Case Of Duplication Research Articles

Establishing the Mortality Rate of under Five-Year-Old Children by Capture-Recapture Method

Background. Under count is a common phenomenon in health systems. One of the methods used for sensitivity identification of care system or identification of cases in registry is capture recapture method. Using two resources, this study aimed to estimate the actual mortality rates of under five-year-old children. Methods. This study was conducted by capture-recapture method (two resources), using the recorded data in death cause systems of the Iranian Ministry of Health and Medical Education (MOHME) and Treatment and Registry Office. The population included all children aged five years in Tabriz, Iran. We also considered all the death cases in the target population from 2020.03.20 to 2021.03.20. The death cases were extracted from two resources and entered into the Microsoft Excel software. After removing duplicate cases with a special formula, we obtained the actual mortality rates using capture-recapture method with 95% confidence interval (CI) and estimated the actual mortality rates and death cases. Results. In 2020, the death rate of under five-year-old children was calculated to be 344 cases (338 to 350 with 95% CI). The sensitivity rate of causal registry system for all death cases in the target population was 43.17%. Also, the mortality rate of under one-year-old children was calculated as 275 cases (271 to 280 with 95% CI). While the sensitivity rate of causal death for the mortality of under one-year-old children was 92.72%, it was 82.28% for the Registry Office. Conclusion. A combination of different software for death information registry and the registration of information in the occurrence location could be efficient techniques to reduce under count registrations. It is believed that better and more reliable information could be obtained on death case numbers through using two lists and capture-recapture method compared to using one of the two resources.

Prenatally diagnosed fetal thoraco-lumbar spine duplication associated with lipomyelomeningocele: An extremely rare case of split cord malformation.

Spine duplication is considered rare, a more serious form of split cord malformation. Ultrasonographic evaluation of the spine in the second trimester is central to the antenatal diagnosis of spinal malformations. Here, we report a case of thoraco-lumbar spine duplication associated with lipomyelomeningocele diagnosed by ultrasonography at 19 weeks of gestation. To the best of our knowledge, this is the first case report of spine duplication diagnosed by antenatal ultrasonography.

Analysis of Newborn Hearing Screening Results in South Korea after National Health Insurance Coverage: A Nationwide Population-Based Study.

Newborn hearing screening (NHS) has been covered by national health insurance since October 2018 in Korea. However, the results of the NHS are not reported due to the absence of a follow-up tracking system. This study analyzed the status and the predicted referral rates of NHS after the Korean national health insurance coverage by analyzing the National Health Insurance Service database in 2019 and 2020. The NHS coverage was 91.7% of total birth in 2019 and 92.1% in 2020. The predicted referral rate of NHS calculated by the duplicated NHS cases was 1.05% in 2019 and 0.99% in 2020. However, another predicted referral rate calculated by the number of diagnostic auditory brainstem responses (ABRs) performed was 1.44% in 2019 and 1.43% in 2020. The first NHS was performed within one day of birth for 96.5% of the babies and within three days of birth for 97%. However, diagnostic ABR was adequately performed within three months of birth for only 4.3%, while 82.3% performed the test after six months which delays appropriate intervention for hearing loss. National support such as national coordinators, follow-up tracking, and data management systems are needed for early hearing detection and intervention of newborns and infants in Korea.

Subtype, Frequency, and Associated Background Histology in Males Diagnosed with Hepatocellular Adenomas: A Single Institution Study

Abstract Introduction/Objective Hepatocellular adenomas (HCAs) are rare, benign hepatic neoplasms arising from noncirrhotic livers, most commonly diagnosed in reproductive-age women using oral contraception with female:male ratio of 10:1. These tumors are also associated with anabolic steroid use, obesity, and diabetes. HCA subtypes and their incidence in the general population are as follows: inflammatory (HCA-I) accounting for approximately 50% of cases, HNF1A- inactivated (HCA-H) in 35-40%, β-catenin-activated (HCA-B) in 10-15%, and unclassified HCA in <5-10%. We aimed to determine HCA subtype frequency in male-only cases and their associated background liver histologies. Methods/Case Report We performed a retrospective review of all HCAs diagnosed in males from 2000–June 2022 at Mount Sinai Hospital using keywords “hepatocellular adenomas” and “hepatic adenomas;” a total of 54 cases fulfilled the criteria. Liver biopsies and resection specimens were included; duplicate cases were eliminated, and only those cases with a definitive diagnosis of HCA were included. Results (if a Case Study enter NA) There were 31 patients (age range 17-73 years) included with a total number of 41 HCAs (17 from resections and 14 from biopsies). HCA-I comprised 23/31 cases (74%), HCA-H and HCA-B each encompassed 2/31 cases (6%, respectively), one HCA-I had coexistent β-catenin mutation (3%, 1/31), and one unclassified HCA had mixed HCA-I and HCA-H features (3%, 1/31). Twelve cases were diagnosed as HCA without further subtype specification (NOS) (38%). Background liver histology was available in 24 cases. Fatty liver disease (steatosis and steatohepatitis) was found in five cases, of which four were classified as HCA-I. Of seven hepatocellular carcinomas diagnosed, four arose from NOS HCAs with either unremarkable or steatohepatitis backgrounds. Three of five HCA-I showed background nonspecific chronic hepatitis while two had glycogen storage disease. The remaining ten cases had unremarkable liver backgrounds and were found involving all HCA subtypes. Conclusion In this cohort of male-only patients, HCA-I was the most common subtype, the frequency of which is significantly higher than is reported in the general population. Only 6% of cases were HNF1A-inactivated and β- catenin-activated, far less than the reported incidence of 35-40% and 10-15%, respectively. Additionally, our findings show that the majority of HCAs had an unremarkable liver background. Further studies are necessary to determine the neoplastic drivers among male patients that develop hepatocellular adenomas.

A proposed feasible classification of common bile duct duplications based on a newly described variant and review of existing literature

BackgroundDuplication of the common bile duct (CBD) is extremely rare among the anatomical variations in the biliary tract system, which presents a septum within the CBD or an accessory CBD. In our study, we report a rare case of duplication of the common bile duct combined congenital biliary dilatation.we present a rare case of a septum in the dilated biliary tract.Case presentationWe reported a 5-year-old Asian girl who had history of repeated abdominal pain for 4 days and aggravated for 1 day. Magnetic resonance cholangiopancreatography (MRCP) examination revealed duplicated common bile duct (DCBD) malformation with congenital biliary dilatation and distal cholelithiasis. The patient underwent choledochal cyst resection and biliary tract reconstruction and abdominal cavity irrigation and drainage under general anesthesia. A septum was found within the common bile duct during the operation. The septum divided the extrahepatic bile duct into two parts connected to the left and right hepatic ducts respectively and the gallbladder is attached to the repeated right bile duct which was not previously reported in the literature.ConclusionsWe complement and adjust the classification of common bile duct duplication by reviewing the literature.

PERSISTENTLY ELEVATED BASELINE TRYPTASE - A CASE OF HEREDITARY ALPHA TRYPTASEMIA

<h3>Introduction</h3> Hereditary Alpha Tryptasemia (HaT) is an autosomal dominant genetic condition resulting from inheriting an extra <i>TPSAB1</i> gene copy, which encodes alpha and beta tryptase. Most cases involve increased copy numbers of alpha tryptase gene, but documented cases of beta tryptase gene duplications exist. HaT typically presents with tryptase levels greater than 8 ng/mL. Phenotypes vary in severity and history may include idiopathic anaphylaxis, vibratory urticaria, musculoskeletal problems, and dysautonomia. HaT can coexist with clonal mast cell diseases, particularly systemic mastocytosis (SM). <h3>Case Description</h3> A 15-year-old female presented for elevated blood tryptase levels. She reported frequent emesis, diarrhea, anorexia and unintentional weight loss. She reported generalized fatigue, anxiety, and musculoskeletal pain with 2-years of frequent flushing and postural orthostatic hypotension. She denied dysphagia, urticaria, and anaphylaxis. Lab evaluation revealed negative <i>c-KIT</i> mutation. Tryptase range was 12.2-14.2 ng/mL. <i>TPSAB1</i> gene analysis was obtained demonstrating two copies of alpha-tryptase and three copies of beta-tryptase. She was diagnosed with HaT based on a duplication at <i>TPSAB1</i> allele. Initiation of cromolyn and high dose cetirizine resulted in suboptimal symptomatic improvement. Management is currently ongoing. <h3>Discussion</h3> When assessing elevated tryptase levels, considering HaT in the differential diagnosis is important, in addition to possible confounding conditions. A diagnosis of HaT also does not preclude concomitant conditions such as SM. This case demonstrates the need for more inclusive nomenclature to account for beta-tryptase duplications sometimes presenting with similar clinical manifestations. We propose HaT be renamed Hereditary Tryptasemia, accounting for cases of additional beta-tryptase copies as demonstrated in this patient.

Factors associated with seizure in tramadol overdose: a 12-year retrospective study in Hong Kong

Background Early identification of patients at risk of seizure after acute tramadol overdose is crucial. Yet, current evidence has been inconclusive regarding the factors associated with the seizure. There is a lack of study on the Chinese population and the value of electrocardiogram (ECG) in risk prognostication has not been fully evaluated. Objectives We aimed 1) to characterise the clinical presentations of isolated tramadol overdose in Hong Kong; 2) to study the frequency of seizure in such overdose and the factors associated with it using multivariable analysis; and 3) to explore the association between individual ECG parameters and seizure. Methods This was a retrospective observational study on consecutive patients reported to the Hong Kong Poison Information Centre for tramadol overdose from 1 January 2008 to 30 November 2020. Duplicate cases or patients with an overdose of other co-ingestants were excluded. Univariate and multivariable logistic regression was performed to identify factors significantly associated with seizures in general and seizures that occurred after emergency department (ED) arrival. Results We identified 93 patients, including 54 women and 39 men, with a median age of 38 years during the study period. The majority was Chinese (90%) and only five patients had a history of seizure. The seizure occurred in 23 patients. Multivariable analysis showed that sinus tachycardia > 100 beats/min was significantly associated with a higher seizure risk (OR 27.95, 95% CI 2.22–351.84, p = 0.010) and age per 10 years increase was associated with a lower risk (OR 0.61; 95% CI 0.39–0.96, p = 0.033). No reliable predictors of seizure after ED arrival were identified. Many patients had ECG features consistent with sodium channel blockade but none of them was predictive of seizure. Conclusions A younger age and sinus tachycardia > 100 beats/min were associated with a higher seizure risk after tramadol overdose but no reliable predictors of seizure after ED arrival were identified. Individual ECG parameters were not predictive of seizure.

A Case of Duplication of Inferior Vena Cava and Turner Syndrome

Turner syndrome is one of the most common sex chromosome disorders with many anatomical abnormalities that affect physiological systems of human body. The most common cardiovascular anomalies in Turner syndrome are bicuspid aortic valve and coarctation of aorta. The venous anomalies include partial anomalous pulmonary venous return and persistent left sided Superior vena cava. Duplication of inferior vena cava (IVC) is rare in occurrence. On extensive literature search, no such case of IVC duplication in Turner syndrome is found. We, herein, report an incidental finding of IVC duplication in a known case of Turner syndrome. Any patient with Turner syndrome should be evaluated for additional venous anomalies.

S166 Osteonecrosis of the Jaw Associated With Bevacizumab in Treatment: A Case Series Using the FDA Adverse Event Reporting System (FAERS) Database

Introduction: Osteonecrosis of the jaw (ONJ) is a rare but serious adverse drug reaction (ADR) historically associated with denosumab and bisphosphonate therapy. Studies have demonstrated an association between ONJ and bevacizumab, a VEGF inhibitor now used for some gastrointestinal malignancies. This study reviewed cases of bevacizumab associated ONJ reported to the FDA Adverse Event Reporting System (FAERS) database Methods: The FAERS database was searched for all reported cases of ONJ from 2010 to 2021. Cases lacking patient age or gender were excluded from review. Only adults (age 18 and older) and reports from Healthcare Professions were included for analysis. Duplicate cases were removed. A dataset was created for bevacizumab associated ONJ and demographics were summarized. A subgroup analysis was performed for subjects receiving bevacizumab without prior or concomitant denosumab or bisphosphonate therapy. Results: 19,670 cases of ONJ were reported to the FAERS database from 2010 to 2021 with approximately half (9,556) containing complete patient demographic data. 146 cases (1.5%) of bevacizumab associated with ONJ were identified. 65.8% (96) of the patients were female and the average age was 60.9 years +/- 9.3 years. There were 34 cases without prior or concomitant bisphosphonate or denosumab therapy. Male gender was associated with 65% (22 of 34) of these cases and average age was 61 years +/- 12.0. Table/Figure depicts clinical indications for each of these 34 cases. Gastrointestinal malignancies (i.e., colon cancer and esophageal cancer) were present in 6/34 (17.6%) cases without prior denosumab/bisphosphonate therapy, 5 patients with breast cancer (14.7%) and 5 cases of prostate cancer (14.7%). Conclusion: 146 cases of bevacizumab associated with ONJ have been reported to the FAERS database and 23% of these cases did not involve medications known to cause ONJ. Clinicians should be aware that ONJ is a potential adverse effect of bevacizumab treatment.Figure 1.: This Figure represents the distribution of the clinical indications of bevacizumab-associated with ONJ as reported to the FAERS database from 2010 to 2021 Table 1. - This Table represents the distribution of the clinical indications of bevacizumab associated with ONJ as reported to the FAERS database from 2010 to 2021 along with the respective number of cases Indication for use Number of cases Colon cancer 5 Breast cancer 5 Prostate cancer 5 Unspecified 5 Renal cell cancer 4 Lung cancer 3 Other 3 Esophageal cancer 1 Brain cancer 1 Rheumatoid Arthritis 1 Plasma cell myeloma 1

A Rare Case of Complete Urethral Duplication and Short Review of the Literature

Abstract Duplication of the urethra is a rare congenital anomaly, predominantly seen in males. Due to the rarity of the condition, there is no fixed consensus regarding the management of these patients. We report the case of a 4-year-old male child who presented with phimosis and balanoposthitis, with the occasional double stream of urine and was incidentally found to have duplication of the urethra. Cystoscopy revealed the duplication to be Effman Type II A-1. No surgical intervention was done for the duplication as the patient was asymptomatic. Our aim is to report this rare case and to enhance the knowledge by reviewing the already existing scanty literature of this rare condition.

Muscle/musculocutaneous versus fasciocutaneous free flap reconstruction in the lower extremity: A systematic review and meta-analysis.

Free flaps for soft tissue coverage of the lower extremity can be broadly divided into muscle/musculocutaneous and fasciocutaneous flaps. The purpose of this systematic review and meta-analysis was to assess their different post-operative outcomes. A systematic search was performed in PubMed, Scopus, and the Web of Science from their inception to February 2022. Non-randomized comparative studies, which describe any post-operative outcome of muscle/musculocutaneous and fasciocutaneous free flaps reconstruction in the lower extremity were included. Articles with duplicate titles, editorials, review articles, case series, case reports, and publications lacking an abstract, those reporting pediatric patients, those describing only muscle/musculocutaneous or fasciocutaneous free flaps, those with incomplete or incomparable post-operative outcomes, and studies involving <10 muscle/musculocutaneous or fasciocutaneous free flaps were excluded. A comparative meta-analysis was conducted on muscle/musculocutaneous and fasciocutaneous free flaps outcomes, comprising vascular thrombosis, partial or complete flap necrosis, infection, donor-site complications, non-union, and primary or recurrent osteomyelitis. The fixed-effects meta-analysis model was used when low heterogeneity (I2 < 50%) was identified. Twenty-two articles with a total of 2711 flaps (1584 muscle/musculocutaneous flaps and 1127 fasciocutaneous flaps) were included in the qualitative and quantitative assessment. The rates of any flap necrosis (12.0% vs. 7.4%; p=0.007) and donor-site complications (16.7% vs. 6.7%; p < 0.0001) were significantly higher for muscle/musculocutaneous flaps than for fasciocutaneous flaps. There were no significant differences in the rates of vascular thrombosis (10.5% vs. 10.7%; p=0.98), complete flap necrosis (6.2% vs. 4.7%; p=0.30), infection (19.4% vs. 14.7%; p=0.18), non-union (18.9% vs. 14.8%; p=0.33), and primary or recurrent osteomyelitis (14.7% vs. 12.4%; p=0.69). This meta-analysis revealed no significant difference in long-term post-operative outcomes, but suggested that fasciocutaneous flaps should be preferred to avoid flap necrosis and donor-site complications.

Direct percutaneous endoscopic jejunostomy tube placement in patients post Roux-en-Y gastric bypass, a single tertiary care center experience

Background and study aims Obesity prevalence continues to rise in the United States with Roux-en-Y gastric bypass (RYGB) surgery being one of the most common bariatric procedures. With this trend, more patients with altered upper gastrointestinal (UGI) anatomy have required endoscopic intervention including direct percutaneous endoscopic jejunostomy (DPEJ) placement. We aimed to assess the safety and success rates of DPEJ in RYGB patients. Patients and methods All patients at a tertiary care referral center who underwent DPEJ during an 8-year period were queried from a prospectively maintained registry of all enteroscopy procedures. Duplicate cases and altered upper UGI anatomy subtypes other than RYGB were excluded. The final cohort consisted of two groups: RYGB vs native anatomy (NA). Demographic, procedural, readmission, follow-up, and complication data were recorded. Comparative analysis was performed. Results Seventy-two patients were included where 28 had RYGB and 44 had NA. Both groups had similar baseline and pre-procedure data. Procedure success rate was 89 % in RYGB patients and 98 % in NA patients ( P = 0.13). There were no intraprocedural complications. Early and late postprocedural complication rates were similar between the groups (both 4 % vs 7 %). Average follow-up times in the RYGB and NA groups were 12.97 ± 9.35 and 13.44 ± 9.21 months, respectively. Although readmission rates at 1 and 6 months were higher in the NA versus the RYGB group (21 % vs 7 % and 25 % vs 15 %), these differences were not significant. Conclusions DPEJ can be successful and safely placed in RYGB patients with no significant difference in procedure success, complication, or readmission rates when compared to control.

Utilization Review of Antibiotics in the Treatment of Urinary Tract Infection

Aim: To evaluate the rationality of pharmacotherapy of UTI and to identify drug related problems (DRPs) in the treatment of UTI. Methodology:, a prospective study was perfomed in Ayub Teaching Hospital Abbottabad Pakistan for a period of three months (December 2019 to March 2020) on 62 patients suffering from UTI. Data of patient disease and treatment was collected from patient medical chart record file and then pharmacotherapy was evaluated for accessing rationality and identification of DRP using standard book like British national formulary and standard treatment guidelines. Statistical analysis of the data was performed by using SPSS. Results: Result of this study showed that prevalence of UTI was more in female (67.74%) than males (32.25%). Patients belonging to the age group of 20-40 years were more prone to UTI. The most frequent problems were presence of drug interactions, dosage problems cases, overprescribing cases, therapeutic duplication cases and lack of cost effectiveness cases. After analyzing the use of antibiotics it was found that most widely used antibiotics in the treatment of UTI was ceftriaxone, followed by levofloxacin and ciprofloxacin. Culture Sensitivity test for appropriate selection of antibiotics was not perfomed in 80% of cases. Wrong dose of antibiotics was prescribed in 27.4% cases; therapeutic duplication of antibiotics was found in 6% of patient prescription and over usage of antibiotics was observed in 18% of cases. Conclusion: Irrational use of drugs especially antibiotics in the treatment of UTI can adversely affect desired therapeutic outcome, lead to therapy failure and emergence of resistance of antibiotics which is a major concern. Drugs for the treatment of UTI should be used rationally according to the need and standard prescribing protocol to improve patient therapeutic outcome and to decrease the adverse consequences of drug therapy. . Keywords: Urinary tract infection, drug related problems and antibiotic use

Laparoscopic treatment of bilateral duplex kidney and ectopic ureter: A case report

BACKGROUNDDuplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal pelvis, while bilateral duplication is extremely rare. Herein, we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy. CASE SUMMARYA 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10, 2018. She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula. The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years. No renal function damage and vaginal leakage were found.CONCLUSIONLaparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.

Interstitial duplication syndrome in the chromosomic region 15q11q13: a case report

Introduction: The chromosomal region 15q11-13 contains a group of genes essential for normal neurodevelopment and alterations in this region result in different syndromes. Among the most frequent alterations, there are chromosomal deletions and duplications. Duplications of chromosome region 15q11q13 occur as a supernumerary chromosome 15, and may occur as interstitial duplications. The main clinical manifestations are intellectual impairment, problems with vision, hearing, teething and in bones and joints. Currently, there are few cases reported in the literature about this genetic condition, which justifies the relevance of this study. Objective: To report a case of duplication in the chromosomal region 15q11q13 and describe the clinical manifestations. Methodology: This is a case report of a qualitative nature. Case report: J.V.A.S., male, eight years old, attended at the Associação de Pais e Amigos dos Excepcionais (APAE), in Anápolis, Goiás, Brazil, in 2017, diagnosed with neuropsychomotor developmental delay (ADNPM) and macrocrania. No complications during childbirth. The patient had head support at six months, sat up at nine months, walked and talked at one year and ten months. He attends school and has good interaction, but has learning difficulties. In 2018, the CGH – ARRAY (aCGH) revealed the presence of a duplication in 15q11.2q13.1 of approximately 6.1Mb classified as pathogenic. Results and discussion: Due to the rarity of this syndrome, we did not find a satisfactory number of articles that specifically addressed this duplication. Conclusion: It is necessary to carry out more studies, in the long term and through satisfactory samples, in order to elucidate the main aspects involved in this pathology.

Clinical Characteristics, Genetic Findings and Arrhythmic Outcomes of Patients with Catecholaminergic Polymorphic Ventricular Tachycardia from China: A Systematic Review.

Introduction: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy. The present study aims to examine the clinical characteristics, genetic basis, and arrhythmic outcomes of CPVT patients from China to elucidate the difference between CPVT patients in Asia and Western countries. Methods: PubMed and Embase were systematically searched for case reports or series reporting on CPVT patients from China until 19 February 2022 using the keyword: “Catecholaminergic Polymorphic Ventricular Tachycardia” or “CPVT”, with the location limited to: “China” or “Hong Kong” or “Macau” in Embase, with no language or publication-type restriction. Articles that did not state a definite diagnosis of CPVT and articles with duplicate cases found in larger cohorts were excluded. All the included publications in this review were critically appraised based on the Joanna Briggs Institute Critical Appraisal Checklist. Clinical characteristics, genetic findings, and the primary outcome of spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) were analyzed. Results: A total of 58 unique cases from 15 studies (median presentation age: 8 (5.0–11.8) years old) were included. All patients, except one, presented at or before 19 years of age. There were 56 patients (96.6%) who were initially symptomatic. Premature ventricular complexes (PVCs) were present in 44 out of 51 patients (86.3%) and VT in 52 out of 58 patients (89.7%). Genetic tests were performed on 54 patients (93.1%) with a yield of 87%. RyR2, CASQ2, TERCL, and SCN10A mutations were found in 35 (71.4%), 12 (24.5%), 1 (0.02%) patient, and 1 patient (0.02%), respectively. There were 54 patients who were treated with beta-blockers, 8 received flecainide, 5 received amiodarone, 2 received verapamil and 2 received propafenone. Sympathectomy (n = 10), implantable cardioverter-defibrillator implantation (n = 8) and ablation (n = 1) were performed. On follow-up, 13 patients developed VT/VF. Conclusion: This was the first systematic review of CPVT patients from China. Most patients had symptoms on initial presentation, with syncope as the presenting complaint. RyR2 mutation accounts for more than half of the CPVT cases, followed by CASQ2, TERCL and SCN10A mutations.

A remarkable teratological case in Carabus violaceus L. (Coleoptera: Carabidae) from Poland

Background and purpose: Teratological cases in insects can be of different characteristic, quite often they are bifurcations, for example of antennal segments or parts of the legs. The aim of this paper is to report a remarkable case of leg duplication in Carabus violaceus L.&#x0D; &#x0D; Materials and methods: In the context of an interdisciplinary monitoring in the frame of a conservation project on the European bison (Bison bonasus (L.)) in Poland the carabid fauna (Carabidae) on areas grazed by this species was studied using pitfall traps in the Pszczyna forest, located in Silesia Province, to the south of the town Tychy. The traps were located inside a mixed fresh coniferous forest, with domination of Scots pine (Pinus sylvestris L.).&#x0D; &#x0D; Results: Among the carabids gathered a remarkable teratological female specimen of the species Carabus violaceus L. with repeated anatomical duplications on the right front leg was collected.&#x0D; &#x0D; Conclusions: The repeated incident of bifurcation suggest a genetic base of the teratology. An increased rate of teratological cases may have potential as bioindicator.

A 40-Year Litigation Review of Transurethral Surgeries for Benign Prostatic Hyperplasia

ObjectiveTo describe litigation patterns of transurethral surgery in the treatment of benign prostatic hyperplasia including verdicts, types of lawsuits, plaintiff claims, and timing of the claims. MethodsData was gathered by searching for litigation cases between January 1, 1980 and December 1, 2021 in the Westlaw legal database using keywords for transurethral surgeries for benign prostatic hyperplasia. Extracted data included case type, general description of the plaintiffs and defendants, plaintiff claims, and whether the claim involved preoperative, perioperative, or postoperative management, verdict, and indemnity awards. ResultsThe Westlaw search yielded 44 unique cases after removing duplicate and irrelevant cases. The most common surgery resulting in a lawsuit was transurethral resection of the prostate (70%) and urologists were the most frequently named defendant (80%). The most common plaintiff claims were sexual dysfunction (36%), irritative lower urinary tract symptoms (32%), and lack of consent (27%). Among malpractice cases, the verdict was in favor of the defendant in most cases (71%) and among Eighth Amendment violation cases, the verdict was in favor of the defendant in every case. The average indemnity payment was $565,845 and the highest indemnity payment was $1,020,000. ConclusionComplications of transurethral surgeries and lack of consent are common reasons for patient's filing a lawsuit. Healthcare providers should ensure patient understanding of surgical risks and thoroughly document the conversation. Providers should be aware of the causes for litigation among transurethral surgeries for benign prostatic hyperplasia and of the possibility of Eighth Amendment violation lawsuits when treating prison inmates.

Transcriptome of the synganglion in the tick Ixodes ricinus and evolution of the cys-loop ligand-gated ion channel family in ticks

BackgroundTicks represent a major health issue for humans and domesticated animals. Exploring the expression landscape of the tick’s central nervous system (CNS), known as the synganglion, would be an important step in understanding tick physiology and in managing tick-borne diseases, but studies on that topic are still relatively scarce. Neuron-specific genes like the cys-loop ligand-gated ion channels (cys-loop LGICs, or cysLGICs) are important pharmacological targets of acaricides. To date their sequence have not been well catalogued for ticks, and their phylogeny has not been fully studied.ResultsWe carried out the sequencing of transcriptomes of the I. ricinus synganglion, for adult ticks in different conditions (unfed males, unfed females, and partially-fed females). The de novo assembly of these transcriptomes allowed us to obtain a large collection of cys-loop LGICs sequences. A reference meta-transcriptome based on synganglion and whole body transcriptomes was then produced, showing high completeness and allowing differential expression analyses between synganglion and whole body. Many of the genes upregulated in the synganglion were associated with neurotransmission and/or localized in neurons or the synaptic membrane. As the first step of a functional study of cysLGICs, we cloned the predicted sequence of the resistance to dieldrin (RDL) subunit homolog, and functionally reconstituted the first GABA-gated receptor of Ixodes ricinus. A phylogenetic study was performed for the nicotinic acetylcholine receptors (nAChRs) and other cys-loop LGICs respectively, revealing tick-specific expansions of some types of receptors (especially for Histamine-like subunits and GluCls).ConclusionsWe established a large catalogue of genes preferentially expressed in the tick CNS, including the cysLGICs. We discovered tick-specific gene family expansion of some types of cysLGIC receptors, and a case of intragenic duplication, suggesting a complex pattern of gene expression among different copies or different alternative transcripts of tick neuro-receptors.

Polyorchidism presenting as cryptorchidism

Polyorchidism is a rare birth defect of the male genital system characterized by the presence of extra testis on one or both sides. To date, more than a hundred cases have been reported in the literature. The problem is asymptomatic and comes across incidentally. The management of polyorchidism is conservative if there are no associated problems, but some authors suggest surgical treatment in individualized patients. We present a case of testicular duplication in a 6-year-old boy who presented with left-side cryptorchidism, confirmed by ultrasonography (US). We performed orchiopexy for both testes on the ipsilateral side, and the operation ended uneventfully.