High morbidity cutaneous enzootic myiasis by Dermatobia hominis (Diptera: Oestridae) in sambar deer (Rusa unicolor)

SummaryThe development of neutralizing alloanti-bodies (inhibitors) to factor VIII (FVIII) is one of the most serious complications in the treatment of haemophiliacs. Inhibitors occur in approximately 20 to 30% of previously untreated patients (PUPs), predominantly children, with severe haemophilia A within the first 50 exposure days (ED). Immune tolerance induction (ITI) leads to complete elimination of the inhibitor in up to 80% of the patients and offers the possibility to restore regular FVIII prophylaxis. However, patients with high titre inhibitors, in whom standard ITI fails, usually impose with high morbidity and mortality and therefore prompting physicians to alternate therapy regimens. Rituximab, an anti-CD 20 monoclonal antibody has been successfully used in children and adults for the management of B-cell mediated disorders. We report on the use of a new protocol including rituximab in two adolescents with severe haemophilia A and high titre inhibitors, severe bleeding tendency and high clotting factor consumption after failing standard ITI. Both patients received a concomitant treatment with FVIII according to the Bonn protocol, cyclosporine A and immunoglobulin. Treatment with rituximab resulted in a temporary B-cell depletion leading to the disappearance of the inhibitor. FVIII recovery and half-life turned towards normal ranges. In patient 1 the inhibitor reappeared 14 months after the last rituximab administration. In patient 2 complete immune tolerance could be achieved for 60 months. Bleeding frequency diminished significantly and clinical joint status improved in both patients. In patient 1 the treatment course was complicated by aspergillosis and hepatitis B infection. Conclusion: Rituximab may be favourable for patients with congenital haemophilia, high-titre inhibitors and a severe clinical course in whom standard ITI has failed. Prospective studies are required to determine safety, efficacy and predictors of success.

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Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer

Perspectives in Surgery ◽

10.33699/pis.2020.99.5.200-206 ◽

2020 ◽

Vol 99 (5) ◽

pp. 200-206

Keyword(s):

Oesophageal Cancer ◽

Surgical Procedure ◽

Anastomotic Dehiscence ◽

Gastric Conduit ◽

Morbidity And Mortality ◽

High Morbidity ◽

Therapeutic Algorithm

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

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Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1216 ◽

2015 ◽

Vol 18 (1) ◽

pp. 006

Author(s):

Hasan Reyhanoglu ◽

Kaan Ozcan ◽

Murat Erturk ◽

Fatih İslamoglu ◽

İsa Durmaz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Failure ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Significant Risk ◽

High Morbidity ◽

Factors Associated

Objective: We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery. Methods: One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group (C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated. Results: Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while 26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P < .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively. Conclusion: Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.

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Overview of Treatment Options for Critical Limb Ischaemia Patients

European Cardiology Review ◽

10.15420/ecr.2011.7.1.51 ◽

2011 ◽

Vol 7 (1) ◽

pp. 51 ◽

Cited By ~ 1

Author(s):

Frederic Baumann ◽

Nicolas Diehm ◽

◽

Keyword(s):

Treatment Options ◽

Critical Limb Ischaemia ◽

Treatment Modalities ◽

High Morbidity ◽

Limb Ischaemia ◽

Arterial Revascularisation ◽

Planning Treatment ◽

Treatment Concepts ◽

Peripheral Arterial ◽

Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

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Delayed Treatment of Spinal Cord Injury In Young: A Case Report

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.93 ◽

2018 ◽

Vol 1 (2) ◽

pp. 15

Author(s):

Joshua Sutikno

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Traffic Accidents ◽

Epidemiological Data ◽

Morbidity Rate ◽

High Morbidity ◽

Low Back ◽

Traditional Treatment ◽

Delayed Treatment ◽

Cord Injury

Background: Spinal cord injury (SCI), one of the problems caused by traffic accidents, has a high morbidity in developing country like Indonesia. In Indonesia, the use of motorcycles is increasing every year. The epidemiological data from Fatmawati Hospital of spinal cord injury in 2014 was 104 cases both traumatic and non-traumatic SCI. In this case, a young boy with worsening of SCI, delayed the treatment for about 3 months.Case: A 19 years-old male complained of limbs paralysis for the past two weeks. He felt numbness and tingling in hamstring and calf areas. From past medical history, he had a motorcycle accident 3 months prior. After the accident, he suffered from extreme low back pain, but he could still move his legs. Due to economic restrictions, the patient refused to go to the hospital, and they chose a traditional treatment. For about three months, the pain was decreasing, but he was never pain-free. As the symptoms continued to worsen, the neurosurgeon decided to decompress the spinal cord and performed discectomy. After a week of treatment, the pain disappeared, motor muscle got better, and he could feel again the sensation on the dermatome of S1. Conclusion: Early treatment is recommended to get a better outcome. The surgery is not the only treatment, rehabilitation and orthotics using are important too. Delayed treatment increases morbidity rate.

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Incidence of depression and its influencing factors in 387 patients with asthma from Xinjiang, China

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.190034 ◽

2020 ◽

Vol 41 (2) ◽

pp. e45-e53 ◽

Cited By ~ 1

Author(s):

Dilinuer Wufuer ◽

Haidiya Aierken ◽

Yan Fang ◽

Mihereguli Simayi ◽

Kelibiena Tuerxun ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Depression Scale ◽

High Morbidity ◽

Hamilton Depression Scale ◽

Multiple Factors ◽

Asthma Symptoms ◽

Depression Status ◽

Treatment Of Depression ◽

Quality Life

Background: Our study aimed to investigate the incidence of depression in 387 patients with asthma. Methods: The Zung self-rating depression scale and the Hamilton depression scale were used to evaluate the depression status in patients with asthma. Results: Results of logistic regression analysis indicated that, severity of asthma symptoms, taking medicine, frequency of asthma onset, and lack of education were the major risk factors for depression in patients with asthma. Conclusion: Depression is a complication with high morbidity in patients with asthma. It largely affects disease control of asthma and the quality life in patients. Multiple factors are relevant for depression in the patient with asthma. This study provided a comprehensive horizon for clinical management and treatment of depression in patients with asthma.

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Clinico-bacteriological Profile and Outcome of Empyema Thoracis in Children at a Tertiary Care Hospital of Central Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i3.30661 ◽

2020 ◽

Vol 16 (3) ◽

Author(s):

Atanu Pan ◽

Debarshi Jana

Keyword(s):

Ct Scan ◽

Broad Spectrum ◽

Chest Tube ◽

Chest Tube Drainage ◽

Diagnostic Tools ◽

High Morbidity ◽

Care Hospital ◽

Empyema Thoracis ◽

First Line ◽

Tube Drainage

Background: Empyema thoracis (ET) is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, Empyema Thoracis remains associated with high morbidity worldwide. Delay in early diagnosis, failure to institute appropriate antimicrobial therapy, multidrug resistant organisms, malnutrition, comorbidities, poor health seeking behaviour and high treatment cost burden contribute to increased morbidity in children. The available treatment options include intravenous broad-spectrum antibiotics either alone or in combination with surgical procedure (thoracocentesis, chest tube drainage, fibrinolytic therapy, decortications with video assistedthoracoscopic surgery (VATS) and open drainage. Methods: Fifty Children between 1 month to 16 years admitted in the Pediatrics Ward, PICU of College of Medical Sciences, Bharatpur,Nepal. Data analysis was done by SPSS 24.0. Results: Present study found that according to blood culture, 3(6.0%) patients had enterococcus, 40(80.0%) patients had no growth, 2(4.0%) patients had pseudomonas, 4(8.0%) patients had staphylococcus and 1(2.0%) patients had streptococcus. We found that 20(40.0%) patients had done CT scan thorax, 30(60.0%) patients had not done CT scan thorax and 32(64.0%) patients had Amoxiclav first line antibiotic and 18(36.0%) patients had Ceftriaxone first line antibiotic. Conclusions: Suitable antibiotics and prompt chest tube drainage is an effective method of treatment of childhood empyema, especially in resource-poor settings. Majority of the patients progress on this conservative management and have good recovery on follow up.

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A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

10.31487/j.jscr.2020.01.03 ◽

2020 ◽

pp. 1-3

Author(s):

Jinping Xu ◽

Ruth Wei ◽

Salieha Zaheer

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Femoral Hernia ◽

Rare Case ◽

Hernia Recurrence ◽

High Morbidity ◽

Diagnostic Challenge ◽

Abdominal Ct ◽

Abdominal Ct Scan ◽

History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

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Hallazgos oftalmológicos en enfermedad de Fabry: relación de su severidad en una familia mexicana

Latin american journal of clinical sciences and medical technology ◽

10.34141/ljcs4143209 ◽

2019 ◽

Vol 1 (1) ◽

pp. 43-49

Author(s):

Araceli Borja Borja ◽

Gabriela Salas Pérez ◽

Pablo Radillo Díaz

Keyword(s):

Premature Mortality ◽

Retinal Vessel ◽

Multiple Organ ◽

High Morbidity ◽

Lysosomal Storage ◽

Enzyme Replacement ◽

Non Invasive ◽

High Incidence ◽

Cornea Verticillata ◽

Gla Gene

Introduction. Fabry disease (FD) is a lysosomal storage disorder associated with multiple organ dysfunction which eventually leads to high morbidity and premature mortality. Ophthalmologic findings in FD are very common and have been described extensively. We describe the ophthalmologic findings of a family diagnosed with FD at Hospital de Especialidades de Puebla and establish their relationship with other phenotypic findings. Cases Presentation. A renal, cardiac, audiological, neurological, and ophthalmologic evaluation was carried out. The disease was confirmed by GLA gene sequencing. The ophthalmologic assessment was focused on the changes described in the literature, as well as the search for other anomalies possibly related to the disease. All the patients had the c.260delA (P.Glu87Glyfs*34) mutation in the GLA gene. The main ophthalmologic finding in our patients was cornea verticillata (in 100 % of the female patients). Other ophthalmologic manifestations were dry eye, retinal vessel tortuosity, ametropia, chromatic vision disorders, ocular annexes, eyelids, and conjuntiva disorders. Conclusions. Most of the assessed patients showed ophthalmologic changes, consistent with the results described in the literature. A remarkable finding in the sample was the high incidence of changes in women, in whom one would not expect the disease to be as severe because they are heterozygous. Ophthalmologic abnormalities in FD require deeper evaluation to establish their possible use as markers of disease progression and/or enzyme replacement therapy initiation due to the benefit of the non-invasive nature of ophthalmologic evaluations.

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