Prognostic factors influencing the outcome of empyema surgical management: prospective study in a Moroccan university center.

Background: Pleural empyema is a public health problem, and is the most frequent complication of pleural infection with significant morbidity and mortality worldwide. Our study aims to highlight the management of pleural empyema and evaluate its prognosis factors involved especially in surgical treatment. Patients and Methods: A prospective analysis of 53 patients who underwent surgical treatment of pleural empyema, from January 2015 to December 2019 at the thoracic surgery department in a tertiary referral university teaching hospital. Our study included patients who required surgical treatment for pleural empyema and were excluded patients with destroyed lungs associated with pyothorax. Results: The mean age of patients was 39.24±15.89 years and 79,24% of them were males. In 85.7% of the cases, the etiology was undetermined in 34%, parapneumonic in 1.9%, of tuberculosis in 54.71%, post-traumatic in 11, 3%, postoperative in 7.5% and iatrogenic in 1.9%. 45 patients were treated with broad-spectrum antibiotics therapy adapted after antibiogram 14.38±21.76 days before the operation. A complete debridement and decortications were performed by VATS in 28 and by PLT in 22 patients. No major complications occurred. At a mean term follow-up of 20 months (3months—3 years); all patients were alive with no recurrence. The analysis of the results showed 4 factors of poor prognosis: delay of diagnosis and surgery (P = 0.02), chronic alcoholism (P = 0.034), preoperative ventilation disorder/COPD (P = 0.04) and active tuberculosis (P= 0, 05). Conclusion: The success of surgical management of pleural empyema depends on several factors, which predict the prognosis, but can be prevented.

Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab

Neoehrlichia (N.) mikurensis, an intracellular tick-borne bacterium not detected by routine blood culture, is prevalent in ticks in Scandinavia, Central Europe and Northern Asia, and may cause long-standing fever, nightly sweats, migrating pain, skin rashes and thromboembolism, especially in patients treated with rituximab. The multiple symptoms may raise suspicion of both infection, inflammation and malignancy, and lead in most cases to extensive medical investigations across many medical specialist areas and a delay of diagnosis. We describe a complex, albeit typical, case of neoehrlichiosis in a middle-aged splenectomised male patient with a malignant lymphoma, receiving treatment with rituximab. The multifaceted clinical picture associated with this tick-borne disease is addressed, and longitudinal clinical and laboratory data, as well as imaging, are provided. Longstanding relapsing fever in combination with thrombosis in superficial and deep veins in an immunocompromised patient living in a tick-endemic region should raise the suspicion of the emerging tick-borne disease neoehrlichiosis. Given the varied clinical presentation and the risk of delay in diagnosis and treatment, we believe it is important to raise clinicians’ awareness of this emerging infection, which is successfully treated with doxycycline.

Socioeconomic characteristics and costs of rare and orphan diseases in Peru, 2019

Introduction: The rare and orphan diseases (ROD) constitute a current challenge due to the lack of investigation. Objective: Describe the socioeconomic characteristics of rare and orphan diseases (ROD) in Peru, 2019. Methods: Descriptive observational design. The information was obtained from FISSAL administrative records, and an intentional sample of 20 patients was taken to carry out the questionnaire on ROD. For the economic records, a review of the public budget of the MEF was made. The data analysis was descriptive and inferential. Results: There were 454 patients with a total of 49 ROD; of these, the most representative age groups were schoolchildren and young adults (18% each), and the most frequent diagnosis was Tetralogy of Fallot (22%). The questionnaire on ROD reports a median of 7 months in the delay of diagnosis and between 3 and 5 doctors were visited. Likewise, 30% considered that it generated a high to very high expense. It was calculated that the ROD budget constitutes 2.25% of the total budget for high-cost diseases. Likewise, the ROD budget was different between 2014 and 2019. Conclusions: The population with ROD in Peru is not large; however, it requires greater attention to access to health services and a greater budget allocation.

Clinical and Paraclinical Biomarkers and the Hitches to Assess Conversion to Secondary Progressive Multiple Sclerosis: A Systematic Review

Conversion to secondary progressive (SP) course is the decisive factor for long-term prognosis in relapsing multiple sclerosis (MS), generally considered the clinical equivalent of progressive MS-associated neuroaxonal degeneration. Evidence is accumulating that both inflammation and neurodegeneration are present along a continuum of pathologic processes in all phases of MS. While inflammation is the prominent feature in early stages, its quality changes and relative importance to disease course decreases while neurodegenerative processes prevail with ongoing disease. Consequently, anti-inflammatory disease-modifying therapies successfully used in relapsing MS are ineffective in SPMS, whereas specific treatment for the latter is increasingly a focus of MS research. Therefore, the prevention, but also the (anticipatory) diagnosis of SPMS, is of crucial importance. The problem is that currently SPMS diagnosis is exclusively based on retrospectively assessing the increase of overt physical disability usually over the past 6–12 months. This inevitably results in a delay of diagnosis of up to 3 years resulting in periods of uncertainty and, thus, making early therapy adaptation to prevent SPMS conversion impossible. Hence, there is an urgent need for reliable and objective biomarkers to prospectively predict and define SPMS conversion. Here, we review current evidence on clinical parameters, magnetic resonance imaging and optical coherence tomography measures, and serum and cerebrospinal fluid biomarkers in the context of MS-associated neurodegeneration and SPMS conversion. Ultimately, we discuss the necessity of multimodal approaches in order to approach objective definition and prediction of conversion to SPMS.

COVID-19 and Mucormycosis: The Double Edge Sword

Background and aim India has declared mucormycosis as an epidemic. The incidence rate is rising day by day as there are more than 29000 cases in 28 states until March 2021. COVID-19 is already burdening the health care system, and post-COVID mucormycosis leads to mortality and morbidity in patients treated with COVID-19. This article aims to understand the various complications of mucormycosis and how it is impacting COVID-19 infected patients. Methods A thorough literature search was performed using PubMed, Google Scholar, and Embase from May 2021 to June 2021. The authors selected the articles based on relevance. Mucormycosis, black fungus, fungal infection, COVID-19, pathogenesis, corticosteroids, treatment, antifungals were the major keywords searched. Secondary resources included from the published news articles. Results Through the literature, we observed that patients after COVID-19 are more vulnerable to these fungal infections, especially immunocompromised patients, patients with long-term steroid use, and uncontrolled diabetes. This review enlightens the manifestations, pathogenesis, and various treatment and anticipation policies for mucormycosis. Conclusion Awareness about the possibility of the disease is necessary to reduce the delay of diagnosis and timely treatment to prevent further implications of the disease. In addition, prevention of the disease with strict follow-up measures with sanitation and hygiene maintenance is also essential.

Detection of Factors That Cause Delay to Surgical Treatment of Patients with Gastrointestinal Malignancies in Patients of Hospital during 2 Years

Background: Many patients with gastrointestinal malignancies suffer from false treatments and incorrect diagnostic studies before diagnosis. This study examines the time taken to diagnose gastrointestinal cancer, identify the cause of delay, and judge its clinical importance. Materials and Methods: Patients with gastrointestinal malignancies (Esophageal, gastric, and colorectal) who were admitted for the first surgery were considered. The delay of diagnosis and treatment and responsible factors were analyzed from patients' history by recall of patients and reviewing para-clinical data, patient's records, and pathology report. Results: A total of 123 patients underwent diagnostic endoscopy 140 times. This study shows that the rate of biopsy in the three groups of patients with esophageal, gastric and colorectal cancers was 0.8%, 11.4% and 87.8%, respectively, which was not significantly different. A comparison of the number of patients who have undergone endoscopy more than once in the three groups of esophageal, gastric and colorectal malignancies shows that 6% of patients with esophageal cancer and 12% of patients with gastric cancer have undergone endoscopy more than once. This rate was 82%% in patients with colorectal cancer (P Value = 0.05). Conclusion: from this study can we educate the public about the symptoms of these diseases; and work that can be offered as a suggestion in this field, in prioritizing surgeries related to malignancies referred to medical centers, as well as establishing a systemic management of the initial diagnosis and finally treatment leading to surgery in patients with malignancies in each classification is.

Atypical Kawasaki Disease in an Adolescent with Multivisceral Involvement

Kawasaki disease (KD) is a vasculitis mostly seen in children aged less than 5 years. It can involve different organs and tissues. Its diagnosis is based on the clinical criteria of the American Heart Association (AHA). We report a case of a Moroccan adolescent with an atypical presentation of KD initially treated as typhoid fever. Gastrointestinal, renal, and pulmonary signs were the main clinical findings that made the diagnosis of KD challenging and delayed. The consequence was a severe cardiac damage with myocarditis and coronary artery dilation. KD is uncommon in adolescents, and it is important to recognize the atypical forms and the different presentations of KD in order to prevent the delay of diagnosis and treatment, and hence the cardiac complications.

Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.

Timing, delays and pathways to diagnosis of endometriosis: a scoping review protocol

IntroductionPathways to diagnosis for women with endometriosis are frequently characterised with delays. Internationally, women face significant barriers and times to diagnosis. The prolonged time without a diagnosis may result in treatment delay, with clinical implications of chronic pain and an unknown effect on fertility outcomes. As delays in diagnosis extend, those suffering from endometriosis incur more cost and frequently experience a reduction in quality of life. The scoping review described in this protocol will (1) map current international scientific peer-reviewed and grey literature investigating pathways, timing, and delay of diagnosis of endometriosis, (2) define common concepts used in the literature, and (3) identify gaps for future examination and intervention development.Methods and analysisThis protocol outlines a scoping review to investigate the current research focused on pathways, timing, and delays in endometriosis diagnosis. The scoping review uses the Joanna Briggs Institute Methodology. The researchers applied the Population, Concept, Context approach to form the research questions. A search string of key terms and Medical Subject Headings will be used to systematically search the PubMed, CINAHL, EMBASE, Web of Science, and Cochrane databases. We will also search ClinicalTrials.gov and grey literature sources. The original search was performed in July 2020, and it will be rerun prior to the manuscript submission. Finally, the reference lists of included works will be reviewed for additional studies. The search results will be screened and reviewed according to predetermined inclusion and exclusion criteria. Data will be extracted from the studies identified for final inclusion using a predetermined tool. The resulting data will be analysed to report the state of the science.Ethics and disseminationThe proposed scoping review does not require review or approval by an ethical board. The researchers will disseminate the study results via conference presentations and publication in a peer-reviewed journal.