Common Clinical Causes Research Articles

Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review

BackgroundPulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications.Case presentationA 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient’s oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula.ConclusionPulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.

Identification of biomarkers associated with macrophage infiltration in non-obstructive azoospermia using single-cell transcriptomic and microarray data.

Non-obstructive azoospermia (NOA) is a common clinical cause of male infertility. Research suggests that macrophages are linked to testicular function; however, their involvement in NOA remains unknown. To evaluate the importance of macrophages infiltration in NOA and identify the macrophage-related biomarkers, the gene-expression microarray data GSE45885 and the single-cell transcriptomic data GSE149512 were utilized from the Gene Expression Omnibus (GEO). A single-sample gene set enrichment analysis (ssGSEA) was conducted to investigate immune cell proliferation. The Seurat package was used for the single-cell data analysis, and the limma package was used to identify the differentially expressed genes between the NOA and normal samples. Moreover, we conducted a weighted gene co-expression network analysis (WGCNA) to identify the macrophage-related key modules and genes, and conducted Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses for the functional exploration. To identify the macrophage-related biomarkers, we conducted least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE) analyses. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to verify the marker genes present in NOA. We confirmed that open reading frame 72 gene on chromosome 9 (C9orf72) [area under the curve (AUC) =0.861] and cartilage-associated protein (CRTAP) (AUC =0.917) were the hub genes of NOA, and the RT-qPCR analysis revealed the critical expression of both genes in NOA. Through the combination of tissue transcriptomic and single-cell RNA-sequencing analyses, we concluded that macrophage infiltration is significant in different subtypes of NOA, and we hypothesized that C9orf72 and CRTAP play critical roles in NOA due to their high expression in macrophages.

Experience and findings from surveillance peer review in Nigeria, August 2017-May 2019.

acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states. we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers. there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified. Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality.

Hsa_circ_0008870 suppresses bone formation of growth plate through inhibition of miR-185-3p/ MAPK1 axis in idiopathic short stature.

Idiopathic short stature (ISS) is the most common clinical cause of the short stature with an unclear aetiology and a lack of effective treatment. Circular RNAs have been shown to play a significant regulatory role through various signal transduction pathways in a variety of diseases in recent years. However, the role of circular RNAs on ISS is not yet well-understood and requires a special attention. The differentially expressed circular RNAs were screened by microarray chip analysis, and RT-qPCR was used to verify the expression of hsa_circ_0008870 in ISS patients. Subsequently, in vitro and in vivo experiments were conducted to determine the biological functions of hsa_circ_0008870 in ISS. The authors first confirmed that hsa_ circ_0008870 was downregulated in ISS children. Meanwhile, we also observed that the downregulated hsa_circ _0008870 significantly inhibited chondrocyte proliferation and endochondral ossification in vivo and in vitro. Mechanistically, hsa_circ_0008870 regulates MAPK1 expression by sponge miR-185-3p. This mechanism of action was further verified through rescue experiments. Finally, the authors revealed that the silencing of hsa_circ_0008870 induces low expression of MAPK1 by impairing the sponge action of miR-185-3p, thereby inhibiting chondrocyte proliferation, hypertrophy, and endochondral ossification, which results in a short stature phenotype. In addition to these, we also observed an interesting phenomenon that upregulated of miR-185-3p can in turn inhibit the expression of hsa_circ_0008870 in chondrocytes. This suggests that hsa_circ_0008870 could potentially serve as a therapeutic target for the treatment of ISS.

The global epidemiology of Japanese Encephalitis virus infection

The Japan encephalitis virus and its infection remain an important public health problem in Asian countries. Even though effective antiviral therapy and vaccines are now available, still the cases or infections of JEV are not getting declined. According to the World Health Organization (WHO), 30,000–50,000 JEV cases can be obtained annually. Various modes of transmission of this disease are present, which are very important to create awareness among people to minimise this infection. Most people infected with JEV are undetectable and few are infected with the JE virus and cause neurological disorders. So it is very necessary to understand the common clinical laboratory findings to understand the factors associated. This study reviews the common clinical and pathological causes of viral encephalitis and also the risk factors associated with this disease. The overall epidemiology of this deadly disease JEV and the factors associated with it have been summarized. This review is based on the scenario of epidemiology and molecular prospective of JEV disease.

Trends and patterns in urgent pediatric otolaryngology inter-hospital referrals in Saudi Arabia.

Objectives:To assess trends in otolaryngology-head and neck surgery (ORL-HNS) referrals among pediatric patients, and to address common urgent causes of ORL-HNS referrals in this population. Additionally, to give recommendations regarding these causes, and assessing the impacts of coronavirus desease-19 on such referrals.Methods:A retrospective descriptive study were the data was extracted from the referral system of the Saudi Ministry of Health (Ehalati), from 2019-2020. Pediatric patients from all hospitals across Saudi Arabia with problems related to ORL-HNS who have been referred urgently to other hospitals were included.Results:A total of 1318 urgent ORL-HNS referrals were collected. The average age of the sample was 6.5 years, with the unavailability of specialty being the major cause for referrals. Foreign bodies, recurrent epistaxis, and tracheostomy were also common clinical causes. The average time for accepting referrals was 21 hours. Most cases had medical or surgical intervention prior to referral. The Western region of Saudi Arabia was the most common sender and receiver of all referrals. In 2020, referrals decreased by 18.4%.Conclusion:Maternity and pediatric hospitals make up the largest number of referring hospitals for ORL-HNS urgent cases. Expanding ORL-HNS services has been recommended in highly demanding areas. standards for urgent ORL-HNS referrals may limit inappropriate urgent referrals.

Research Progress on the Pharmacological Mechanism of Chuanxiong Rhizome in the Treatment of Migraine

Migraine is a common clinical cause of primary neurovascular headache, which is closely related to psychosocial factors and has a great impact on people's daily life. The pathogenesis of migraine is diverse, and the more mature mechanisms include vascular theory, neuronal theory, inflammatory mediator theory, neurotransmitter theory, neurotrophic factor, central sensitization and activation of the limbic system of the thalamus, and dopaminergic system-related gene theory. Chinese medicine believes that headache can occur when the evil of the six leucorrhea attacks the top of the body, stagnating the evil qi and blocking the clear yang, or when internal injuries lead to the reversal of qi, and blood, stagnation of the meridians, and loss of nourishment for the brain. Chuanxiong, as a common clinical herb, has the function of promoting blood circulation, dispelling wind, and relieving pain. Based on the pattern of medication used in the treatment of migraine during the Song, Jin, and Yuan dynasties, it was found that Chuanxiong was used very frequently in the treatment of headaches, headwinds, first wind, and migraine. In addition, modern pharmacological studies have found that the main components of Chuanxiong Ligusticum include tetramethylpyrazine (Chuanxiongzin), ferulic acid, volatile oil, ligustilide, chuanxiong lactone and alkyl phenyl peptides such as butenolide and that Chuanxiong Ligusticum has analgesic, anti-inflammatory, antioxidant, anti-tumor, anti-coagulant, anti-depressant, anti-aging, anti-atherosclerosis, cytoprotective, and cardiac function improving effects. In conclusion, Chuanxiong has great research potential in the treatment of migraine. In this paper, we mainly classify and summarize the effects of Chuanxiong in the treatment of migraine and provide a scientific basis for the application of Chuanxiong in the treatment of migraine.

Clinical and Genetic Etiologies of Neonatal Unconjugated Hyperbilirubinemia in the China Neonatal Genomes Project

To investigate the clinical and genetic causes of neonatal unconjugated hyperbilirubinemia. We included 1412 neonates diagnosed with unconjugated hyperbilirubinemia (total serum bilirubin >95 percentile for age), from the China Neonatal Genomes Project between August 2016 and September 2019, in the current study. Clinical data and targeted panel sequencing data on 2742 genes including known unconjugated hyperbilirubinemia genes were analyzed. Among the 1412 neonates with unconjugated hyperbilirubinemia, 37% had severe unconjugated hyperbilirubinemia, with total serum bilirubin levels that met the recommendations for exchange transfusion. Known clinical causes were identified for 68% of patients. The most common clinical cause in the mild unconjugated hyperbilirubinemia group was infection (17%) and in the severe group was combined factors (21%, with infection combined with extravascular hemorrhage the most common). A genetic variant was observed in 55 participants (4%), including 45 patients with variants in genes associated with unconjugated hyperbilirubinemia and 10 patients with variants that were regarded as additional genetic findings. Among the 45 patients identified with unconjugated hyperbilirubinemia-related variants, the genes were mainly associated with enzyme deficiencies, metabolic/biochemical disorders, and red blood cell membrane defects. G6PD and UGT1A1 variants, were detected in 34 of the 45 patients (76%). Known clinical causes, which varied with bilirubin levels, were identified in approximately two-thirds of the patients. Genetic findings were identified in 4% of the patients, including in patients with an identified clinical cause, with G6PD and UGT1A1 being the most common genes in which variants were detected.

EVALUATING THE EFFECTIVENESS OF SUPPORTIVE TREATMENT BY MOXA ROLLER ON SOME TRADITIONAL WIND-COLD DISEASES

Background: According to traditional medicine, the wind-cold agent is a common clinical cause, may appear in such diseases as: lumbar pain, neck shoulder pain, and flu… The wind-cold agent enters the meridian and collateral system, skin and hair on the body, lead to blood stasis due to qi stagnation cause pain and affect the patient’s quality of life. The moxa roller method is a form of moxibustion, which based on the use of a warm heat. The use of moxa roller is a new method in clinical to make moxibustion in patients more convenient and effective. Materials and method: 30 patients were diagnosed with lumbar pain and neck shoulder pain according to wind-cold traditional disease, treatment at Thua Thien Hue Traditional Medicine Hospital with supportive of moxa roller. The study was designed by method of prospective study, assessed the results before and after treatment. Results: Neck shoulder treatment: the rate good and very good accounts for 78.6%, lumbar pain treatment: the rate good and very good accounts for 87.6%. The general treatment effect is good and very good accounting for 83.4%. The change compared to before treatment was statistically significant with p < 0.05. Conclusion: Practising moxibustion by moxa roller supportive treatment of some diseases by wind-cold results in high clinical effectiveness. Key words: lumbar pain, neck shoulder pain, moxa roller, wind-cold.

Underlying Causes of High Output Heart Failure

In the U.S., each year, there are more than 500,000 new cases of all types of heart failure. With high output cardiac failure, there is an elevated cardiac output associated with several conditions and diseases, including obesity, chronic anemia, systemic arterio-venous fistula, hypercapnia, mitochondrial dysfunction, and hyperthyroidism. The underlying pathophysiologic mechanisms relate to a reduction in systemic vascular resistance from arterio-venous shunting or peripheral vasodilation. Often there is a decrease in systemic arterial blood pressure and neurohormonal activation leading to heart failure symptoms of dyspnea and fatigue. In a persistent high output state, patients may experience tachycardia, valvular abnormalities, and ventricular dilatation and/or hypertrophy. In this article, there is a review of high output heart failure, including the prevalence, pathophysiology, and common clinical causes of this disease.

Identifying Populations and Neighborhoods at High Risk for Hospital Admission-Driven Radiotherapy Interruption Using Geospatial Analytics

Hospital admission driven radiotherapy interruption (HADRI) remains understudied despite its association with increased costs and inferior cancer outcomes. In this study we benchmark HADRI for patients receiving external beam radiotherapy (RT), identify predictors for HADRI, and geographically map HADRI at the neighborhood level across a large region served by a single academic referral center. Data was collected for all patients treated with RT at our center from January 1, 2015 to December 31, 2017. HADRI was defined as postponement of at least one RT treatment due to either hospital inpatient or emergency room admission. We examined differences in the proportion of patients with HADRI by cancer type, race, insurance, and patient predicted income (PPI) which was modeled using 2017 US Census data by patient residence census tract and categorized as low (<$34k), middle, or high (>$67k). Proportion of patients with HADRI were compared using Pearson’s Chi square testing and mapped by patient residence at the neighborhood (census tract) level. 82,773 total fractions (median 24, IQR 10-30) were delivered to 3729 patients with 7107 interruptions (8.6%) in 1928 patients (51.7%). 2022 (54.5 %) were Caucasian, 1577 (42.3%) were African American, and 120 (3.2%) were other races. Insurance status was defined as Commercial, Medicare, or Medicaid/Uninsured in 1794 (48.1%), 1503 (40.3%), and 432 (11.6%) patients, respectively. There were 727 interruptions (10.2%) due to hospital admission in 197 (5.3%) patients. Statistically significant elevations in HADRI were seen in patients treated for HN, lung, metastatic, and GYN cancers (19.9%, 18.5%, 10.3% and 8.9% of patients with each tumor type, respectively; p = <0.0001). Elevations in HADRI were seen between Medicaid/Uninsured patients v. those with Commercial or Medicare insurance (7.4% v. 3.5% p = <0.0001; OR 2.21 [95%CI 1.48-3.32]), African American v. Caucasian patients (5.1 % v 3.1% p = 0.002; OR 1.66 [95%CI 1.19-2.32]), and low PPI v. high PPI patients (5.5% v 2.4% p = 0.0002; OR 2.31 [95%CI 1.48-3.62]). The most common clinical causes for HADRI were: dehydration (22.3%); acute respiratory failure (13.6%); fever/sepsis (11.4%); renal disease (11.4%); radiation induced mucositis or dermatitis (9.1%); and PEG tube complication (6.8%). Spatial analysis revealed elevated rates of HADRI in low income, majority African American neighborhoods (p = 0.0002). Significant elevation in hospital admission driven RT interruption was seen in low income, racial minority, Medicaid/uninsured populations and patients with cancer sites associated with high morbidity. Geospatial analytics revealed neighborhood hotspots eligible for targeted intervention. Further investigation of hospital admission driven RT interruption could prevent treatment interruption and reduce costs in cancer care delivery in the era of value-based care.

Penile intraepithelial neoplasia, penile cancer precursors and human papillomavirus prevalence in symptomatic preputium: a cross-sectional study of 351 circumcised men in Sweden.

ObjectivesTo investigate the prevalence of pathological disease and spectrum of human papillomavirus (HPV) types among symptomatic foreskin tissue.Patients and MethodsConsecutively excised symptomatic foreskins from 351 men were sent for histopathological evaluation. During the surgical procedure, a fresh biopsy was taken for HPV analysis by modified general primer polymerase chain reaction. A medical questionnaire regarding medication, smoking habits, number of lifetime sexual partners, former diseases and surgery performed on penis was completed by all participants.ResultsThe most common clinical diagnosis and cause for circumcision was phimosis, seen in 85.2%. Histopathologically inflammatory dermatological conditions were present in 87% of the men. The most common histopathological diagnosis was lichen sclerosus (LS) observed among 58.7%. Notably, penile intraepithelial neoplasia (PeIN) was present in 2% without former clinical suspicion. Overall, HPV was detected in 17.1% of the men and 28 different HPV types were found. High‐risk (HR) HPV types were identified in 9.1% and HPV16 was present in 2.3%. Current smoking increased the risk of HPV (crude odds ratio [OR] 2.8, confidence interval [CI] 1.4–5.6; P = 0.005). Having >15 lifetime sexual partners increased the risk of HPV (crude OR 2.6, 95% CI 1.4–5.1; P = 0.003) and when adjusted for current smoking the OR was substantially increased (OR 6.0, 95% CI CI 2.2–16.8; P < 0001).ConclusionsHistopathological evaluation of circumcised symptomatic foreskin revealed PeIN in 2% of the men without any clinical suspicion of malignancy and that treatable dermatological conditions were present in 87%, LS being the most common. HR‐HPV types were present in 9%. Due to risk of malignant development both in PeIN and in inflammatory skin diseases we recommend sending all excised foreskins from patients with symptoms for histopathological evaluation as guidance for further clinical management.

A preclinical animal model for evaluating the sealing capacity of covered stent grafts in acute vessel perforation

BackgroundPercutaneous coronary intervention is among the most common therapeutic interventions in cardiology. This procedure may, however, be associated with a rare, though life-threatening complication: acute coronary perforation (CP). CP is primarily treated using covered stents, which are made of bare metal stents with a polytetrafluoroethylene (PTFE) or polyurethane coating. These stents’ major limitations include higher rates of thrombus formation and restenosis. Hence, there is a still unmet need for new stents regarding their design and composition. Or, to test new covered stent designs, the rabbit iliac artery has become the best-established animal model. This study sought to present a preclinical animal approach designed to test covered stents that are utilized following vessel perforation.MethodsThe animal experiments were performed using New Zealand white rabbits, each weighting 3.5–4.5 kg. The animal models described herein relied on the three most common clinical causes for CP, such as guidewire-induced, balloon catheter bursting, and device oversizing. Moreover, the sealing capacity of covered stent grafts was assessed for each of these models by means of angiography.ResultsWe herein report a rabbit iliac artery perforation model using three different types of vessel perforation that closely mimic the clinical setting, such as guidewire-induced, balloon catheter rupture, and device oversizing. Using the same rabbit iliac perforation model, we additionally assessed the sealing capacity of a covered stent graft for each model.ConclusionsThe novel rabbit iliac artery perforation models, as described in this report, represent promising animal testing approaches. While their setting is very similar to the real-life context encountered in humans, all three models are based on an animal model that is ideally suited for evaluating the sealing capacity and performance of new medical devices for humans.

Common clinical causes and audiological manifestations of unilateral hearing loss in children

Objective:To analyze the common clinical causes and audiological manifestations of unilateral hearing loss in children, and to provide a basis for early prevention and intervention. Method:A retrospective analysis of 20 cases of children diagnosed with unilateral hearing loss was conducted. The medical history was collected, followed by audiological and imaging examinations. Result:The audiological performance of 20 children with unilateral hearing loss: 1 case of conductive deafness, whose hearing curve was flat and showed moderate hearing loss. There were 19 cases of sensorineural deafness, of which 1 case was moderate deafness, 16 cases were severe deafness, and 2 cases were extremely severe deafness. The imaging results showed that there were 1 case with transverse fracture of the temporal bone, 1 case with congenital cholesteatoma, 9 cases with dysplasia of the cochlear nerve, and 4 cases with malformation of the inner ear. The history of the two children was collected and there were clear congenital cytomegalovirus infection and mumps virus infection. The causes of the remaining 3 cases were unknown. Conclusion:Unilateral hearing loss in children is a common clinical diseasewith complex and diverse causes. Carefully analysis should be made to find out the causes and symptomatic treatment to provide a basis for early prevention and intervention of children's hearing.

Turnaround time for common clinical chemistry examinations and root cause analysis for its delay

Objectives: Measurement of turnaround time for common clinical chemistry examinations and performing root cause analysis for causes for inadequate turnaround time for examinations. Materials and Methods: The Turnaround Times (TAT) of common biochemistry tests ordered by physicians for OPD, IPD and ICU patients were evaluated. Various time periods were recorded, calculated and evaluated. Root cause analysis for delay in TAT was performed by Ishikawa fishbone method. Results and Conclusions: The study shows that average TAT for OPD patients was 22-23 hours, for indoor patient was 6-7 hours and for ICU patient was 7-8 hours. There was major contribution of report transport system in the total TAT, while actual analytical TAT contributed very small to over all TAT. The study shows that, lack of efficient sample and report transport, lack of man power and lack of electronic transport of report is root cause of delay in TAT. Keywords: Turnaround time, Root cause analysis, Ishikawa fishbone method.

The mechanism and treatment of nasal obstruction in allergic rhinitis

SummaryNasal obstruction is one of the main symptoms of allergic rhinitis（AR） as well as one of the most common complains in the otolaryngology department. Among the many causes of nasal congestion, such as inflammation and anatomy, the most common clinical cause is the nasal mucosal inflammatory response that caused by AR. The nasal congestion caused by AR can induce nighttime sleep disturbance and mental-psychological burden. Nasal congestion has a greater impact on children, which can directly affect growth and development due to affecting nighttime sleep, and may even affect maxillofacial development, which should be paid special attention by physicians. According to the particularity of AR nasal congestion, this review summarizes how to carry out clinical consultation, select specialist examination and objective examination methods, and develop the optimal treatment strategy.

Inhibition of PTEN activity aggravates cisplatin-induced acute kidney injury.

Cisplatin (cis-Diamminedichloroplatinum II) has been widely and effectively used in chemotherapy against tumors. Nephrotoxicity due to cisplatin is one of the most common clinical causes of acute kidney injury (AKI), which has a poor prognosis and high mortality. The signaling mechanisms underlying cisplatin-induced AKI are not completely understood. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a tumor suppressor that negatively regulates the cell-survival pathway and is considered a double-edged sword in organ damage. In this study, we examined the effect that inhibiting PTEN activity in experimental models of cisplatin-induced AKI had on the degrees of AKI. Compared with vehicle mice, mice treated with bpV(pic) (specific inhibitor of PTEN) had exacerbated renal damage due to cisplatin-induced AKI. Furthermore, inhibition of PTEN activity increased cell apoptosis in the kidneys of mice induced by cisplatin. More inflammatory cytokines were activated after cisplatin treatment in mice of the bpV(pic)-treated group compared with vehicle mice, and these inflammatory cytokines may be partially derived from bone marrow cells. In addition, inhibiting PTEN activity decreased the phosphorylation of p53 in the pathogenesis of cisplatin-induced AKI. In summary, our study has demonstrated that inhibiting PTEN activity aggravates cisplatin-induced AKI via apoptosis, inflammatory reaction, and p53 signaling pathway. These results indicated that PTEN may serve as a novel therapeutic target for cisplatin-induced AKI.

Injury to the male external genitalia: a comprehensive review.

While rare, trauma and injury to the male external genitalia can result in significant consequences regarding function, appearance, psychological effects, and overall quality of life. Due to the relative paucity of literature regarding male external genitalia injuries, few standardized protocols exist. This review aims to outline common clinical causes of male external genitalia injuries by both anatomic location and etiology. Initial stabilization, long-term reconstruction, and coverage options are discussed in detail. Outcomes of complex grafts have favorable success rates of 90-100% in the hands of experienced surgeons. Outcomes of penile, testicular trauma also have favorable outcomes when managed appropriately. Attempts at reconstruction after initial injury stabilization should be undertaken at high-volume centers where a multidisciplinary approach can be employed. This manuscript will be an excellent reference and source that can provide direction for evaluation and management of these complex presentations.

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOS_ICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOS_hosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOS_ICU = 10.6 days and that of LOS_hosp = 20.2 days). Key Messages: Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.

Upper Gastrointestinal Bleeding at a Public Referal Hospital in Malawi

Background: Upper gastrointestinal bleeding (UGIB) is a medical emergency. Timely and appropriate treatment can be lifesaving. Where medical equipment and supplies are inadequate, management of upper gastrointestinal bleeding is challenging. Methods: A retrospective review of charts of patients who were admitted during the year 2010, with a diagnosis of Upper Gastrointestinal Bleeding (UGIB), was done at Kamuzu Central Hospital, Lilongwe, Malawi. A Rockall score was applied to determine mortality risk. Results: A total number of 187 records (119 men and 68 women, mean age of 40.7 ± 15.3 years) were reviewed. The mortality rate was 23.5%, with a non-significant gender difference. Bleeding oesophageal varices were the most common clinical cause of UGIB (42.8%), with more males (63.1%) than females affected. About 40% of patients had no cause of UGIB indicated in their records. 14 (7.5%) patients had a normal oesophagogastroduodenoscopy (OGD). Oesophageal tumor was present in 2.7% of the subjects as a cause of UGIB. Access to endoscopy, for diagnosis and therapeutic intervention, and surgery (Hassab procedure) was available to less than 50% of the patients. Sixteen patients (9.5%) had surgery after endoscopy due to lack of variceal banding materials. Conclusion: Upper gastrointestinal bleeding is an important and common clinical problem at Kamuzu Central Hospital. Oesophageal varices seem to be the commonest cause of UGIB. Inadequacy of resuscitation materials and perhaps timely diagnostic and therapeutic endoscopic and surgical interventions are important limiting factors to favourable patient outcome. Work towards regular provision and supply of interventional resources regarding UGIB management may improve patient outcome.