Psychiatric disorders and hepatitis C treated with direct-acting antivirals in a French reference center
HCV can cause psychiatric disorders. It is crucial to re-evaluate them with direct-acting antiviral treatment (DDAs), since the interferon-based treatments of the past were capable of causing identical psychiatric adverse effects. A system of multidisciplinary team (MDT) meetings was implemented in France in December 2014 in regional reference centers with the aim of controlling the prescription and administration of these new treatments, along with optimizing how the patients undergoing these treatments are followed up. Our study sought to compare the characteristics and type of medical care received for chronic hepatitis C in patients with (PSY+ group) and without (PSY- group) psychiatric disorders using data from MDT meetings in the Alsace area of France collected from 2015 to 2019. All included patients were mono-infected and treated with DAAs in successive rounds between 2015 and 2019, as per recommendations from the French Hepatology Society. We compared the two groups (PSY+ and PSY-) based on 21 variables regarding the characteristics and medical care of hepatitis C. Psychiatric disorders were observed in 15% of patients. On multivariate analysis, a positive correlation was found between them and drug use (OR: 2.35; 95%CI: 1.40-3.98; p=0.001), excessive alcohol consumption (OR: 1.92; 95%CI: 0.98-3.69; p=0.05), smoking (OR: 1.81; 95%CI: 1.09-2.98; p=0.02), and incidence of drug interactions (OR: 3.94; 95%CI: 2.15-7.17; p
This paper underlines scientific arguments on the clitoris’ contribution to health and to immunity in particular. Sexology misses key elements that reduce the sexual abilities of men, and it tries to bridge the gap with simple arguments, chromosomal and biophysical.
Objectives: Gout has a predilection for the foot and ankle, but the impact of gout has limited presence in the literature. The aim of this systematic review was to synthesise existing literature which has investigated the characteristics of foot and ankle involvement in gout; identifying consensus and highlighting areas for further study. Methods: Studies were included if they were published in English and involved participants over 18 years of age with gout, and presented original findings relating to outcome measures associated with the foot and ankle. Methodological quality was assessed using a modified version of the Quality Index Tool. Results. Of 707 studies identified, 16 met the inclusion criteria and were included in this review. The mean (range) quality score was 68.1% (38.9%-88.9%). Compared to controls, participants with gout reported higher levels of activity limitation, foot-related pain and disability and walked more slowly. Plain radiography, dual-energy Computer Tomography and diagnostic ultrasound consistently demonstrated pathological features of gout in the first metatarsophalangeal joint and Achilles tendon. However, studies offered limited quality, particularly around recruitment strategies, validity and potential impact of confounding factors, making definitive statements difficult. Conclusions: This systematic review highlights the negative impact of gout on the structure and function of the foot and ankle causing significant impairment and disability. To effectively guide management, improvements in methodological quality are recommended.
Lung cancer is the second most common solid tumour and the first in mortality worldwide. Important progress has been reached in recent years in this pathology, focusing its treatment on histology, molecular biology and clinical presentation. Cardiac metastatic involvement consists in a severe clinical entity with increasing incidence due to better radiological techniques and longer survival of lung cancer. It requires special care and attention from many specialists. Clinical review about cardiac involvement secondary to lung cancer is provided, focused on its epidemiology, clinical presentation, diagnoses and treatment. Better understanding about cancer natural history is needed to offer the best treatment and care. Condensed abstract Cardiac metastatic involvement consists in a severe clinical entity with increasing incidence due to better radiological techniques and longer survival of lung cancer. It requires special care and attention from many specialists. Clinical review about cardiac involvement secondary to lung cancer is provided, focused on its epidemiology, clinical presentation, diagnoses and treatment.
Unexpected Combined Double Posterior and Anterior Approach to Treat Thoracic Disc Herniation: a Case Report
Introduction: Although frequently observed in magnetic resonance images, symptomatic thoracic disc herniations are rare. Surgical treatment is indicated when patients suffer from functional symptoms with no response to medical treatment, when neurologic symptoms appear or worsen or in the event of myelopathy. Posterolateral approaches are commonly accepted as the treatment for lateral and mediolateral disc herniations and non-calcified medial herniations. On the other hand, anterior approaches have been accepted to treat gigantic calcified medial disc herniations. Case presentation: This case report presents on a 57-year-old female patient suffering from thoracolumbar pain and impairment. The magnetic resonance study showed images compatible with a posteromedial T12-L1 disc herniation that, after medical treatment failure, required surgical treatment. Initially, a posterior approach was performed, resulting in the immediate postoperative period in motor and sensitive deficit of the lower left limb, so a surgical reintervention was performed using an anterior approach, obtaining good clinical and functional results. Conclusion: Thoracic disc herniations are uncommon. Surgical indication is decided in the presence of neurologic symptoms. Neurologic injury is a common complication due to the lesion’s characteristics and it can also be secondary to the surgical procedure. An adequate election of the surgical approach may minimize neurologic injuries.
We describe a case of a teenager who presented with palpitations and abnormal low atrial rhythm. Celiac Disease (CD) serology, sent due to low ferritin, was positive and gastroscopy confirmed CD diagnosis. Both palpitations and abnormal rhythm resolved after gluten-free diet with normalization of CD serology.
SARS-CoV 2 was designated a pandemic by WHO on March of 2019. There have been over 120 million confirmed cases of COVID-19 globally with greater than 4 million hospitalizations in the US alone. These cases can range from asymptomatic disease to multi-organ dysfunction resulting in death. The spectrums of complications stemming from COVID-19 are much broader and can include other autoimmune disorders. Here we present a case of a woman who developed autoimmune hemolytic anemia from COVID-19 infection and was successfully treated with high dose corticosteroids.
Successful treatment for bladder rupture after explosion during transurethral resection of prostate: a case report
Extra or intraperitoneal bladder explosion is a rare complication of transurethral resection of the prostate (TURP) or bladder tumor resection associated with high morbidity. There were just over 25 reports of bladder explosion described in the literature until 2015. We report the case of a 56-year-old black man, diagnosed with prostatic adenocarcinoma and scheduled for tunneling by transurethral resection of prostate (TURP). His medical history included diabetes mellitus, hypertension, retinopathy with bilateral amaurosis, ischemic stroke, and myocardial infarction. He was successfully submitted to a continuous spinal technique and sedation. During the hemostatic phase of the procedure, a loud “pop sound” was heard in the operating room and the patient presented sudden arterial hypotension and abdominal distention. An exploratory laparotomy was done to manage the bladder explosion. The adequate resolution of this adverse event requires awareness and high clinical suspicion for prompt intervention.
Background: Craniopharyngioma is a benign tumor of the sellar region that is typically characterized by a maldevelopment tumor with a high recurrence rate, as well as substantial morbidity and mortality in the long term. Signal transducers and transcription activators have been identified as critical components of cytokine signaling pathways that have previously been documented in craniopharyngioma-related literature. Purpose: The primary goal of this investigation is to examine transcription factor expression in craniopharyngiomas. In addition, a clinical-pathological and immunohistochemistry correlation will be sought. The current study enlisted the participation of forty patients. AdaCPs exhibited: β-catenin STAT2, STAT3, STAT6, and HDAC1 expression. While, STAT4, HDAC2, and GATA 3 were all negative. TTF1 was found in proteinaceous substances within the cyst formation (OMF). β-FGR, DPGR, TNFa, and Nrf2 were found to be associated with inflammation, OMF presence, and finger protrusion in brain surrounding tissue or brain invasion. Conclusions: Tumor recurrence was associated with increased expression of STAT3, STAT6, HDAC, β-catenin, and TNFα in WLA when compared to no recurrence. Coexpression of β-catenin, STAT2, STAT3, and STAT6 with TNFα was also shown using double fluorescence merge stains. There was no association between HDAC1 and HDAC2 coexpression and β-catenin, notably in the WLAs. Discussion: Histologically complicated features include cystic and solid components, the latter of which is made up of diverse morphological cell types. HDAC1 and HDAC2 regulate the enhanced expression of inflammatory genes during inflammation and macrophage response.
Acute limb ischemia(ALI) in a paediatric patient is a rare condition but may result in limb loss and life long complications. We present here a case of a 34 weeks premature infant, with birth weight 1530 grams, who was having respiratory distress at time of birth. Infant was referred to advanced pediatric center for further management, where he was kept in neonatal ICU. He was put on C-PAP and oxygen support and an infant feeding tube for feeding. On 21st day infant developed ischemia of the right upper limb. Color Doppler flow study was done which revealed thrombosed right radial and ulnar artery and biphasic flow in brachial artery. He was put on low molecular weight heparin and was advised referral to higher center for further management. Patient developed dry gangrene of right hand and wrist resulting in the autoamputation of the hand and wrist after a period of 15 day from development of gangrene. In order to prevent such complications there should well trained staff to detect early ischemic changes in the limb so that timely treatment can be started and the long term chronic complications can be prevented.