Clinical Presentation Research Articles

Comprehensive Insights Into Renal Perivascular Epithelioid Cell Neoplasms: From Molecular Mechanisms to Clinical Practice

Comprehensive Insights Into Renal Perivascular Epithelioid Cell Neoplasms: From Molecular Mechanisms to Clinical Practice

Clinical presentation, diagnosis, management and outcomes of multisystem inflammatory syndrome in children (MIS-C)- a systematic review and meta-analysis

Clinical presentation, diagnosis, management and outcomes of multisystem inflammatory syndrome in children (MIS-C)- a systematic review and meta-analysis

Infantile Hemangioma with Minimal or Arrested Growth: Different Clinical Presentations in a Retrospective Case Series

Objectives: Infantile hemangioma with minimal or arrested growth (IHMAG) has been established as a subtype of infantile hemangioma (IH) due to positive glucose transporter-1 staining; however, it is clinically differentiated by a proliferative component of <25% of its total surface area. IHMAG can be misdiagnosed as a capillary malformation, an IH precursor, a noninvoluting congenital hemangioma, or an arteriovenous malformation among others. In this case series, we aim to further illustrate the various clinical characteristics of IHMAG and the features that distinguish this unique entity from the other vascular entities. It is important to recognize the differentiating characteristics to avoid unnecessary evaluation and provide patients with the appropriate management plan. Methods: A retrospective chart review approved by the University of Rochester Medical Center Institutional Review Board was performed from January 2014 to December 2020, with the search terms: “infantile hemangioma with arrested or minimal growth,” “IHMAG” and “abortive hemangioma.” In total, 29 IHMAGs were identified in 27 patients. Charts were reviewed for demographic and clinical characteristics as well as workup, response to treatment, and outcomes. Results: In total, we identified 29 IHMAGs in 27 patients. Female to male ratio was 2:1. Average gestational age was 40 weeks. Lesions were present at birth in 22/27 patients. Out of the 29 IHMAGs, 18 were focal (62%) and 11 were segmental (38%). In most patients, skin examination revealed fine telangiectatic patches with focal areas of bright red papules. Out of 29 IHMAGs, 20 involved the lower body and 18 were focal, whereas 11 were segmental. PHACES syndrome (posterior fossa anomalies, infantile hemangioma, arterial anomalies, cardiac anomalies, eye anomalies, and midline skin defects) was identified in 2 of 2 patients with facial segmental IHMAGs. LUMBAR syndrome (lower body infantile hemangiomas and other skin defects; urogenital anomalies and ulceration; myelopathy; bony deformities; anorectal malformations and arterial anomalies; and rectal anomalies) was ruled out in 2 of 2 patients with extensive IHMAGs involving the sacral area. Semicircular lipoatrophy was seen in 1 patient with segmental circumferential IHMAG of the leg. Ultrasonography was the most used modality. Out of 27 infants, 18 were treated with topical timolol, 4 were treated with oral propranolol, and 2 patients were treated with a combination of both. Conclusion: Trends of the epidemiologic, clinical, and prognostic data of our 27 cases are in concordance with prior reports on IHMAG, further consolidating our understanding of this peculiar entity. IHMAG typically presents as a telangiectatic pink to violaceous patch present at birth in term newborns predominantly involving the lower half of the body. It is important to keep a high index of suspicion for the other vascular anomalies in the differential diagnosis. A segmental IHMAG should prompt providers to screen for associated syndromes such as PHACES and LUMBAR. Additional studies are warranted to better elucidate the pathogenesis of IHMAG and its associated anomalies. Level of evidence: Original report (case series).

Emerging Nanotechnology for the Treatment of Alzheimer's Disease.

Nanotechnology is a great choice for medical research, and the green synthesis approach is a novel and better way to synthesize nanoparticles. Biological sources are cost-effective, environmentally friendly, and allow large-scale production of nanoparticles. Naturally obtained 3 β-hydroxy-urs-12-en-28-oic acids reported for neuroprotective and dendritic structure are reported as solubility enhancers. Plants are free from toxic substances and act as natural capping agents. In this review, the pharmacological properties of ursolic acid (UA) and the structural properties of the dendritic structure are discussed. UA acid appears to have negligible toxicity and immunogenicity, as well as favorable biodistribution, according to the current study, and the dendritic structure improves drug solubility, prevents drug degradation, increases circulation time, and potentially targets by using different pathways with different routes of administration. Nanotechnology is a field in which materials are synthesized at the nanoscale. Nanotechnology could be the next frontier of humankind's technological advancement. Richard Feynman first used the term 'Nanotechnology' in his lecture, "There is Plenty of Room at the Bottom," on 29th December, 1959, and since then, interest has increased in the research on nanoparticles. Nanotechnology is capable of helping humanity by solving major challenges, particularly in neurological disorders like Alzheimer's disease (AD), the most prevalent type, which may account for 60-70% of cases. Other significant forms of dementia include vascular dementia, dementia with Lewy bodies (abnormal protein aggregates that form inside nerve cells), and a number of illnesses that exacerbate frontotemporal dementia. Dementia is an acquired loss of cognition in several cognitive domains that are severe enough to interfere with social or professional functioning. However, dementia frequently co-occurs with other neuropathologies, typically AD with cerebrovascular dysfunction. Clinical presentations show that neurodegenerative diseases are often incurable because patients permanently lose some neurons. A growing body of research suggests that they also advance our knowledge of the processes that are probably crucial for maintaining the health and functionality of the brain. Serious neurological impairment and neuronal death are the main features of neurodegenerative illnesses, which are also extremely crippling ailments. The most prevalent neurodegenerative disorders cause cognitive impairment and dementia, and as average life expectancy rises globally, their effects become more noticeable.

Heart Failure with Normal Natriuretic Peptide Levels and Preserved Ejection Fraction: A Prospective Clinical and Cardiac MRI Study.

Purpose To describe the clinical presentation, comprehensive cardiac MRI characteristics, and prognosis of individuals with predisposed heart failure with preserved ejection fraction (HFpEF). Materials and Methods This prospective cohort study (part of MISSION-HFpEF [Multimodality Imaging in the Screening, Diagnosis, and Risk Stratification of HFpEF]; NCT04603404) was conducted from January 1, 2019, to September 30, 2021, and included individuals with suspected HFpEF who underwent cardiac MRI. Participants who had primary cardiomyopathy and primary valvular heart disease were excluded. Participants were split into a predisposed HFpEF group, defined as HFpEF with normal natriuretic peptide levels based on an HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, and Final Etiology) score of 4 from the latest European Society of Cardiology guidelines, and an HFpEF group (HFA-PEFF score of ≥ 5). An asymptomatic control group without heart failure was also included. Clinical and cardiac MRI-based characteristics and outcomes were compared between groups. The primary end points were death, heart failure hospitalization, or stroke. Results A total of 213 participants with HFpEF, 151 participants with predisposed HFpEF, and 100 participants in the control group were analyzed. Compared with the control group, participants with predisposed HFpEF had worse left ventricular remodeling and function and higher systemic inflammation. Compared with participants with HFpEF, those with predisposed HFpEF, whether obese or not, were younger and had higher plasma volume, lower prevalence of atrial fibrillation, lower left atrial volume index, and less impaired left ventricular global longitudinal strain (-12.2% ± 2.8 vs -13.9% ± 3.1; P < .001) and early-diastolic global longitudinal strain rate (eGLSR, 0.52/sec ± 0.20 vs 0.57/sec ± 0.15; P = .03) but similar prognosis. Atrial fibrillation occurrence (hazard ratio [HR] = 3.90; P = .009), hemoglobin level (HR = 0.94; P = .001), and eGLSR (per 0.2-per-second increase, HR = 0.28; P = .002) were independently associated with occurrence of primary end points in participants with predisposed HFpEF. Conclusion Participants with predisposed HFpEF showed relatively unique clinical and cardiac MRI features, warranting greater clinical attention. eGLSR should be considered as a prognostic factor in participants with predisposed HFpEF. Keywords: Heart Failure with Preserved Ejection Fraction, Normal Natriuretic Peptide Levels, Cardiovascular Magnetic Resonance, Myocardial Strain, Prognosis Clinical trial registration no. NCT04603404 Supplemental material is available for this article. © RSNA, 2024.

Use of the Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment to aid differential diagnosis in acute vestibular syndrome in the hyperacute stroke setting.

Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment is a clinical bedside test used to aid diagnosis. Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed. Further education was completed with more members of the stroke and emergency department multi-disciplinary team. Quality improvement measures including magnetic resonance imaging use and bed utilisation were explored. Following training of one stroke consultant, the Head Impulse, Nystagmus, Test of Skew assessment was found to be a feasible, accurate bedside test within this acute stroke service. Further training for the multi-disciplinary team was completed, but outcome measures were not explored because of the coronavirus disease 2019 pandemic and maternity leave. There is a role for trained members of the multi-disciplinary team to successfully use the Head Impulse, Nystagmus, Test of Skew assessment in hyperacute stroke settings, to aid diagnosis in acute vertigo syndrome.

Glomus tumor of the great toe: An uncommon case report

Introduction: Masson’s glomus tumor is a neuromyoarterial hamartomatous proliferation that develops from corpuscules located at the dermal-hypodermal junction, it is a rare but not exceptional benign tumor and it is less frequently reported in the foot. Case presentation: We present a unique case based on its unusual location, clinical presentation (pain being the primary symptom) and its misleading appearance on MRI. Treatment involved surgical excision of the tumor, resulting in a favorable outcome. Histopathological examination of the excised specimen remains crucial for definitive diagnosis, highlighting the importance of considering this unusual location in the differential diagnosis. Discussion: Pathogenesis remains poorly understood, and diagnosis can be difficult. It preferentially affects the hands (75%) and it is subungual in 50% of cases. Diagnosis is based on the clinical triad of sensitivity, pain and intolerance. Advances in high-resolution MRI have improved false negatives, with lesions showing hypo-signal in T1 and hypersignal in T2, with clear contrast between normal tissue and tumor. Diagnostic certainty is provided by histology. After complete removal of the tumor, results are generally considered excellent. In most cases, pain disappears rapidly, and the affected finger or limb returns to normal within three months. Conclusion: Glomus tumors are certainly rare, but not exceptional, and a high degree of suspicion is required when faced with a painful purplish nodule. Usually distal, periungual in location, they can occur anywhere, with sometimes unusual and puzzling localizations.

Covid-19 in HIV-infected patients: A report of 14 cases experience of the infectious diseases department of the University Hospital Mohamed VI Marrakech - Faculty of Medicine and Pharmacy Marrakech

Objective: Evaluation of clinical, biological, radiological characteristics, therapeutic management and outcome in patients with HIV / SARS-COV-2 co-infection. Materials and Methods: Descriptive retrospective study of 14 files of patients with HIV / SARS-COV-2 co-infection confirmed by SARS-COV-2 PCR between April 2020 and May 2022 in the infectious diseases department of the University Hospital Mohamed VI Marrakech Results: 14 patients were included, with a sex ratio M/F: 2.5. The mean age of our patients was 40.7 years. The clinical symptoms presented by our patients were: asthenia (71%); febrile pneumonia (64.20%); anosmia (46.6%); diarrhea (28.5%); and lower limb thrombophlebitis (7.14%). The HIV status was as follows: 9 new cases (64.2%), while HIV was already present in 5 patients (35.8%). On the radiological level, 10 patients had moderate damage (72%), 3 patients had mild damage (21%), while 1 patient had severe damage (7%). Our patients' treatment changed during the study period; in particular, one group of patients was treated with the national covid-19 therapeutic protocol, while others received molnupiravir. The outcome was overall good, with a clear clinical and biological improvement; and only 4 patients died. Conclusion: The predisposition to SARS-COV2 infection as well as the clinical presentation and evolution of Covid 19 in PLHIV do not differ from the general population.

Hematocolpos- variations: Case report

Hemato/hydrocolpos is an obstruction of the menstrual flow due to an anomaly of the genital tract, with imperforate hymen being the most common one, which is found in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed due to its rare incidence and nonspecific symptoms (usually misdiagnosed as constipation. In case of late diagnosis/ misdiagnosis and/or delay in treatment, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.

Levothyroxine management in Hashimoto’s thyroiditis: A comprehensive revie

Hashimoto thyroiditis and hypothyroidism are related thyroid conditions with different aetiologies and clinical manifestations. Insufficient synthesis of thyroid hormones causes hypothyroidism, which may lead to systemic symptoms that impact energy, metabolism, and overall wellness. Thyroid tissue damage mediated by the immune system is the hallmark of the autoimmune thyroid condition known as Hashimoto thyroiditis, which is the most prevalent cause of hypothyroidism. A wide range of symptoms, such as fatigue, weight gain, cold sensitivity, constipation, dry skin, and cognitive impairment, are clinical indications of hypothyroidism and Hashimoto thyroiditis. Thyroid function tests, which measure serum levels of free thyroxine, thyroid-stimulating hormone, and thyroid autoantibodies, must be performed for the diagnosis. Imaging techniques, such ultrasonography, may aid with nodular changes detection and thyroid morphology assessment. The goals of management plans for Hashimoto thyroiditis and hypothyroidism are to stop complications, relieve symptoms, and return the body to normal. The cornerstone of treatment is levothyroxine-based thyroid hormone replacement medication, which is customized for each patient depending on their clinical presentation and thyroid function testing. Dietary restrictions, patient education, and lifestyle changes are essential components of illness management.

Adult niemann-pick disease: A case report

Adult niemann-pick disease: A case report

Epidemiological, clinical and biological profile of COVID-19 in patients hospitalized at the Avicenne Military Hospital in Marrakech

In late December 2019, a series of cases of viral pneumonia caused by a novel coronavirus emerged in Wuhan, China, and quickly spread to all continents. This coronavirus, identified in respiratory tract samples, was named SARS-CoV-2 for Severe Acute Respiratory Syndrome Coronavirus-2 by the ICTV (International Committee on Taxonomy of Viruses). The disease it causes was designated COVID-19 for Coronavirus Disease 2019 by the Word Health Organization. Most often, SARS-CoV-2 infection is responsible for a mild or moderate form, with the most typical clinical presentation being that of a febrile respiratory infection with dry cough, dyspnea, fatigue, and myalgia. Approximately 10-15% of cases are severe, and 5% are critical. Cases of reinfection have been described. Treatment for COVID-19 is currently symptomatic, relying on supportive care. The present study aims to investigate the demographic, clinical, and diagnostic aspects, as well as the study of risk factors associated with SARS-CoV-2 infection among 318 patients admitted to the Avicenne Military Hospital in Marrakech during the first wave of the pandemic. This is a retrospective descriptive and analytical study involving 318 cases of SARS-CoV-2 infection, diagnosed at the microbiology-virology department, and followed up in various non-intensive care units of the Avicenna Military Hospital in Marrakech, during the period of the first wave of the epidemic in Morocco, schematically between March 22, 2020, and July 19, 2020. For patients who developed pneumonia, 20% were diabetic and 13.3% were hypertensive. A quarter of patients with pneumonia experienced desaturation upon admission. In the multivariate logistic regression model, risk factors associated with the development of pneumonia and the various disease outcomes included advanced age and absence of a history of contact with a confirmed case. In the univariate analysis, hyperleukocytosis, neutrophilia, lymphopenia, eosinopenia, anaemia, hyperferritinaemia with elevated aspartate aminotransferase, hyponatraemia and fasting hyperglycaemia were significantly associated with a higher risk of an unfavourable outcome. Patients who presented with pneumonia on admission had an unfavourable outcome during their hospitalisation compared with patients who did not develop pneumonia. The statistically significant risk factors associated with an unfavourable outcome were advanced age (&gt;60 years) with p &lt;0. 001: OR=1.194; 95%IC= [1.114-1.278], absence of contact with a confirmed case (p &lt;0.001 : OR= 43.138; 95%IC= [8.893-209.263]), presence of comorbidity (P&lt;0.001 : OR=11. 503; 95%CI= [3,306-40,028]), mainly diabetes (P&lt;0.001: OR=16,971; 95%CI= [4,267-67,504]) and arterial hypertension (P&lt;0.001: OR=18,812; 95%CI= [3,977-88,954]). The study of the epidemiological, clinical and biological characteristics of COVID 19 at the Avicenne military hospital in Marrakech has enabled us to gain a better understanding of the profile of our patients with SARS-CoV-2 infection, and then to detect shortcomings in terms of prophylaxis, diagnosis and management, in order to be able to provide the necessary solutions aimed at further improving the quality of care for this population.

Burden of Invasive Group B Streptococcus Infection Among Omani Infants Less Than 90 Days Old: A Multicenter Study.

Group B Streptococcus (GBS) infection is the leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the incidence of invasive GBS disease among infants less than 90 days old in Oman and to describe their risk factors, clinical presentations and clinical outcomes. We retrospectively collected the data of less than 90-day-old Omani infants with culture-positive GBS from sterile samples. This study was conducted in 3 tertiary hospitals in Oman from 2009 to 2018. Over 10 years, we identified 92 cases of culture-confirmed invasive GBS infection from 178,285 live births in the 3 hospitals, giving an overall incidence of 0.53 per 1000 live births [95% confidence interval (CI): 0.4-0.7)]. Of those, 59 (64.1%) had early-onset neonatal GBS disease and 33 (35.9%) had late-onset neonatal GBS disease. The incidence of invasive GBS disease was significantly higher in the last 5 years from 2014 to 2018 (0.69 per 1000 live births, 95% CI: 0.5-0.9) compared to the previous years from 2009 to 2013 (0.36 per 1000 live births, 95% CI: 0.2‒0.5), (P = 0.004). Infants with late-onset neonatal GBS disease had a higher risk of meningitis compared to infants with early-onset neonatal GBS disease (30.3% vs. 10.2%, P = 0.021). The mortality rate was 13.5%. The incidence of invasive GBS disease in Oman is similar to what was reported worldwide, however, the burden of the disease in terms of mortality is high. In addition, a significant increase in the annual incidence of invasive GBS disease in Omani infants was found over the study period.

An analysis of urodynamic parameters in diabetic and nondiabetic women.

Diabetes is highly prevalent worldwide, with an estimated 536 million living with diabetes in 2021, and that number projected to increase to 783 million by 2045. Diabetic bladder dysfunction is thought to affect up to 60%-90% of individuals with diabetes and can significantly impact quality of life. Despite the prevalence of diabetic bladder dysfunction, the exact pathophysiological mechanism, and resulting clinical presentation, remains debated. Our objective was to compare urodynamic parameters between diabetic and nondiabetic women, assessing the impact of various markers of diabetes severity on bladder function. A retrospective chart review was conducted on female patients aged 18 and above who underwent urodynamic studies at a single tertiary care university hospital system from 2014 to 2020. Patients were categorized based on diabetes status, and diabetes severity including duration of disease, hemoglobin A1c levels, insulin dependence, and markers of end-organ dysfunction. Urodynamic variables, including compliance, bladder voided efficiency, bladder contractility index, postvoid residual, maximum flow rate, capacity, voided volume, and detrusor overactivity, were assessed by two independent reviewers. Statistical analyses were performed to assess the impact of diabetes and diabetic severity on urodynamic parameters. A total of 652 female patients were included in the study, of which, 152 (23.3%) had diabetes, with an average duration of diagnosis of 82.3 months. Diabetic women were older and had higher body mass index compared to nondiabetic women. Diabetic retinopathy and neuropathy were present in 18% and 54.6% of diabetic patients, respectively. Significant differences in urodynamic parameters were observed between diabetic and nondiabetic women, with diabetic women showing higher rates of detrusor overactivity (p = 0.01), particularly associated with increasing BMI (p = 0.03). However, classic markers of diabetes severity including duration, as well as markers of end-organ damage, showed mixed associations with urodynamic changes. Despite the prevalence of diabetic bladder dysfunction and its impact on patient quality of life, the exact mechanisms and clinical presentation remain elusive. Our study highlights the significant differences in urodynamic parameters between diabetic and nondiabetic women, emphasizing the need for further research into the relationship between diabetes and diabetic bladder dysfunction.

ENT Manifestations of Sjögren’s Syndrome: A Comprehensive Narrative Review

Background: Sjögren's Syndrome (SjS) is a chronic autoimmune disorder predominantly affecting exocrine glands, leading to symptoms such as keratoconjunctivitis sicca and xerostomia. This review focuses on the ear, nose, and throat (ENT) manifestations of SjS, which significantly impact patient quality of life and pose diagnostic challenges. Aim: The review aims to consolidate current knowledge on the ENT manifestations of SjS, exploring pathophysiological underpinnings, clinical presentations, and treatment strategies, while addressing the diagnostic challenges associated with the disease. Review Summary: ENT manifestations in SjS include nasal dryness, recurrent sinusitis, otitis, and laryngeal dryness, which may precede other systemic manifestations, aiding in early diagnosis and management. This review highlights the importance of recognizing these symptoms for timely intervention, which can significantly improve disease prognosis. Future Implications: Understanding ENT manifestations can enhance multidisciplinary management approaches and foster development in diagnostic and therapeutic strategies, potentially improving patient outcomes and quality of life. Clinical Policy and Development: Enhanced awareness and training on the ENT aspects of SjS are recommended for healthcare professionals. Development of more sensitive diagnostic tools and personalized treatment plans could also address the variability in symptom presentation and response to treatment. Keywords: Sjögren's Syndrome, ENT Manifestations, Xerostomia, Keratoconjunctivitis Sicca, Multidisciplinary Management

Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections—A Five-Year Retrospective Study

Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. : This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.

Review of the Ticagrelor Trials Evidence Base.

Ticagrelor is a platelet P2Y12 receptor inhibitor approved for use in patients with acute coronary syndromes, coronary artery disease, and low-moderate risk acute ischemic stroke or high-risk transient ischemic attack. Clinical trials have evaluated the efficacy and safety of ticagrelor on ischemic and bleeding outcomes for different indications and with varying treatment approaches. As a result, there is a large body of clinical evidence demonstrating different degrees of net clinical benefit compared with other platelet inhibitor drugs based on indication, patient characteristics, clinical presentation, treatment duration, and other factors. We provide a review of the major trials of ticagrelor in the context of other randomized trials of clopidogrel and prasugrel to organize the volume of available information, elevate corroborating and conflicting data, and identify potential gaps as areas for further exploration of optimal antiplatelet treatment.

Primary Renal Angiosarcoma: Rare Tumour with Lethal Outcomes

Introduction: Renal haemangioma is a benign tumour, and due to its characteristics, it must be distinguished from malignant diseases. We present a clinical case of primary renal angiosarcoma initially mistaken for haemangioma due to their similarity. Case report: A 58-year-old man was admitted to the hospital with suspicion of pulmonary embolism. The patient complained of pain on the left side. An ultrasound and CT scan of the abdomen showed a tumour mass ~20.5 × 17.2 × 15.4 cm in size in the projection of the left kidney. On CT images, there were data for clear cell renal clear cell carcinoma (ccRCC). A left nephrectomy was performed. However, histological examination revealed renal haemangioma. Three months later, the patient presented to the hospital with abdominal and lumbar pain. A CT scan showed multiple small hypoechoic foci up to 2 cm in size in the liver, lungs, and intra-abdominally, with the most data for carcinosis. Histological re-verification of the left kidney showed a renal vascular tumour with pronounced signs of infarction and necrosis with the majority of the evidence supporting angiosarcoma. Despite treatment, the patient’s outcome was fatal. Conclusions: Based on the clinical presentation, radiological images and histological examination data, the tumour was initially misdiagnosed as kidney haemangioma. Due to the rarity of this tumour, there are no established treatment protocols or clinical guidelines for managing primary kidney angiosarcoma.

Insights into the Transmission, Host Range, Genomics, Vaccination, and Current Epidemiology of the Monkeypox Virus

This review delves into the historical context, current epidemiological landscape, genomics, and pathobiology of monkeypox virus (MPXV). Furthermore, it elucidates the present vaccination status and strategies to curb the spread of monkeypox. Monkeypox, caused by the Orthopoxvirus known as MPXV, is a zoonotic ailment. MPXV can be transmitted from person to person through respiratory droplets during prolonged face-to-face interactions. While many cases of monkeypox are self-limiting, vulnerable groups such as young children, pregnant women, and immunocompromised individuals may experience severe manifestations. Diagnosis predominantly relies on clinical presentations, complemented by laboratory techniques like RT-PCR. Although treatment is often not required, severe cases necessitate antiviral medications like tecovirimat, cidofovir, and brincidofovir. Vaccination, particularly using the smallpox vaccine, has proven instrumental in outbreak control, exhibiting an efficacy of at least 85% against mpox as evidenced by data from Africa. Mitigating transmission requires measures like wearing surgical masks, adequately covering skin lesions, and avoiding handling wild animals.

Features of the clinical course of Autoimmune Encephalitis Associated with various antibodies.

Despite the increasing incidence of autoimmune encephalitis and the incomplete recovery observed in patients post-affliction, the issue of timely diagnosis remains unresolved. The primary objective of this study is identification the distinctive clinical presentation features evaluation the management strategies, and assess the outcomes of the disease in patients with various forms of autoimmune encephalitis. The research aims to contribute in a better understanding of the disease progression and facilitate the selection of optimal therapeutic interventions. A retrospective observational study enrolled 68 patients aged 18 years and older with verified autoimmune encephalitis who underwent treatment in state hospitals in Sofia, Bulgaria, from the beginning of 2014 to the end of 2022. The number of patients with pathology linked to antibodies against glycine receptors (Gly-R) was half as much, with 32 and 17 patients, respectively. The primary manifestations of autoimmune encephalitis included cognitive impairments observed in 51 patients, seizures occurring in 44 patients, and mood disorders observed in 22 patients. While the findings of imaging studies were nonspecific, hospitalizations for patients with this pathology, especially those with antibodies to CASPR2 and DPPX, were prolonged (114 and 232 days, respectively). In the vast majority of cases, incomplete recovery with residual symptoms was noted. Among the diverse forms of autoimmune encephalitis, the most prevalent is NMDA-R. Cognitive impairments predominate in the autoimmune encephalitis clinical presentation. Prolonged hospitalization periods and incomplete recovery of patients are characteristic features of autoimmune encephalitis, despite combined therapy involving intravenous administration of methylprednisolone and immunoglobulins.