A retroperitoneal bronchogenic cyst clinically mimicking an adrenal mass: three case reports and a literature review

Bronchogenic cysts are a congenital primitive foregut-derived developmental malformation, generally occurring in the posterior mediastinum. Their development in the retroperitoneum is extremely rare. Imaging techniques, such as multidetector computed tomography (MDCT), are typically effective in the detection of these lesions. Here, we describe three cases of a retroperitoneal cyst presenting as a para-adrenal mass. Only one boy presented with abdominal pain, and the other two showed no clinical symptoms. Endocrinological evaluation of all three cases was performed, and no adrenal hormone secretion was detected. All three cases were misdiagnosed preoperatively. Each patient underwent surgery, and one symptomatic patient became asymptomatic after surgery. Pathologic examination confirmed all three masses as bronchogenic cysts. The three cases showed some similar MDCT imaging features, including a complete adrenal structure, a cystic or solid mass in the adrenal region, and no obvious enhancement. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal masses, even though accurate preoperative diagnosis remains difficult. A contrast-enhanced MDCT scan may be useful for differentiating hyper-attenuated cysts from other soft tissue masses.

Patient with false negative RT-PCR for COVID-19 referred to cancer hospital for lung cancer screening: A case report

Background: Even though RT-PCR tests are generally considered the gold standard for diagnosing SARS-CoV-2, they are not without flaws, and the likelihood of detecting an infection varies depending on when the test is performed. There is chance of false negative due to different pitfalls. So there is essential of correlation of radiological characteristics, abnormalities in biochemical tests and symptoms of suspected patient during COVID-19 epidemic. Case presentation: Herein, we report a 42-year-old male patient with high-grade fever, dry cough, headache and dizziness. He went for the RT-PCR test two times and reported negative. On the chest X-Ray, there was opacity on both lungs and referred to cancer-hospital for lung-cancer screening. The patient underwent chest-HRCT and laboratory tests for further evaluation and was identified as typical COVID-19 findings. Then the patient was isolated and treatment of given according to COVID-19 treatment guidelines Conclusion: It is concluded that a clinically symptomatic patient with typical chest HRCT and abnormal lab findings for COVID-19 should be considered as a COVID-19 patient and isolated even with two negative RT-PCR tests.

Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway

Purpose Faecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients. Methods A retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10–149/150–399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ2 test. Multivariate binary logistic regression identified independent predictors of CRC. Results A total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683–142.325; p < 0.001)), and anaemia (OR 1.956 (1.071–3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC. Conclusion GP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services.

Surgical Management for a Rare Pedunculated Left Ventricular Apical Lipoma: A Case Report and Review of Literature

Cardiac lipomas, though extremely rare, are encapsulated tumors composed primarily of mature fat cells. Despite their benign character, cardiac lipomas can cause life-threatening complications by rapid growth. Cardiac lipomas, which are frequently located in the left ventricle (LV) or right atrium, can originate either from the subendocardium, subpericardium, or the myocardium. They are usually asymptomatic and carry a good prognosis during long-term follow-up; however, published reports show that untreated cardiac lipomas may be fatal when they cause arrhythmic or obstructive symptoms. In addition, several surgical options have been reported to obtain an appropriate operative view following poor visualization, primarily when tumors are located in the LV. Herein, we present a case of a pedunculated LV apical lipoma in a symptomatic patient successfully managed by surgical resection. We also discuss diagnostic modalities in surgical planning and the choice of surgical approach.

Practices, awareness, and perception towards home-based COVID-19 management among the general population in south India.

Background: Most patients with COVID-19 experience mild illness which can be managed in a home environment. This study was done to assess the perception, awareness and practices regarding home-based management of COVID-19 among the general population in India. Methods: This cross-sectional study was done in May and June 2021. Data were collected using a Google Form. Results: Mean age of the 294 participants was 36.6 ± 12.1 years. Of these participants, 45 (15.3%) were diagnosed with COVID-19 anytime in the past. Among them, 37 (82.2%) underwent home-based management for COVID-19. Monitoring of body temperature and oxygen saturation was performed just once a day by 15.2% and 5.9% of COVID-19 patients respectively. Self-medication was practiced by 11 (29.7%) patients. Disposable face masks were worn by 23 (62.2%) patients beyond eight hours of continuous usage. The disposable type of face mask was not discarded despite becoming wet and cloth masks were worn by eight (21.6%) patients. Disposable gloves were only worn by 14 (37.8%) care providers of COVID-19 patients. As many as 10 (27%) patients were tested for COVID-19 after completion of home isolation. Awareness of all mild symptoms and signs of the disease were known to only 19 (6.5%) participants. Normal oxygen saturation in the blood was known to 40 (13.6%) participants. Just six (2%) participants were aware of the correct duration of home isolation in a symptomatic patient with COVID-19. The recommended duration of hand washing with soap and water was known to 102 (34.7%) participants. As many as 17.4% and 32.7% participants were not confident in using thermometer and pulse oximeter respectively. Conclusion: Practices, awareness and perception regarding certain essential measures in COVID-19 home management were found lacking among a number of participants. These need to be addressed by suitable training programs among the general population.

P-OGC21 Patient perspectives on symptoms of importance and preferences for follow-up after major upper gastro-intestinal cancer surgery

Background Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery. Methods An electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed. Results Among 362 respondents with a median follow-up of 58 months since surgery (range 3-412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Unsatisfied patients were more likely to have received shorter follow-up than 5 years (27% among unsatisfied patient vs. 60% among satisfied patients, p &lt; 0.001and were less likely to have seen a dietitian as part of routine follow-up (37% vs. 58%, p = 0.005). Conclusions This patient survey highlights preferences with regard to follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.

Using Telemedicine to Provide Education for the Symptomatic Patient with Chronic Respiratory Disease

Technology-enabled learning, using computers, smartphones, and tablets, to educate patients on their respiratory disease and management has grown over the last decade. This shift has been accelerated by the global COVID-19 pandemic and the need to socially distance for public health. Thirteen recently published papers examined experience, knowledge, skills and attitude acquisition, behaviour change, and impact on health outcomes of patient education using technology (websites and mobile device applications) for people with chronic respiratory disease. Technology-enabled patient education that includes relevant information, with activities that encourage the patient to interact with the digital platform, appears to lead to better patient experience and may increase learning and behaviour change with improved quality of life. Developing online relationships with healthcare providers, lower digital capabilities, and poor access to a computer/smartphone/tablet, appear to be barriers that need to be overcome for equity in access. Maintaining the principles of quality educational design, ensuring interactive experiences for patient involvement in the educational activities, patient co-design, healthcare professionals connecting with experts in the field of technology-enabled learning for development of education models, and ongoing research lead to the best patient outcomes in technology-enabled education for respiratory disease.

Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution in a Mildly Affected Symptomatic Patient

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is caused by a respiratory virus with a wide range of manifestations, varying from asymptomatic to fatal cases, with a generally short outcome. However, some individuals present long-term viral shedding. We monitored 38 individuals who were mildly affected by the SARS-CoV-2 infection. Out of the total studied population, three (7.9%) showed atypical events regarding the duration of positivity for viral RNA detection. In one of these atypical cases, a previously HIV-positive male patient presented a SARS-CoV-2 RNA shedding and subgenomic RNA (sgRNA) detected from the upper respiratory tract, respectively, for 232 and 224 days after the onset of the symptoms. The SARS-CoV-2 B.1.1.28 lineage, one of the most prevalent in Brazil in 2020, was identified in this patient in three serial samples. Interestingly, the genomic analyses performed throughout the infectious process showed an increase in the genetic diversity of the B.1.1.28 lineage within the host itself, with viral clearance occurring naturally, without any intervention measures to control the infection. Contrasting widely spread current knowledge, our results indicate that potentially infectious SARS-CoV-2 virus might be shed by much longer periods by some infected patients. This data call attention to better adapted non-pharmacological measures and clinical discharge of patients aiming at preventing the spread of SARS-CoV-2 to the population.

Clinical Improvement of Cervical Disc Herniation 24 hours after a Single Oxygen-Ozone Injection

Oxygen-ozone therapy is a minimally invasive treatment for disc herniation, compared to surgery, which uses the beneficial biochemical properties of a gas mixture of ozone and oxygen. A satisfactory efficacy is usually obtained within one month after the injection. We assessed the therapeutic outcome of a single injection of oxygen-ozone in a symptomatic patient with C5-C6 cervical discal herniation with compression of the nerve roots. He experienced immediate pain relief seconds after the injection, and neuro-imaging improvement 24 hours afterwards. To our knowledge this is the fastest improvement ever reported in literature.