Skoukrog3964

Diaphragm disease of the small bowel is an uncommon condition with nonspecific symptoms, which causes strictures of the small bowel associated with non-steroidal anti-inflammatory drug (NSAID) use. Due to the nature of the disease process and the strictures it can form, patients often present with a clinical picture suggestive of small bowel obstruction, and the true diagnosis is not confirmed until histopathological examination. In this article, we present the case of a 73-year-old female with chronic NSAID use and gastrointestinal complaints who had undergone multiple endoscopic procedures which failed to identify the cause of her symptoms. Further investigation with video capsule endoscopy and CT enterography led to a diagnosis of intussusception believed to be caused by a small bowel mass. Retention of the video capsule endoscope prompted the decision to undertake diagnostic laparoscopy with push endoscopy and direct visualization of a string of small bowel strictures in the area of intussusception. This characteristic appearance of the bowel was then confirmed by pathology as diaphragm disease lesions. Diagnosis of this disorder is difficult due to its rarity and common symptoms that make other disease processes seem more probable. Early diagnosis can prompt counseling on cessation of NSAID use and interventions to decrease the risk of complications that may require surgical intervention. Physicians should be able to recognize diaphragm disease of the small bowel as a differential in patients presenting with obstructive bowel symptoms and even rare cases of intussusception in the setting of chronic NSAID use.Introduction Multiple sclerosis (MS) is a chronic disease of progressive demyelination in the central nervous system and carries a significant risk for depression and other psychological difficulties associated with low quality of life. There is a paucity of data on the prevalence of anxiety and depression in Saudi Arabia among patients with MS. We conducted a cross-sectional study to determine the prevalence of anxiety and depression in Saudi Arabia among patients with MS by age, disease severity, compliance to medication, and social support. BTK inhibitors Methods This cross-sectional study measured the prevalence of anxiety and depression in 184 adult patients with MS. The patients were selected through a random sampling method from a pool of MS societies in Saudi Arabia. The participants completed self-administered questionnaires that included demographic variables. The participants also completed the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) questionnaire. Results Depression was detected among 139 (75.5%) patients with MS, with most participants having mild depression (31%). More women (83.1%) experienced depression than men (62.1%; p = 0.002). Anxiety disorder was present in 123 (66.8%) patients with MS, and most had mild anxiety (n = 56; 30.4%). Conclusion We found a very high rate of depression and anxiety among patients with MS in Saudi Arabia. Our results highlight the need for periodic screening and examination of patients with MS by psychiatrists to facilitate the early detection and treatment of these comorbidities, potentially improving patient quality of life and health outcomes.Low back pain (LBP) is a common affliction with numerous causes. Some individuals experience LBP attributed to disc pathology. Disc pathology has been implicated in a plurality of cases of LBP, and some cases are associated with annular fissures (AFs). AFs are weaknesses in the structure that contains the nucleus pulposus and is the site of possible disc herniations. On magnetic resonance imaging (MRI), some AFs manifest as the high-intensity zone (HIZ), otherwise known as an annular enhancement region. In this report, we present three patients with LBP, mild radiculitis, and HIZ who later developed herniated nucleus pulposus (HNP) with extrusion through the HIZ. These cases suggest that HIZ indicates a propensity for the future development of disc extrusion through the weakened tissue at the AF visualized as HIZ on MRI. With a better understanding of the association between AFs and disc herniations with HIZ, clinicians may be able to predict and prevent the pain and disability associated with disc extrusion.A 67-year-old man presented to the emergency department for two weeks of progressive shortness of breath with orthopnea and new-onset back pain. On admission, vital signs were normal, and physical exam was remarkable for jugular vein distention with the rest of the cardiovascular exam in normal limits. A bedside transthoracic echocardiogram showed a large circumferential pericardial effusion with M-mode analysis revealed diastolic collapse of the right ventricle (RV) and > 40% tricuspid inflow respiratory variation in Doppler. Emergency pericardiocentesis yielded 800 cm3 of yellow-colored fluid. Subsequently, the patient underwent lymph node biopsy showing tumor cells consistent with squamous cell carcinoma of unknown origin. This case highlights the use of bedside echocardiogram and M-mode imaging for the diagnosis of cardiac tamponade.Primary thyroid sarcomas (PTS) are an incredibly uncommon type of thyroid cancer. Undifferentiated pleomorphic sarcomas of the thyroid (UPS-T) are extremely rare subtypes of thyroid sarcoma with no defined cell differentiation. Here, we report the case of a 60-year-old female with a two-year history of hypothyroidism who presented to our hospital with productive cough, dyspnea, and diffuse facial edema for two weeks. Her chest computed tomography (CT) scan revealed a large anterior mediastinal mass and multiple bilateral pulmonary nodules. Her thyroid ultrasound showed two hypoechoic nodules, while a CT-venogram of the right upper extremity showed superior vena cava and the right brachiocephalic vein obstruction, which was relieved with angioplasty. A biopsy of the anterior mediastinal mass showed poorly differentiated pleomorphic thyroid sarcoma. The patient was not a candidate for inpatient chemo- or radiotherapy because of her overall medical condition. One week later, she developed worsening respiratory failure, was intubated and transferred to the intensive care unit (ICU), where she passed away two days later.Thrombotic microangiopathies (TMA) are a group of disorders characterized by generalized microvascular occlusion, thrombocytopenia, and microangiopathic hemolytic anemia, which may present with organ dysfunction. These include hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) among others. The triad of anemia, thrombocytopenia, and acute kidney injury is the hallmark of HUS. It can be associated with Shiga toxin-producing Escherichia coli infection, complement-mediated (atypical HUS), coagulation or metabolism-mediated (predominantly in children of less than one year of age), or secondary HUS with the coexisting disease. HUS is a potentially fatal condition irrespective of its cause, and hence the diagnosis and management approach must be swift. The treatment is support-based; however, in severe cases, the use of plasmapheresis has shown favorable outcomes. In this report, we discuss a case of a 30-year-old male who presented with acalculous acute pancreatitis with HUS, a rare case of secondary HUS previously reported in a few case reports.Introduction Nephrin is a podocyte-specific protein that may serve as a urinary biomarker in patients with diabetic nephropathy. The objectives of the study were to determine urinary nephrin levels in patients with and without type 2 diabetic nephropathy and to assess the correlation between urinary nephrin and albuminuria. Methods This was a cross-sectional comparative study that was carried out at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry over 18 months. Diabetic study subjects were divided into three groups-normoalbuminuria, microalbuminuria, and macroalbuminuria. Urinary albumin was detected by the dipstick method in a spot urine sample for all study subjects. In subjects with trace or no albuminuria, nephelometry was used to quantify urinary albumin levels. Urinary nephrin was estimated by the ELISA technique for all study subjects. Results Subjects in the microalbuminuria group had higher urinary nephrin levels than those in the normoalbuminuria and macroalbuminuria groups. There was a weak positive correlation between urinary albumin and nephrin levels among the study subjects (p less then 0.001). Conclusion Urinary nephrin levels are increased in patients with diabetic nephropathy. There was a weak positive correlation between urinary albumin and nephrin levels among these patients.Hemophagocytic lymphohistiocytosis (HLH) is a severe systemic inflammatory syndrome that is often fatal. In the adult population, it is believed to develop secondary to immune dysregulation due to rheumatologic, infectious, malignant, and recently, immunomodulatory drugs. It has been well documented that infectious etiologies can lead to HLH however to date there is a paucity of case reports of HLH stemming from the 2019 novel coronavirus (SARS-CoV-2). Furthermore, it is well established that overlap exists between the extensive hyper-inflammatory syndromes produced from both HLH and severe COVID-19 infection. Here, we present a case of COVID-19-associated HLH with recurrent neutropenic fever in a patient with controlled follicular non-Hodgkin lymphoma who received treatment with etoposide after continued hospital admissions with refractory medical treatment.Background Biomedical waste management has recently emerged as an issue of major concern for every health facility and healthcare provider due to human and environmental hazards. As per government guidelines, every health facility, either large medical institutes or small clinics, should ensure appropriate biomedical waste management at their facilities level. Objective To assess biomedical waste management in various health care facilities of Etawah district. Methodology It was a facility-based cross-sectional assessment that included government and private health facilities. The selection of facilities was done based on a simple random sampling method. All the people in charge of concerned health care facilities were interviewed to know the current biomedical waste management situation concerning health facilities and the problems they face in biomedical waste management. Health care professionals' knowledge was also assessed. Results A total of 56 health care facilities (HCFs) from both government and private sectors were selected. Biomedical waste guidelines are mainly available at tertiary care centers (93%) and secondary care centers (51.5%). Awareness among doctors related to hazards and prevention of hazards ( less then 0.001), knowledge of unused sharps (0.048), contact with a blood-related product (0.003), hazardous waste ( less then 0.001), and need for training ( less then 0.001) are statistically significant with respect to nurses. Conclusions Government of India guidelines on biomedical waste management (BMW) are in place, but the use of guidelines currently is not up to the mark or at a satisfactory level. Spreading awareness of the BMW guidelines and their strict implementation is the need of the hour.