old woman presented with an 8-year history of a growing erythematous plaque on the left lower eyelid; physical examination revealed a single plaque involving the left lower eyelid, including its border, and eyelashes were absent. What is your diagnosis?
https://ift.tt/2EXESCQ
https://ift.tt/2EXESCQ
Association of Celecoxib Use With Decreased Opioid Requirements After Head and Neck Cancer Surgery
This matched cohort study examines the association of the addition of celecoxib to the standard analgesia regimen with opioid use in patients after head and neck cancer surgery.
https://ift.tt/2H95Jly
https://ift.tt/2H95Jly
Human papillomavirus: An unlikely etiologic factor in sinonasal inverted papilloma
The Laryngoscope, EarlyView.
https://ift.tt/2qLTmky
Photodynamic therapy induces antifibrotic alterations in primary human vocal fold fibroblasts
The Laryngoscope, EarlyView.
https://ift.tt/2Hayq1D
Long‐term outcome of selective neurectomy for refractory periocular synkinesis
The Laryngoscope, EarlyView.
https://ift.tt/2qGBQ0U
Treatment of chronic neurogenic cough with in‐office superior laryngeal nerve block
The Laryngoscope, EarlyView.
https://ift.tt/2Hay9M9
Sonographic assessment of swallowing in irradiated nasopharyngeal carcinoma patients
The Laryngoscope, EarlyView.
https://ift.tt/2qJ6l6t
Molekulargenetische Diagnostik – zielgerichtete Therapie des malignen Melanoms
Zusammenfassung
Hintergrund
Mit der Identifizierung der Schlüsselrolle des MAPK-Signalwegs (MAPK „mitogen-activated protein kinase") für die Entstehung und Progression des malignen Melanoms gelang ein Durchbruch in dessen Behandlung. Die Entwicklung zielgerichteter Therapien und Immuntherapien führte zu einem breiten therapeutischen Spektrum in der Behandlung fortgeschrittener oder metastasierter Melanome.
Ziel
Dieser Artikel befasst sich mit der Wirksamkeit der aktuellen selektiven Kinaseinhibitoren bei der Behandlung des malignen Melanoms mit nachgewiesener BRAF-Mutation und auch den seltener vorkommenden Mutationen im NRAS- und cKIT-Gen. Die Ergebnisse neuester klinischer Studien einschließlich des Toxizitätsprofils sowie neue Therapieansätze werden beschrieben.
Material und Methoden
Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed und ClinicalTrials zum Thema Behandlung des fortgeschrittenen Melanoms.
Ergebnisse
Eine Kombination von BRAF- und MEK-Inhibitoren führt zu einer Steigerung des Therapieansprechens und des Gesamtüberlebens im Vergleich zur Chemotherapie oder Monotherapie. Weitere spezifische Inhibitoren zeigen vielversprechende Resultate.
Diskussion
Durch die zielgerichtete Therapie und Checkpointblockade hat sich die Prognose des fortgeschrittenen und metastasierten Melanoms deutlich verbessert. Eine Kombination dieser therapeutischen Ansätze, könnte zukünftig in der Behandlung des Melanoms eine wichtige Rolle spielen. Sowohl eine detaillierte genetische Analyse des Tumors als auch ein besseres Verständnis der biologischen Prozesse sind notwendig, um insbesondere hinsichtlich der Resistenzmechanismen die Wirksamkeit moderner Melanomtherapien zu verbessern.
https://ift.tt/2J5tck1
A novel method for demonstrating cold agglutinin disease: a case report
Cold agglutinin disease is a rare disorder characterized by an autoimmune hemolytic anemia occurring at low temperatures. Physical examination findings, often limited to acrocyanosis, are combined with a therm...
https://ift.tt/2HHIcVM
Regulatory T cells control endothelial chemokine production and migration of T cells into intestinal tumors of APC min/+ mice
Abstract
Tumor-infiltrating lymphocytes are crucial for anti-tumor immunity. We have previously shown that regulatory T cells (Treg) are able to reduce T-cell transendothelial migration in vitro and accumulation of effector T cells in intestinal tumors in vivo. Treg depletion also resulted in increased levels of the chemokines CXCL9 and CXCL10 specifically in the tumors. In this study, we investigated the mechanisms for Treg mediated suppression of T-cell migration into intestinal tumors in the APCmin/+ mouse model. By breeding APCmin/+ mice with DEREG mice, which harbour a high affinity diphtheria toxin receptor under the control of the FOXP3 promoter, we were able to deplete Treg in tumor-bearing mice. Using adoptive transfer experiments, we could document a markedly increased migration of T cells specifically into Treg depleted tumors, and that Treg depletion results in increased production of the CXCR3 ligand CXCL10 from endothelial cells in the tumors. Furthermore, we were able to demonstrate that T cells use CXCR3 to migrate into intestinal tumors. In addition, human colon adenocarcinomas express high levels of mRNA CXCR3 ligands and tumor endothelial cells produce CXCL9 and CXCL10 ex vivo. In conclusion, this study demonstrates that Treg reduce endothelial CXCL10 production, inhibit T-cell migration into tumors and that CXCR3 mediated signalling is crucial for lymphocyte accumulation in intestinal tumors. Thus, immunotherapy aimed at Treg depletion may be effective by increasing not only T effector cell activity, but also their accumulation in tumors.
https://ift.tt/2qDybRs
IGEL Laryngeal Mask Airway Device Effectiveness in Irradiated Necks
Condition: Laryngeal Masks
Intervention: Device: IGEL Laryngeal mask
Sponsor: NHS Lothian
Not yet recruiting
https://ift.tt/2JUMF8p
Intervention: Device: IGEL Laryngeal mask
Sponsor: NHS Lothian
Not yet recruiting
https://ift.tt/2JUMF8p
Comparative Study of Robot BABA Approach and Chest Breast Approach for Lateral Neck Dissection
Conditions: Thyroid Carcinoma; Robot Surgery; Endoscopic Surgery
Interventions: Device: Robot; Device: Total endoscopic
Sponsor: Fujian Medical University
Recruiting
https://ift.tt/2J80ZJz
Interventions: Device: Robot; Device: Total endoscopic
Sponsor: Fujian Medical University
Recruiting
https://ift.tt/2J80ZJz
Diagnosis and Treatment of Paracoccidioidomycosis in the Maxillofacial Region: A Report of 5 Cases
Paracoccidioidomycosis is a fungal infection initially described in Brazil in 1908 by Adolfo Lutz. Manifestation of this disease depends on numerous factors, such as microorganism virulence, hormonal profile, genetic predisposition, nutrition, and immune system. It is characterized classically by cutaneous lesions, lymphadenopathy, and pulmonary involvement. It presents male predilection, which can be explained by the protective effect of female hormones. Classic presentation within oral cavity is a superficial ulcer characterized by hemorrhagic dots of moriform aspect. Treatment should be established individually and closely monitored. This manuscript aims at reporting five cases of this pathology.
https://ift.tt/2vpjN54
Disruptive behavior in the operating room: prevalence, consequences, prevention, and management
Purpose of review Disruptive workplace behavior can have serious consequences to clinicians, institutions, and patients. There is a range of disruptive behaviors, and the consequences are often underappreciated. The purpose of this manuscript is to review the definition, prevalence, consequences, prevention, and management of disruptive behavior in the operating room. Recent findings Although a small minority of operating room clinicians act disruptively, 98% of clinicians report having recently been exposed to disruptive behavior, with the average being 64 events per clinician per year. The causes include intrapersonal factors, workplace relationships, workplace logistics, and broader contextual factors. Disruptive behavior undermines patient care by decreasing individual and team clinical performance. It decreases clinician well being, sets a poor example for medical students who are susceptible to negative role models, and decreases hospital efficiency. The way that clinicians respond to disruptive behavior may either exacerbate or reduce the consequences of the behavior. In order to prevent disruptive behavior, the causes must be addressed. Institutions must have robust policies to deal with disruptive behavior and have preventive measures that include regular staff education. Whenever disruptive behavior does occur, it must be expeditiously addressed, which may include graded discipline. Summary Disruptive intraoperative behavior is prevalent and harms multiple parties in the operating room. Institutions require comprehensive measures to prevent the behavior and to mitigate consequences. Correspondence to Dr Eric Jacobsohn, MBChB, MHPE, FRCPC, AE215, Harry Medovy House – 671 William Avenue, Winnipeg, MB R3E 0Z2, Canada. Tel: +1 204 787 1518; e-mail: EJacobsohn@exchange.hsc.mb.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2J7JXet
https://ift.tt/2J7JXet
Efficacy of combination therapies of topical 5% imiquimod and liquid nitrogen for penile molluscum contagiosum
The Journal of Dermatology, EarlyView.
https://ift.tt/2qGBabP
Type 1 diabetes in a melanoma patient treated with ipilimumab after nivolumab
The Journal of Dermatology, EarlyView.
https://ift.tt/2Hap4mw
High-riding brachiocephalic (innominate) artery during surgical tracheostomy
Two cases of a high-riding innominate artery, which were found during routine surgical tracheostomy. A cartilage flap was applied to cover the significant vessel to prevent the life-threatening complications. These two cases were followed up for 2 months without any adverse events. We discussed the related vascular anatomy, imaging studies and brief literature review.
https://ift.tt/2qI8hNh
Double trouble!!! An unusual presentation of cervical cord herniation and medial end clavicle non-union in a single patient
Non-union of medial end clavicle is rare. Though traditionally they have been treated with conservative methods, surgery at initial presentation should be considered in these patients since conservative treatment can lead to non-union. Herniation of spinal cord, though rare, is seen in the thoracic region but can also occur in the cervical region post-traumatically as seen in our patient.
https://ift.tt/2J4L4eR
Uterus didelphys: two pregnancies, two term breech caesarean deliveries
We report the case of a woman with uterus didelphys who spontaneously conceived two singleton pregnancies, one in each uterus, and was delivered in both instances of a healthy breech infant at term by elective caesarean section.
https://ift.tt/2Hw6SCU
Transverse testicular ectopia with persistent mullerian duct syndrome
Persistent mullerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism caused by defects in synthesis or actions of mullerian inhibiting factor characterised by persistence of mullerian duct structures in a normal karyotype male. Transverse testicular ectopia (TTE) is a rare disease in which both testes are located in the same inguinal canal. We report a case of PMDS with TTE in a 1-year-old child who presented with non-palpable testis on right side with hernia on left side. Left herniotomy with bilateral trans-septal orchidopexy was done in this patient.
https://ift.tt/2vonHek
Ribavirin-induced anaemia reduced tacrolimus level in a hepatitis C patient receiving haemodialysis
A 37-year-old man with hepatitis C virus (HCV) genotype 3A developed renal failure. In 2007, the patient received a renal transplant and started receiving tacrolimus (Tac); the transplant subsequently failed. In April 2015, the patient restarted haemodialysis and in May initiated sofosbuvir 400 mg and ribavirin 400 mg daily. Baseline Tac level was 6.6 ng/mL and haemoglobin (Hb) was 10.3 g/dL. The patient then left the country for vacation and Hb was found to be dramatically low at 3.7 g/dL on return on 5 August. Ribavirin was put on hold, while darbepoetin dose was increased. On 23 August, Tac level was found undetectable; hence, dosage was increased. Hb eventually bounced back to >10 g/dL in October and Tac to 7.2 ng/mL; ribavirin was restarted at 200 mg three times weekly. HCV RNA level was undetectable at 3 months and remained undetectable 12 weeks after therapy finished.
https://ift.tt/2Hw6FQ8
A case of autoimmune haemolytic anaemia after 39 cycles of nivolumab
With growing use of nivolumab, rare but serious side effects have surfaced in some patients. We present a case of autoimmune haemolytic anaemia that developed after 39 cycles of nivolumab. A 78-year-old man with metastatic lung adenocarcinoma, refractory to multiple lines of chemotherapy was switched to nivolumab. After around 2 years of stable course on nivolumab, he developed transfusion-dependent anaemia with haemoglobin of 8.6 g/dL. Nivolumab was held immediately. Bone marrow biopsy findings were inconclusive of myelodysplastic syndrome. Further testing was suggestive of haemolysis with haptoglobin <10 mg/dL, elevated reticulocyte count and identification of immunoglobulin G antibody. Haemoglobin improved significantly with initiation of 1 mg/kg prednisone in addition to rituximab weekly x four doses. The development of transfusion-dependent anaemia with the exposure to cytotoxic chemotherapy usually raises the question for myelodysplastic syndrome. In contradiction, our patient was diagnosed to have a haematological autoimmune complication related to immunotherapy.
https://ift.tt/2J1eOJF
Rare case of hepatic haematoma following endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used diagnostic and therapeutic technique but it is not free of complications. Subcapsular hepatic haematoma is a rare but potentially fatal complication. A 71-years-old male patient resorted to the emergency department 36 hours after an uneventful ERCP presenting with severe abdominal pain and haemoglobin drop. Abdominal ultrasound and CT scan diagnosed a subcapsular hepatic haematoma. The patient was haemodynamically normal and was successfully treated with a conservative management. Signs and symptoms of hepatic haematoma following ERCP are non-specific. The most common symptom is abdominal pain. Abdominal CT, ultrasound or MRI make the diagnosis. Conservative management is possible if the patient is stable, nevertheless invasive treatment such as surgery or angiographic embolisation, may be required. A low threshold of suspicion is crucial for an early diagnosis and treatment. Fatal cases have been described but most patients have a favourable outcome.
https://ift.tt/2qGhVQB
Accidental and potentially life-threatening finding: pulsatile mass of the hypopharynx
Anatomical variations of the cervical part of the internal carotid artery (ICA) are not rare in the general population. They are usually asymptomatic and more common in the elderly. We report the case of a 70-year-old Caucasian woman who was referred to our department due to chronic cough. We performed a flexible nasofibrolaryngoscopy that demonstrated the presence of a pulsatile mass in the hypopharynx. After performing a cervical contrast-enhanced CT, the mass turned out to be an aberrant variation of the cervical part of the ICA. This case is intended to alert otolaryngologists, anaesthesiologists, radiologists and surgeons for this accidental finding and the possible consequences for the patient if not diagnosed and properly oriented.
https://ift.tt/2vq8TvF
Haematometrocolpos and acute pelvic pain associated with cyclic uterine bleeding: OHVIRA syndrome
Obstructed hemivagina and ipsilateral renal agenesis syndrome is a complex urogenital malformation usually presenting with obstructed menses and pelvic pain during female adolescence. The diagnosis can be established preoperatively with relative certainty by MRI or ultrasonography, and outcomes are usually satisfactory following surgical resection of the septal portion of the obstructed hemivagina. Such cases are best managed in referral centres with expertise in anatomical disorders of the female genital tract.
https://ift.tt/2qGhQMN
A case of H3N2 complicated by acute kidney injury secondary to rhabdomyolysis
H3N2 was first detected in July 2011 in the USA. It is responsible for sporadic cases of influenza and localised outbreaks and has not yet taken over on an epidemic or pandemic scale. An 84-year-old man presented with a dry cough, fever and myalgia for 3 days. On examination, he had a pulse of 98 bpm and blood pressure of 124/88 mm Hg. The patient was tachypnoeic, SpO2 was 90%. Auscultation revealed bilateral diffuse wheeze and crackles. He had generalised muscle tenderness on examination. On admission, creatinine was 1.9 mg/dL and CK(creatine kinase) was 44 000 U/L. Chest X-ray was suggestive of ARDS (acute respiratory distress syndrome). Throat swab was positive for H3N2. The patient was given intravenous fluids, oral sodium bicarbonate, oxygen and oseltamivir tablet. In view of ARDS, he was given intravenous methylprednisolone and bronchodilators for bronchospasm. The patient improved symptomatically; vitals and lab reports were normal at the time of discharge.
https://ift.tt/2vn8qud
Hydroxychloroquine-induced hypoglycaemia in non-diabetic renal patient on peritoneal dialysis
Hydroxychloroquine (HCQ) is a commonly used drug for the treatment of systemic lupus erythematosus (SLE). Renal involvement is common in SLE. We present a 25-year-old woman with lupus nephritis on peritoneal dialysis whose lupus was quite silent for almost three years, and secondary to HCQ she developed severe hypoglycaemic episodes, which were completely resolved after stopping HCQ.
https://ift.tt/2HsqYhw
Transient immune-mediated agranulocytosis following Mycoplasma pneumoniae infection
Mycoplasma pneumoniae is a common respiratory pathogen which may cause haematological manifestations including haemolytic anaemia and thrombocytopaenia. Severe neutropaenia is rare with very few cases reported in the literature. An 85-year-old man was transferred to our facility with agranulocytosis in the context of an infective exacerbation of chronic obstructive pulmonary disease with positive serological testing for M. pneumoniae. No alternative infective, autoimmune or lymphoproliferative cause of the neutropaenia was identified. Granulocyte autoantibody testing was performed with a positive result for neutrophil-bound IgG and IgM autoantibodies and significant agglutination reactions. The patient was treated with azithromycin and granulocyte colony-stimulating factor which resulted in a sustained resolution of his neutropaenia.
https://ift.tt/2J497KY
Nasal septal schwannoma: a rare sinonasal tumour with certain peculiarities
Sinonasal schwannomas constitute 4% of head and neck nerve sheath tumours; however, schwannomas involving the nasal septum are quite rare. We present a 57-year-old male patient with nasal septal schwannoma who was managed successfully by endoscopic excision. 32 cases of septal schwannoma have been reported so far in the literature. This report discusses certain peculiar features exhibited by schwannomas of the nasal septum. Septal schwannoma does not show any age, sex or side predilection. However, they tend to involve posterior part of the septum and presumed to arise from the nasopalatine branch of the trigeminal nerve. Imaging findings of the sinonasal schwannoma are non-specific, but the histopathological characteristics are diagnostic, with seldom need for immunohistochemistry. Endoscopic excision is the safe and effective treatment option for the septal schwannoma of any size and location. Recurrence has not been reported in the literature following endoscopic excision.
https://ift.tt/2qLX8v5
Lemierres syndrome: cavitary lung disease caused by uncommon bacteria
Description
A 32-year-old Asian man with a history of gastritis presented to the emergency room with abdominal pain, fever, cough and dyspnoea, one episode of haemoptysis. He also reported a sore throat 3 days ago. The patient was a sushi chef and an active smoker. Early lab work was remarkable for leucocytosis of 21 x109/L, lactic acidosis of 3 mmol/L, bandaemia of 19% with a procalcitonin of >100 and platelets of 74 x109/L . CT of the lungs was performed without contrast and was significant for multiple cavity lesions throughout the lungs (figures 1 and 2). The patient was intubated due to respiratory failure. He was empirically started on vancomycin, cefepime and azithromycin. A right internal jugular central line was attempted for triple lumen catheter placement but the vessel was not compressible. A CT scan of the neck revealed a right internal jugular vein 9 mm thrombosis (figure 3). Blood culture grew Fusobacterium necrophorum....
https://ift.tt/2vnJJOl
Seizure-Associated ST Elevation Myocardial Infarction in Absence of Plaque Rupture
Acute coronary syndrome (ACS) is a very common cause of morbidity and mortality in the U.S. Here, we present a case of acute ST elevation myocardial infarction (STEMI) in the setting of seizure activity. In this rare case, we have data from optical coherence tomography (OCT) that showed no plaque disruption, showing the role of OCT in understanding the pathophysiology of STEMI and providing some ideas for the mechanism of this seizure-induced STEMI.
https://ift.tt/2H91TEX
Aflatoxin M 1 contamination of raw cow’s milk in five regions of Kosovo during 2016
Abstract
During February and August 2016 (winter and summer season), 192 samples of raw bulk tank milk have been collected from small dairy farms in five different regions of Kosova (Prishtina, Prizren, Peja, Mitrovica, and Gjilan). These samples were analyzed for aflatoxin M1 (AFM1) contamination level by ultra-high performance liquid chromatography coupled with electrospray ionization triple quadrupole tandem mass spectrometry (UHPLC–ESI–MS/MS). The limit of quantification for AFM1 was 0.02 μg/L and recovery at 0.1–0.5 μg/L was 90–95% (coefficient of variation 15–25%). A total of 74 milk samples (38%) were found to be contaminated with AFM1 and 11 samples (5.7%) slightly exceeded the European Union maximum level of 0.05 μg/L. The maximum AFM1 level was at 0.082 μg/L. There was no relevant difference between summer and winter with regard to AFM1 frequency and levels. Although the frequency of AFM1-positive samples varied between regions, from 7% (Prishtina) to 53% (Prizren), only minor regional differences were observed with regard to average and maximum toxin levels. The high percentage of milk samples which were non-compliant with AFM1 maximum levels indicates that efforts to reduce the contamination levels of aflatoxin B1 in cows feed in Kosovo are necessary.
https://ift.tt/2H7EZ4Z
Characterisation of DOG-1 Expression in Salivary Gland Tumours and Comparison with Myoepithelial Markers
Abstract
DOG1 is an established diagnostic marker for gastrointestinal stromal tumours (GIST), but has been reported in salivary gland tumours (SGT) as an acinar and intercalated duct marker. However, its specificity and distribution is not well established. The aim of this study was to evaluate the diagnostic utility of DOG-1 expression in SGT in addition to comparing it with myoepithelial markers. Normal salivary tissue and SGT (n = 184) were examined for expression of DOG1 and a range of myoepithelial markers. SGT included: acinic cell carcinoma (ACC, n = 15), secretory carcinoma (SC, n = 9), pleomorphic adenoma (PA, n = 49), carcinoma ex-PA (Ca ex-PA, n = 11), adenoid cystic carcinoma (AdCC, n = 20), polymorphous adenocarcinoma (PAC, n = 6), myoepithelioma (n = 6), myoepithelial carcinoma (MC, n = 2), basal cell adenoma (BCA, n = 14), canalicular adenoma (CA, n = 19), mucoepidermoid carcinoma (MEC, n = 11), oncocytoma (n = 2), adenocarcinoma NOS (AdNOS, n = 4), basal cell adenocarcinoma (BCAC, n = 2), salivary duct carcinoma (SDC, n = 3) and papillary cystadenocarcinoma (PCAC, n = 1). Normal acini and ACC (14/15) showed strong luminal DOG1 staining; SC were largely negative with only focal expression in 3/9 cases. Luminal staining was seen in PA (14/49), PAC (4/6), Ca ex-PA (4/11) and AdCC (6/20). 8/11 MEC showed luminal and/or mucous cell staining. No staining was seen in myoepithelioma, MC, CA, adNOS and BCAC. BCA showed strong staining of myoepithelial cells in some cases (5/14). Variable myoepithelial DOG1 staining was seen in PA, Ca ex PA, BCA, SDC and PCAC which was not as consistent as myoepithelial markers such as calponin, p63 and αSMA. Absence of DOG1 can differentiate ACC from SC, but staining is variable in PA, PLGA and Ca ex-PA. Myoepithelial staining in some tumours but not in normal gland suggests a wider distribution in SGT than originally envisaged.
https://ift.tt/2H7hHw5
Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India
Abstract
Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006–2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.
https://ift.tt/2qHaOq5
Characterisation of DOG-1 Expression in Salivary Gland Tumours and Comparison with Myoepithelial Markers
Abstract
DOG1 is an established diagnostic marker for gastrointestinal stromal tumours (GIST), but has been reported in salivary gland tumours (SGT) as an acinar and intercalated duct marker. However, its specificity and distribution is not well established. The aim of this study was to evaluate the diagnostic utility of DOG-1 expression in SGT in addition to comparing it with myoepithelial markers. Normal salivary tissue and SGT (n = 184) were examined for expression of DOG1 and a range of myoepithelial markers. SGT included: acinic cell carcinoma (ACC, n = 15), secretory carcinoma (SC, n = 9), pleomorphic adenoma (PA, n = 49), carcinoma ex-PA (Ca ex-PA, n = 11), adenoid cystic carcinoma (AdCC, n = 20), polymorphous adenocarcinoma (PAC, n = 6), myoepithelioma (n = 6), myoepithelial carcinoma (MC, n = 2), basal cell adenoma (BCA, n = 14), canalicular adenoma (CA, n = 19), mucoepidermoid carcinoma (MEC, n = 11), oncocytoma (n = 2), adenocarcinoma NOS (AdNOS, n = 4), basal cell adenocarcinoma (BCAC, n = 2), salivary duct carcinoma (SDC, n = 3) and papillary cystadenocarcinoma (PCAC, n = 1). Normal acini and ACC (14/15) showed strong luminal DOG1 staining; SC were largely negative with only focal expression in 3/9 cases. Luminal staining was seen in PA (14/49), PAC (4/6), Ca ex-PA (4/11) and AdCC (6/20). 8/11 MEC showed luminal and/or mucous cell staining. No staining was seen in myoepithelioma, MC, CA, adNOS and BCAC. BCA showed strong staining of myoepithelial cells in some cases (5/14). Variable myoepithelial DOG1 staining was seen in PA, Ca ex PA, BCA, SDC and PCAC which was not as consistent as myoepithelial markers such as calponin, p63 and αSMA. Absence of DOG1 can differentiate ACC from SC, but staining is variable in PA, PLGA and Ca ex-PA. Myoepithelial staining in some tumours but not in normal gland suggests a wider distribution in SGT than originally envisaged.
https://ift.tt/2H7hHw5
Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India
Abstract
Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006–2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.
https://ift.tt/2qHaOq5
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