A rare anatomical variation in foramen of Vesalius: A useful guide for maxillofacial surgeons

Background: Foramen of vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus. It lies in the anteromedial side of the foramen ovale. Foramen ovale allows the passage for the mandibular branch of trigeminal nerve, the main site for the trigeminal rhizotomy. The presence and description of anatomical variations about the foramen of Vesalius is important during the surgical procedure on the trigeminal nerve which may injure the emissary vein in the foramen leading to intracranial bleeding. Objectives: The aim of the present study is to report the presence and to enlighten the anatomical variations of foramen vesalius which may serve as a guideline for surgeons. Methods: The study was conducted on 100 dry adult human skulls collected from the department of anatomy at Panimalar medical college hospital & research institute Chennai. The skulls were viewed both extracranially and intracranially to identify the presence of foramen of vesalius. The presence and variation of the foramen was noted and discussed. Result: A total of about 200 sides of 100 skulls were studied. Among them 20% of the skull showed presence of foramen of Vesalius bilaterally, 25% unilaterally and one particular skull showed doubled opening on the left side with the presence of a bony septum. This is a rare variation which was less documented in the literature. Conclusion: The knowledge of variations in foramen of Vesalius may help the surgeons for safer planning and execution of the trigeminal rhizotomy technique.

Association of Non-Alcoholic Fatty Liver Disease with Metabolic Syndrome: A Single Center Study

Background: NAFLD is a condition defined by excessive fat accumulation in the form of triglycerides (steatosis) in the liver (> 5% of hepatocytes histologically). Non-alcoholic fatty liver disease is increasingly being recognized as a major cause of liver-related morbidity and mortality among 15-40% of the general population. Aim of the study: To evaluate the clinical profile of patients with non-alcoholic fatty liver disease and its association with metabolic syndrome.Methods:The present cross-sectional, retro-spective study was conducted as outdoor patient basis in the Department of Medicine, Jashore medical college hospital & a private diagnostic centre, Jashore.. A total of 74 cases were included for the study. All patients in the study underwent routine investigations including complete blood counts, blood sugar, liver function tests, HBsAg, anti-HCV, lipid profile andUSG of whole abdomen. The data was collected during OPD treatment and was recorded in predesigned and pretested proforma and analyzed.Results:Mean age of the patient was 53.70±7.22 years. On physical examination findings showed the mean BMI was 27.6±4.39 kg/m2, mean waist circumference was 74.22±7.44 cm. Mean diastolic blood pressure (mm Hg) was 92.87±6.25 and mean systolic blood pressure (mm Hg) 132.0±18.17. Maximum 52% patients had triglycerides >150 mg/dl while low serum HDL level was seen in 37% patients and increased waist circumference was found in 32% patients. Altered ALT ≥41 IU was observed in 10 (62.50%) of Grade II of patients with NAFLD with metabolic syndrome. Central obesity was observed in 12 (75.00%) of Grade II patients with NAFLD with metabolic syndrome. While 14 (87.50%) Grade II of patients with NAFLD with metabolic syndrome showed impaired fasting glucose (>110 mg/dl). Hypertriglyceridemia (>150 mg/dl) in 12 (70.58%) seen in Grade I of patients with NAFLD without metabolic syndrome.Conclusion:Higher prevalence of all the components of metabolic syndrome in cases of NAFLD was observed. It can be concluded that symptoms and signs of NAFLD are non-specific and occur later in the course of the disease hence the physician should have a high index of suspicion in order to detect NAFLD early in the course of the disease.

Prostate Volume Measurement by Ultrasonography Over 40 Years Age of Bangladeshi Population

Background: Benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy, is a histologic diagnosis status characterized by proliferation of the ‘glandular elements’ of the prostate, which may lead to an enlarged prostate gland. In many studies, people over the age of 40 years found as the most vulnerable for BPH. Ultrasonography is a prominent method to determine prostate volume or size. Aim of the study: The aim of the present study was to evaluate the prostate volume measurement for the Bangladeshi population over the age of 40 years by ultrasonography.Methods:This prospective, observational study was conducted in the Department of Anatomy, Chattogram Medical College Hospital, Chattogram, Bangladesh during the period from January 2019 to December 2020. In total 157 suspected patients of benign prostatic hyperplasia were selected as the study population. All patients were clinically diagnosed for BPH, based on the present prostate symptoms and digital rectal examination. To measure the prostate volume, abdominal ultrasonography was performed for all the patients. After enucleation, another ultrasonogram was performed for all the patients to measure the existing sizes of the prostates of the patients. All the data were processed, analyzed, and disseminated by MS-word and SPSS programs as per need.Results:Finally, in this study in analyzing the volumes of the prostates of the participants according to the abdominal ultra-sonographic reports of pre-operative stage we observed, in 9%, 34%, 31%, 30%, 21% and 32% patients, the prostate sizes (In cc) were <20, 21-40, 41-60, 61-80, 81-100 and >100 cc respectively. On the other hand, after enucleation, in 11.46%, 24.20%, 28.66%, 27.39%, 7.01% and 1.27% patients, the prostate sizes (In cc) were found <20, 21-40, 41-60, 61-80, 81-100 and >100 cc respectively. The mean changes of prostate sizes between pre- and post-operative stages among the participant was not significant where the P value was found 0.464.Conclusion:The findings of this study support the applications of abdominal ultrasonographic evaluation for suspected benign prostatic hyperplasia patients to know about the exact volumes of their prostates for selecting the appropriate surgical approach.

Evaluation of Epididymo-Orchtis-A Study of 100 Cases

Background: Acute epididymo-orchitis is a common clinical problem in urological practice. It is not an uncommon disease in our country to cause work loss particularly in active group of people. Aim of the study: The aim of this study was to see the predisposing factors involved, aetiopathology and progression of disease process.Methods:This prospective study was conducted in department of surgery, Kumudini Women’s Medical College Hospital, Tangail from April 2008 to March 2009. Hundred patients of inflammation of epididymis and testis were included in this study.Results:Out of 100 patients, majority (48%) were in monogamous relationship. All patients (100%) had scrotal pain, 22% had scrotal swelling, 59% had fever, 32% had dysuria and 11% had urethral discharge. All patients presented with tenderness of the testis and epididymis and 82% cases had both epididymal and testicular swelling. Thirty two percent cases had urinary tract infection, trauma and promiscuous sexual contact were associated with the disease in 2% and 18% cases, respectively. History of masturbation was noted in 18% cases. By urine routine microscopy 28% had pus cell and 03% had RBC in urine, 16 cases were positive in urine culture, among 15% were E.coll and 01% were found Klebsiela. Forty patients were tested Chlamydial CFT and 16(40%) were found positive, out of 12 Filarial CFT tested 01(8.33 %) was found positive, Gram staining of urethral discharge revealed Neisseria gonorhhoae in 02(18.18%) cases. In maximum cases no actiological factor was found. Majority cases under 35 years were infected with Chlamydia and patients older than 35 years were mostly infected with E.coli.Conclusion:This study reflects that maximum of our study patients report to hospital nearly at right time with relatively better health status and outcome of available treatment facilities are satisfactory.

Clinico-Epidemioogical and Radiological Profile of Broncholitis at Sher-E-Bangla Medical College Hospital in Barishal, Bangladesh

Background: Bronchiolitis, caused mostly by Respiratory syncytial virus (RSV) virus is the leading cause of lower respiratory tract infection in infants. The disease is mostly presents with cough runny nose, fever, breathing difficulties and respiratory failure This infection usually affects children up to age of 24 months, with younger infants often more severely affected and is the most prevalent cause of hospitalization in infants under the age of 12 months. The treatment is supportive; therefore, epidemiology, clinical, laboratory, and radiologic findings can help to ensure appropriate diagnosis and proper treatment.Methods:This descriptive cross-sectional observation study was conducted at Paediatrics department of Sher-E-Bangla Medical College & Hospital (SBMCH), Barishal, Bangladesh between October 2018 to March 2019To find out the clinico-epidemiological and radiological profile of Bronchiolitis. Children below 24 months of age diagnosed as bronchiolitis were studied.Results:200 children were evaluated, including 150 boys and 50 girls; Infants below 6 months accounted for the highest proportion (60%). All the bronchiolitis patients had cough or cold with respiratory distress. Other symptoms were fever (98.0%), restlessness (63.0%), poor feeding (60%) and fast breathing. On examination lower chest indrawing and rhonchi were found in all cases. Hyperinflation was the most prevalent radiological finding (60%) and more than half (55%) patients had lymphocytosis on CBC.Conclusion:Most children present with typical clinical and radiological feature of bronchiolitis which can help the clinicians to clinically identify this disease more efficiently.

Treatment of Infertility in Women with Polycystic Ovary Syndrome in a Single Center Study

Background: Anovulatory infertility is caused by polycystic ovarian syndrome in 80 percent of patients. Preconception guidelines, such as lifestyle modification (weight loss) to avoid fetal neural tube abnormalities, and quitting smoking and drinking alcohol, are all part of the early treatment. A clomiphene citrate medication for timed intercourse is the first-line pharmacological treatment for producing ovulation. Exogenous gonadotropins or laparoscopic ovarian surgery are two options for second-line pharmaceutical treatment (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective, with a 70 % cumulative live birth rate. When laparoscopy is necessary, ovarian drilling should be done; this operation is usually successful in around half of the instances. Finally, when the previous interventions have failed, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is recommended. There is no evidence that metformin should be used routinely in the treatment of infertility in anovulatory women with polycystic ovary syndrome. Aromatase inhibitors show promise, but more research is needed to confirm their safety.Methods:This study was conducted in Department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, from January 2019 to December 2019. A total number of 100 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 24.0.Conclusion:PCOS is a frequent syndrome and the most frequent cause of infertility. PCOS is defined as a syndrome with at least two of three of the Rotterdam criteria. A complete evaluation of the infertility is needed to exclude other causes of infertility..

Clinical Features and Surgical Management of Pituitary Adenoma During Pregnancy: Case Series and Literature Review

Purpose Although conservative treatment was recommended for pregnant patients with pituitary adenomas (PAs), surgical treatment is occasionally necessary for those with acute symptoms. However, surgical intervention among these patients is poorly studied. Methods Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 and another 35 pregnant patients profiled in the literature were included. Results All the 41 enrolled patients (mean age 29.8 ± 5.3 years) had acute symptoms including visual field defects, severe headaches, or vision loss requiring emergency pituitary surgeries. Mean tumor diameter was 2.16 ± 0.9 cm, and 92.6% were macroadenomas. PA apoplexies were found in 23 patients. The average gestation time at surgery was 25.1 ± 7.1 weeks; 55.9% of these patients underwent surgery in the second trimester of pregnancy. Multidisciplinary team was involved from before surgery to after delivery. Except one patient underwent an induced abortion, and one fetus died due to a nuchal cord, thirty-nine patients delivered successfully, and 37 of fetuses were healthy till the last follow-up. One fetus died of congenital diaphragmatic hernia, and another had a low Apgar score after a cesarean section but survived. Conclusion PA surgery for pregnant patients with PAs is effective and safe during the second and third trimesters. Pregnant patients requiring emergency PA surgery need multidisciplinary evaluation and healthcare management. Cooperation of neurosurgery, endocrinology, obstetrics, anesthesiology, and neonatology is necessary for a successful surgical intervention for pregnant patients with PAs.

Population-split-based risk assessment model of venous thromboembolism in Chinese medical inpatients

Objective Inpatients with high risk of venous thromboembolism (VTE) usually face serious threats to their health and economic conditions. Many studies using machine learning (ML) models to predict VTE risk neglected an important statistical phenomenon, "fuzzy feature", and achieved inferior results. Considering the effect of "fuzzy feature", our study aims to develop a VTE risk assessment model suitable for Chinese medical inpatients. Materials and Methods Inpatients in the medical department of Peking Union Medical College Hospital (PUMCH) from January 2014 to June 2016 were collected. A new ML VTE risk assessment model was built through population splitting. First patients were classified into different groups based on values of VTE risk factors, then trustless groups were filtered out, and finally ML models were built on training data in unit of groups. Predictive performances of our method, five traditional ML models, and the Padua model were compared. Results The "fuzzy feature" was verified on the whole dataset. Compared with the Padua model, the proposed model showed higher sensitivities and specificities on training data, and higher specificities and similar sensitivities on test data. Standard deviations of predictive validity of five ML models were larger than the proposed model. Discussion The proposed model was the only one which showed advantages on both sensitivity and specificity over Padua model. Its robustness was better than traditional ML models. Conclusion This study built a population-split-based ML model of VTE for Chinese medical inpatients and it may help clinicians stratify VTE risk and guide prevention more efficiently.

Molecular surveillance reveals widespread colonisation by carbapenemase and extended spectrum beta-lactamase producing organisms in neonatal units in Kenya and Nigeria

Objectives Neonatal sepsis, a major cause of death amongst infants in sub-Saharan Africa, is often gut derived. Impairments in immunity and the gut barrier in sick neonates allow colonisation by opportunistic pathogens such as Enterobacteriaceae to progress to blood stream infection. Colonisation by Enterobacteriaceae producing extended spectrum beta-lactamase (ESBL) or carbapenemase enzymes is particularly problematic and can lead to antimicrobial-resistant (AMR) or untreatable infections. We sought to explore the rates of colonisation by ESBL or carbapenemase producers and their genotypes in two neonatal units (NNUs) in West and East Africa. Methods Stool and rectal swab samples were taken at multiple timepoints from newborns admitted to the NNUs at the University College Hospital, Ibadan, Nigeria and the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, western Kenya. Samples were tested for ESBL and carbapenemase genes using a previously validated qPCR assay with high resolution melt analysis. Kaplan-Meier survival analysis was used to examine colonisation rates at both sites. Results A total of 119 stool and rectal swab samples were taken from 42 infants admitted to the two NNUs. Six (14.3%) infants were extremely preterm (gestation <28 weeks), 19 (45.2%) were born by Caesarean section and 3 (8.6%) mothers were HIV positive. Median (IQR) duration of admission was 12.5 (5-26) days and 12 (28.6%) infants died. Overall, colonisation with ESBL (37 infants, 89%) was more common than with carbapenemase producers (26, 62.4%; P = 0.093). Median survival time before colonisation with ESBL organisms was 7 days and with carbapenemase producers 16 days (P=0.035). The majority of ESBL genes detected belonged to the CTX-M-1 (36/38; 95%), and CTX-M-9 (2/36; 5%) groups. The most prevalent carbapenemase was blaNDM (27/29, 93%). Single blaVIM (1/32, 3%) and blaOXA-48 genes (1/32, 3%) were also detected. Conclusions Gut colonisation of neonates by AMR organisms was common and occurred rapidly in NNUs in Kenya and Nigeria. Active surveillance of colonisation will improve the understanding of AMR in these settings and guide infection control and antibiotic prescribing practice to improve clinical outcomes.

Radiotherapy for Postsurgical Vaginal Recurrences of Cervical Squamous Cell Carcinoma: Analysis of Dosing and Prognosis

Background: This study aimed to investigate the efficacy of salvage radiotherapy for vaginal recurrence of cervical squamous carcinoma in patients who previously underwent surgery and to explore prognostic factors (particularly dose-related) associated with survival post-recurrence.Methods: Ninety-seven patients with histologically proven squamous cell carcinoma-subtype cervical cancer who were treated for vaginal recurrence at Peking Union Medical College Hospital between July 2011 and November 2019 were identified. All patients had previously undergone surgery for the primary tumor and received salvage external beam radiotherapy, brachytherapy, or both. Factors predictive of overall survival (OS), progression-free survival (PFS), and local control (LC) were investigated, as were adverse effects.Results: The median follow-up time was 42.5 months. The estimated 5-year OS, PFS, and LC rates were 84%, 79%, and 91%, respectively. On multivariate analysis, a tumor size ≤4 cm and an endovaginal recurrence pattern were associated with longer PFS (both P < 0.05); however, only the latter was predictive of a longer LC (P < 0.05). In the 33 patients with recurrences that were paravaginal or invasive of surrounding organs, biologically equivalent doses in 2 Gy fractions of ≥70 Gy were independently predictive of longer LC (P < 0.05). Finally, 12.4% of the patients experienced grades ≥2 late complications; only 1 patient who received EBRT alone experienced grade 5 late complications.Conclusions: RT is an effective treatment for post-surgical vaginal recurrence in patients with cervical squamous cell carcinoma. For patients with extravaginal recurrence, a salvage dose of ≥70 Gy appears to be optimal.