Common Finding Research Articles

A77 COMPLICATIONS OF DUODENAL DIVERTICULA: A SYSTEMATIC REVIEW ON CLINICAL PRESENTATION AND MANAGEMENT OF ENTEROLITH ILEUS SECONDARY TO DUODENAL DIVERTICULA FORMATION

Abstract Background Duodenal diverticula (DD) are relatively common findings in the gastrointestinal (GI) tract with their presence noted in up to 20% of the population. Rarely, however, these diverticula predispose to enterolith formation which can lead to small bowel obstruction, a phenomenon termed “enterolith ileus”. Both surgical and non-surgical approaches have been espoused in tackling this complication but definitive literature on optimal management is lacking and is limited to scattered case reports and case series. With this phenomenon carrying significant morbidity and mortality, we have conducted a comprehensive review of all available case reports to summarize our understanding of this condition. Aims To investigate the prevalance and clinical presentation of enterolith ileus secondary to duodenal diverticula and their optimal management whether that be medical or surgical. Methods A comprehensive search of PubMed, OVID, CINAHL, and Cochrane databases up to February 2023 was conducted to identify all studies reporting clinical information on enterolith formation in DD leading to small bowel obstruction. Each article was qualitatively assessed, and relevant data were extracted from selected studies to determine clinical courses and optimal management. Results Our literature review identified 17 case reports of enterolith ileus secondary to DD. The mean age of the patients was 72 years (SD 11.43), with 59% of them being female. Three patients had previously undergone Roux-en-Y gastric bypass, while one patient had undergone a distal gastrectomy. The most common symptoms reported were abdominal pain, nausea, and vomiting (88%), followed by abdominal distension (47%). Dilated bowel loops was the most common finding on X-rays, while CT scans revealed signs of small bowel obstruction and DD with an endoluminal mass in most of the cases. Upper GI series was performed in five cases, revealing multiple duodenal diverticula. Despite initial conservative management, 16 out of 17 patients eventually required surgical intervention. Enteroliths were extracted via enterotomy in 14 out of 17 cases, while surgical resection of the bowel was performed in three cases due to suspicion of tumor or perforation. Conclusions Our findings highlight the importance of prompt diagnosis and management of DD leading to enterolith ileus, particularly in elderly patients and those with a history of gastric surgery. Surgical intervention is almost always required and therefore early recognition and intervention can help minimize the risk of morbidity and mortality associated with this condition. Funding Agencies None

A103 A COMPREHENSIVE REVIEW OF ENTEROLITH ILEUS SECONDARY TO COMPLICATIONS OF ILEAL DIVERTICULA AND INVESTIGATIONS INTO OPTIMAL MANAGEMENT

Abstract Background Acquired ileal diverticula are rarely found in adults and are only apparent in 1.9% of small bowel contrast studies. Even more rarely, these diverticula can lead to enterolith formation which can obstruct the bowel, a term coined “enterolith ileus”. Both surgical and non-surgical approaches have been espoused in tackling this complication but definitive literature on optimal management is lacking and is limited to scattered case reports and case series. With this phenomenon carrying significant morbidity and mortality, we have conducted a comprehensive review of all available case reports to summarize our understanding of enterolith ileus secondary to ileal diverticula. Aims To understand the varying clinical presentations of enterolith ileus from ileal diverticula complications and understanding optimal management for the pathology. Methods A comprehensive search of PubMed, OVID, CINAHL, and Cochrane databases up to February 2023 was conducted to identify all studies reporting clinical information on enterolith formation in ileal diverticula leading to small bowel obstruction. Relevant data were extracted from selected studies to determine clinical courses and optimal management. Results Our literature review identified 61 case reports of enterolith ileus secondary to complications of ileal diverticula. The mean age of the patients was 51.64 years (SD 20.9), with 27% of them being female. The most common symptoms reported were abdominal pain (87%), nausea, and vomiting (51%), followed by constipation (18%) and melena (5%). Notably, localized abdominal tenderness was a common finding, observed in 74% of cases across 29 out of 34 studies reporting physical examination findings. Diagnostic investigations, including abdominal X-rays and CT scans, consistently revealed dilated bowel loops and signs of bowel obstruction. Surgical intervention was eventually required for almost all patients (97%), with diverticulectomy performed in 47%, enterectomy in 12%, and surgical resection of the bowel in 32% of cases respectively. These surgical interventions demonstrated high success rates, effectively resolving the condition in most cases. Complications, such as wound infection (2 cases), postoperative ileus (3 cases), anastomotic leak, and wound dehiscence (1 case each) were observed in a limited number of patients. Conclusions Our findings highlight the critical importance of prompt diagnosis and management of enterolith ileus secondary to complications of ileal diverticula. We recommend avoidance of initial conservative management as surgical intervention has proven almost always necessary and is highly successful in tackling this pathology. Early recognition and intervention can help minimize the risk of morbidity and mortality associated with this condition. Funding Agencies None

Expanding the phenotype of PPP1R21-related neurodevelopmental disorder.

PPP1R21 encodes for a conserved protein that is involved in endosomal maturation. Biallelic pathogenic variants in PPP1R21 have been associated with a syndromic neurodevelopmental disorder from studying 13 affected individuals. In this report, we present 11 additional individuals from nine unrelated families and their clinical, radiological, and molecular findings. We identified eight different variants in PPP1R21, of which six were novel variants. Global developmental delay and hypotonia are neurological features that were observed in all individuals. There is also a similar pattern of dysmorphic features with coarse faces as a gestalt observed in several individuals. Common findings in 75% of individuals with available brain imaging include delays in myelination, wavy outline of the bodies of the lateral ventricles, and slight prominence of the bodies of the lateral ventricles. PPP1R21-related neurodevelopmental disorder is associated with a consistent phenotype and should be considered in highly consanguineous individuals presenting with developmental delay/intellectual disability along with coarse facial features.

Sarcoidosis and skin manifestations

Sarcoidosis is a multisystemic inflammatory disease of unknown etiology, affecting all organs and systems. Skin involvement is seen in one-third of cases. Cutaneous findings alone do not determine the prognosis of sarcoidosis, but they are useful in early diagnosis. There are specific and nonspecific cutaneous findings. The most common cutaneous findings are papules and plaques. This review summarizes the cutaneous manifestations of sarcoidosis.

Prevalence of common and rare ophthalmic findings in adults attending a medical survey institute

PurposeTo examine the ophthalmic data from a large database of people attending a general medical survey institute, and to investigate ophthalmic findings of the eye and its adnexa, including differences in age and sex.MethodsRetrospective analysis including medical data of all consecutive individuals whose ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects examined at a single general medical survey institute.ResultsData were derived from 184,589 visits of 3676 patients (mean age 52 years, 68% males). The prevalence of the following eye pathologies were extracted. Eyelids: blepharitis (n = 4885, 13.3%), dermatochalasis (n = 4666, 12.7%), ptosis (n = 677, 1.8%), ectropion (n = 73, 0.2%), and xanthelasma (n = 160, 0.4%). Anterior segment: pinguecula (n = 3368, 9.2%), pterygium (n = 852, 2.3%), and cataract or pseudophakia (n = 9381, 27.1%). Cataract type (percentage of all phakic patients): nuclear sclerosis (n = 8908, 24.2%), posterior subcapsular (n = 846, 2.3%), and capsular anterior (n = 781, 2.1%). Pseudophakia was recorded for 697 patients (4.6%), and posterior subcapsular opacification for 229 (0.6%) patients. Optic nerve head (ONH): peripapillary atrophy (n = 4947, 13.5%), tilted disc (n = 3344, 9.1%), temporal slope (n = 410, 1.1%), ONH notch (n = 61, 0.2%), myelinated nerve fiber layer (n = 94, 0.3%), ONH drusen (n = 37, 0.1%), optic pit (n = 3, 0.0%), and ON coloboma (n = 4, 0.0%). Most pathologies were more common in males except for ONH, and most pathologies demonstrated a higher prevalence with increasing age.ConclusionsNormal ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects seen at a single medical survey institute.

Acute Cholecystitis Complicating Cardiac Disease: A Cohort Study From a Tertiary Care Center in Mexico City, Mexico.

Background Acute cholecystitis (AC) presents as inflammation of the gallbladder, predominantly attributed to gallstones obstructing the cystic duct. Another notable etiology is ischemic cholecystitis, often stemming from severe illnesses that compromise blood flow to the splanchnic system. Individuals with pre-existing cardiovascular conditions or undergoing cardiopulmonary surgery encounter elevated risks of gastrointestinal pathology, leading to heightened morbidity and mortality rates. In these cases, AC stands out as a significant concern, whether it originates from gallstones or is acalculous (ischemic). Methods We conducted a single-center, retrospective cohort study at the National Medical Center in Mexico City, Mexico. We included demographic, clinical, laboratory, preoperative, intraoperative, and postoperative data. Our main objectives were to describe the characteristics of our population and identify predictors of major complications following surgery for AC in patients with heart disease. Results Our study encompassed 18 patients diagnosed with both AC and cardiac disease, with acute myocardial infarction being the leading cause of admission, constituting 38.9% of cases. The clinical presentation was characterized by right hypochondrial pain, observed in all patients, while Murphy's sign was evident in 44.4% of cases. Additionally, various non-specific symptoms were present in varying percentages across the patient cohort. Concerning imaging studies, 88% of our cohort underwent ultrasound (USG), while computed tomography (CT) was utilized in 55% of patients. Among those who had USG, the most prevalent findings were gallbladder wall thickening in 56% and perivesicular fluid in 37.5%. In patients who underwent CT scans, the predominant observations included perivesicular fluid in 66% and perivesicular fat stranding in 55%. In terms of intraoperative findings, gallbladder empyema and necrosis were the most common findings identified in 55.6% of the cases. After surgery, 61.1% had no complications or developed mild complications, while 11.1% experienced moderate to severe complications without resulting in death; the mortality rate was 27.8% in our cohort. Overall, major complications or death were present in 38.9% of our cohort. In the postoperative data analysis, the use of mechanical ventilation and vasopressors showed a significant correlation with increased morbidity and mortality. Conclusions Our study contributes valuable information to the international literature, providing insights into the complications faced by the Mexican population in the context of heart diseases, particularly among patients suffering from cholecystitis. Within individuals with cardiac disease, the occurrence of AC requiring surgical intervention is associated with heightened morbidity and mortality rates, with our cohort experiencing rates as high as 38.9%. Consistent with findings in the international literature, these results underscore the critical importance of continuing the search for novel clinical or laboratory predictors for this high-risk population. While most parameters assessed in this study did not show any correlation with major complications, exceptions were observed in postoperative vasopressors and mechanical ventilation.

The Role of Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of the Adherent Placenta: An Observational Study.

Introduction Placenta accreta is an important factor responsible for maternal morbidity and mortality and is commonly associated with emergent postpartum hysterectomy. The precise prenatal diagnosis of affected pregnancies allows optimal obstetric management. Ultrasonography (USG) and magnetic resonance imaging (MRI) are the only diagnostic modalities available for the prenatal diagnosis of placenta accreta. Objective This study aims to evaluate the accuracy of USG and MRI in diagnosing adherent placenta. Methods Thirty females with placenta previa or a history of previous cesarean sections were evaluated with USG at 28-30 weeks, followed by MRI. The findings of USG and MRI were compared with the intra-operative findings (gold standard) as determined at surgery and by pathological examination. Results Abnormal bridging vessel (n = 24; 80%) was the most common finding seen on USG, whereas abnormal bulge (n = 22; 73.3%) and heterogenous placenta (n = 21; 70%) were the most common findings seen on MRI. The sensitivity of USG and MRI was in the range of 86.7%-92.9% and 92.9%-100%, respectively, in diagnosing three types of adherent placenta. The positive predictive values (PPV) of USG and MRI were in the range of 86.7%-86.7%and93.8%-100%, respectively, in diagnosing three types of adherent placenta. The accuracy of USG and MRI was in the range of 86.7%-96.7% and 96.7%-100%, respectively, in diagnosing three types of adherent placenta. Conclusion MRI helps to accurately classify placental invasion according to depth, as can be seen from the results of the present study, where the MRI technique was more accurate in diagnosing three types of adherent placenta.

Serum ferritin level is associated with liver fibrosis and incident liver-related outcomes independent of HFE genotype in the general population

Background & Aims Hyperferritinemia reflects iron accumulation in the body and has been associated with metabolic disturbances and alcohol use, and is also a common finding in individuals diagnosed with liver disease. The major genetic regulator of iron metabolism is the HFE gene. Methods The aim of this this study was to investigate the association between serum ferritin and liver fibrosis using the enhanced liver fibrosis (ELF) test, and the association between ferritin and liver-related outcomes in a Finnish population-based cohort of 6194 individuals (45% male, mean [± standard deviation] age, 52.9 ± 14.9 years; body mass index 26.9 ± 4.7 kg/m2). The effects of HFE variants on these associations were also evaluated. Results Serum ferritin levels were significantly associated with liver fibrosis, as estimated by enhanced liver fibrosis (ELF) test in weighted linear regression analysis. Serum ferritin was significantly associated with both all liver-related outcomes (n = 92) and severe liver-related outcomes (n = 54) in weighted Cox regression analysis (hazard ratio [HR] per 1 SD, 1.11 [95% confidence interval (CI) 1.02–1.21]; p = 0.012 and HR 1.11 [95% CI 1.02–1.21]; p = 0.013, respectively). However, there was association neither between HFE risk variants and ELF test nor between HFE risk variants and liver-related outcomes. Conclusion Serum ferritin levels were associated with liver fibrosis and incident liver disease, independent of HFE genotype in the general population. Furthermore, data demonstrated that metabolic disturbances and alcohol use were major risk factors for hyperferritinemia.

Epidemiological and clinical characteristics of open globe injuries in Southwest China.

Open globe injuries (OGIs) are one of the leading causes of monocular vision loss, and the clinical characteristics of OGIs are region specific. The features and patterns of OGIs in Southwest China are poorly known and not well studied. Our study aimed to review the epidemiological and clinical characteristics of patients hospitalized for OGIs in Southwest China. A retrospective study of OGI patients admitted to the West China Hospital from January 1st, 2015, to December 31st, 2019, was performed. Demographic characteristics and injury details were recorded. The Birmingham Eye Trauma Terminology system and the ocular trauma score (OTS) were used. A total of 3,014 patients were included. The male-to-female ratio was 5.2:1, and the mean age was 35.6 ± 19.1 years. 15.2% of patients were from the ethnic groups. The highest-risk occupation was the farmer (30.3%), followed by the worker (28.5%). OGIs occurred more frequently in people with middle (37.0%) and primary school (33.1%) education levels. Types of injuries included 46.8% penetration, 21.2% rupture, 2.9% perforation, and 29.1% intraocular foreign body (IOFB). The injuries types differed between age and occupation groups (p < 0.001). IOFBs had a higher risk of causing endophthalmitis, retinal detachment, and traumatic cataracts (p < 0.001). The most common injuries resulted from sharp objects (72.7%). The causes of the injuries were significantly associated with age, ethnicity, and occupation (p < 0.001). Explosion injuries and attacks by animals were more common among people of Tibetan and Yi ethnicities. Blunt trauma, vehicle crashes, falls and age older than 60 years were risk factors for a lack of light perception and lower OTS scores prognosis. OGIs in Southwest China mainly affected working-aged males, especially workers or farmers. Severe vision loss and IOFBs are more common findings. OGIs in older patients and ethnic minorities requires additional attention.

Morbidity and Prognostic Factors Associated with Wild Hedgehogs Admitted to a Wildlife Rehabilitation Center in Catalonia (NE Spain) from 1995 to 2020.

Wildlife rehabilitation centers (WRC) play a crucial role in the collection of data and the monitoring of hedgehog populations. The main objective of this study was to identify the morbidity and prognostic factors associated with the mortality of wild hedgehogs admitted at a WRC in Catalonia. A total number of 3397 hedgehogs admitted from 1995 to 2020 were studied. The principal cause of admission was orphaned/young category (41%) followed by misplacement (19%), natural disease (17%), and trauma (14%). The best outcomes for release were for misplacement (93.6%), orphaned/young (72.3%), and other causes (77.6%), and the lowest proportion of released animals were found for natural disease (41.4%) and trauma (44.7%) categories. The most common macroscopic findings were the respiratory and digestive lesions. Internal parasites were also prevalent in 61% of the animals but with no association with a higher mortality. In the multivariate analyses, the prognostic indicators related with the mortality outcome were the presence of systemic (OR = 3.6, CI 95%: 2.8-4.6) and neurological (OR = 4.3, CI 95%: 2.9-6.4) signs. Morbidity and prognostic factors in wildlife rehabilitation are essential for providing effective care, making informed decisions, optimizing resources, and improving rehabilitation success rates.

IDIOPATHIC (AUTOIMMUNE) THROMBOCYTOPENIC PURPURA: A CASE REPORT

This report aims to describe a school patient, from the city of Juazeiro da Bahia, diagnosed with idiopathic thrombocytopenic purpura (autoimmune) and diagnosed with thrombocytopenia that had been sustained for months. Initially, he was diagnosed with dengue and anemia. Although this report describes a patient's favorable evolution, the relevance of carrying out future studies to evaluate the effects of thrombocytopenic purpura is highlighted. In short, this study aims to reference the most common findings through scientific literature as well as signs of worsening.

Diagnostic Utility of Thoracic Radiography and Abdominal Ultrasonography in Canine Immune-Mediated Polyarthritis: 77 Cases.

Thoracic radiography and abdominal ultrasonography are part of standard diagnostic investigations in cases of canine immune-mediated polyarthritis (IMPA). However, the clinical importance of thoracic and abdominal imaging towards the management of canine IMPA currently remains unknown. The primary aim of this study was to describe the findings documented on thoracic radiography and abdominal ultrasonography in dogs diagnosed with IMPA, and to evaluate the diagnostic utility of thoracic radiography and abdominal ultrasonography in the initial approach and management of these cases. Seventy-seven dogs diagnosed with IMPA who underwent thoracic radiography and abdominal ultrasonography at a single referral hospital between 2008 and 2022 were included. The diagnostic imaging studies of these 77 dogs were reviewed by one blinded board-certified diagnostic imaging specialist for quality assurance. The medical records, including the diagnostic imaging reports of these dogs, were then reviewed by three blinded board-certified internal medicine specialists. Using a modified version of a previous question and scoring system, the three internal medicine specialists then generated an answer for the overall diagnostic utility and a diagnostic utility score for thoracic radiography and abdominal ultrasonography for each case. The abnormal findings identified in radiography and ultrasonography were described. In the cases where the findings were considered significant enough to immediately affect the case management, the results of the further investigations that were subsequently performed were also described. No abnormalities were detected in thoracic radiography for 30 cases, and none were detected in abdominal ultrasound for 6. The majority of the internists considered thoracic radiography to be not useful in the overall case management at the time of IMPA diagnosis in 70 cases, and considered abdominal ultrasonography to be not useful in the overall case management in 57 cases. The majority of the internists agreed on the utility of thoracic radiography in 95% of the cases, and in 61% of the cases for abdominal ultrasonography. The most common finding in the thoracic radiography was a mild bronchial pulmonary pattern, and the most common in the abdominal ultrasonography was mild lymphadenomegaly. Therefore, although thoracic radiography and abdominal ultrasonography identified numerous abnormal findings in this population of dogs, in the majority of the cases, the findings were deemed not useful towards the overall case management at the time of the initial diagnosis of IMPA. Thus, the use of thoracic radiography and abdominal ultrasonography should be taken into careful consideration when considering initial diagnostic investigations for canine IMPA.

Our 10-Year Experience with Atrial Myxomas: Is Concurrent Valve Intervention Really Warranted?

Primary cardiac myxomas are rare tumors. Concurrent valvular lesion is a common finding on evaluation which is thought to be due to annular dilatation secondary to tumor movement across the valve, functional obstruction across the valve, and severe pulmonary hypertension secondary to chronic obstruction. A common belief among surgeons is that excision of myxoma leads to abatement of symptoms, and further valve intervention may not be warranted. A 10-year retrospective descriptive study was designed to analyze patients who underwent excision of cardiac myxoma at our center. Data was analyzed regarding presenting features, echocardiographic findings of myxoma and valve morphology, intraoperative assessment, and postoperative outcome with/without valve repair/replacement in all patients. A total of 22 patients underwent surgery for myxoma. Six patients underwent successful mitral valve repair with ring annuloplasty, two had moderate mitral regurgitation, three had severe mitral regurgitation, and one patient had no mitral regurgitation on preoperative assessment, but moderate mitral regurgitation was found intraoperatively. Four of these patients had no residual mitral regurgitation in follow-up period while two had mild residual mitral regurgitation. One patient had severe mitral stenosis of concurrent rheumatic etiology and successfully underwent mitral valve replacement. Cardiac myxomas are rare benign tumors commonly associated with mitral valve insufficiency. Mitral valve should be assessed intraoperatively after excision of mass as preoperative assessment might often be insufficient. Concomitant mitral valve intervention might be needed with a case-specific tailored approach, and mitral valve repair with ring annuloplasty offers best surgical outcome in such cases.

Multiorgan Dysfunction and Associated Prognosis in Transthyretin Cardiac Amyloidosis.

Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive and ultimately fatal cardiomyopathy. Biomarkers reflecting multiorgan dysfunction are of increasing importance in patients with heart failure; however, their significance in ATTR-CA remains largely unknown. The aims of this study were to characterize the multifaceted nature of ATTR-CA using blood biomarkers and assess the association between blood biomarkers and prognosis. This is a retrospective cohort study of 2566 consecutive patients diagnosed with ATTR-CA between 2007 and 2023. Anemia (39%), high urea (52%), hyperbilirubinemia (18%), increased alkaline phosphatase (16%), increased CRP (C-reactive protein; 27%), and increased troponin (98.2%) were common findings in the overall population, whereas hyponatremia (6%) and hypoalbuminemia (2%) were less common. These abnormalities were most common in patients with p.(V142I) hereditary ATTR-CA, and became more prevalent as the severity of cardiac disease increased. Multivariable Cox regression analysis demonstrated that anemia (hazard ratio [HR], 1.19 [95% CI, 1.04-1.37]; P=0.01), high urea (HR, 1.23 [95% CI, 1.04-1.45]; P=0.01), hyperbilirubinemia (HR, 1.32 [95% CI, 1.13-1.57; P=0.001), increased alkaline phosphatase (HR, 1.20 [95% CI, 1.01-1.42; P=0.04), hyponatremia (HR, 1.65 [95% CI, 1.28-2.11]; P<0.001), and troponin-T >56 ng/L (HR, 1.72 [95% CI, 1.46-2.03]; P<0.001) were all independently associated with mortality in the overall population. The association between biomarkers and mortality varied across the spectrum of genotypes and left ventricular ejection fraction, with anemia remining independently associated with mortality in p.(V142I) hereditary ATTR-CA (HR, 1.58 [95% CI, 1.17-2.12]; P=0.003) and in a subgroup of the overall population with a left ventricular ejection fraction ≤40% (HR, 1.39 [95% CI, 1.08-1.81]; P=0.01). Cardiac and noncardiac biomarker abnormalities were common and reflect the complex and multifaceted nature of ATTR-CA, with a wide range of biomarkers remaining independently associated with mortality. Clinical trials are needed to investigate whether biomarker abnormalities represent modifiable risk factors that if specifically targeted could improve outcomes.

A Possible Case of Hypertensive Crisis With Aortic Dissection After an Anti-COVID-19 Vaccine.

Aortic dissection, a potentially fatal event, usually presents with acute intense chest or back pain. Painless aortic dissections constitute about 10% of all cases. High blood pressure is a common finding in both painless and painful aortic dissections. During the coronavirus disease (COVID-19) pandemic, various anti-COVID vaccines have been massively used. Although these vaccines are generally safe, there is a small risk of adverse effects which are mostly mild and transient, but sometimes they could be life-threatening. We report a case of painless aortic dissection that occurred within minutes of receiving the COVID-19 inactivated vaccine. A 65-year-old woman with chronic controlled systemic hypertension developed slurred speech, decreased level of consciousness, generalized weakness, and dyspnea without chest, back, or abdominal pain a few minutes after receiving the second dose of inactivated COVID-19 vaccine; she had a systolic blood pressure of 220mmHg and left-sided pleural effusion. Drainage of the pleural effusion revealed gross blood and a spiral chest and mediastinum CT with intravenous contrast showed a penetrating atherosclerotic ulcer in the descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was carried out, and the patient was discharged in satisfactory condition after 3days.

Risk Factors for Post-traumatic Epilepsy in Patients with Traumatic Brain Injuries

Background: Post-traumatic epilepsy (PTE) is one of the types of epilepsy, which is a complication of traumatic brain injury (TBI) that occurs after TBI or 7 days later. Objectives: The present study aimed to determine the risk factors for PTE in patients with TBI. Methods: The computed tomography (CT)-scan results of all TBI patients were investigated in this retrospective study. At first, initial evaluation, including the examination of airways, vital signs, and breathing, was performed, and the level of consciousness was checked according to the Glasgow Coma Scale (GCS) for all traumatic patients. Then, the results of all CT scans were evaluated by a neurologist. If the patient had PTE, she/he was included in the study. Data analysis was carried out using descriptive statistics in SPSS software (version 16). Results: The results showed that mild, moderate, and severe GCS scores were reported in 8 (14.3%), 30 (52.5%), and 18 (32.2%) participants, respectively. Vehicle accidents were the main cause of TBI (n = 34, 60%), and the lowest TBI rate was due to other cases (n = 4, 7.2%). The most and least frequent CT-scan finding was epidural hemorrhage (EH) (n = 24, 42.3%) and midline shift and intracerebral hemorrhage (n = 6, 10.8%), respectively. A total of 24 patients (42.3%) had tonic epilepsy, and 10 patients (17.9%) had epilepsy duration of more than 10 minutes. Conclusions: The most frequent risk factors included vehicles, falling from a height, and strikes, respectively. Additionally, the most common CT scan findings included EH and subarachnoid hemorrhage (SH). Motor vehicle accidents account for the highest rate of TBI-related PTE. For this reason, it is necessary to take preventive measures in this regard.

The clinical, dermoscopic, and histopathologic differentiation of cutaneous leishmaniasis from cutaneous sarcoidosis and tuberculosis: A review article

Leishmaniasis is a neglected tropical disease caused by infected female sandflies (Phlebotomus and Lutzomyia), which are vector-borne protozoan parasites belonging to the genus Leishmania. The diagnosis of cutaneous leishmaniasis (CL) can be challenging and delayed, particularly in areas where leishmaniasis is not endemic. CL is known as “the great imitator” because it can mimic many skin disorders due to its various clinical manifestations. Cutaneous sarcoidosis (CS) and cutaneous tuberculosis (CTB), which are also known as “the great imitators,” should be differentiated from CL due to the common clinical, dermoscopic, and histopathologic features. In this article, we aim to help clinicians differentiate CL by listing its clinical manifestations those are similar to CS and CTB and highlighting common and uncommon dermoscopic and histopathologic findings. We have also created a brief approach to diagnose CL, CS, and CTB, which is presented as a diagram. A search was performed on PubMed and Google Scholar using the keywords CL, CTB, CS, and granulomatous disease for all articles, with no restrictions. Updated articles on leishmaniasis, tuberculosis, and sarcoidosis, including some new concepts in clinical presentations, dermoscopy, and histopathology, were reviewed.

Colonic diverticulosis as an isolated colonoscopy finding for iFOBT-positive patients

Colonic diverticular disease is a common medical condition throughout the world. It is one of the most common findings during the endoscopic evaluation of the colon, such as colonoscopy. A retrospective cohort single-centre study was carried out for all patients referred for colonoscopy with positive immunochemical faecal occult blood test (iFOBT) results in 2016-2018, mostly within The National Bower Cancer Screening Program (NBCSP) in QLD, Australia. The cohort of 319 patients were isolated from all iFOBT-positive individuals with such finding as a diverticular disease. Colonic diverticulosis affected the patients above 43 years old with positive iFOBT, more males than females in this study. In most cases, colonoscopy consisted of benign findings, and diverticular disease was revealed in 47.7% of the patients with such indication for colonoscopy as positive iFOBT. 28.8% of the patients were diagnosed with colonic diverticulosis only. The sigmoid colon was affected by diverticulosis in 96.2% of the cases. Overall, the colorectal cancer (CRC) diagnosis rate of 2.7% for the patients in the positive FOBT cohort (Group A) is comparable with other studies. However, the diverticulosis group's CRC rate of 1.6% (Group B) was lower than in available published data.

Clinical and Sociodemographic Features of Alopecia Areata in Five Colombian Cities: An Analysis of the RENAAC Registry

BackgroundAlopecia areata (AA) is an autoimmune disease characterized by non-scaring hair loss and preservation of hair follicles. The information available on disease course, and clinical features of AA is scarce worldwide, and almost nonexistent in Colombia. ObjectiveTo determine the clinical and sociodemographic characteristics of patients diagnosed with AA who presented to a dermatology consultation in five Colombian cities. Material and methodsThis was a retrospective and multicenter study on data from an ongoing National Registry of Alopecia Areata in Colombia (RENAAC) collected in Bogota, Cali, Cartagena, Barranquilla, and Medellin, Colombia from March 2022 through April 2023. Data was recorded in a standardized form by trained physicians. The variables were expressed as measures of central tendency and dispersion, and absolute and relative frequencies. ResultsA total of 562 patients were included, 59.4% of whom were women, aged between 15 and 49 years (63.9%) with a mean disease course of 1.7 years. The most common finding was multiple plaque (53.2%), the predominant AA subtype was patchy (71.4%), and 29.5% of the patients had a past dermatological history, 18.3% had a past endocrinological history, and 8.9% had a past psychiatric history. The treatments most widely used were steroid injections (76.4%), 5% topical minoxidil (46.4%), followed by high-potency corticosteroids (42.5%). Study limitations and conclusionsAA was slightly predominant in women. As seen in other populations, this disease had an earlier onset in men vs women. Presentation in pediatric age was uncommon. The previous history of other dermatological diseases was checked in almost one third of the patients. Analysis of the co-presentation of AA with other autoimmune diseases is biased due to excluding patients with systemic erythematous lupus from the study.

Positional nystagmus is observed in the vast majority of healthy individuals.

Benign paroxysmal positional vertigo (BPPV) is a vestibular disease characterized by brief positional vertigo. When examined, characteristic patterns of positional nystagmus (PN) are found with specific head position changes. Previous studies have shown a high prevalence of PN among vestibular healthy subjects. Considering the current diagnostic criteria of BPPV and the potentially high prevalence of PN in healthy individuals, this raises the question of potential over diagnosing BPPV, if diagnostics are based exclusively upon objective findings. This study aims to determine the prevalence of PN within a healthy, adult population and furthermore include a characterization of the PN observed. This is a prospective cross-sectional study. 78 subjects were included. The subjects underwent four standardized positional tests for BPPV in a mechanical rotational chair while using a VNG-goggle to monitor and record eye movements. Positional nystagmus was recorded in 70.5% (55/78) of the subjects. Of the 55 subjects, who presented with PN, 81.8% (45/55) had upbeating PN.The 95th percentile of the maximum a-SPV was found to be 10.4 degrees per second, with a median of 4. Five subjects (6.4%) in total presented with PN mimicking BPPV. This study found PN to be a common finding within a healthy, adult population based on the high prevalence of PN in the study population. Upbeating PN mimicking posterior canalolithiasis was found in numerous subjects. The authors recommend a cautious approach when diagnosing BPPV, especially in cases of purely vertical PN (without a torsional component) and if no vertiginous symptoms are present during Dix-Hallpike and Supine Roll Test examinations.