Case Report of Maggot Infestation on Diabetic Foot Ulcer

Myiasis is originated from the Greek word, Miya, which means fly. Fly larva are called maggots. Infestation in humans by maggots is called myiasis. Fly maggots feed on and develop in the tissues of living beings and this condition is known as myasis. The maggot (larvae) invades the skin and subcutaneous tissue is known as Maggot infestation. It was found that farmers who are working in agricultural fields are more susceptible to this infestation. Myiasis symptoms may vary according to the fly type, the number of larvae, and the location of the infected area. Many organs can be infested by these larvae and the most common form is cutaneous myasis. The predisposing factors of cutaneous myasisare cutaneous immobilization, advanced age, poor social conditions, mental retardation, diabetes mellitus, alcoholism, vascular occlusive disease, and infected dermatitis as myiasis. Myiasis is more common in tropical and subtropical countries, especially in rural regions where people are in close contact with animals.Myiasisrepresents the fourth most common travel-associated skin disease. Here we report case on 55-year-old female patient was admitted with complaints of diabetic foot ulcer over left foot for 1 and half months and maggots were examined in the wound. The complete blood cell count [CBC] test shows that her HbA1c level was increased to 10.1%. The patient has undergone wound debridement on left forefoot and maggots were completely removed.

Ultrasonographic features of an cryoglobulinemia vasculitis：Case report and Literature review

Cryoglobulinemia vasculitis (CV) is a rare, small vascular occlusive disease caused by cryoglobulin precipitation in the plasma. We report the case of a 61-year-old female suffering from pain in the toes of the left foot in autumn, who subsequently developed acute pain, during hospitalization.

Exercise Stress Testing Is a Useful Adjunct in the Evaluation of Patients With Claudication and Normal Ankle-Brachial Index: A Case Report

A 45-year-old man presented with bilateral lower extremity claudication and was evaluated for lower extremity peripheral arterial disease. Ankle-brachial indices (ABIs) were performed with exercise stress testing. Resting ABI was normal, with postexercise arterial testing revealing a significant drop in ankle pressures, suggesting moderate proximal atherosclerotic vascular occlusive disease. It is important that sonographers are sufficiently trained to determine true claudication symptoms, and lab protocols should be established to effectively appropriate exercise stress testing when necessary.

Protecting the aging eye with hydrogen sulfide

Research demonstrates that senescence is associated with tissue and organ dysfunction, and the eye is no exception. Sequelae arising from aging have been well-defined as distinct clinical entities and vision-impairment has significant psychosocial consequences. Retina and adjacent tissues like retinal pigmented epithelium (RPE) and choroid are the key structures that are required for visual perception. Any structural and functional changes in retinal layers and blood retinal barrier (BRB) could lead to age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma. Further, there are significant oxygen gradients in eye that can lead to excessive reactive oxygen species (ROS) resulting in endoplasmic reticulum (ER) and mitochondrial stress response. These radicals are source of functional and morphological impairment in RPE, and retinal ganglion cells (RGCs). Therefore, ocular diseases could be summarized as disturbance in the redox homeostasis. Hyperhomocysteinemia (HHcy) is a risk factor and causes vascular occlusive disease of the retina. Interestingly, hydrogen sulfide (H2S) has been proven to be an effective antioxidant agent, and it can help treat diseases by alleviating stress and inflammation. Concurrent glutamate excitotoxicity, ER stress, and microglia activation are also linked to stress, thus H2S may offer additional interventional strategy. A refined understanding of the aging eye along with H2S biology, and pharmacology may help guide newer therapies for the eye

An unusual combination of persistent silent truncus arteriosus Type-II with ascending aortic aneurysm

Truncus arteriosus (TA) is a relatively uncommon cyanotic congenital cardiac anomaly accounting for 1.3% of all congenital cardiac malformations. TA associated with an ascending aortic aneurysm is an extremely rare congenital cardiovascular abnormality. A 15-year-old male presented with shortness of breath and cough for 2 weeks. Radiological examinations showed that the ascending aorta and main pulmonary arteries originate from a single truncus with ascending aortic aneurysm. TA has a poor prognosis if remain unrepaired and surgical intervention is necessary to avoid severe pulmonary vascular occlusive disease.

National trends in cerebral bypass surgery in the United States, 2002–2014

OBJECTIVECerebral bypass procedures are microsurgical techniques to augment or restore cerebral blood flow when treating a number of brain vascular diseases including moyamoya disease, occlusive vascular disease, and cerebral aneurysms. With advances in endovascular therapy and evolving evidence-based guidelines, it has been suggested that cerebral bypass procedures are in a state of decline. Here, the authors characterize the national trends in cerebral bypass surgery in the United States from 2002 to 2014.METHODSUsing the National (Nationwide) Inpatient Sample, the authors extracted for analysis the data on all adult patients who had undergone cerebral bypass as indicated by ICD-9-CM procedure code 34.28. Indications for bypass procedures, patient demographics, healthcare costs, and regional variations are described. Results were stratified by indication for cerebral bypass including moyamoya disease, occlusive vascular disease, and cerebral aneurysms. Predictors of inpatient complications and death were evaluated using multivariable logistic regression analysis.RESULTSFrom 2002 to 2014, there was an increase in the annual number of cerebral bypass surgeries performed in the United States. This increase reflected a growth in the number of cerebral bypass procedures performed for adult moyamoya disease, whereas cases performed for occlusive vascular disease or cerebral aneurysms declined. Inpatient complication rates for cerebral bypass performed for moyamoya disease, vascular occlusive disease, and cerebral aneurysm were 13.2%, 25.1%, and 56.3%, respectively. Rates of iatrogenic stroke ranged from 3.8% to 20.4%, and mortality rates were 0.3%, 1.4%, and 7.8% for moyamoya disease, occlusive vascular disease, and cerebral aneurysms, respectively. Multivariate logistic regression confirmed that cerebral bypass for vascular occlusive disease or cerebral aneurysm is a statistically significant predictor of inpatient complications and death. Mean healthcare costs of cerebral bypass remained unchanged from 2002 to 20014 and varied with treatment indication: moyamoya disease $38,406 ± $483, vascular occlusive disease $46,618 ± $774, and aneurysm $111,753 ± $2381.CONCLUSIONSThe number of cerebral bypass surgeries performed for adult revascularization has increased in the United States from 2002 to 2014. Rising rates of surgical bypass reflect a greater proportion of surgeries performed for moyamoya disease, whereas bypasses performed for vascular occlusive disease and aneurysms are decreasing. Despite evolving indications, cerebral bypass remains an important surgical tool in the modern endovascular era and may be increasing in use. Stagnant complication rates highlight the need for continued interest in advancing available bypass techniques or technologies to improve patient outcomes.