After A Year of Follow Up Non-Cirrhotic Portal Hypertension Patient with Partial Spleen Embolization (PSE) Management

Non-cirrhotic portal hypertension (NCPH) is a heterogeneous group of liver disorders leading to portal hypertension. There are multiple approaches to managing portal hypertension' clinical complications to treat/prevent spontaneous hemorrhage by mitigating thrombocytopenia. Portal hypertension complications have been traditionally managed with serial endoscopic variceal ligation (EVL) or with invasive open surgical procedures such as orthotopic liver transplantation (OLT) or portosystemic shunting, splenectomy.6–9 There are several risks associated with splenectomies, such as hemorrhagic complications or intraoperative blood loss.5,6,14 Partial Spleen Embolization (PSE) ‎may overcome the limitations of splenectomy and provide patients with an alternative treatment. An eighteen-year-old male has a splenomegaly history since he was 12 years old and has recurring hematemesis and melena. After performing abdominal computed tomography, laboratory studies, and several endoscopies, the results indicated secondary hypersplenism due to non-cirrhotic portal hypertension. The patient had 13 endoscopies and 2 EVL in 5 years. Despite adequate treatment, the patients developed recurrent variceal bleeding and no improvement in blood function. The patient underwent PSE at Integrated Cardiovascular Center in Dr. Cipto Mangunkusumo, General Hospital, Jakarta, Indonesia. It was performed through the femoral access with a PVA (polyvinyl alcohol) embolus. The procedure went successful, and there was no major complication with the patient. Twenty days after the patient had an abdominal CT scan, it showed no abscess, and the spleen volume was reduced by 20%. Long-term results over a year after the procedure are presented. PSE is a safe, effective, semi-invasive alternative to splenectomy in non-cirrhotic portal hypertension because it preserves functional spleen mass and avoids postprocedure accelerated liver disease or encephalopathy.

Dental fractures: types, causes, and treatment

Studies indicate that the management of dental fractures might be challenging because many cases present with minor, hard-to-discover traumas, requiring extensive evaluation and diagnostic procedures. Accordingly, adequate management can only be achieved by establishing a proper diagnosis, drawing an adequate treatment plan, and conducting regular follow-up appointments. We have discussed the different causes, types, and treatments of dental fractures. The commonest causes include impaction by trauma, whether direct or indirect. Many traumatic events were reported in the literature, and age and carious lesions are important factors to consider. Many types of dental fractures were also reported in the literature, including root fractures, crown root fractures, enamel-dentin fractures with and without pulp exposure or crown fractures, enamel infractions, and fractures. Other types include avulsion, intrusion, extrusion, lateral luxation, concussion or subluxation, splinting, and alveolar segment fractures. The treatment should be integrated based on the fracture type, and adequate follow-up should be established to achieve the best predictive outcomes.

Autoimmune Hepatitis and Primary Biliary Cholangitis Overlap in a Patient with Systemic Lupus Erythematosus and Rheumatoid Arthritis Overlap (Rhupus) - An Unusual Association

The diagnosis of overlap syndrome involving systemic lupus erythematosus (SLE) and autoimmune hepatitis (AIH) isn’t easily established due to its similar clinical presentations and biochemical features to those of lupus hepatitis. The term overlap syndrome is typically utilized in the context of overlap of autoimmune hepatitis with PSC (primary sclerosing cholangitis) or PBC (primary biliary cholangitis). Few rare cases of AIH complicated by SLE are reported within the literature. Overlapping of SLE and AIH should be suspected when patients with SLE have abnormal liver function tests or AIH patients present with a rash. Liver biopsy plays a really important role in establishing the medical diagnosis of SLE with liver impairment or overlap with AIH. The prompt diagnosis and adequate treatment plan can improve the disease outcome. Key words: autoimmune hepatitis, primary biliary cholangitis, systemic lupus erythematosus, overlap syndrome.

Clinical outcomes of dengue virus infection in pregnant and non-pregnant women of reproductive age: a retrospective cohort study from 2016 to 2019 in Paraná, Brazil

Background The increasing number of dengue cases worldwide implies a greater exposure of at-risk groups, such as pregnant women. DENV infection during pregnancy has been increasingly associated with unfavorable outcomes, but the evolution of the disease and its clinical outcomes remain unclear. The objective of this study was to characterize dengue cases in reproductive aged women by comparing the development of the disease in pregnant and non-pregnant women. Methods A population based retrospective cohort study that used data reported in the Brazilian Mandatory Notifiable Diseases Information System from 2016 to 2019 in Paraná, Brazil. We compared sociodemographic, clinical, and laboratory variables between pregnant and non-pregnant women. Hospitalization and disease severity classification (Dengue, Dengue with warning signs, Severe Dengue) were considered outcome variables. Results The two groups had differences in the year of notification, age distribution, and region of residence. Laboratory investigation was more frequent among pregnant women, and DENV-2 prevailed in both groups. The risks of hospitalization and development of Severe Dengue were higher in pregnant women. There were no deaths observed among pregnant women. Conclusion This study identified pregnancy as a risk factor for an increase in the severity of DENV infection. It reinforces the importance of identifying early signs of complication, close monitoring, and adequate treatment for pregnant women.

Malignancy prediction of cutaneous and subcutaneous neoplasms in canines using B-mode ultrasonography, Doppler, and ARFI elastography

Background Cutaneous and subcutaneous neoplasms are highly prevalent in dogs, ranging from benign to highly aggressive and metastatic lesions. The diagnosis is obtained through histopathology, however it is an invasive technique that may take a long time to obtain the result, delaying the beginning of the adequate treatment. Thus, there is a need for non-invasive tests that can help in the early diagnosis of this type of cancer. The aim of this study was to verify the accuracy of B-mode ultrasonography, Doppler, and ARFI elastography to predict malignancy in cutaneous and subcutaneous canine neoplasms. In addition, we aim to propose an ultrasonography evaluation protocol and perform the neoplasms characterization using these three proposed techniques. Results Twenty-one types of specific neoplasm were diagnosed, and using B-mode, we verified the association between heterogeneous echotexture, invasiveness, presence of hyperechoic spots, and cavity areas with malignancy. An increased pulsatility was verified in malignant neoplasms using Doppler (cut-off value > 0.93). When using the elastography, malignancy was associated with non-deformable tissues and shear wave velocity > 3.52 m/s. Evaluation protocols were proposed associating 4, 5, 6, or 7 malignancy predictive characteristics, and characterization was done for all tumors with at least two cases. Conclusions We concluded that ultrasonography methods are promising and effective in predicting malignancy in these types of tumors, and the association of methods can increase the specificity of the results.

Invasive Assessment of Coronary Microvascular Function

The critical role of the coronary microvascular compartment and its invasive functional assessment has become apparent in light of the significant proportion of patients presenting signs and symptoms of myocardial ischemia, despite the absence of epicardial disease, or after the adequate treatment of it. However, coronary microvascular dysfunction (CMD) represents a diagnostic challenge because of the small dimensions of the coronary microvasculature, which prevents direct angiographic visualization. Several diagnostic tools are now available for the invasive assessment of the coronary microvascular function, which, in association with the physiological indices used to investigate the epicardial department, may provide a comprehensive evaluation of the coronary circulation as a whole. Recent evidence suggests that the physiology-guided management of CMD, although apparently costly and time-consuming, may offer a net clinical benefit in terms of symptom improvement among patients with angina and ischemic heart disease. However, despite the results of several observational studies, the prognostic effect of the physiology-driven management of CMD within this population is currently a matter of debate, and therefore represents an unmet clinical need that urgently deserves further investigation.

Clinico-Epidemiological Profile of Patients with Psoriasis in a Tertiary Care Hospital of Western Nepal

INTRODUCTION: Psoriasis is a common, chronic, inflammatory and proliferative condition of the skin which poses a significant health problem in general population. It is clinically characterized by erythematous plaques covered by silvery white scales, associated with systemic manifestations in many organ systems. MATERIAL AND METHODS: This is a descriptive study conducted at the Department of Dermatology, Universal College of Medical Sciences, Bhairahawa, Nepal. All psoriasis patients who gave consent were clinically examined and proforma documentation including patient’s clinical and demographic details was studied. RESULTS: Fifty two psoriasis patients were studied. The median age was 40 years and male: female ratio was 1.7:1 with 33 (63.5%) male and 19 (36.5%) female psoriasis patients. The most common clinical type of psoriasis observed according to morphology was chronic plaque psoriasis 45 (86.54%) and according to involvement of anatomical site was nail psoriasis 33 (63.5%). This study showed that 30 (57.7%) had no symptoms of pruritus and pain and 29 (55.8%) of psoriatic cases had seasonal variation. The commonest treatment modality was a combination of oral and topical medication 29 (55.8%). CONCLUSION: Psoriasis is a common skin disorder associated with systemic manifestations seen by dermatologists. This study outlines the clinico-epidemiological profile of patients with psoriasis which can provide further guidance for taking appropriate measures in diagnosing, providing adequate treatment, and undertaking various preventive measures among psoriasis patients.

Systematic segmentation method based on PCA of image hue features for white blood cell counting

Leukocyte (white blood cell, WBC) count is an essential factor that physicians use to diagnose infections and provide adequate treatment. Currently, WBC count is determined manually or semi-automatically, which often leads to miscounting. In this paper, we propose an automated method that uses a bioinspired segmentation mimicking the human perception of color. It is based on the claim that a person can locate WBCs in a blood smear image via the high chromatic contrast. First, by applying principal component analysis over RGB, HSV, and L*a*b* spaces, with specific combinations, pixels of leukocytes present high chromatic variance; this results in increased contrast with the average hue of the other blood smear elements. Second, chromaticity is processed as a feature, without separating hue components; this is different to most of the current automation that perform mathematical operations between hue components in an intuitive way. As a result of this systematic method, WBC recognition is computationally efficient, overlapping WBCs are separated, and the final count is more precise. In experiments with the ALL-IDB benchmark, the performance of the proposed segmentation was assessed by comparing the WBC from the processed images with the ground truth. Compared with previous methods, the proposed method achieved similar results in sensitivity and precision and approximately 0.2% higher specificity and 0.3% higher accuracy for pixel classification in the segmentation stage; as well, the counting results are similar to previous works.

Recent advances, influencing factors, and future research prospects using photocatalytic process for produced water treatment

Oilfield-produced water is the primary by-product generated during oil and gas extraction operations. Oilfield-produced water is often severely toxic and poses substantial health, safety, and environmental issues; adequate treatment technologies must bring these streams to a quality level. Photocatalysis is a photochemical catalytic reaction that is a highly promising tool for environmental remediation due to its efficiency in mineralizing persistent and potentially toxic contaminants. However, there is limited understanding of its application to treating oilfield-produced water with a complex and highly variable water composition. This review article discusses the mechanisms and current state of heterogeneous photocatalytic systems for oilfield-produced water treatment, highlighting impediments to knowledge transfer, including the feasibility of practical applications and the identification of essential research requirements. Additionally, the effects of significant variables such as catalyst quantity, pH, organic compound concentration, light intensity, and wavelength were discussed in detail. Some solutions are proposed for scientists and engineers interested in advancing the development of industrial-scale photocatalytic water treatment technologies.

How to live an elderly woman with prolapse of the genitals?

Несмотря на значительное развитие современной медицины, проблема пролапса органов малого таза не теряет своей актуальности и по сей день. Симптомокомплекс, который возникает при изменении анатомии тазового дна и органов малого таза, существенно ухудшает качество жизни пациенток. Это обстоятельство особенно важно учитывать у женщин старшей возрастной группы. Безусловно, повышенного внимания требуют все пациентки, страдающие пролапсом тазовых органов, который может быть диагностирован в различных возрастных категориях. Однако особую обеспокоенность вызывает состояние пациенток именно постменопаузального периода. Это обусловлено тем, что в старшем возрасте происходят значительные изменения в организме женщины, которые выступают провоцирующими или усугубляющими факторами в развитии пролапса тазовых органов. Одним из основных аспектов у таких пациенток является состояние гипоэстрогении. Кроме того, в старшем возрасте встречается большое количество других соматических заболеваний, которые оказывают существенное влияние на прогрессирование патологического процесса. Также необходимо учитывать, что современная женщина практически треть своей жизни проводит в постменопаузальном периоде. Поэтому перед врачами стоит серьезная задача по достижению должного качества жизни возрастных пациенток. В настоящее время причины, приводящие к развитию пролапса, известны, однако окончательного ответа относительно этиологии данного заболевания до сих пор нет. Это обстоятельство диктует необходимость дальнейшего глубокого и детального изучения проблемы пролапса, а также поиска более совершенных диагностических и лечебных методик. Внедрение в клиническую практику новых методов и подходов будет способствовать своевременной диагностике заболевания и адекватному лечению, что существенно повлияет на состояние здоровья пациенток постменопаузального периода и позволит начать жить полноценной жизнью. In spite of the significant development of modern medicine, the problem of pelvic organ prolapse does not lose its actuality nowadays. Complex of symptoms that occurs when the anatomy of the pelvic floor and pelvic organs changes greatly decrease the quality of patients lives. This circumstance is especially important to take into account in older women. Certainly increased attention is required by all patients suffering from pelvic organ prolapse, which can be diagnosed in different age categories. However, the condition of postmenopausal patients is of particular concern. This is due to the fact that at an older age, significant changes occur in a woman's body, which act as provoking or aggravating factors in the development of pelvic organ prolapse. One of the main aspects of such patients is the state of hypoestrogenism. Besides, at an older age there are a large number of other extra genital pathology somatic diseases that influence significantly on the progression of the pathological process. It is also necessary to take into account that a modern woman spends almost a third of her life in the postmenopausal period. That is why doctors face a serious challenge to achieve the proper quality of life of age-related patients. Nowadays the causes leading to the development of prolapse are known, but there is still no definitive answer regarding the etiology of this disease. This circumstance dictates the necessity for further in-depth and detailed studying the problem of prolapse, as well as the search for more advanced diagnostic and therapeutic techniques. The introduction of new methods and approaches into clinical practice will contribute to the timely diagnosis of the disease and adequate treatment, which will significantly affect the health of postmenopausal patients and will allow them to start living a full life.