Pasteurella multocida Endocarditis with Septic Arthritis: Case Report and Review of the Literature

Background: There is a paucity of evidence regarding optimal management of Pasteurella spp. endocarditis. The authors report the first case of Pasteurella spp. endocarditis with septic arthritis and review the literature. Case Description: A 79-year-old patient with significant comorbidities, including prosthetic aortic valve, was admitted with left knee swelling, fever, and confusion, having been scratched by a cat 2-weeks prior. At presentation, there was a metallic click, a Grade 3 pan-systolic murmur and Grade 1 flow murmur audible on auscultation. Blood and synovial fluid cultures both isolated Pasteurella multocida, identified by matrix-assisted laser desorption ionisation–time of flight, which was sensitive to penicillin according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST); minimum inhibitory concentration: 0.094). The patient underwent joint washout and received intravenous piperacillin/tazobactam for 3 days before switching to benzylpenicillin once sensitivities were known. Due to continued pyrexia, a transthoracic echocardiogram was obtained, which revealed a small mobile mass on a thickened mitral valve suspicious for a vegetation. On review by the Infective Endocarditis team, conservative management was deemed best, given the presence of comorbidities. Despite requiring further joint washout due to persistent knee pain, the patient was successfully treated with 8 weeks of antibiotic therapy (24 days of benzylpenicillin monotherapy, 2 weeks of benzylpenicillin and ciprofloxacin, and 15 days ciprofloxacin monotherapy). Discussion: Previous literature reviews report a higher mortality of Pasteurella spp. endocarditis when managed without cardiac surgery, thus recommending surgery in all cases. The authors found these to have confounding factors, including inadequate duration of antimicrobials, aortic root abscess, and rapid progression to death. The authors’ case of Pasteurella spp. endocarditis, complicated by septic arthritis, showed successful therapy without cardiac surgery.

Largest sized enterolith ileus due to a duodenal diverticulum in a virgin abdomen causing small bowel obstruction

We describe the case of a 73-year-old woman with a high body mass index and a virgin abdomen who presented with a 5-day history of abdominal pain, emesis and confusion on admission. Inflammatory markers and renal function were significantly deranged. CT of the abdomen and pelvis demonstrated a clear transition point and faecalisation of the small bowel proximal to the obstruction. It was suggested that the patient may have ingested a foreign object. A collateral history was obtained, making this less likely and confirmed an acute cognitive impairment. She was optimised following multidisciplinary discussion preoperatively. Thereafter, the patient underwent a laparotomy, where a hard, mobile mass was identified in the jejunum. This was diagnosed as an enterolith of dimensions 62×38×32 mm secondary to a duodenal diverticulum. She improved postoperatively with complete resolution of her confusion and renal function. She was discharged on day 14 of admission.

Bartholin’s Abscess with Bacterial Vaginosis Coinfection Successfully Treated with a Modified Word Catheter and Combined Antibiotics

BACKGROUND: Bartholin’s abscess is an infection of the Bartholin gland that often occurs in women of childbearing age. The prevalence of Bartholin’s abscess is 2% in the female population worldwide. Patients often complain dyspareunia with a high recurrence rate. Bacterial Vaginosis (BV) is a syndrome of changes in the vaginal ecosystem that occurs spontaneously in sexually active women. BV can contribute to the development of a Bartholin’s gland abscess. CASE REPORT: A 30-year-old woman came with the chief complaint of a 5 cm × 5 cm erythematous, tender, and mobile mass on the right side of the labia majora. In addition, the patient also experienced recurrent vaginal discharge. The patient was diagnosed with Bartholin’s abscess with BV coinfection that was successfully treated with a modified word catheter and combination of antibiotics that showed no recurrence. CONCLUSION: Combination of modified word catheter and antibiotics can be a simple yet effective way in treating Bartholin’s abscess.

A rare case of mobile ball-like mass in right atrium associated with dilated cardiomyopathy

Mobile thrombus in the Right Atrium (RA) is a rare condition. Here, we described a case of a 59-year-old male who presented in emergency room with complaints of progressively worsening dyspnea for 7 years. He was normotensive, had elevated jugular venous pressure and clear lungs. ECG revealed ventricular tachycardia. After successfully electrical defibrillation, an urgent 2D echocardiogram was obtained and revealed the enlargement of all heart chambers and a ball-like, mobile mass in the right atrium. An emergent CT scan revealed no sign of pulmonary embolism. Based on morphological features on echocardiogram, we highly suspected it as RA thrombus. The patient was treated with anticoagulant therapy comprising of low molecular heparin and warfarin since he rejected surgical treatment. Repeat echocardiogram was performed 7 days after anticoagulant therapy and showed disappearance of the RA mass. He was subsequently maintained on warfarin (INR=2.4- 3.0) and other medications for heart failure. The patient was followed up as outpatient and kept in good clinical condition. We concluded that early recognition of this rare situation and prompt management can help in preventing life-threatening complications, and anticoagulant therapy was a therapeutic option for RA thrombus.

A New Optimization Algorithm Based on the Fungi Kingdom Expansion Behavior for Antenna Applications

This paper presents a new optimization algorithm based on the behavior of the fungi kingdom expansion (FKE) to optimize the radiation pattern of the array antenna. The immobile mass expansion of the fungi is mimicked in this work as a chaotic behavior with a sinusoidal map function, while the mobile mass expansion is realized by a linear function. In addition, the random germination of the spores is utilized for randomly distributing the variables that are far away from the best solution. The proposed FKE algorithm is applied to optimize the radiation pattern of the antenna array, and then its performance is compared with that of some well-known algorithms. The MATLAB simulation results verify the superiority of the proposed algorithm in solving 20-element antenna array problems such as sidelobe reduction with sidelobe ratio (SLR = 25.6 dB), flat-top pattern with SLR = 23.5 dB, rectangular pattern with SLR = 19 dB, and anti-jamming systems. The algorithm also results in a 100% success rate for all of the mentioned antenna array problems.

Visual Impairment Caused by Monovision Surgical Design

Neurophysiological anatomy of natural binocular vision shows the need to focus with both eyes to jointly produce the two corneas accommodation, correcting, in a compensatory way, the divergences inherent in the two different images, of the same visual field projected in the two distinct spaces, the two retinas. Corneal accommodation is part of the forced convection mechanism for the transfer of mobile mass in the cornea, trabecular meshwork and retina, to inhibit the accumulation of dehydrated intraocular metabolic residue, which can cause refractive errors in the cornea, obstruction of the trabecular meshwork and reduction of the amplitude of the signals produced by the phototransducers and sent to the brain. The IOL monovision surgical implantation technique differs from the physiology of natural binocular vision, which can cause after surgery disorders, described in this chapter, in that it imposes a different adaptation from the neurophysiological anatomy of human vision in addition to favoring the continuous progression of residue accumulation dehydrated intraocular metabolic and stimulate ocular.

A Rare Case of Papillary Fibroelastoma Involving The Tricuspid Valve. A single Center experience over a period of 22 years (1999-2021)

Background and aim Papillary fibroelastoma (PFE) represents only 16% of the benign cardiac tumor and approximately 15% of these are located on tricuspid valve. Materials and Methods Over a period of 22 years (1999-2021) we observed 75 pts with cardiac tumors at our Center over 9650 pts operated on. Most of them were mixoma but in 10 cases histology showed a PFE. We describe a rare case (1/75 of cardiac tumors) of a tricuspid valve PFE in a 69-year-old patient. Trans-thoracic echocardiography demonstrated a mobile mass (20 x 10 mm), adhering to the atrial side of the septal leaflet of the tricuspid valve. In consideration of the mobility of the mass and the consequent high embolic risk, surgical removal was made. Patient underwent surgery through a median sternotomy on CPBP. A “gelatinous” mass adhering to the tricuspid leaflet was found and completely removed. The postoperative course was uneventful. The pathological evaluation confirmed the diagnosis of PFE. Conclusions PFE of the tricuspid valve is rare entities being in most cases found incidentally. In our experience the incidence of this tumor in this location is 1/10000 cases of cardiac surgery. Although most patients are asymptomatic, surgical treatment is nevertheless recommended in consideration of the high embolic risk.