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The Relationship of Cholangiocarcinoma with Human Immunodeficiency Virus Cholangiopathy and Cytomegalovirus Infection
Get PDFHuman immunodeficiency virus (HIV) is a worldwide disease with an increasing number of cases globally. Initially, HIV cholangiopathy was often observed among such patients but has become rare after three decades because of the availability of new treatment options and potent antiretroviral drugs. Consequently, its occurrence now suggests drug resistance or disease progression. The relationship between cholangiocarcinoma and HIV remains unclear. We report the case of a patient with high-grade dysplasia of the ductus choledochus and uncontrolled disease which was treated with potent antiviral agents and bile duct dilatation
Treatment of Mobile Right Heart Thrombi
Get PDFRight heart thrombi are detected in approximately 4% of patients with pulmonary embolism. The associated mortality is high, but the optimal strategy remains controversial. We report a case of a large mobile right heart thrombus, complicated by embolism of the right pulmonary artery, which was successfully treated with half-dose alteplase. We briefly review the literature and discuss the therapeutic options, focusing on the advantages of thrombolysis
Spontaneous Uterine Leiomyoma Torsion: A Challenging Differential Diagnosis for Radiologists
Get PDFUterine leiomyomas are very common gynaecological benign tumours. Spontaneous torsion of a uterine subserosal leiomyoma is a rare cause of acute lower abdominal pain and should be treated immediately with surgery. We report a case of an enlarged subserosal leiomyoma that was first detected by computed tomography (CT) and further confirmed by laparoscopic surgery to be a subserosal leiomyoma with torsion
Embolic Showering from Non-Bacterial Thrombotic Endocarditis and Adenocarcinoma of the Lung
Get PDFBackground: Non-bacterial thrombotic endocarditis (NBTE) is a paraneoplastic phenomenon with sterile vegetations. It is associated with adenocarcinoma and can shower emboli, which can be the presenting symptom. Case Presentation: A 44-year-old woman with adenocarcinoma of the lung presented with chest pain, left hand weakness, and ataxia due to repeated embolic showering from NBTE to the central nervous system (CNS) and spleen. Conclusion: NBTE is a rare condition that should be on the differential diagnosis in patients with culture-negative endocarditis and a history of adenocarcinoma
Disseminated Nocardia beijingensis Infectionin an Immunocompetent Patient
Get PDFNocardia is a genus of aerobic, non-motile and non-spore-forming filamentous branching bacteria with fragmentation into bacillary or coccoid forms. Infections caused by Nocardia often occur in immunocompromised hosts and are potentially life-threatening. Nocardia beijingensis has rarely been reported to cause infection in immunocompetent hosts. We present a case of disseminated infection due to Nocardia beijingensis in a patient with no known medical comorbidities, who presented with new-onset seizure. Another interesting finding in our case is that our patient did not have any pulmonary symptoms despite chest CT showing the pulmonary system as the likely primary site of infection. As per our literature review, this is the seventh reported case of infection due to Nocardiabeijingensis in an immunocompetent host
Genetic Warfarin-Resistance Resulting in Surgery to Change a Prosthetic Valve
Get PDFWarfarin is a readily available anticoagulant used worldwide in a variety of clinical scenarios. Patients who need more than 15 mg/day are considered to be warfarin resistant. Numerous genes have been implicated in warfarin pharmacogenetics, with genes encoding CYP2C9 and VKORC1 shown to be the most important determinants of drug dosage requirements. A 27-year-old woman was admitted as she had a sub-therapeutic international normalized ratio (INR) after prosthetic mitral valve replacement. Even after a warfarin dose of 50 mg/day, her INR was not in the therapeutic range, so the heart team decided to replace her metallic valve with a bioprosthetic valve, thus alleviating the need for anticoagulation
Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura
Get PDFBackground: Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP.Case description: A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient’s general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized. Conclusion: TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called ‘TTP resembling presentation’) is an area of further research
Soil erosion measurement using fallout Cesium 137 technique in Sidi Salah Basin (Eastern Central Tunisia)
Get PDFAccording to FAO, Tunisia is classified among the countries worst hit by different processes of soil degradation, particularly the semi-arid domain, making the example of an ecosystem with increased steppization. Climatic deterioration and inadequate reckless human intervention have led to a deterioration of edaphic factors accompanied by a progressive invasion by steppe facies at the expense of a previously dense and stable forest. This change in landscape has exposed the domain to a severe erosive manifestation and has attracted the attention of many researchers on the problem of water erosion which has been weighing heavily on rural communities for decades. Efforts aimed at estimating soil losses have been made worldwide to choose adequate ways of intervention and deal with this significant degradation. Different empirical models have been established, tested and compared to have a quantitative estimation of this degradation (Tamura, 1964; Rogowski and Tamura, 1970 a and b; Kachanoski et al., 1984, 1987 and 1993; Mabit et al., 1999, 2002, 2008 and 2013; Moukhchane, 2008; Felah 2010; Azaiez, 2016 and 2020 and Akwasi et al., 2020). In this context, it was proposed to quantify soil losses in a test watershed through the Cesium 137 method known for its preferential absorption by the soil’s fine particles and its high sensitivity to mechanical erosion. To do this, a representative transect has been selected in a small basin of 2.3 km2 in area, that of wadi Sidi Salah located on the semi-arid margins of the Eastern tell. Seven samples have been taken along the transect oriented by the soil loss map issued from the application of the USLE equation, allowing to integrate as many compartments subject to various erosive factors and processes as possible. The results of the modeling of soil loss through the Cesium 137 technique have shown a significant specific loss of 32.5 t / ha / year but one which is variable between the different compartments of the basin
Analisi comparativa sulle retribuzioni dei Direttori di Istituto. L’impatto della riorganizzazione della rete scientifica e del sistema retributivo differenziato
Get PDFIl Consiglio Nazionale delle Ricerche nel 2018 ha avviato il processo di riorganizzazione della Rete Scientifica, con l’obiettivo di razionalizzare l’organizzazione delle attività svolte ed i costi sostenuti dagli Istituti. Parallelamente a tale azione, è stata attuata una revisione sugli incarichi e le retribuzioni del Direttore di Istituto, pleno jure e facente funzioni, in particolare suddividendo gli Istituti in classi con diversa indennità e focalizzando più correttamente gli incarichi temporanei. Il presente documento si prefigge lo scopo di correlare le due iniziative e mostrarne gli effetti sulla spesa sostenuta dall’Ente per suddetti incarichi apicali
Editoriale
Get PDFIn questo anno, le immagini di una moltitudine di vittime dovute alla pandemia da Covid 19 hanno invaso la nostra vita, provocando disagi, sofferenze e morte