Breast Mass with Bloody Discharge: A Case of Idiopathic Granulomatous Mastitis

One of the rare identity of breast diseases is Idiopathic Granulomatous Mastitis (IGM), a chronic inflammatory breast condition that can mimic advanced breast cancer. The case came with nipple discharge and mass with skin changes, which was definitively diagnosed following core-cut biopsy of the mastitis group idiopathic granulomatous.

Recurrent Peptic Ulcer Perforation: A Case Report

Background: Refractory peptic ulcers are ulcers in the stomach or duodenum that do not heal after eight to twelve weeks of medical/surgical treatment or those that are associated with complications despite medical tssreatment. We herein present a case of a 44 year old man with a recurrent perforated duodenal ulcer requiring emergent surgical intervention.

Melena Revealing an Attenuated Familial Adenomatous Polyposis in an Elderly Patient: A Case Report

We describe a patient who was diagnosed with multiple tubulleuvillous adenomas with focus of high-grade tubular dysplasia all over the colonic mucosa, discovered during a colonoscopy performed during an episode of melena. Genetic testing has identified a germline truncating mutation at the codon (5q22.2) of the adenomatous polyposis (APC) gene. This mutation is localized in the alternately spliced region of exon 12, a region which is associated with an attenuated familial adenomatous polyposis (PAFA) phenotype. Our patient had no extracolic manifestations of PAFA and none of her relatives had a history of rectocolic polyposis. Treatment consisted of colectomy with ileorectal anastomosis. PAFA is an ill-defined condition of unknown prevalence and penetrance, requiring individual treatment and lifelong monitoring. It is essential to identify these patients with a view to setting up appropriate endoscopic surveillance at an early age in family members carrying this mutation, due to the marked intra-family phenotypic variance.

Modulation of Gluteus Medius Strength by Yang Qiao Mai Stimulation: A Multiple Case Report

Yang Qiao Mai, one of the eight channels known as extraordinary meridians, is used in traditional Chinese medicine (TCM) to relieve tension in the lateral muscles of the legs. According to TCM, each extraordinary vessel has main points, coalescent points, and one single master point (BL62 Shenmai for Yang Qiao Mai), which can influence the entire path of the meridian. We performed a test which involved measuring the changes in abduction strength of the gluteus medius following stimulation with a new type of photobiomodulation device, which delivers a very low level of modulated light on the BL62 Shenmai acupuncture point. Twenty-two healthy volunteers were measured, stimulated, and the measurement repeated 30 minutes after the first measurement. In addition to showing a regulatory effect of the stimulation, the test confirmed that a modulated red-light emission with a stimulus duration of 20 s for a total delivered energy of 0.35 mJ can induce an acupuncture-like response, even in the short term. The difference between the two body sides generally results as being around 6 Kg: this figure appears to be a physiological limit, probably due to an anatomical compensation of the body asymmetries. These results offer a new insight into the interpretation of the signaling process along the meridians, and appears to involve the return to homeostasis of the extracellular soft tissue matrix promoted by the photon flow.

Esophageal Variceal Bleeding as the First Manifestation of COVID-19 Infection: A Case Report

Liver cirrhosis is a defined liver disease with a wide range of clinical manifestations. Variceal bleeding is the main source of gastrointestinal hemorrhage among cirrhotic patients induced by several factors, such as alcohol consumption or infections. This is a report of a cirrhotic patient presenting with esophageal variceal bleeding in the context of COVID-19 infection. We report the case of a 53-year-old patient with liver cirrhosis and multifocal hepatocellular carcinoma presenting with upper gastrointestinal bleeding as the first manifestation of COVID-19 infection. Upon admission, the patient had no symptoms suggestive of a respiratory tract infection or any contact with positive SARS-CoV-2 individual and upper gastrointestinal endoscopy revealed variceal hemorrhage. After a few hours the patient manifested with fever, cough and dyspnea and a SARS-CoV-2 polymerase chain reaction test obtained was positive. The patient was initially treated with endoscopic band ligation and transferred in the COVID-19 infection clinic, where after a few days of hospitalization he passed away. The devastating pandemic of coronavirus disease 2019 had altered the pathophysiology and clinical presentation of several chronic diseases. This case report suggests that coronavirus disease as a potential triggering factor of variceal bleeding.

Primary Actinomycosis of the Leg: A Case Report and Literature Review

Actinomycosis is an indolent, slowly progressive, suppurative infection caused by gram-positive branching bacteria of the genus Actinomyces. The disease actinomycosis most commonly occurs in 3 body regions: cervicofacial (55% of patients), abdominopelvic (20%), and pulmonothoracic (15%). Primary infection of an extremity is an uncommon feature of actinomycosis. We present a case of rare primary Actinomycosis of the lower extremity.

Knowledge, Attitude and Practices of Osteoporosis Risk Factors among Jazan University Students, 2019

Osteoporosis is one of the non-communicable diseases that closely links to lifestyle and nutrition. This is a cross-sectional descriptive epidemiologic study, carried out on 440 Jazan university students (males& females). They are chosen by a stratified multistage cluster sampling technique to assess their knowledge, attitude, and practices (KAP) about osteoporosis risk factors. The data are collected using a validated semi structured Arabic questionnaires. The findings revealed that almost all survey participants agreed with the definition of osteoporosis, which is the decrease of bone density, with only 8.7% disagreeing. Furthermore, 80.0 percent of survey participants classified osteoporosis as a cause of bone fracture. The findings suggest that the study participants' good attitudes toward risk factor prevention of osteoporosis are linked to the daily consumption of an acceptable amount of milk. Another positive attitude toward osteoporosis prevention stemmed from a reduction in the amount of energy drinks consumed, which has been identified as an osteoporosis risk factor. The study recommends that university students of all grades participate in health education programs about osteoporosis risk factors and preventive treatment.

Topical Treatment with Bergamot Flavonoid-Based Gel in Post-Surgical Wounds after Hemorrhoidectomy: Preliminary Results

Background: Haemorrhoidal Disease (HD) is a very diffuse anorectal condition that involves a large part of the population, both male and female of every age. Among the several procedures proposed to treat HD, conventional excisional surgery remains one of the most performed, it is characterized by important post-operative pain whose historical knowledge often scare the patients. The pain is mainly related to the anal wounds and the healing speed surely influence the post-operative course. The aim of this study was to evaluate the effect of using Benebeo Gel® on post-operative wound healing after open haemorrhoidectomy. Methods and Results: This was an observational prospective study conducted in the Proctological and Pelvic Floor Clinical Centre (PPFCC) of the University Hospital of Pisa. From April 2019 to January 2020 all the 175 patients aged between 18 and 75 undergone to open hemorrhoidectomy were enrolled. The post-operative follow-up was scheduled as follows: 7 day, 15 day, 22 days and 30 days after surgery. The primary end point was: time taken to get complete wound healing with a re-epithelized tissue. Secondary endpoints were: evaluate post-operative pain using VAS scale, bleeding, discharge and overall patients satisfaction about the procedure and the topical gel. All the patients were instructed to take topical gel by using the cannula provided with the product put it into the finger phalanx and then upon injured area twice a day (once in the morning after defecation and once before sleeping) for 25 days after. The administration of the product begins in 4th post-operative day. The mean post-operative pain at 7 days was 6±2, at 15 days 4±1 at 22 day 3 and at 30 days was 2±1. The mean time to get complete wound healing was 23±4 days. Conclusions: He present study aimed to evaluate the efficacy of a new topical gel mainly composed by bergamot-derived flavonoids and hyaluronic acid in patients treated with excisional hemorrhoidectomy. The results after 2 weeks of treatment seems to be promising with a very good clinical outcome and patient satisfaction within 1 month.

Comparative Evaluation of Diagnostic Performance of Circulating free DNA by Conventional vs. Real Time PCR in Gallbladder Cancer

Background: Circulating free DNA (cfDNA) in serum/plasma has been studied as a promising biomarker in various pathologies, including cancer. However, there is no standardized method for the isolation and quantification of serum cfDNA. An effective and reliable method for isolation and quantification is of utmost importance before any clinical decision. The current study compares the conventional and real-time PCR methods to find any differences and concordance in cfDNA levels between the two methods and the diagnostic accuracy of cfDNA by each method. Methods: Serum sample was collected from 67 subjects, including 17 normal healthy individuals (control, n=17), 19 disease controls (cholecystitis, n=19), and 31 Gallbladder cancer patients (cancer, n=31) before any treatment for cfDNA quantification. Results: The cfDNA level did not differ significantly between two methods in both control and cholecystitis groups. In cancer group, cfDNA level was significantly (P < 0.001) different and higher in real time PCR as compared to conventional PCR. There was no significant correlation between two methods in control (r=0.02, P = 0.937), cholecystitis (r=0.10, P = 0.697), cancer (r=-0.08, P = 0.657) and total cases (control + cholecystitis + cancer) (r=0.06, P = 0.622). The diagnostic accuracy of two methods was found similar (P > 0.05) when assessed between control vs. cholecystitis (Z=0.85, P = 0.397), and control vs. total cases (Z=1.35, P = 0.177). However, the diagnostic accuracy of real time PCR was found significantly different and higher as compared to conventional PCR when assessed between control vs. cancer (Z=2.98, P = 0.003), and cholecystitis vs. cancer (Z=4.41, P < 0.001). Conclusion: Quantitative real-time PCR method is of high accuracy, reproducibility, and time-effectiveness. The diagnostic accuracy of real-time PCR was higher compared to conventional PCR.

Adverse Cardiac Events Risks of Non-Obstructive Coronary Artery Disease by Cardiac CT Angiography at One-Year Follow-Up: Results of the Coronary Risk Determination in Intermediate Stratum Coronary CT Angiography (CORDISC) Study

We conducted a retrospective cohort study of the adverse events at one year post-cardiac computed tomography (cardiac CT) using data gathered from the Marshfield Clinic Health System (MCHS) Cardiac CT registry to compare non-fatal myocardial infarction (MI), revascularization, all-cause mortality, and composite major adverse cardiac events (MACE) one year following cardiac CT in patients with non-obstructive coronary artery disease (CAD) and normal coronary arteries. From 2009 to 2017, the records of 2,649 patients who underwent cardiac CT were reviewed. CAD detected by cardiac CT was defined as normal (0% luminal stenosis) and non-obstructive (1-49% luminal stenosis). Clinical outcomes were nonfatal MI, revascularization, including percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG), all-cause mortality, and MACE. Cohorts were compared using t-tests and Fisher exact tests, and a logistic regression was performed to assess risk of clinical outcomes at one year. Compared with patients with normal coronary arteries, patients with non-obstructive coronary disease on cardiac CT had higher event rates of MACE (3.7% vs. 1.2%; P =0.006), revascularization (1.1% vs. 0.2%; P=0.033), and all-cause mortality (1.7% vs. 0.4%; P=0.012). After adjusting for baseline difference in demographics, risk factors, and medication use, the odds ratio of revascularization was 3.77 (95% CI: 1.03,13.79) and MACEs was 2.06 (95% CI: 0.94,4.51). Symptomatic congenital heart diseases accounted for about 50% of the non-death MACEs. Cardiac CT-defined non-obstructive CAD was associated with higher rates of revascularization, all-cause mortality and MACE compared to those with normal coronary arteries.