Urinary Retention Secondary to Colpocleisis: A Case Report

Introduction: Pelvic Organ Prolapse (POP) is common in older women, and depending on its extent, it is conservative or surgically treated. Colpocleisis is a technique for POP treatment, in which the vaginal canal is closed, entirely or partially, in order to avoid the protrusion of the pelvic structures, with preservation of the urethral meatus in order to preserve normal micturition. Clinical Case: We present a case of a 61-year old woman, who 8 years after a colpocleisis, progressed to urinary retention associated with the progressive scarring of the labia, causing the obstruction of the urethral meatus. The patient underwent a labiaplasty with anterior colpoperineoplasty, with complete normalization of her micturition and sexual activity. Conclusion: Long term urinary retention complication has not been previously reported in the literature and should be included as a possible adverse event after colpocleisis.

Effects of Orally Administered Preliminary Analgesic Therapy in Diagnostic Colposcopy Patients: A Prospective Questionnaire Study

Background: Colposcopy has a key role in the diagnostic work-up and management of abnormal cervical cytology, but it might generate negative feelings of mainly anxiety and pain to the patients undergoing such examination. These feelings are interrelated, with the anxiety fueling the painful sensations. The aim of our study was to investigate the effects of preliminary administration in terms of pain and anxiety relief that the preliminary administration of paracetamol would have on patients undergoing diagnostic colposcopy. Materials & Methods: We conducted a single center prospective study which enrolled 112 patients with diagnosed or suspected cervical pathology who were examined at the Outpatient Colposcopy Clinic of Patras University Hospital, over a 7-months period. Patients were randomly assigned to one of the two groups. The interventional group received 1gr of paracetamol (acematiminofen) in pill form, 30 to 60 minutes before colposcopic assessment; the control group received no medication. At the end of consultation, all participants completed a 2-page questionnaire. Results: More patients of the interventional arm did not experience any pain at all during colposcopy compared with the control group. However, this difference was statistically not significant, probably because of the small number of patients. Moreover, there were no differences in mild and moderate pain rates between the interventional and control groups. Severe pain was only experienced by patients in the control group. Further data analysis from the first time as and for repeat colposcopy patients showed similar findings regarding pain intensity rates in the interventional and control group. When considering anxiety levels, no differences were observed between the two groups. Conclusion: The preliminary administration of low dose paracetamol in a pilot sample of colposcopy patients did not illustrate significant benefits in terms of experienced pain and anxiety levels.

A Case Report: Type II Abernethy Malformation Complicated with Congenital Polydactyly and Enlargement of all Cardiac Chambers

Background: Abernethy malformation is a kind of congenital malformation of the portal vein system caused by abnormal portacaval shunts. It can be in combination with many other congenital malformations. There has been a limited number of patients since the first patient was reported, leading to limited knowledge of this kind of disease. Methods: In August 2018, we treated a patient diagnosed with type II Abernethy malformation complicated with both congenital polydactyly and enlargement of all cardiac chambers, which is extremely rare and can be supplementary to the existing cases. According to a comprehensive and adequate assessment of patients' condition, we treated him with oral silybin (70 mg every time and 3 times a day) for 3 months, and advised him to make follow-up visits. Results: At the latest follow-up, we knew the health condition of this patient was generally satisfactory, whether in terms of laboratory test results or his daily life experience. Conclusion: Although the major therapy for Abernethy malformation is surgery, this case suggests that simple conservative treatment with regular follow-up visits can be suitable for certain patients.

Early-onset of Frontotemporal Dementia and Amyotrophic Lateral Sclerosis in an Albanian Patient with a c.1319C>T Variant in the UBQLN2 Gene

Background: Frontotemporal Dementia (FTD) is the second most common cause of dementia under 65 years of age; it has a prevalence of 4-15 per 100,000 persons. The overt disease usually manifests in the sixth decade, and it is extremely rare to find affected patients in their twenties. Objective: Here, we present the clinical and molecular genetic findings of an Albanian family with a patient with early-onset FTD and Amyotrophic Lateral Sclerosis (ALS). Methods: Given the great variability of clinical presentation of FTD and the number of genes involved, targeted Next Generation Sequencing (NGS) was used to screen the DNA of the 27-year-old male patient. Segregation analysis was performed in available family members. Results and Discussion: A variant, consisting of a proline-leucine amino acid substitution in position 440, was identified in the UBQLN2 gene on the X-chromosome. This variant was previously reported as a variant of unknown significance in a 30-year-old female patient with amyotrophic lateral sclerosis. With the description of our case, we add evidence on its involvement, also in ALS-FTD. The variant is in a functional domain important for interaction with HSP70 and this, in turn, may impair the shuttling of proteins to the proteasome leading to an accumulation of protein aggregates. The variant was inherited from the unaffected mother, in line with the fact that incomplete penetrance has been widely described for this gene. Conclusion:The present report adds information regarding one of 34 variants in the UBQLN2 gene reported so far in association with neurodegeneration and proposes a molecular pathogenesis of ALS-FTD in this patient.

Fibrin-Specific Thrombolytic Therapy for Acute CVA within 6 Hours of Onset, Systematic Review and Meta-analysis

Objective: Cerebrovascular Accident (CVA) remains a major cause of disability and death and fibrinolytic agents might reduce long-term disability. We sought to determine whether patients receiving fibrin-specific thrombolytic agents acutely (within 6 h) following CVA had improved functional outcome, or decreased mortality or increased intracerebral bleeding at 6-months than patients receiving placebo. Materials and Methods: We conducted a systematic review of randomized controlled clinical trials that assessed 6-months functional outcome, mortality and intracranial hemorrhage and compared thrombolytic therapy with placebo in patients randomized within the first 6 hours following CVA. We searched these databases: MEDLINE (1990-2018), Cochrane Central Register of Controlled Trials, and Cochrane Database for Systematic Reviews. Two blinded reviewers reviewed the eligible articles and rated study quality using the Jadad score. We calculated pooled Odds Ratios (ORs) using a random effect model. Results: We included 9 studies with 6523 enrolled participants and had 673 deaths. Compared with placebo, thrombolytic therapy within 6 hours of CVA did not result in a statistically significant reduction in 6-month mortality (OR 1.21, 95% confidence interval [CI] 0.94–1.55). More patients in the thrombolytic therapy group had favorable functional outcome (OR 1.20 confidence interval [CI] 1.07–1.35). Thrombolytic therapy caused more fatal intracerebral bleeding than placebo (OR 5.61 confidence interval [CI] 3.40-9.24). Conclusion: Fibrin-Specific thrombolytic within 6 hours of CVA improves functional outcome at the expense of increasing symptomatic and fatal intracerebral bleed. Future studies are required before extending the thrombolytic window to 6-hours.

A Method for the Assessment of Mitral Valve Regurgitation Grade and Severity

Background: Previous grading and severity scores of MR were based on a mix of objective echocardiographic data and subjective findings such as the presence or absence of symptoms. There is a need for a grade - and a severity -score for Mitral Valve Regurgitation (MR) that is based purely on objective findings and avoids the ambiguity of labelling the same degree of MR differently according to symptoms severity and/or the underlying etiology. Methods: We reviewed published reports regarding MR severity and grades and provided a method for the assessment of MR severity and grades based purely on objective data regardless of the symptom(s) and/or underlying cause(s) of MR. Objective Echocardiographic and/or Cardiac Magnetic Resonance (CMR) findings of Vena Contracta (VC) size in cm2, Effective Regurgitant Orifice area (ERO) in cm2, Effective Regurgitant Volume (ERV) in mls/beat, and Regurgitation Fraction (RF) as a percentage of the left ventricular stroke volume, were given a score value of A, B, C or D with increasing severity, thus ranging from the mildest degree“A” to most severe “D”. Results: As summarized in Table 4, MR severity ranged between 4 “As” to 4 “Ds”. Further elaboration regarding the parameter(s) most severely affected may be added to the score value, e.g., scoring MR with a VC = 0.60 cm2 associated with EROA = 0.4cm2, ERV = 60mls and RF = 45% will be 2D (EROA and ERV) MR, thereby avoiding overlap between various degrees of MR and/or further data manipulation to make other parameters fit one grade of MR or another. Conclusion: Applying this scoring/grading system to Echocardiographic and/or CMR studies of patients with mitral valve regurgitation will enhance our endeavors to use a clear and unified language regarding MR severity without compromising the quality of Echocardiographic or CMR findings and/or reporting.

Analgesic Equivalent Days: A Novel Approach to Assess Chronic Analgesic Use in the Population

Introduction: There is no simple method to compare the use of multiple analgesic products in mild to moderate pain. The aim of this study is to validate a new tool to assess analgesic use. Methods: A measure of Analgesic Equivalent Days (AEDs) was developed using Defined Daily Doses (DDD) and the total mg of each analgesic over a 12 month period. Comparisons were made using analgesic class and all analgesics combined. Results: In a group of newly initiated patients with Osteoarthritis, AEDs values indicated that patients received around 70% of AEDs from paracetamol, 20% from NSAIDs and 10% from opioids. AEDs were similar between the two paracetamol formulations. However, one group took 8 more AEDs of NSAIDs, while the other group took 7 more AEDs of opioids. Conclusion: Even though the total AED scores, there was no significant difference in total analgesic use between the two formulations, differences were found among the analgesic classes. The AED methodology was sufficiently sensitive to demonstrate that one group of patients climbed higher up the analgesic ladder than the other group. AEDs are easy to calculate and seem to produce valid outcomes from both a statistical and a clinically meaningful perspective.

A Review on the Recent Flavoring Herbal Medicines of Today

Background: Herbs are the most trending taste enhancers, carrying multiple benefits. Sprinkling them in minute amounts in pasta, salads, sautéed vegetables, curries, fried rice or adding them in dips and sauces can lead to enhanced flavours. The fresh and dried versions serve the same purpose, especially when the fresh ones are not available. Objective: The objective of this article is to explore and review trending flavouring herbs of the present era with reference to the knowledge available from previous texts. Materials and Methods: A literature review has been performed on various herbs such as dill, cilantro, parsley, chives, mint, oregano, etc, which can be used as healthy and taste enhancing sprinklers and garnishers for foods. Results: There are various herbs present in nature in many forms and patterns, some provide anti-inflammatory benefits, are anti-microbial and most of them are digestive in nature. Conclusion: These herbs are very rich in phytoconstituents, having multiple properties like anti-oxidant and carminative effects. They are superior as compared to artificial additives as well.

Mean Platelet Volume and Red Cell Distribution Width in Differentiated Thyroid Cancer Patients

Aim: The purpose of this study was to investigate MPV and RDW values in DTC patients. Background: Differentiated Thyroid Cancer (DTC) is subdivided into papillary, follicular and papillary micro thyroid cancers. Mean Platelet Volume (MPV) and red cell distribution width (RDW) are markers which have been investigated in many cancers, but no data are available for DTC. Objective: MPV and RDW values were assessed in 108 patients with DTC, consisting of 44 with Papillary Thyroid Cancer (PTC) (mean age 43±13.9 years), 34 with Papillary Micro Thyroid Cancer (PmTC) (mean age 43.1 ± 10.6), and 28 with Follicular Cancer (FC) (mean age 46.9±12.5), and 77 control subjects (mean age 47.5±5.9). Methods: The patient and control groups were matched in terms of age, and body mass index. All subjects were investigated using platelet and biochemical parameters. Results: Both MPV [(PTC, PmTC, and FC) (p=0.000, p=0.000 and p=0.001, respectively)] and RDW (PTC, PmTC, and FC) (p=0.02, p=0.04 and p=0.02, respectively)] values increased in patients with DTC compared to the controls. MPV values were significantly positively correlated with CRP (r=0.247; p=0.043), postoperative thyroglobulin (r=0.246; p=0.03), gamma glutamyl transferase (r=0.024; p=0.762), tumor size (r=0.209; p=0.047) and RDW (r=0.207; p=0.005). Age, gender, total cholesterol, and C-reactive protein were identified as independent predictors of MPV. Adjustment for other these factors produced no alteration in these relative risks at multiple regression analysis. Conclusion: Our results suggest that patients with DTC have higher MPV and RDW values than healthy controls. MPV may represent a good follow-up criterion in DTC patients because of its positive correlation with tumor size and thyroglobulin.