International Journal of Clinical Research
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The Simultaneous Occurrence of Acute Appendicitis and Bowel Perforation in Taenia Infection: A Case Report
Get PDFBackground: Appendicitis is most likely due to obstruction of the appendiceal lumen. Parasitosis is an unusual cause of obstruction and in specific, Taenia Saginata is a very rare cause of appendicitis, even more so of small bowel perforation. Teiniosis is usually an asymptomatic process but a greater load or migration of the adult form may complicate some cases. The simultaneous occurrence of acute appendicitis and ileal perforation in the same setting has not been reported in the literature.
Case Presentation: A 60-year-old Lebanese female patient presented to the emergency department with right lower quadrant pain radiating to the left lower abdomen. The patient reported associated fever, chills, and anorexia prior to presentation. On physical examination, she was afebrile and normotensive, abdominal examination revealed diffuse lower abdominal tenderness. A blood workup revealed an elevated c-reactive protein (CRP) value with a normal white blood count (WBC). Computed tomography (CT) scan done with intravenous (IV) and per os (PO) contrast disclosed a leak of PO contrast in the absence of pneumoperitoneum implying a contained perforated appendicitis or colitis. The patient underwent urgent laparoscopic exploration. Intraoperatively patient had gangrenous appendicitis and an inflamed right fallopian tube, as well as small bowel perforation and the presence of a tapeworm. The tapeworm was removed and the patient ended up having an appendectomy, right salpingectomy, and oophorectomy, with the closure of ileal perforation. Her hospital stay was uneventful and she was discharged on ciprofloxacin, mebendazole, and metronidazole. Soon after her discharge from the hospital, the patient resumed her normal daily activities. Histopathological studies revealed mixed inflammatory infiltrates and the worm to be Taenia Saginata.
Conclusion: Patients with teniosis are mostly asymptomatic. In symptomatic patients, the course is usually mild except for some rare occasions including appendicitis or bowel perforation. The diagnosis of Taenia Saginata infection in such cases should be considered in endemic areas such as the Middle East and North Africa (MENA) region where eating raw meat is habitual
Forestalling Anti-Ergonomics in Plastic Surgery: Challenging the Modus Operandi?
Get PDFDespite formidable advances throughout surgical disciplines spanning decades, plastic surgeons, especially microsurgeons, have most certainly ignored the memo to sufficiently recognize the alarming prevalence of musculoskeletal disorders (MSDs), a consequence of anti-ergonomic postures assumed during intricate procedures (eg. microsurgery), capable of physical limitations which can lead to early retirement. Collective ignorance of the aforementioned predicament is reflected in the plastic surgery literature wherein epidemiologically rigorous studies remain non-existent. Anecdotal reports evidencing the crippling effect of anti-ergonomic postures along with rigorous operative practices in plastic surgery procedures that have exaggerated operative durations suggest increased predisposition to occupational disorders like cervical disk disease, distal interphalangeal arthrosis, ligamentous injury, pulmonary embolism secondary to deep vein thrombosis and tendinitis. Remarkably, evidence in the literature highlights the commencement of musculoskeletal discomfort as early as in residency, even though previous studies have documented 35.4 years as the initiation point of musculoskeletal symptoms.
Manuka Honey Versus Wet to Dry Dressing for Wound Closure Time After Open Pilonidal Sinus Surgery
Get PDFBackground: Sacrococcygeal pilonidal sinus disease is a very common chronic inflammation of the natal cleft that presents frequently as an abscess. Management requires the eradication of the sinus tract and postoperative wound care. Manuka honey (Medihoney) was used in acute and chronic wounds. In our study, we sought to investigate the clinical effectiveness of Manuka honey in decreasing wound healing time post excision.
Material and Methods: We describe patients’ characteristics using traditional descriptive statistics. We compared the study endpoint (wound closure time) in patients who received Medihoney versus those who did not by Kaplan-Meier analysis.
Results: A total of 119 patients underwent pilonidal cyst surgery between the years 2017 and 2018. The median time for healing in the Medihoney group was 40 days compared with 39 days in the control group. After adjusting for age, BMI, wound length, wound volume, smoking and operative time, the time to healing in the Medihoney group was significantly less compared to the group not receiving the treatment (Hazard Ratio 1.56, 95% Confidence interval 1.02- 2.49, p= 0.041).
Conclusion: Postoperative use of Manuka honey showed a significant decrease in wound healing time when compared to gauze fabric dressings. Further research would be beneficial to explore optimal treatment protocols for this dressing technique
Rudimentary Horn Adenomyosis in A 20-Year-Old Patient With Unicornuate Uterus: A Case Report
Get PDFBackground: A unicornuate uterus with a rudimentary horn is a rare Mullerian anomaly with few cases reported in the literature. The symptoms vary depending on the functionality of the endometrial cavity and the presence of an obstruction. Adenomyosis is a disease defined as areas of endometrial glands and stroma present within the myometrium. Reports describing adenomyosis in relation to the Mullerian anomalies are scarce.
Case Report: We present a 20-year-old middle eastern woman admitted for chronic pelvic pain and abdominal distension. Pelvic ultrasound revealed a unicornuate uterus with an adjacent mass of 10 x 8 cm. An MRI (Magnetic Resonance Imaging) was performed, and a left unicornuate uterus was demonstrated. On the right side, a large non-communicating rudimentary horn with features suggesting diffuse adenomyosis was found. Laparoscopic removal of the horn was performed successfully, and the extraction of the specimen was made by a power morcellation containment system. The patient was discharged uneventfully the second day after the surgery, and the pathology result confirmed the presence of diffuse adenomyosis.
Conclusion: Non-communicating rudimentary horn is a rare finding manifesting as different symptoms in young women. The enlargement of the horn can have obstructive consequences on an active endometrium, and this would lead to the formation of a hematometra and the distension of the cavity, and sometimes adenomyosis
Awareness, Perception and Behaviors Related to Electronic Cigarettes in Lebanon: A Survey Study
Get PDFBackground: Electronic cigarettes (E-cigarettes) are gaining momentum worldwide. They are looked at as an effective way to cease smoking with reduced harm. Since Lebanon is a country with a high smoking prevalence, it is of interest then to analyze the current and expanding role of E-cigarettes among the Lebanese population.
Aim: The objective of our study was to evaluate the awareness, perception, and behaviors related to E-cigarettes in Lebanon.
Methods: A cross-sectional survey of Lebanese pedestrians chosen from random sectors of Beirut was recruited in our sample study. A self-administered questionnaire was distributed to examine their awareness, perception, and behaviors related to E-cigarettes. SPSS was used for analysis. The main outcome was to assess the awareness of E-cigarettes in the Lebanese population and evaluate their perception as an effective smoking cessation tool.
Results: Of the 364 respondents, 53% were males, 84% were aware of E-cigarettes, and 16% never-tried them. E-cigarettes helped 56% of users to cut down on tobacco smoking, and among all respondents, 60% believed that it is less harmful than tobacco cigarettes. Moreover, 30% perceived it as an effective way to quit smoking. The majority of participants (61%) who tried it were between 18 and 25 years of age, and 36% of them were nonsmokers.
Conclusion: Our study is the first in Lebanon to assess the awareness, perception, and behaviors related to E-cigarettes. The majority of our population was aware of E-cigarettes, and some perceived them as a less harmful replacement compared to tobacco smoking. Additionally, non-smokers may be attracted to E-cigarette smoking which may lead to developing a new attraction and gateway for smoking. Therefore, awareness about E-cigarette's correct use, benefits, and harms need to be highlighted among the public, particularly the young generation in Lebanon
Streptococcus Intermedius Brain and Liver Abscesses After Dental Manipulation: a Case Report
Get PDFBackground: Brain abscesses are intracerebral infections with pus accumulation that can be fatal in most cases without appropriate treatment. The most common cause of brain abscesses are infections with streptococci and staphylococci. Streptococcus anginosus is a group of streptococci that are part of the normal flora of the oropharynx and are rarely the cause of severe bacterial infections.
Case Report: Our patient is a 64-year-old man who underwent a dental procedure, and presented a few days later with a high-grade fever and decreased level of consciousness. He was found to have multiple brain abscesses and a liver abscess, and blood cultures revealed Streptococcus intermidius, which belongs to the Streptococcus anginosus group. The patient received appropriate treatment and recovered completely.
Conclusion: Dental procedures, even simple tooth brushing, can cause bacteremia leading to multiple abscesses in different parts of the body, especially if a germ of the Streptococcus anginosus group has been detected in the blood culture
The Impact of COVID-19 Pandemic, Financial Wellness, and Online Teaching on Schoolteachers’ Mental Health: A Cross-Sectional Study in Lebanon
Get PDFBackground: Teaching is a mentally and physically draining occupation, and due to the SARS-CoV-2 pandemic, the education system shifted to online platforms, which made it even harder. Lebanon is a developing country that is not well prepared for such a daunting outbreak. In addition to its tremendous economic crisis, it will be even harder for teachers to maintain mental stability. The aftermaths of this crisis could, perhaps, impact all the fundamental systems within the country including education
Aim: This study aims to assess stress, anxiety, and depression levels among Lebanese schoolteachers based on the COVID-19 outbreak, the Lebanese economic crisis, and online education.
Methods: A cross-sectional study was carried out, enrolling 300 schoolteachers currently working in Lebanon. An online survey was used, assessing sociodemographic factors, teaching status, financial wellness, fear of COVID-19, and mental health. The IFDFW scale is used to assess financial distress, DASS-21 to assess psychological distress, and the COVID-19 fear scale to measure fear.
Results: Results showed that 23% of teachers had severe depression, 25% had severe anxiety, and 16% had severe stress. Depression was correlated to both fear of COVID-19 and financial wellness (p<0.0001 for both). Anxiety and stress were correlated with online teaching (p<0.05), fear of COVID-19 (p<0.001), and financial wellness (p<0.001).
Conclusion: Lebanese teachers showed severe levels of anxiety and stress as a consequence of online teaching, associated as well with depression when correlated with fear of COVID-19 and financial wellness. It is urgent to take measures to keep the Lebanese educational system productive, and dynamic, and prevent the storm of the stressful environment from worsening.
Keywords: Anxiety, Depression, Stress, Online teaching, Pandemic, Economic crisi
Risk Factors for Invasive Fungal Disease in Pediatric Oncology
Get PDFBackground: Invasive fungal infections are a major cause of death in pediatric oncology, especially among patients under chemotherapy. This study aims to identify risk factors for invasive fungal infections in pediatric oncology.
Methods: We conducted a monocentric retrospective case-control multi-cohort study on a population of 30 patients with malignant hemopathies or solid cancers under chemotherapy, admitted in the Pediatric Oncology unit of Nafissa Hammoud Hospital in Algiers, amongst which 24 patients were controls, and 6 patients were cases.
Results: In a total of 30 patients (53.3 % male), 13 patients developed a fever, from which 6 patients were identified as invasive fungal infection cases according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and Infectious Diseases Mycoses Study Group (EORTC/MSG) guidelines, with an incidence of 20 %. The mean age was 7.47 years old at the admission date. Four statistically significant risk factors were identified (p-value < 0.05, CI 95 %): mucositis with an odds ratio (OR) at 10 (1,34 – 74,51), the most aggressive chemotherapy protocol according to the ITR2 with an OR at 115 (6,10 – 2165,95), severe prolonged neutropenia with an OR at 7,6 (1,07 – 54,09) and severe prolonged lymphopenia with an OR at 25 (2,27 – 275,71).
Conclusion: Many conditions were identified as risk factors for invasive fungal infections in pediatric oncology, especially severe lymphopenia and aggressive chemotherapy. These patients may have to receive close monitoring or even antifungal prophylaxis
Artificial Intelligence: A New Era in Cardiology
Get PDFVery few fields have evolved as Cardiology has. The last four centuries have brought extraordinary discoveries, achievements, inventions, and innovations, and we are now on the verge of witnessing the beginning of a new chapter of Cardiology that will unlock diagnostic and therapeutic interventions that are today considered impossible. Why? Artificial Intelligence (AI).
Varicella Zoster Reactivation Post COVID-19 Vaccination: Two Case Reports
Get PDFBackground: After initiation of COVID-19 vaccination, many side effects were described (Itching, swelling, pain, redness, induration, coughing, fatigue, fever, diarrhea, nausea, headache, vomiting, pruritus, myalgias, arthralgias, anorexia, malaise). Whether traditional, vector-based, or mRNA-based, all COVID-19 vaccines have had many mild and severe adverse events. In this article, we describe two cases of Varicella-Zoster Virus (VZV) reactivation one day after receiving Pfizer’s mRNA-based vaccine first dose, and another one month after the second dose. Both patients were not immunodeficient and not on immunomodulator therapy. To our knowledge, few similar cases have been described in the literature before, and thus it would be an important addition to guide future expectations and management in morbid patients receiving the mRNA vaccine for COVID-19.
Case presentation: Case one is a 74-year-old male who presented with zoster reactivation one day after receiving the first mRNA COVID-19 vaccine. He was treated successfully with valacyclovir. The second case is an 83-year-old lady who presented with facial zoster reactivation one month post the second dose of the mentioned vaccine and was also treated with oral valacyclovir.
Conclusion: The patients were not immunodeficient and not on immunomodulatory therapy, which is a major difference from the other reported cases, which are already few in the literature. To our knowledge, very few similar cases have been described in the literature before. Reporting more of such rare side effects would be of utmost importance to establish a full side effect profile of mRNA vaccines and to better understand such clinical finding. It is worth noting, however, that despite the risks that accompany these vaccines, the benefits far outweigh them