Inguinoscrotal hernias containing stomach: risk of emergency presentation

Introduction Inguinoscrotal hernias are the commonest form of abdominal wall hernia, but for them to contain stomach is extremely rare. The management of these hernias can be very challenging owing to their acute nature of presentation and distortion of anatomy. Our aim was to systematically review the literature for all reported cases of inguinoscrotal hernias containing stomach. In turn we analysed patient demographics, site of hernia, presentation and treatment. Outcomes were reviewed where available. Method We conducted a systematic search of the PUBMED, Embase and Medline databases with a combination of keywords: Hernia AND (inguin* OR scrot*) AND (gastric OR gastro*). An author's own case has also been included. Results There were 20 case reports included in the review, plus the author’s own case. They ranged in publication date from 1942 to 2020. Mean age at presentation was 71 years (range 49 to 87). All cases were male. In total, 62% (n = 13) of cases presented with combined symptoms of abdominal pain and vomiting, 48% (n = 10) presented with gastric outlet obstruction (GOO) and 48% (n = 10) presented with gastric perforation. All successfully treated cases with gastric perforation required a midline laparotomy approach, whereas 56% (n = 5) of patients in the GOO group were successfully treated conservatively. There were three deaths reported in this review, all in the gastric perforation group. Conclusion Stomach as a content of inguinoscrotal hernias is extremely rare. These hernias predominantly present acutely in the form of GOO or gastric perforation. All patients with gastric perforation will require a midline laparotomy. Patients with GOO can be successfully managed either surgically or in selective cases with conservative management.

Targeting NSP16 Methyltransferase for the Broad-Spectrum Clinical Management of Coronaviruses: Managing the Next Pandemic

With the approval and distribution of demonstrably safe COVID-19 vaccines bearing exceptionally high efficacy profiles, it may be tempting to envision a return to “normal” in the coming months. However, if there is one lesson to be learned from the ongoing pandemic, it is that, in a world of evolving zoonotic viruses, we must be better prepared for the next deadly outbreak. While the acute nature of the COVID-19 pandemic demanded a highly specific approach, it is advisable to consider the breadth of seemingly endless possibilities in our approach to managing the next inevitable occurrence of an outbreak. Though there is little chance of discovering a “magic pill” to combat all future pathogens, the highly conserved nature of non-surface viral proteins exposes an “Achilles’ heel” in the structural genome of viral pathogens. Herein, we consider the potential of targeting such proteins to develop broad-spectrum therapeutics for the future. To illustrate this point, we outline the therapeutic potential of targeting the nonstructural protein 16 methyltransferase, which is conserved across most coronaviruses.

Mixed germ cell tumour of the testicle: a case report of a patient presenting with acute abdomen

Testicular tumours are a group of heterogenous neoplasms seen commonly in men between the ages of 15 and 35 years. The two main types are seminoma and non-seminomatous germ cell tumour (NSGCT). Testicular cancers are highly treatable and usually curable, even if they present at an advanced stage of the disease with a five-year survival rate of over 95 percent. The symptoms at initial presentation can vary depending on the metastasis, but a nodule or painless swelling of testicle is usually noted. In this case report we will study how a patient with metastatic testicular tumour presents with symptoms indicative of gastrointestinal infection of acute nature with no associated features. We will review current literature on testicular cancers, reasons for delay in treatment and its impact on patient care.

Chronic pancreatitis: what should be considered in diagnosis, treatment, and prognosis

The aim of the literature review is to draw attention of doctors to the need of considering not only well-known etiological factors, but also pathogenetic ones that have an impact on the progression, chronicity of the process, treatment, prevention, and prognosis. The role of alcohol, mechanism of obstruction of the pancreatic ducts in the occurrence of abdominal pain in chronic pancreatitis, and the development and progression of exocrine pancreatic insufficiency are discussed in detail.The issues of the onset of chronic pancreatitis in elder age, comorbidity with other diseases of the internal organs, with a lack of certain vitamins are considered. It is necessary to remember that exocrine insufficiency can be associated with the progression of glandular fibrosis, metabolic disorders, food intolerance, allergic syndrome, which provoke acute attacks.The author draws attention to the fact that the syndrome of inflammatory, enzymatic intoxication and the syndrome of disseminated intravascular coagulation should not be missed out in the acute nature of the process. Above-listed recommendations will help to correctly evaluate the clinical picture and prescribe the proper treatment, as well as to prevent the development of complicationsin time.

A hospital based cross sectional study of acute pancreatitis with special reference to computed tomographic evaluation

Background: All suspected cases of acute pancreatitis should undergo CT scan. It is non invasive and reliable. CT scan is able to give complete picture of acute pancreatitis. The objective of the presentMethods: The present study was hospital based. 60 cases with evidence of acute pancreatitis were included. They were studied for 3 years from June 2015 to May 2018. CT scan was performed in all cases. CT features of the pancreas were noted and described.Results: Acute pancreatitis incidence was four times more in males compared to females i.e. 80% vs. 20%. CT scan showed that pancreatic gland was normal only in 16.7% of the cases. The contour was irregular in 66.7% of the cases. Eight cases showed necrosis. Less than 30% three patients (10%) had grade A acute pancreatitis. 28 cases were showing Phlegmonous changes. In 24 cases it was observed that lesser sac was affected.Conclusions: Authors conclude that for grading and staging of the pancreatitis of acute nature, CT scan is must and is very helpful to the clinicians. CT scan helps not only in precise diagnosis but also in predicting the proper prognosis of the patients who are affected by the pancreatitis of acute in nature.

Religion and Spirituality in the Intensive Care Unit

The Intensive Care Unit is an area of the hospital that can elicit high levels of emotional and spiritual distress due to high mortality and prognostic uncertainty. Religion and spirituality are often manifest through prayer, rituals, and ceremonies, which can unite the patient and family with the care team. However, miracle language and other religious or spiritual topics that misalign with the expectations of the medical team can also lead to discord. The acute nature of ICU care poses challenges in creating a therapeutic alliance necessary to effectively address the religious and spiritual needs of patients and families. In this chapter, we provide a practical approach to provide high quality spiritual care in the ICU.

Genetic and molecular expression patterns in critical illness

Investigators who study RNA, proteins, or metabolites use analytic platforms that simultaneously measure changes in the relative abundance of thousands of molecules in a single biological sample. Over the last decade, the application of these high-throughput, genome-wide platforms to study critical illness and injury has generated huge quantities of data that require specialized computational skills for analysis. These investigations hold promise for improving our understanding of the host response, thereby transforming the practice of intensive care. This chapter summarizes recent technological and computational approaches used in genomics, proteomics, and metabolomics. While major advances have been made with these approaches when applied to chronic diseases, the acute nature of critical illness and injury has unique challenges. The rapidity of initiating events, the trajectory of inflammation that follows injury or infection and the interplay of host responses to a replicating infection, all have major effects on changes in gene and molecular expression. This complexity is further accentuated by measurement that may vary with the timing and type of tissue sampled after the critical event. In addition, the hunt for novel molecular markers holds promise for identifying patients at risk for severe illness and for enabling more individualized therapy.

Sleep in the intensive care unit

ABSTRACT Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

Concern Over the Future of the Nation. A Discourse Analytical Study on Changes in Russian Demographic Policy in the Years 2000-2010

This article discusses statements on demographic policy issued by the Russian stateleadership in the years 2000-2010. During the years covered in this study, there hasbeen an increase in publicly expressed concern over the state of the population, i.e.low birth rate in conjunction with high mortality. This concern over population asa research topic is made relevant, first of all, by the acute nature it has as a socialpolitical issue. Secondly, it has a variety of connections with other important areas,such as family life, gender, and labor market.The research material consists of annual speeches delivered by Russian stateleadership, as well as three official long-range plans, in which discussion concerningthe demographic situation is given a central role. Discourse analysis was adopted asthe theoretical framework to guide the interpretations because it facilitates observationof the linguistic mechanisms used to define certain phenomena as problems, and tooffer other phenomena as solutions to these problems.The analysis revealed three types of discourse, each a part of a broaderdemographic policy discourse, and each defining Russian demographic policy inits own characteristic way. In the Serious Problem discourse, the demographicphenomenon is taken apart and rationalized, while awareness of an impending crisisis created. The State Support discourse offers solutions to a defined problem andlends legitimacy to state leadership as a successful executor of these solutions. TheFamily Centered discourse argues for the traditional family model, according towhich legal marriage, reproduction and high fertility rate are key values.