82 research outputs found
SDC – Supplemental material for Introduction of Novel Surgical Techniques: A Survey on Knowledge, Attitude, and Practice of Surgeons
No full textSupplemental material, SDC for Introduction of Novel Surgical Techniques: A Survey on Knowledge, Attitude, and Practice of Surgeons by Ali Mahmoud Ahmed, Hoang Thi Nam Giang, Sherief Ghozy, Hosni Salem, Mohamed Osman Algazar, Ahmed Altibi, Huynh Thanh Son, Tang Ha Nam Anh, Tran Dinh Cuong, Le Quan Anh Tuan, Nguyen Lam Vuong, Mohamed Abdou, Muhammad Mohieddin Ghorab, Ngan Bich Tran, Sameh Samir Elawady, Ahmed Elmaraezy, Le Huu Nhat Minh, Kenji Hirayama and Nguyen Tien Huy in Surgical Innovation</p
Microalbuminuria among Type 2 Diabetic Patients in the Gaza Strip
No full textDiabetic nephropathy is defined as the appearance of persistent proteinuria in an individual with diabetes. The present study was carried out to assess microalbuminuria among type 2 diabetic patients in the Gaze strip. The target population was type 2 diabetic patients from Al Remal diabetic clinic. The sample size was 99 type 2 diabetic patients (44 males and 55 females) and 95 healthy individuals (52 males and 43 females) aged 30-60 years. Data were collected from a questionnaire interview and biochemical analysis of blood and urine samples of the diabetics and controls. Random spot urine and fasting blood samples were collected. Microalbuminuria was determined by immunoturbodimetric technique to calculate albumin/creatinine ratio. Serum glucose, urea, creatinine, uric acid, iron, sodium, potassium, magnesium, calcium, phosphorus, alkaline phosphatase (ALP), amylase, cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), HbA1c and C-reactive protein were determined. Urine components including urea, creatinine and phosphorus were measured. Dipstick was used to exclude macroalbuminuria and microalbuminuria was confirmed by 24 hours collection. Results showed that 22.2% were microalbuminuric diabetic patients, 22.2% were macroalbuminuric diabetic patients and 55.5% normoalbuminuric diabetic patients. Microalbuminuria was found to be related to diabetes mellitus (X2=10.0 and P=0.002). There were significant differences in age and body mass index between controls and diabetic patients (t=8.8, p=0.000 and X2=27.87, P=0.000). Smoking was significantly associated with macroalbuminuria (X2=8.33, P=0.004). About half of patients were found to be diabetics since 5 years or less and they can develop microalbuminuria and macroalbuminuria within this period. Serum urea, creatinine and uric acid concentrations were significantly decreased in diabetic patients compared to controls 23.89±6.80, 0.49±0.15 and 3.05±0.98 respectively versus 26.65±6.98, 0.57±0.11 and 3.79±0.85, respectively with t=2.8, p=0.006,t=4.12, p=0.000 and t=5.6, p=0.000 respectively. In microalbuminuric and macroalbuminuric diabetic patients, only urea concentrations were significantly increased 26.00±9.29 and 25.59±8.35 mg/dl compared to that of normoalbuminurics 22.38±4.24 mg/dl, (t=2.35, p=0.021 and t = 2.2, p = 0.030). In urine, urea and creatinine showed significant decreases among diabetics compared to controls (1426.97+542.43, 105.94+59.50, respectively) compared to controls (1627.16+552.71, 132.55+63.23 respectively) with t=2.55, p=0.012 and t=3.02, p=0.003 respectively. In microalbuminuric diabetic patients urine, urea, creatinine and phosphorus showed significant decreases compared to normoalbuminurics (1153.64±434.22, 72.32±42.39 and 32.14±15.44, respectively) compared to normoalbuminurics (1454.±509.24, 110.21±54.23 and 51.78±32.86, respectively) with t=2.34, p=0.022, t=2.84, p=0.006 and t=2.66, p=0.010, respectively. Iron and magnesium levels were significantly decreased in diabetics 78.31±29.29 and 2.04±0.21 compared to controls 92.05±30.51, 2.15±0.16 with (t=3.5, p=0.001 and t=4.26, p=0.000). In contrast potassium levels were increased 4.74±0.37 compared to controls 4.61±0.36 (t=2.31, p=0.022). Calcium levels were increased in microalbuminuric diabetic patients 9.81±0.31 and normoalbuminurics 9.57±0.49 in relation to serum levels of calcium with t=2.03, p=0.046 and iron levels were increased in macroalbuminuric79.18±30.37 and normoalbuminurics 77.00±28.71 with (t=2.41, p=0.018). ALP was significantly increased in diabetics 131.91+38.73 compared to controls 117.40+23.06 with (t=3.15, p=0.002). Lipid profile including, total cholesterol, triglyceride and LDL-C were higher among diabetics (198.90+ 30.50, 227.27 + 116.59 and 128.27+ 40.38, respectively ) compared with those of controls (186.22+ 33.43, 128.98 + 53.01 and 109.04+ 29.42 respectively ) with t=2.76, p=0.006, t=7.51, p=0.000 and t=2.60, p=0.010. In contrast, the average of HDL-C of diabetics (44.30+7.60) was lower than that of controls (47.14+5.83) with t=2.90, p=0.004. However, these parameters were not affected by the presence of macroalbuminuria and microalbuminuria. HbA1c was significantly increased in diabetic patients versus controls 6.73+1.22 versus 5.26+0.57 with t=23.22, p=0.000 and microalbuminuric diabetic patients have significantly higher HbA1c than normoalbuminurics 7.27±1.65 and 6.55±1.09 with (X2=7.75, p=0.021)
Editorial: Unveiling the clinical implications of left atrial remodeling assessment methods
No full textCutaneous Fusariosis in a Patient with Job’s (Hyper-IgE) Syndrome
No full textFusarium is a filamentous fungus that is ubiquitous in nature and can cause severe opportunistic infections in immunocompromised hosts. The association between Fusarium and hyper-IgE syndrome is exceedingly rare and has only been documented in a single report previously. A 44-year-old male, working as marijuana grower, with prior diagnosis of hyper-IgE syndrome and recurrent infections presented with enlarging right knee ulcer that did not respond to antimicrobial treatment. The patient was diagnosed with cutaneous fusariosis, confirmed with punch biopsy and positive wound cultures. The patient was managed with extended antifungal therapy (i.e., posaconazole) and surgical debridement resulting in remarkable improvement with wound healing leaving a pale scar. Fusarium should be considered in differential for cutaneous and invasive fungal infections in presence of cutaneous manifestations. Exposure to Cannabis plants is a noticeable risk factor. Multimodal approach involving systemic antifungals and wound debridement is essential for favorable outcome. Posaconazole was demonstrated to be a highly efficacious antifungal choice
Clinical and biochemical features of type 2 diabetic patients in Gaza Governorate, Gaza Strip
No full textBACKGROUND:
Diabetes is a multifactorial disease characterized by severalmetabolic disorders. Its prevalence rate in Gaza Strip is alarming.
OBJECTIVE:
To describe the clinical and biochemical features of patients with Type 2 diabetes in Gaza Governorate.
METHODS:
Data were obtained through a questionnaire interview, patients’ records and of 99 type 2 diabetes patients and 95 healthy individuals.
RESULTS:
Family history and obesity were risk factors for diabetes. The mean age at diagnosis was 41.7±8.1 years. Fifty five (55.6%) patients had diabetes since d” 5 years. Distribution of diagnosed diabetic complications was low. Micro-and macroalbuminuria in controls and patients (8.4 v 22.2% and 9.5 v 22.2%, respectively) were associated with diabetes (÷ 2= 7.06, P= 0.007 and÷ 2= 5.87, P= 0.015, respectively). HbA1c% was significantly higher in diabetics (6.93+ 1.22 v 5.36+ 0.57, p< 0.001). Serum urea and creatinine were significantly decreased in diabetics than controls (mean= 23.5±6.9 v 27.2±7.4 and 0.49±0.15 v 0.58±0.14,% differences= 13.6 and 15.5, respectively, p= 0.000). Alkaline phosphatase (ALP) was increased in diabetics (136.9±38.7 v 117.4±23.5,% difference= 16.6, p= 0.001). Cholesterol, triglycerides and low density lipoprotein cholesterol (LDLC) were significantly higher in diabetics (207.6±36.5, 184.1±104.5 and 124.6±32.9) than controls (181.2±39.1, 139.8±76.1 and 102.2±37.4) with% differences of 14.6, 31.7 and 21.9%, respectively, p< 0.001. In contrast, high density lipoprotein cholesterol (HDLC) was significantly lower in diabetics (42.6±7.8 v 48.2±5.7,% difference= 11.6 and p< 0.001).
CONCLUSIONS:
Diabetes
A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female
No full textBACKGROUND: Austrian syndrome, which is also known as Osler\u27s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications.
CASE PRESENTATION: A case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy.
CONCLUSIONS: Clinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients
Native Valve Endocarditis Caused by Erysipelothrix Rhusiopathiae: Presenting with Refractory Heart Failure and Requiring Surgical Valve Replacement—Report on a Rare Zoonosis
No full textErysipelothrix Rhusiopathiae is a Gram-positive bacillus that is ubiquitous in nature. The bacterium is a zoonotic pathogen known to infect wild and domestic animals. Human infections, however, are uncommon and typically present with localised or generalised cutaneous lesions. Systemic infection in the form of bacteraemia with seeding to various organs is the least common form of the disease. Infections in humans tend to be associated with occupational exposure and close contact with animals. Clinical data of a 61-year-old male patient with Gram-positive bacilli bacteraemia and E. Rh usiopathiae-induced endocarditis are presented here. The patient presented with refractory congestive heart failure secondary to severe acute aortic regurgitation mandating surgical valve replacement. The described case has special clinical merit given the lack of fever and leukocytosis, absence of erysipeloid cutaneous manifestations and refractoriness to medical management. E. Rhusiopathiae should be considered in the differential diagnosis for Gram-positive bacilli bacteraemia and endocarditis. In the proper clinical setting, occupational exposure and animal contacts are helpful clues to raise suspicion for this bacillus. The high mortality associated with the pathogen should urge for early identification and initiation of antimicrobial treatment
Cryptococcus neoformans automated implantable cardioverter-defibrillator (aicd) endocarditis: A challenging case of a rare fungal endocarditis
No full textBackground Fungal endocarditis is a rare form of endocarditis accounting for less than 2% of all cases. Common offending pathogens include: Candida and Aspergillus. Cryptococcal endocarditis is extremely rare with only ten prior cases reported. To our knowledge, only one prior case of AICD-associated cryptococcal endocarditis was described in the literature. Case A 57-year-old female patient presented to the emergency department with headache, fatigue, and a near-syncope event. Her past medical history includes ischemic cardiomyopathy with AICD implantation and vasculitis (on prednisone and cyclophosphamide). Examination was unremarkable. CT scan of the head was negative for acute intracranial process. In lieu of persistent headache, lumbar puncture (LP) was performed revealing lymphocytic pleocytosis. Transthoracic and transesophageal echocardiography revealed vegetations on the ventricular lead of the defibrillator measuring 2.0 × 0.67 cm. Decision-making Patient was initially started on IV vancomycin before adding flucanzole empirically to the regimen given her immunosuppressed status and lymphocytic pleocytosis on LP. On the 4th day of admission, two sets of blood cultures grew Cryptococcal Neoformans. Hence, patient was switched into amphotericin B and flucytosine for 2 weeks before resuming fluconazole. Concomitantly, a decision was made to remove the AICD device along with leads to achieve source control. Despite lack of data on proper duration of treatment, high-dose fluconazole was continued for a total of 4 weeks (one year is typically recommended in cryptococcal meningitis). Patient improved gradually before achieving complete recovery, without relapse. Conclusion Cryptococcal endocarditis is an extremely rare event with no prior standardized treatment protocol established. Hence, treatment duration with antifungals need to be individualized. Following an initial inductive phase, prolonged suppressive therapy with Fluconazole might be warranted to prevent recurrence, especially in immunocompromised patients. AICD-related infections mandate device removal. Surgical intervention has no clear indication but should be considered
LVOT obstruction and severe aortic regurgitation caused by anterolateral muscle bundle of the left ventricle: The embryologic remnant of the bulbo-atrioventricular flange
No full textBackground An anterolateral muscle bundle runs along the wall of the left ventricular outflow tract (LVOT) and may extend up to the level of aortic valve (AV). The muscle bundle may occasionally bulge into the LVOT without causing significant obstruction. Case A 53 year old female patient presented with worsening chest discomfort and exercise intolerance. Initial TTE showed ejection fraction of 56% and AV area (AVA) of 0.66 cm2 indicative of severe stenosis, but with peak gradient of 29 mmHg. However, TEE showed very mild aortic stenosis with 3D aortic valve planimetry measuring 1.8 cm2. TEE showed hypertrophied basal septum (thick membrane connecting mitral leaflet with AV). The thickened septum was causing severe LVOT obstruction (LVOT area was 0.85 cm2) and a tertiary cord was attached to its base. The septum attaches to the right coronary cusp causing restriction and severe regurgitation. Cardiac catheterization showed severe stenosis at the LVOT. Decision-making The findings are indicative for anterolateral muscle bundle causing LVOT obstruction, rather than primary AV pathology. Hence, patient underwent septal myectomy, resection of subaortic membrane, and AV repair successfully. Post-myomectomy TTE showed minimal stenosis with AVA of 1.34 cm2. Conclusion LVOT obstruction can be caused by hypertrophied anterolateral muscle bundle in the absence of primary valvular pathology. Proper diagnosis is crucial since resection of the subaortic membrane and septal myectomy is the treatment of choice
Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review
No full textBACKGROUND: Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardio-biliary fistula. However, BPT in the absence of a detectable fistula is extremely rare.
CASE PRESENTATION: A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). Patient underwent extensive workup to identify a potential fistula between hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified.
LITERATURE REVIEW: A total of six previously published BPT were identified: all were males, mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. - Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid - HIDA scan) for an iatrogenic vs. traumatic pericardio-biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula
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