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.

Clinical Problem Solving: Decreased Level of Consciousness and Unexplained Hydrocephalus

We present a clinical reasoning case of 42-year-old male with a history of type 1 diabetes who presented to hospital with decreased level of consciousness. We review the approach to coma including initial approach to differential diagnosis and investigations. After refining the diagnostic options based on initial investigations, we review the clinical decision-making process with a focus on narrowing the differential diagnosis, further investigations, and treatment.

Measuring Effects on Pain and Quality of Life after Abobotulinum Toxin A Injections in Children with Cerebral Palsy

Sixty-seven percent of children with cerebral palsy (CCP) experience pain. Pain is closely interrelated to diminished quality of life. Despite this, pain is an overlooked and undertreated clinical problem. The objective of this study was to examine the analgesic effect of a single lower extremity intramuscular injection of Abobotulinum toxin A/Dysport in CCP. Twenty-five CCP with at least moderate pain (r-FLACC ≥ 4) during passive range of motion were included. Localized pain and pain in everyday living were measured by r-FLACC and the Paediatric Pain Profile (PPP), respectively. Functional improvements were evaluated by the goal attainment scale (SMART GAS). Quality of life was evaluated by either the CPCHILD or the CP-QOL. The subjects were evaluated at baseline before injection, then after 4, 12, and 28 weeks. Twenty-two subjects had a significant mean and maximum localized pain reduction (p < 0.001) at four weeks post-treatment in 96% (21/22). The reduction was maintained at 12 (19/19) and 28 weeks (12/15). Daily pain evaluated by the PPP was significantly reduced and functional SMART GAS goals were significantly achieved from 4 to 28 weeks. Quality of life improved significantly at four weeks (CPCHILD). Significant functional gains and localized and daily pain reduction were seen from 4 to 28 weeks.

Idiopathic granulomatous mastitis - new approach in operative treatment

Introduction. Idiopathic granulomatous mastitis (GM) is described as a very rare, non-lactating, chronic mastitis that occurs primarily in women of childbearing age. Significant clinical problem related to GM is the diagnostic differentiation from breast cancer. Less advanced forms of GM can be successfully treated with limited surgical excisions and radical treatment is recommended only for the most extensive forms. Case report. First examination of the patient, by the surgeon at Oncology Institute of Vojvodina was in December 2018., when initial suspicion of breast cancer was set up. Core needle biopsy was performed and after histopathological (HP) analysis, confirmation of GM was obtained. The patient was initially offered Prednisone and Methotrexate therapy, which she refused and accepted only surgical treatment. Surgical treatment was performed few weeks after needle biopsy and consisted of performing a nipple spearing mastectomy with excision of the orifices of all fistulous ducts and their primary sutures. The HP findings of the operative specimen confirmed the diagnosis of GM. While there were no signs of dieses relapse, patient was suggested secondary reconstruction of the left breast. Twelve months after the primary operation, secondary breast reconstruction was performed with the interposition of a contoured silicone implant into a muscle pocket in a standard manner. Conclusion. Nipple spearing mastectomy with secondary breast reconstruction is aesthetically satisfactory treatment for patients with locally advanced GM.

Bioinspired Bimodal Micro-Nanofibrous Scaffold Promotes Tenogenic Differentiation of Tendon Stem/Progenitor Cells for Achilles Tendon Regeneration

Poor tendon repair remains a clinical problem due to the difficulties in replicating the complex multiscale hierarchical structure of native tendon. Herein, a bioinspired fibrous scaffold with bimodal micro-nanofibers and...

Mechanical diagnosis and therapy in patients with extremity problems: A Systematic review

Background: Mechanical Diagnosis and Therapy (MDT) is used in the treatment of extremity problems. It is an effective approach in cases of spinal conditions for target population. Availability of the reliable data like RCT and systematic review is a key factor to determine the precise clinical problem and to direct an appropriate intervention. Objectives: The primary aim of this systematic review is to assess the methodological quality of well-designed RCTs related to the MDT classification and treatment for extremity problems. Design: Systematic review. Method: Electronic search on various data bases was done. The level of evidence was determined considering the methodological quality of the studies. Results: 1 RCT was included and it met the criteria for high quality. After the assessment of RCT according to the CONSORT guidelines it was found that out of 25 checklist points; 4 methodological faults were found in assessed RCT. Those were; a) sample size determination, b) Blinding after assessment c) Generisability of the trial findings d) Where the full trial protocol can be accessed. Conclusion: The current systematic review found strong evidence of benefits of MDT approach for extremity problems (knee joint). But there was limited evidence in other extremity joints.

Peculiarities of Quality of Life in Patients with Pemphigus Vulgaris according to the Results of the Analysis of the SF-36V2 Questionnaires and Dermatological Index of Quality of Life in the Background of Glucocorticosteroid Therapy

The purpose of the study was to carry out a comparative assessment of the parameters of the quality of life in patients with pemphigus vulgaris according to the results of the analysis of the SF-36V2 questionnaires and the dermatological index of the quality of life against the background of glucocorticosteroid therapy. Materials and methods. The results of the study are based on the data of a comprehensive study and further follow-up of 47 patients with pemphigus vulgaris (of which 30 are the main group and 17 are the comparison group) who were hospitalized at the Zaporizhzhya Regional Skin and Venereal Clinical Dispensary, Zaporizhzhia. At the time of observation, the majority of patients were aged 61-70 years old. As a control group, 20 apparently healthy people were examined, randomized by age and sex. Results and discussion. Pemphigus vulgaris is a severe systemic dermatosis, which, according to the literature, accounts for about 1% in the structure of dermatological pathology, the main pathomorphological sign of which is acantholysis. Although the share of pemphigus vulgaris in the structure of dermatological pathology is 0.6 per 100 thousand people per year, the severity of the disease and its outcome determine the relevance of further study of the pathogenesis of dermatosis and the search for new effective therapies. The etiology of true pemphigus still remains unclear. The obtained results of questioning the patients with the SF-36V2 questionnaires and the dermatological index of quality of life indicate a significant negative impact of pemphigus vulgaris on the key parameters of the quality of life of patients in the main group and in the comparison group before treatment – the ability to perform their daily duties, work or study, have personal relationships, and also on the desire to be treated and adhere to all the rules of the therapy. Patients with pemphigus vulgaris in the group of monotherapy with glucocorticosteroids had statistically worse indicators of the quality of life after treatment than patients with additional use of Armadin, which was characterized by a low level of physical activity, an increase in the role of physical and psychoemotional problems in everyday life, general discomfort and subjective health. Conclusion. Evaluation of the quality of life of patients allowed for a more qualified study of the health disorders of patients with pemphigus vulgaris, to see the essence of the clinical problem, to select the most optimal treatment regimen for each patient, and also to assess the expected results in terms of parameters that are on the verge of a scientific approach and evidence-based medicine on the one hand, and also the subjective point of view of patients with pemphigus vulgaris on the other hand

Endoscopic findings in patients with persistent dyspepsia in a tertiary care hospital of South Punjab

Background: One of the most common clinical problem encountered by physicians in clinical practice is dyspepsia. This symptom has great impact on quality of life of patients. There are numerous causes of dyspepsia, organic as well as functional. Endoscopy is the diagnostic test of choice in these patients. Aim: The aim of our study was to see the endoscopic findings in patients with persistent dyspepsia. Methods: Retrospective analysis of data of patients who underwent Esophagogastroduodenoscopy (EGD) for persistent dyspepsia was collected and evaluated. Results: There were 495 patients in our study, 244 females and 251 males, with a mean age of 41 years. Almost half of the patients belonged to 21-40 years age group. The most common endoscopic finding in patients with persistent dyspepsia was gastritis (n=219, 44.2%), followed by normal endoscopy (n= 94, 19%), incompetent lower esophageal sphincter (n=67, 13.5%), gastric malignancy (n=48, 9.7%). Ulcer disease was found in just 15 patients (3%). Conclusion: Most common endoscopic finding in patients with persistent dyspepsia was gastritis followed by normal endoscopy. Key Words: dyspepsia, endoscopy

A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement

BackgroundChest drain displacement is a common clinical problem, occurring in 9–42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement.MethodsProspective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively-defined unintentional or accidental chest drain displacement.Results267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5/128, 3.9%; standard care displacement 13/129, 10.1%) but this was not statistically significant (Odds Ratio (OR) for drain displacement 0.36, 95% CI 0.13 to 1.0, χ2 1df=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall out rate (adjusted OR 0.27, 95% CI 0.08 to 0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59/131, 45.0%; standard care 18/132, 13.6%; χ2 1df=31.3, p<0.0001).ConclusionBalloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.

BRPF3 knockdown or inhibition moderately reverses olaparib resistance in high grade serous ovarian carcinoma, but depletion of H3K14 acetylation has no effect

Background: PARP inhibitors (PARPi) kill cancer cells by stalling DNA replication and preventing DNA repair, resulting in a critical accumulation of DNA damage. Resistance to PARPi is a growing clinical problem in the treatment of high grade serous ovarian carcinoma (HGSOC). Acetylation of histone H3 lysine 14 (H3K14ac) and associated histone acetyltransferases (HATs) have known functions in DNA repair and replication, but their expression and activities have not been examined in the context of PARPi-resistant HGSOC. Results: Using mass spectrometry profiling of histone modifications, we observed altered H3K14ac enrichment in PARPi-resistant HGSOC cells relative to isogenic PARPi-sensitive lines. By RT-qPCR and RNA-Seq, we also observed altered expression of numerous HATs in PARPi-resistant HGSOC cells and a PARPi-resistant PDX model. Knockdown of HATs only modestly altered PARPi response, although knockdown and inhibition of PCAF significantly increased resistance. Pharmacologic inhibition of HBO1 severely depleted H3K14ac but did not affect PARPi response. However, knockdown and inhibition of BRPF3, which is known to interact in a complex with HBO1, did reduce PARPi resistance. Conclusions: This study demonstrates that severe depletion of H3K14ac does not affect PARPi response in HGSOC. Our data suggest that bromodomain functions of HAT proteins such as PCAF, or accessory proteins such as BRPF3, may play a greater role in PARPi response than acetyltransferase functions.