The Prevalence and Side Effect of Nexplanon in Baghdad

BACKGROUND Nexplanon is a pregnancy-prevention device that is both safe and reliable. It is a novel reversible long-term contraceptive technique. It's a modern long-acting contraceptive device with a subcutaneous implant that releases etonogestrel (ENG). The main objective of this research was to determine the distribution, tolerability, and adverse reactions of Nexplanon among females who used it in Baghdad and find any relationship between these side effects and the acceptability of the device among contraceptive users. METHODS This study was done via the participation of 80 women who were using Nexplanon at the time of study or had recently removed the implant; the data was obtained from a direct interview and medical records. RESULTS The total number of women enrolled for the study was 80. The mean age of contributors was 33.24 (± 2.69) years. None of the participants was nulliparous; 15 % had two children, 85 % had three or more children. Of the participants, 26.25 % and 65 % had secondary and higher education degrees respectively, while only 7 % had primary education and none of the participants had any education. 6.25 % were smokers, only 28.75 % had irregular cycle and the remaining percentage had a regular one. 57 (71.25 %) of them underwent adverse events while using the contraceptive implant, the most common one was bleeding disorders most likely in the form of light intermittent bleeding. 69 (86.25 %) from those only 18 (26.08 %) removed implant because of this irritant bleeding, the next common adverse event was headache 44 (55 %), 8 (18.18 %) of them removed the implant because of headache, 41 (51.25 %) underwent variable mood swing changes, 36 (45 %) suffered from weight gain with use of the implant, 33 (41.25 %) nausea and bowel habits changes, androgenic effects presented in 19 (23.75 %) and 10 (12.5 %) in the form of acne and hirsutism, respectively. 3 (10.34 %) of them removed the device as they could not cope with this complication, only 6 (7.5 %) suffered from low sexual desire. CONCLUSIONS Nexplanon can be a suitable alternative for women who have been adequately informed about long-term contraception but bleeding disturbances and cycle durations (> 8 days) are also key indicators for early removal. The process of consulting the patient and giving them the appropriate educational advice on this subject should be a priority before using the implant, in addition to establishing special induction and educational programs. KEY WORDS Nexplanon, Contraception Method Contraception Method, A Subcutaneous Implant and Etonogestrel.

The Tired Pregnant Woman

Introduction: Many pregnant women develop hyperemesis gravidarum. There are numerous gastrointestinal, genitourinary, neurologic, and metabolic causes to consider in this patient population. Case Presentation: This clinicopathological case presentation details the initial assessment and management of an 18-year-old pregnant patient who presented to the emergency department with a complaint of nausea, vomiting, fatigue, and intermittent bleeding. Discussion: This case takes the reader through the differential diagnosis and evaluation of the patient and the signs and symptoms, including her agitation and tachycardia, that led us to the correct diagnosis.

Laparoscopic resection of small bowel gist: a case report

Small bowel bleed accounts for approximately 5% of all gastrointestinal bleeding. While arteriovenous malformation is the commonest cause of small bowel bleeding, other causes include inflammatory bowel disease, small bowel tumours, ulcers and polyps make up the rest. Tumours range from benign adenomas, hamartomas and leiomyomas to malignant GISTs, adenocarcinomas or lymphomas. We reported a case of a jejunal GIST causing intermittent bleeding. Upper and lower GI endoscopy did not find any abnormality and the diagnosis was made through computerized tomography. It showed a mid-jejunal tumour that was in close proximity to the distal duodenum. The rest of the hollow and solid organs were normal. The patient was prepared and underwent laparoscopic assessment. The tumour was mobile, arising from proximal jejunum and did not show infiltration or adhesions to nearby viscera. A segmental resection with adequate margin was performed laparoscopically and extracted through the umbilical port wound. The pathology report revealed an intermediate GIST with clear margins. Laparoscopic assessment should ideally be carried prior to any resection of small bowel tumours. Uncomplicated small bowel resections can safely be done laparoscopically with good oncological outcome and faster patient recovery.

Pyogenic granuloma-like Kaposi sarcoma presenting in an HIV-negative man who has sex with men

A 36-year-old immunocompetent man who have sex with men first presented to the plastics team with an ulcerating lesion on his left first toe. The lesion was suggestive of pyogenic granuloma (PG) clinically and histologically. Two years later, the same patient presented to the dermatology clinic with a new erythematous lesion with intermittent bleeding on the left second toe. Clinically, this lesion was suggestive of another PG. However, the histology of the skin curettage revealed part of a PG merging with an atypical spindle cell proliferation with characteristic ‘sieve-like’ appearance in keeping with Kaposi sarcoma. This was confirmed with human herpesvirus-8 immunohistochemistry staining. PG-like Kaposi sarcoma is an uncommon variant of Kaposi sarcoma. Often not considered clinically or histologically, a deep skin biopsy is essential to establish the right diagnosis. Our case highlights the need to consider Kaposi sarcoma as a differential diagnosis in all patients, including HIV-negative individuals, presenting with PG-like lesions.

A Rare Case of Life-Threatening Bleeding Caused by a Jejunal GIST

Gastrointestinal Stromal Tumours (GISTs) are rare mesenchymal tumours that are specific to GI tract. GISTs usually associated with advanced age and have a slight male preponderance. GISTs are commonly found in stomach. Jujunal GISTs are the rarest and account for about 0.1-3% of all GI tumours [1]. The most common clinical manifestation of symptomatic GISTs includes intermittent bleeding due to mucosal ulceration. Massive, life threatening gastrointestinal (GI) bleeding is a rare occurrence. We report a rare case of bleeding Jejunal GIST in a 32-year-old female who presented with haemorrhagic shock that required resuscitative laparotomy. Histopathology and immunohistochemistry confirmed the tumour to have features of GIST with clear margins and post-operative cross-sectional imaging excluded any metastatic deposits.

Angiodysplasia of left colon extending to anal verge landed patient into APR: a rare finding

Angiodysplasias is a kind of vascular malformation preferably involves the veins. Angiodysplasia of colon is the second most common cause of lower gastrointestinal bleeding after diverticulosis. It usually involves caecum and ascending colon. Patient may either present with complaints of fresh bleeding per rectum or with melena. It usually occurs in elderly because of age related degeneration of small blood vessel walls. The case presented here involves a male patient of 25-year age with complains of intermittent bleeding per rectum and generalized weakness from one month. After examination it was found to have vascular ectasia involving mid transverse colon, left colon and the rectum coming down to anal verge which culminated into abdominoperineal resection. Biopsy of resected segment came to be angiodysplasia with external surface of specimen showing dilation of multiple vascular channels in entire length up to anal verge. This case report shows that though angiodysplasia is more common in old age but while exploring a young patient with lower gastrointestinal tract bleeding, and congestive changes are found in left colon possibility of angiodysplasia should also be kept in mind.

Upper Gastrointestinal Bleed: Do not Forget a Look at Ampulla

Hemosuccus pancreaticus (HP) and hemobilia (HB) are uncommon causes of upper gastrointestinal bleed. In this report, 4 cases of HP and 1 case of HB with intermittent bleeding are described. The causes of HP are rupture of splenic artery pseudoaneurysm in 3 and gastroduodenal artery aneurysm in one. The cause of HB is due to cystic artery bleed. HP can be secondary to chronic or acute pancreatitis with bleeding from pseudoaneurysm arising from peripancreatic arteries. Iatrogenic transhepatic techniques, trauma, operative injuries, malignancy, and inflammation in hepatobiliary system are the common causes of HB. All the cases are missed on first endoscopy and diagnosed on second‑look endoscopy. A strong clinical suspicion is required at first endoscopy for early diagnosis and management. This case report compares presentation of HP with HB, diagnosis, and their management.

Superficial siderosis of the central nervous system is a rare and possibly underdiagnosed disorder

ABSTRACT Superficial siderosis (SS) of the central nervous system (CNS) is a rare and possibly underdiagnosed disorder resulting from chronic or intermittent bleeding into the subarachnoid space, leading to deposition of blood products in the subpial layers of the meninges. Magnetic resonance imaging (MRI) shows a characteristic curvilinear pattern of hypointensity on its blood-sensitive sequences. Methods Series of cases collected from Brazilian centers. Results We studied 13 cases of patients presenting with progressive histories of neurological dysfunction caused by SS-CNS. The most frequent clinical findings in these patients were progressive gait ataxia, hearing loss, hyperreflexia and cognitive dysfunction. The diagnoses of SS-CNS were made seven months to 30 years after the disease onset. Conclusion SS-CNS is a rare disease that may remain undiagnosed for long periods. Awareness of this condition is essential for the clinician.

Cationic Peptides Facilitate Iron-induced Mutagenesis in Bacteria

Pseudomonas aeruginosa is the causative agent of chronic respiratory infections and is an important pathogen of cystic fibrosis patients. Adaptive mutations play an essential role for antimicrobial resistance and persistence. The factors that contribute to bacterial mutagenesis in this environment are not clear. Recently it has been proposed that cationic antimicrobial peptides such as LL-37 could act as a mutagen in P. aeruginosa. Here we provide experimental evidence that mutagenesis is the product of a joint action of LL-37 and free iron. By estimating mutation rate, mutant frequencies and assessing mutational spectra in P. aeruginosa treated either with LL-37, iron or a combination of both we demonstrate that mutation rate and mutant frequency were increased only when free iron and LL-37 were present simultaneously. The addition of an iron chelator completely abolished this mutagenic effect, suggesting that LL-37 enables iron to enter the cells resulting in DNA damage by Fenton reactions. This was also supported by the observation that the mutational spectrum of the bacteria under LL-37-iron regime showed one of the characteristic Fenton reaction fingerprints: C to T transitions. Free iron concentration in nature and within hosts is kept at a very low level, but the situation in infected lungs of cystic fibrosis patients is different. Intermittent bleeding and damage to the epithelial cells in lungs may contribute to the release of free iron that in turn leads to generation of reactive oxygen species and deterioration of the respiratory tract, making it more susceptible to the infection.