Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen

Introduction: Ventriculoperitoneal shunt (VPS) is most commonly performed surgical treatment for hydrocephalus by draining excessive cerebrospinal fluid (CSF) in ventricles to peritoneal cavity. Despite significant improvement in shunt procedure and being a relatively simple procedure, shunt complications remain common. Aim: The aim of this paper is to report a case of perforated bowel presented with silence abdomen following VPS insertion. Case study: We report a case of protrusion of distal VPS catheter through anus with silent abdomen, managed successfully with minimal intervention. Patient, 11-months-old male infant, diagnosed with congenital communicating hydrocephalus and VPS placement was done at 6 months of life, presented with tip of VPS protruding from anus after 4 months of VPS insertion. Patient was scheduled for removal of VPS, where shunt was disconnected through superficial abdominal incision, distal portion removed through anus without resistance. Postoperative patient recovers well without abdominal complication. Results and discussion: Perforation of bowel by distal peritoneal catheter is rare and only accounts for 0.1%–0.7% of complication. The exact pathogenesis for spontaneous bowel perforation is unclear. Management of bowel perforation secondary to VPS is highly individualized, mainly depending on its clinical symptoms and signs. Conclusions: Although bowel perforation following VPS insertion is rare, it carries high mortality up to 15% especially if unrecognized and delayed in treatment. Early detection and appropriate management are key in reducing VPS related morbidity and mortality.

Kikuchi-Fujimoto disease: State of the art

Introduction: Kikuchi-Fujimoto disease (KFD), also called histiocytic necrotizing lymphadenitis, is a rare disease that occurs with swollen lymph nodes and associated fever. This disease occurs in both children and adults. Aim: The aim of our work was to review the literature and to remind family doctors, otolaryngologists, hematologists and rheumatologists about this rare disease that should be included in the differential diagnosis of long-term cervical lymphadenopathy. Material and methods: Current information on Kikuchi-Fujimoto disease was sought and presented based on literature that was published in reputable magazines in the period 2007–2020 in English. We searched for articles in the Medline, PubMed, and Scopus databases. Results and discussion: KFD occurs in both children and adults. This disease is found all over the world, most often in the Asian population. The etiology of Kikuchi-Fujimoto disease is not entirely known, however, two causal theories are suspected, which are discussed in detail in our article. The course of the disease is mild and usually disappears on its own. A biopsy of an involved lymph node presented as the standard for diagnosis. KFD treatment was causal – nonsteroidal anti-inflammatory drugs and/or glucocorticosteroids were used. Conclusions: There are few reports in the literature about Kikuchi-Fujimoto disease. KFD is associated with cervical lymphadenopathy and associated fever. If the diagnosis of the above-mentioned symptoms is not obvious, then in the differential diagnosis rarer diseases, such as KFD, should be included.

Endoscopic sinus surgery training courses: Benefit and problems – a multicenter evaluation

Introduction: Dissection courses are important for trainees and surgeons in mastering the skills required to perform endoscopic sinus surgery (ESS) which is a common surgery in otorhinolaryngology. Aim: To evaluate the benefits of ESS training courses and ways to improve training. Material and methods: In a prospective study using a structured questionnaire, participants of ESS courses in the United Kingdom, Malaysia, India and Thailand were asked on their experiences in these courses and suggestions on improving them. Results and discussion: The majority of the participants have experiences in performing ESS prior to joining the course. Infundibulotomy was considered the easiest dissection step in ESS while frontal sinus surgery was considered the most challenging by the majority of the participants. The motivation for most of the participants in joining the course is to improve their skills with almost all stating that their expectations of the course have been fulfilled with improvement of their surgical techniques, anatomical skills and on patient’s safety. Almost all the participants were satisfied with the course and would recommend attending it. Conclusions: ESS dissection courses are an integral part in the learning process of trainees in becoming a competent surgeon and for surgeons to improve their techniques. Continuous improvement should be made to ensure that the participants will benefit from attending the course.

Thermovision analysis of the surface of the lower limbs in patients with symptomatic lumbosacral discopathy before and after surgery

Introduction: The subject of the study is analyzing of the temperature distribution on the lower limbs in patients with discopathy of the lumbosacral spine requiring surgery. Aim: The answer to the question whether surgical treatment reduces temperature differences on the lower limbs of patients undergoing surgery. Material and methods: Thermograms of the lower limbs were performed before and on the second day after microdiscectomy or microdiscectomy with posterior lumbar interbody fusion. The study group consisted of 37 patients of the Neurosurgery Department, while the control group consisted of 18 healthy people. Comparative analyzes of temperatures on the lower limb with pain with the temperatures on the lower healthy limb in the same patient indicate significant statistical differences in temperature distribution. Based on the thermograms, two region of interest’s (ROI) of the same area were determined on the thigh and the lower leg. The maximum, minimum and average temperatures were determined for those areas. Results and discussion: Comparative analyzes showed statistically significant differences for both areas and all temperatures between healthy and affected limbs in the group of patients before surgery. In turn, after surgery, no statistically significant differences were observed between the respective limb temperatures for both ROI areas. The analysis of the temperature parameters determined for analogous ROIs in the control group did not show statistically significant differences for all measured temperatures. Conclusions: After selective surgical treatment of lumbar discopathy by microdiscectomy previous significantly statistical temperature differences between the lower limbs in analogical ROIs in those patients decreased to not statistically significant differences.

Extreme hyperbilirubinaemia associated with choledocholithiasis without ascending cholangitis

Introduction: Charcot’s triad was traditionally used to diagnose ascending cholangitis. However it is already proven that only minority of patients with ascending cholangitis who fulfill the triad of fever, jaundice and right hypochondriac pain. Aim: We would like to highlight the rarity of severe hyperbilirubinaemia secondary to benign cause as most of the incidence raised more suspicion for primary liver disease or malignancy. Case study: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Results and discussion: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Conclusions: Benign conditions such as common bile duct stones still can lead to severe hyperbilirubinaemia even though it is very rare. The usage of appropriate imaging is needed to exclude malignant causes.

Investigating the predictors of routine HIV screening behaviors in nurses based on theory of reasoned action

Introduction: Adequate awareness and a positive attitude of nurses about HIV/AIDS can lead to better care and the provision of accurate information to the general public. Misconceptions about HIV/AIDS infection can affect the attitudes of healthcare staff and inappropriately affect the quality of care. Aim: The present study aimed to investigate the factors predicting the routine HIV screening behaviors in nurses based on the theory of reasoned action. Material and methods: This descriptive-cross-sectional study was conducted on 131 nurses working in Vali-e-Asr hospital in Fasa, Iran. The samples were selected by simple random method. Three 75-item standard questionnaires were also used to collect data, including 15 questions on attitudes, 30 questions on the nurses’ knowledge, and 30 questions on the nurses’ performance. Results and discussion: In total, 30 male (22.9%) and 101 (77.1%) female nurses entered in the study. Also, 65.6% of participants were 18–29 years and 48.9% (64) were working in emergency department. The mean attitude and knowledge were calculated to be 20.69 ± 3.17 points and 20.98 ± 4.78 points, respectively. Also, the mean of performance, behavioral control, intention, and subjective norms were calculated to be 84.63 ± 8.06 points, 24.56 ± 2.29 points, 63.93 ± 6.68 points, and 30.53 ± 3.27 points, respectively. The results of the present study indicated a significant relationship between the work experience with their attitude (P = 0.03) and knowledge (P = 0.001) as well as between the age and performance (P = 0.002). Conclusions: In the present study, the mean score of attitude, knowledge and performance was found to be moderate; thus the educational intervention seems necessary.

Efficacy of minimally invasive therapy and laser therapy in the comprehensive treatment of endoperiodontal lesions

Introduction: A strategy for comprehensive treatment of endoperiodontal lesions is discussed, depending on the severity of pathology in the endodontium and periodontium associated with mild chronic generalized periodontitis. Aim: The purpose of the study was to evaluate the efficiency of minimally invasive therapy and laser therapy in the comprehensive treatment of endoperiodontal lesions associated with chronic generalized periodontitis. Material and methods: Sixty patients with apical periodontitis were examined and received periodontal treatment using minimally invasive therapy and laser therapy in combination with endodontic stages of treatment. Results and discussion: Pain when biting down, sometimes aggravated with solid food, was reported for several days in 38% of cases in the control group. The patients of the study group did not report painful sensations; in 20% of cases, inconveniences only occurred with solid food during the first days. Conclusions: The study showed that in all clinical cases selected for this article, a comprehensive treatment including minimally invasive therapy and laser therapy was effective with both endodontic and periodontal sparing treatment.

Immune polychemotherapy regimen choice in B-cell non-Hodgkin lymphoma of high and low malignancy based on the identification of the mutational c-myc and BCL 2 genes

Introduction: The relevance of research is conditioned by the study of the gene expression profile for the identification of molecular subgroups of non-Hodgkin B-cell lymphomas (NHBCLs) in haematology. Aim: The aim of this research was to study the gene expression profile with the identification of molecular subgroups in patients with NHBCLs for personalised treatment. Material and methods: This paper is aimed at analysing the frequency and role of expression of c-myc, B-cell lymphoma 2 (BCL 2) proteins and the Ki 67 proliferative index in patients with NHBCLs and conducting personalised therapy to improve the immediate effectiveness and immediate treatment results. Results and discussion: The paper presents the results of the use of high-dose polychemotherapy (PCT) in 9 patients out of 80 with NHBCL during co-expression of the c-myc, BCL 2 mutational gene and with high values of the Ki 67 proliferative index. High-dose chemotherapy (HDCT) was performed according to the R+HyperCVAD scheme (6 courses) and hematopoietic stem cell (HSC) autotransplantation improved the immediate effectiveness of therapy, with a complete remission rate of 80% and an event-free survival of 28 months. Conclusions: The study of molecular genetic characteristics in 80 patients with NHBCLs revealed co-expression of the c-myc and BCL 2 mutational gene in 9 out of 80 patients, and they differed in the aggressive course, ‘poor’ response to therapy, which predetermined the use of high-dose PCT with transplantation of autologous stem cells.

Pulmonary complications due to COVID-19 – a literature review

Introduction: irst cases of a disease called coronavirus disease 2019 (COVID-19), caused by a novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of the coronavirus family, were detected in December 2019. The disease is manifested by a variety of symptoms and can run a different course: from oligosymptomatic or asymptomatic to the development of acute respiratory failure and even death. Aim: The aim of this paper is to provide critical analysis of the potential pulmonary complications after COVID-19 infection. Material and methods: We have provided the systematic literature review based on which we have discussed the pathophysiology of COVID-19, its outcomes, risk factors and pulmonary complications. Results and discussion: The organs that are most often affected by a SARS-CoV-2 infection are the lungs. An infection with this virus can lead to a severe respiratory tract illness, both in the acute phase and as a complication after a relatively mild case. There are numerous observations of patients convalescing from COVID-19 who suffer from the interstitial pulmonary disease with fibrosis. There are also reported cases of spontaneous pneumothorax after COVID-19. Conclusions: It should be borne in mind that other late complications may appear with time.