International Journal of Medical Science and Clinical Research Studies

Knowledge on Risk Factors of Coronary Heart Diseases Among Diabetic Patient Attending at a Tertiary Level Hospital in Bangladesh

2024-10-02T06:36:26+00:00

Background: Coronary Heart Disease (CHD) remains a leading cause of morbidity and mortality globally, with a significant impact on public health systems, especially in developing countries.

Objective: This study aims to identify the knowledge of CHD risk factors among diabetic patients attending at a tertiary level hospital in Bangladesh.

Methodology: A Cross Sectional Study conducted among the diabetic patients at Khulna Medical College Hospital, Khulna from January 2023 to April 2023. Total 150 known diabetic patients were selected by using simple random sampling method and face to face interview was conducted with a semi structured questionnaire.

Results: The study revealed that, most of the respondents 73.4% were above 52 years and 57.3% were female. 80% respondents reported that low HDL may cause CHD and only 16.7% reported that obesity is a risk factor for CHD.93.3% respondents were knowledgeable about influence of anxiety/worry as a CHD risk factor.

Conclusion: The study highlights significant deficiencies in the knowledge of CHD risk factors among diabetic patients in Bangladesh, indicating a pressing need for more effective educational interventions.

Common Immediate Complications in Postoperative Ward Following General Anesthesia

2024-10-02T06:42:32+00:00

Background: Immediate postoperative complications following general anesthesia are critical considerations in surgical care, impacting patient recovery and healthcare resource utilization. This retrospective observational study aimed to investigate the prevalence and characteristics of immediate complications among patients in the postoperative ward at Sir Salimullah Medical College Hospital in Dhaka, Bangladesh.

Methods: Data from 384 adult patients undergoing surgical procedures under general anesthesia at Sir Salimullah Medical College Hospital were retrospectively analyzed. Demographic variables, surgical details, anesthetic management, and immediate postoperative complications were assessed.

Results: Pain at the surgical site (45.0%), nausea (35.0%), and shivering (30.0%) were the most prevalent immediate complications observed. Complication rates varied significantly across demographic categories, with younger age groups experiencing higher rates of nausea and vomiting, while older age groups had increased incidence of hypertension and respiratory issues. Females exhibited a higher prevalence of nausea, vomiting, and shivering compared to males. Healthcare professionals and office workers showed a greater prevalence of postoperative complications compared to manual laborers and retirees.

Conclusion: This study highlights the diverse nature of immediate postoperative complications and their differential distribution among patient demographics and occupational groups. The findings underscore the importance of personalized perioperative care and targeted interventions to mitigate complications and optimize patient outcomes. Enhanced perioperative monitoring, tailored anesthesia management, and multidisciplinary collaboration are essential for minimizing complications and improving surgical care quality. Future research focusing on risk stratification and preventive strategies is warranted to further enhance perioperative safety and patient satisfaction.

A 32-Year-Old Man Presented with Nephrotic Syndrome Due to Systemic Lupus Erythematosus Developed Lupus Cerebritis, Pancytopenia and Renal Failure: The Need for New Biologicals

2024-10-02T06:47:48+00:00

Case Summary

A 32-year-old man presented with nephrotic syndrome due to membranous nephropathy, secondary to systemic lupus erythematosus (SLE). During intensive immunosuppressive therapy with corticosteroid and cyclophosphamide, the patient developed confusion, fits (lupus cerebritis), pancytopenia and rapidly rising serum creatinine (end stage renal failure). Plasmapheresis and rituximab therapy did not make improvement. Later, the patient had gastro-intestinal bleeding, ARDS secondary to bacterial pneumonia, fits and succumbed. Multiple cerebral hemorrhages, consolidation and bilateral small kidneys were found in autopsy.

Intercondylar Fracture of the Elbow in a Pediatric Patient

2024-09-23T09:43:21+00:00

To present a case assisted at the Pereira Rossell Hospital Center of a very rare injury, its evolution, as well as an update on the diagnostic and therapeutic measures for this type of injury.

Clinical case: A 12-year-old adolescent with no significant personal history who suffered a fall from a horse with direct trauma to the right elbow and no other trauma. Physical examination at the emergency room revealed a painful and swollen right elbow, no skin lesions, and no distal neurovascular alterations were found. Diagnosis was confirmed after requesting a CT scan of the elbow, which showed a supracondylar fracture. The fracture line divided the capitellum and was directed medially. A closed reduction maneuver and medial approach without arthrotomy were performed to identify the ulnar nerve. Three medial and one lateral Kirschner needles were placed. A brachypalmar splint was made. The Kirschner needles were removed at 6 weeks. Follow-up at 3 months after the injury.

Bilateral Foot Drop Treated with Posterior Tibial Tendon Transfer: A Case Report

2024-09-22T14:48:31+00:00

Drop foot is characterized by presenting gait alterations due to the inability to dorsiflex the ankle. Neurological and muscular etiology can cause foot drop. Tendon transfer surgery represents the gold standard of surgical treatment. Clinical case: 15-year-old female patient with a history of congenital common peroneal nerve paralysis. The first surgical stage is performed on the left foot, tendon transfer is performed with the classic Barr's technique, the posterior tibial tendon is disinserted by crossing the interosseous membrane and inserting in a lateral cuneiform. The second surgical procedure was performed 9 months after the first surgery with tendon transfer of the right foot, the procedure began with the classic Barrs technique, with insertion of the posterior tibial tendon in the medial cuneiform of the right foot and fixation with the use of a biotenodesis screw.

Discussion: Drop foot is a pathology characterized by alterations in the anterior tibial tendon. The causes of drop foot are described as neurological and muscular causes. Management with transfer of the posterior tibial tendon is the surgical management of choice, it should be considered when conservative management fails.

Diabetes Mellitus as a Cause of Osteoporosis: A Systematic Review

2024-10-03T15:50:52+00:00

Introduction: Osteoporosis is a metabolic bone condition characterized by decreased bone mineral density and deterioration of the microarchitecture of bone tissue, resulting in fragile bones susceptible to fractures. Diabetes mellitus (DM) is a chronic metabolic disease characterized by persistent hyperglycemia resulting from defects in insulin secretion or action.

Objective: To systematize and analyze the available evidence on the relationship between diabetes mellitus and osteoporosis, exploring the biological mechanisms, clinical impacts and possible management strategies.

Methods: This study constitutes a systematic review, classified as exploratory and descriptive. The research was developed through bibliographic research in electronic databases on methods associated with SLR (Systematic Literature Review) and SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings) applications.

Results: A comprehensive systematic search of the literature yielded a total of 4.490 articles on diabetes mellitus as a cause of osteoporosis, of which 36 articles were eligible to be included in this systematic review.

Conclusion: The challenges observed in the research, such as the difficulty in establishing causal relationships and the presence of confounding factors, indicate the need for more robust and diversified studies. Randomized clinical trials and longitudinal studies will be essential to better understand the relationship between diabetes and osteoporosis, especially with regard to the applicability of therapeutic interventions in different populations.

Knowledge and Attitude About HIV/AIDS Among Easy Bike Drivers at Selected Areas of Khulna City in Bangladesh

2024-10-03T15:59:26+00:00

Background: HIV/AIDS continues to be a major public health issue worldwide, particularly in developing countries where resources for prevention and treatment are often limited. In Bangladesh, the prevalence of HIV/AIDS is relatively low compared to global averages, but the potential for spread remains a significant concern.

Objective: This study aims to assess the knowledge and attitudes about HIV/AIDS among easy bike drivers in selected areas of Khulna City.

Methodology: A Cross Sectional Study was conducted among the easy bike drivers at Khulna City Corporation in Bangladesh from May 2023 to August 2023. Total 150 easy bike drivers were selected by using purposive sampling method and face to face interview conducted with a semi structured questionnaire.

Results: Out of 150 respondents, 43.35% respondents are 25-34 years of age and 25.3% illiterate. 34.67% respondents told HIV can be preventing by using condom and 53.3% respondents had physical relation without their wife and no one ever tested AIDS.

Conclusion: These findings highlight the urgent need for targeted educational initiatives to improve knowledge and reduce stigma among this group.

The Effect of Black Cumin (Nigella sativa) on Hb and VEGF Levels in Lung Cancer Patients Undergoing Chemotherapy at Dr. Saiful Anwar General Hospital, East Java

2024-05-05T04:26:50+00:00

Background: Studies show that the cytotoxic effect of black cumin seed extract and oil can reduce the viability of lung cancer cells including VEGF and increase the Hb of cancer patients. This study aims to compare Hb and VEGF levels between lung cancer patients undergoing chemotherapy with black cumin (Nigella sativa) and those undergoing standard chemotherapy.

Methods: This study used a quantitative approach using the pre-post test control group design method involving 21 lung cancer patients at Dr. Saiful Anwar General Hospital, Malang, who were observed for 9 weeks between August and November 2023. The control group included patients undergoing standard chemotherapy and the treatment group included those undergoing chemotherapy with the addition of black cumin. Examination of Hb and VEGF levels used ELISA.

Results: There were significant pre and post differences between the control and treatment after the 9-week study regarding their Hb and VEGF levels groups with a p-value of 0.021 and a p-value of 0.007, respectively.

Conclusion: The addition of black cumin for 9 weeks plays a role in preventing the decrease in Hb values and reducing VEGF levels in cancer patients receiving standard chemotherapy.

Percutaneous Treatment of Coronary Pseudoaneurysms: A Comprehensive Review

2024-10-03T16:04:02+00:00

Background: Coronary pseudoaneurysms (CPAs) are rare but significant complications of percutaneous coronary interventions (PCIs), trauma, or infections. They pose a considerable risk due to potential rupture and thromboembolism. While surgical repair has been the traditional approach, percutaneous methods have emerged as viable alternatives.

Objective: This review aims to provide a detailed analysis of the current techniques, outcomes, and future perspectives of percutaneous treatment of CPAs.

Methods: A comprehensive literature review was conducted, focusing on studies and case reports that describe the percutaneous management of CPAs. Techniques such as coil embolization, covered stent placement, and thrombin injection were evaluated.

Results: The success rates, complication rates, and long-term outcomes of various percutaneous techniques were analyzed. Additionally, patient selection criteria and procedural considerations were discussed.

Conclusion: Percutaneous treatment of CPAs is a promising alternative to surgical intervention, offering lower morbidity and shorter recovery times. However, careful patient selection and a thorough understanding of the available techniques are crucial for optimal outcomes.

Toxic Epidermal Necrolysis: A Clinical Case Report with Emphasis on Diagnosis, Management, and Prognostic Implications

2024-10-04T12:41:31+00:00

Toxic epidermal necrolysis (TEN) is a rare, life-threatening dermatologic emergency characterized by extensive keratinocyte apoptosis, resulting in widespread epidermal detachment and mucosal involvement. Its pathogenesis is primarily linked to an immune-mediated response triggered by certain medications. This report presents a case of a 45-year-old female who developed TEN following administration of an antibiotic regimen. The patient exhibited progressive skin detachment affecting over 30% of the body surface area, with concurrent ocular and oral mucosal involvement. Despite initial delays in diagnosis, aggressive management with fluid resuscitation, prompt drug discontinuation, and systemic immunosuppressants led to stabilization and eventual recovery. This case highlights the importance of early recognition, the need for a multidisciplinary approach, and the challenges in managing complications such as secondary infections and multi-organ dysfunction. Additionally, we discuss the diagnostic criteria, therapeutic options, and the role of emerging therapies, providing a comprehensive overview for clinicians facing similar cases.

Winter is coming. De Winter Pattern

2024-09-21T23:46:00+00:00

The De Winters electrocardiographic pattern, which is present in only 2% of cases of acute myocardial infarction, is an electrocardiographic pattern with a high risk of complications since acute occlusion of the anterior descending artery must be considered. Early recognition and appropriate therapy are what improve the prognosis in this patients.

Complicated CVC Placement Leading to Endocarditis in a Young Male

2024-09-24T16:31:38+00:00

A 31-year-old patient presents to our service with fever of unknown origin. During his approach, it is discovered that in an event of anaphylactic shock, a central venous catheter was placed, leaving the metal guide for 2 years. This was the cause of endocarditis, so he went to cardiac surgery where the metal wire was removed, with proper evolution.

Comprehensive Management of Pelvic Trauma in Pregnant Patients

2024-02-16T11:36:47+00:00

Pelvic fractures occur frequently due to traffic accidents and high-energy. Pregnant women are susceptible to trauma, with one in 12 pregnancies complicated by such incidents, making trauma the leading cause of non-obstetric maternal deaths during pregnancy. Pelvic fractures during pregnancy pose significant risks, potentially leading to adverse pregnancy outcomes such as preterm delivery, placental abruption, fetal distress, and even maternal or fetal death. The physiological changes that occur during pregnancy, including increased blood volume and altered cardiovascular dynamics, further complicate the management of pelvic trauma in pregnant patients. Prompt and appropriate management of pelvic trauma in pregnant patients is essential to optimize outcomes for both the mother and the fetus. Initial evaluation and stabilization of the mother take precedence, with close attention to airway, breathing, and circulation. Diagnostic imaging, including pelvic X-rays and, when feasible, body CT or MRI, aids in assessing the extent of pelvic injury and identifying associated injuries. Definitive treatment of pelvic fractures may involve a combination of surgical fixation, bed rest, traction, and pelvic slings, depending on the severity of the injury. The timing and approach to delivery in pregnant patients with pelvic fractures require careful consideration, with vaginal delivery being a viable option in many cases, provided that the pelvic architecture remains intact.

Conclussions: The management of pelvic trauma in pregnant patients requires a multidisciplinary approach and careful consideration of maternal and fetal well-being. Further research is needed to establish clear treatment guidelines and preventive strategies to reduce the incidence of pelvic fractures during pregnancy and improve outcomes for both mother and fetus.

Hepatocellular Carcinoma Situation in Indonesia: A Systematic Review of Clinical Staging and Histological Characteristics at the Time of Diagnosis

2024-09-26T15:32:23+00:00

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. However, systematic data on HCC characteristics in Indonesia are limited.

Objective: To summarize the body of literature on the characteristics of HCC in Indonesia.

Methods: A comprehensive search was conducted in MEDLINE, ScienceDirect, Scopus, Web of Science, and Google Scholar databases without date restrictions. Clinical studies investigating the characteristics of HCC exclusively in Indonesia were eligible for inclusion. Risk-of-bias assessments were conducted, and results were presented descriptively.

Results: Ten studies comprising 1,389 HCC patients were included. The Barcelona Clinic Liver Cancer (BCLC) staging system, reported in 5 studies, revealed a predominance of intermediate to advanced stages (B and C) at diagnosis. Child-Pugh scores, available for 7 studies, indicated variability in liver function, with Child-Pugh A ranging from 12.0% to 85.7%. Hepatitis B virus (HBV) infection was the primary etiological factor, with prevalence ranging from 53.8% to 84.0%. Hepatitis C virus (HCV) infection was less common (1.0% to 25.21%). Non-viral etiologies represented a substantial proportion, reaching up to 37.4% of cases. The mean age at diagnosis ranged from 52.43 to 63.1 years.

Conclusion: This review highlights the late-stage presentation of HCC in Indonesia, the predominance of HBV as an etiological factor, and a significant burden of non-viral HCC. The findings underscore the need for improved early detection strategies, strengthened HBV prevention efforts, and increased attention to metabolic risk factors. Regional variations in HCC characteristics suggest the need for tailored approaches to HCC management across different parts of Indonesia.

Surgical Management for Boutonniere Disease

2024-10-06T13:46:03+00:00

Boutonniere disease is a hand injury causing extension lag or restriction in the proximal
interphalangeal joint and hyperextension in the distal interphalangeal joint. This condition often
arises from direct laceration or closure damage to the central tendon, rheumatoid arthritis,
osteoarthritis, Dupuytren contracture, pulley injury, burns, and other conditions. Surgical
management for Boutonniere deformity relies on the expertise of the attending physician and
involves both non-surgical and surgical options. In acute cases, conservative therapy should be
pursued, while in chronic cases, conservative management may be advised.
Surgical intervention is used to transform excessive extension force of the distal interphalangeal
joint into extension force of the proximal interphalangeal joint. This is necessary to heal an open
rupture of the central tendon. Surgical techniques for chronic deformity are complex due to
variables and hand surgeons' expertise. There is no definitive surgical therapy for persistent
buttonhole deformity, but several approaches have been documented in case studies. These include
terminal tenotomy, collateral band surgery, central tendon surgery, tendon transfer and grafting,
stepwise extension mechanism readjustment surgery, and arthrodesis. Central tendon surgery
addresses the central tendon, where injured tissue transforms into scar tissue, resulting in delayed
extension of the proximal interphalangeal joint.
Tendon transfer or grafting have been documented for rotator cuff mechanism rehabilitation, but
no definitive guidance exists for these techniques. Curtis treatment introduced a sequential therapy
approach for traumatic buttonhole deformity, which involves splinting, excising the transverse
reticular ligament, resecting and lengthening the collateral ligament, and repositioning the core
tendon. Arthrodesis may be applicable in cases of advanced arthritis, coronal plane deformity,
functional impairment, or elderly patients. There are no definitive indications for surgical
interventions for persistent buttonhole deformity, and outcomes may be variable or inferior.
Understanding the deformity, its progression, and patient's functional constraints is crucial for
effective treatment

Unicystic Ameloblastoma in a Pediatric Patient: Case Report

2024-09-24T21:02:42+00:00

This article describes the clinical, histological, radiological characteristics, and treatment of unicystic ameloblastoma by presenting a clinical case of an 11-year-old patient, over a period of 2 years of clinical control and follow-up, in which histopathological diagnosis and radiographic control play a crucial role in diagnosis and the choice of an appropriate treatment plan. In this case, the patient underwent marsupialization, and after 4 weeks, enucleation in the mandibular symphysis and parasymphysis, along with odontectomy under general anesthesia. A treatment success rate of 100% without recurrence was achieved, and postoperative follow-up every 6 months was recommended.

Guardian of Oral Cavity- Mechanism of Gingival Defense

2024-10-08T10:40:35+00:00

Defense is the ability to fend off an attack .The oral cavity has several defense systems that can fend off different types of injuries. A variety of mechanical, chemical, and antigenic stresses are continuously applied to gingiva;some of these challenges are temporary, while others are ongoing. his study will go over various defense mechanism the gingiva uses to protect and prepare itself from the harsh environment. Defense e is ability to withstand the attack;the mouth cavity has many defense system that protect it from injuries.A vast range of mechnaical, chemical, and antigenic obstacles are continuously faced by gingiva. This study will go over the several defense mechanism how gingiva will protect from the harsh environmental.

The Role of Plastic Surgery in Management of Migraine Headaches: A Literature Review

2024-09-08T12:43:14+00:00

Introduction: Migraine headache is a neurovascular disorder characterized by primary chronic headache pain, with attacks lasting between 4 to 72 hours. Plastic surgery interventions such as targeted nerve decompression and Botox injections can provide better results.

Methods: We created this literature review by compiling and analysing data and information from publicly accessible scientific journals available on the web.

Results and Discussions: Many studies show that surgical treatment for chronic migraines can produce substantial results. However, such surgery is only effective for those who have not benefited from other treatments. Botox injections can block NO and CGRP activation in the central nervous system, whereas nerve decompression can lessen the activity of pain-signaling nerves associated with chronic migraine headaches. Overall, 68.3% to 93.3% of patients reported satisfactory results. Complete elimination of migraine headaches was achieved in 28.3% to 59% of cases, while significant improvement was observed in 26.5% to 60% of patients.

Conclusion: Botulinum injections for migraine headache treatment are more effective when combined with nerve decompression procedures. Giving preoperative Botox injections can reduce NO activation in the CNS, thereby limiting the activity of decompressed nerves and alleviating migraine headache symptoms.

Nurses' Role in Healthcare Quality Improvement

2024-09-29T08:37:11+00:00

Introduction: In addition to nursing, the nurse gives the patient medical attention by giving injections and managing medications. She helps the physician with diagnosis and therapy. The advancement of technology and rising demands for health care have changed the meaning of this profession. Nursing models that emphasize the practical application of learned information demonstrate the evolution of this profession. The purpose of this study was to outline the responsibilities, skills, and role of the nursing profession in raising the standard of patient care.

Material and method: The literature analysis method is used in this work. The information utilized in the work is derived from scientific journals and publications that have been released in compressed form.

Results: The analysis of the gathered scientific data demonstrated that nurses have a major influence on both the standard of medical care and the smooth operation of the entire institution. Healthcare facilities are part of organizations where a patient's life and health are directly impacted by the quality of care provided. As a result, everyone on staff should prioritize the patient's care, especially the nurses who spend a lot of time getting to know them and meeting them first. Patients look to nurses for medical expertise above all else, but they also expect safety, trust, and appropriate communication.

Conclusions: The nursing field has seen significant change in recent years, necessitating a variety of actions from those working in it to advance their careers. Additionally, patient expectations are evolving. Success depends on getting their feedback and meeting their needs. A happy customer will undoubtedly employ the facility's services once more.

Contribution of biofilm and Cell Surface Hydrophobicity in the resistance of Pseudomonas aeruginosa from some Healthcare settings of Yaounde

2024-04-02T15:41:14+00:00

Antibiotic resistance (ABR) is one of the priority problems around the world which affects the evolution of infectious diseases and leads to economic losses with a considerable impact on increased mortality and morbidity in low-resource countries. One of the bacteria most involved in resistance is Pseudomonas aeruginosa. It is a bacteria belonging to the ESKAPE group, for which there is an urgent and critical need for antibiotic development. The circulation of this bacteria in several countries has been the cause of many infections affecting all ages, patients and healthcare staff, and has promoted the spread of resistance in environmental and animal health. To investigate the determinants of resistance in Pseudomonsa aeruginosa, the aim of this work was to assess the correlation between biofilm, Cell Surface Hydrophobicity (CSH) and antibiotic resistance in clinical isolates of Pseudomonas aeruginosa circulating in Yaounde.

Methods: We conducted a cross sectional study from March 2019 to October 2021. We collected various samples including pus, urine, lochia, wound, bedsore and blood, from patients of the General Hospital of Yaounde (GHY), Central Hospital of Yaounde (CHY), University Teaching Hospital of Yaounde (UTHY) and Centre Pasteur du Cameroun (CPC). The hydrophobicity of the bacterial surfaces was determined by measuring the percentage of adhesion to xylene. Biofilm formation was assessed using the TCP method. The correlation between CSH, biofilm production and ABR were determined.

Results: We included 300 patients in this study. The most represented patients were men (50.67%). P. aeruginosa was isolated from the four settings and the prevalence was 10%. A large proportion of P.aeruginosa were biofilm producer with 30% being strong biofilm producer, 53.33% were weak biofilm producer and 16.67% were non-biofilm producers. Twenty percent of P. aeruginosa were highly hydrophobes while, 23.33% were moderately hydrophobes and 56.67 were low hydrophobes. The activities of most antibiotics were negatively correlated with biofilms and hydrophobicity. Isolates from lochia and wounds were biofilm producers and showed multidrug resistance while isolates from urine and pus was very hydrophobic.

Conclusion: These findings should serve as evidence base that biofilms and hydrophobicity are factors that contribute to antibiotic resistance in Pseudomonas aeruginosa. This demonstrates the need to consider these virulence factors, as well as the nature of the sample or excipient, during patient treatment, especially during empirical antibiotic therapy.

Asymptomatic Presentation of Large Stomach Gastrointestinal Stromal Tumour (GIST) in an Elderly Patient: A Case Report

2024-10-03T07:45:14+00:00

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, accounting for approximately 1% of all gastrointestinal cancers. They primarily arise from the interstitial cells of Cajal in the gastrointestinal wall and can occur throughout the digestive tract, most frequently in the stomach. While symptomatic cases often present with gastrointestinal bleeding, obstruction, or abdominal pain, large tumors can remain asymptomatic for long periods, leading to incidental detection. This case report discusses an 80-year-old woman with a 20-year history of a painless upper abdominal mass, initially presenting without gastrointestinal symptoms, obstruction, or constitutional complaints. Imaging suggested a large GIST, and after surgical resection, histopathology confirmed an epithelioid GIST of the stomach. This case highlights the unusual asymptomatic course of a large gastric GIST and discusses the potential complications, such as rupture, obstruction, and pressure effects, that can arise from tumors of this size, underscoring the importance of early detection and management.

Overcoming Barriers: Diagnosis of High-Grade Melanoma: Perspective from a Clinical Case

2024-10-02T06:17:35+00:00

We present the case of a 30-year-old male patient with loss of visual acuity in the left eye. The imaging study detected a lesion of high suspicion of tumor in the left eye. Enucleation of the left eye was performed, confirming the diagnosis of choroidal melanoma by histopathological study. Subsequently, the disease progressed with neoplastic activity in the lungs, liver, lymph nodes and central nervous system. A case description is provided along with a bibliographic review, focusing on the approach and prognostic factors in patients with metastatic disease.

Comprehensive Review of Shone's Syndrome: Pathophysiology, Clinical Manifestations, and Management Strategies

2024-10-14T11:13:32+00:00

Shone's syndrome, a rare congenital heart disease, encompasses a complex array of obstructive lesions within the left heart. First described in 1963, this syndrome typically presents with a combination of supravalvular mitral ring, parachute mitral valve, subaortic stenosis, and coarctation of the aorta. The intricate nature of these anomalies presents significant diagnostic and therapeutic challenges. This review aims to elucidate the pathophysiological mechanisms underlying Shone's syndrome, provide a detailed account of its clinical manifestations, and discuss current management strategies, including surgical and medical interventions. Through an in-depth analysis of existing literature, we seek to enhance understanding and improve outcomes for patients afflicted with this multifaceted condition.

Gallbladder Polyps: A Literature Review of Basic Concepts, Diagnosis and Treatment Options

2024-10-07T02:26:28+00:00

Gallbladder polyps (GP) are projections of the mucosa toward the light, most of them are benign caused by cholesterol deposits, focal adenomatosis, or hyperplastic lesions secondary to a local infection. It has an estimated prevalence of 5% of the world population. Cholesterol polyps are usually formed by an asymptomatic process, rarely obstructive jaundice or cholangitis due to the blockage of distal bile ducts by detached fragments of polyps. A small number of patients may be symptomatic; cholesterolosis and adenomatosis can also cause chronic dyspeptic abdominal pain, nausea, and vomiting. Ultrasound is the main imaging modality to diagnose polyps of the gallbladder, endoscopic ultrasonography can be a useful tool in patients with clinical pictures suggestive of vesicular pathology and non-invasive imaging studies, and inconclusive. In a patient aged less than 50 years with GP, the likelihood of malignancy is minimal and does not require cholecystectomy. However, those with a size greater than or equal to 10 mm should be resected by cholecystectomy for high risk of malignancy, and those with a size less than 10 mm should be submitted to ultrasound monitoring, observing the risk characteristics during follow-up, to provide timely treatment.

Resection of a Ruptured Epidermoid Cyst with Limberg Flap: Case Report

2024-10-07T18:28:55+00:00

Epidermoid cysts, also known as epidermal cysts, keratin cysts, epithelial cysts, or sebaceous cysts (although this term is no longer widely used), are benign lesions frequently seen in clinical practice. These cysts arise from epidermal cells trapped beneath the skin's surface. The most common complication is cyst rupture, which can lead to significant inflammation and even a granulomatous response. This article presents the clinical case of a male patient with a ruptured epidermoid cyst that triggered a granulomatous reaction, treated with surgical excision and reconstruction using a Limberg flap. Proper surgical management is crucial in such cases to prevent long-term complications and ensure optimal healing.

“Kissing-Balloon” Angioplasty Associated Coronary Artery Perforation in Anterior STEMI: A Cautionary Tale

2024-10-09T01:50:54+00:00

Introduction: Bifurcation technique angioplasty remains one of the most challenging procedures in interventional cardiology, up to 10% of patient with STEMI present with a bifurcation as the culprit lesion. Coronary artery perforation is a known complication of percutaneous coronary intervention and complex coronary anatomy is often posed as a risk factor. Interventional and surgical management of coronary artery perforation is indicated as soon as possible.

Case presentation: A 55-year-old male was admitted to the emergency room with severe chest pain 12-hour prior to his admission. An anterior STEMI was diagnosed, and the patient underwent emergency coronary angiography with a bifurcation lesion of the mid LAD and D1, after transient loss of anterograde flow a secondary vessel a “kissing-balloon” technique was performed and type III coronary artery perforation in the Ellis classification of the side-branch was identified. Patient developed cardiogenic shock and urgent thoracotomy was performed. The patient was discharged in good conditions.

Conclusion: Coronary artery perforation is a feared complication of percutaneous coronary intervention. Chest pain and hemodynamic deterioration can quickly lead to patient’s death. Identification as soon as possible and interventional or surgical management must be performed.