Good General Condition Research Articles

The clinico-epidemiological, diagnostic, and therapeutic aspects of methadone poisoning: a registry-based clinical study.

Methadone is a long-acting synthetic agonist of opioid receptors, which is used as an analgesic and as an alternative treatment in opioid-dependent patients. Clinical manifestations of methadone poisoning include miotic pupils, low levels of consciousness (LOC), respiratory depression or apnea, and coma and death. Considering the high consumption of methadone in society and the prevalent instances of overdose and poisoning, whether accidental or intentional, the authors decided to investigate the clinico-epidemiological, diagnostic, and therapeutic characteristics of methadone poisoning in the Mazandaran province, northern Iran, from 2020 to 2022. This study was a retrospective and descriptive cross-sectional registry-based study, wherein data was collected from the Mazandaran Registry Center of Opioids Poisoning (MRCOP), on patients with methadone poisoning. Data based on various parameters such as individual characteristics, ingestion motivation, and clinical outcomes were collected in a checklist. Of the 385 patients, who entered the study, 264 were men and 121 were women. The mean age of the patients was 29.02 years. Two hundred forty-four patients had intentionally consumed methadone. The most common symptoms observed among individuals with methadone poisoning were decreased arterial blood oxygen (225 patients) and decreased LOC (173 patients). The length of hospitalization for most patients was less than 1 week. Except for seven of them who died, most of them were discharged in good general condition. The study identified sex, age, marital and employment status, and suicidal intent as the most significant factors influencing methadone poisoning, which should be considered in the design and implementation of public education and prevention programs.

Solitary fibrous tumor of the gallbladder: a case report

BackgroundPrimary solitary fibrous tumors (SFTs) of the gallbladder are rare. Here, we report the case of a patient who underwent surgical treatment for a primary SFT originating in the gallbladder.Case presentationA 48-mm gallbladder tumor was detected in a 70-year-old man using abdominal ultrasonography at a primary hospital, and he was subsequently referred to our department. A 50-mm enhanced tumor in the gallbladder was identified using computed tomography. Magnetic resonance imaging revealed a smooth-marginated tumor with hyperintensity on T2-weighted imaging. 18F-Fluorodeoxyglucose positron emission tomography confirmed high-level fluorodeoxyglucose uptake in the gallbladder tumor in the early phase without increasing uptake in the later phase. Surgical resection was planned to evaluate the tumor diagnosis. Initially, we performed open cholecystectomy with wedge resection of the gallbladder bed. Intraoperative pathological examination suggested gallbladder cancer; therefore, we performed radical surgery, including resection of the common bile duct, extended radical lymphadenectomy, and choledochojejunostomy. Ultimately, the final pathological examination revealed an SFT originating from the gallbladder with a negative surgical margin. Postoperatively, the patient developed bile leakage that was treated with tube drainage. The patient recovered satisfactorily and was discharged on postoperative day 20. At 24 months postoperatively, the patient was in good general condition without recurrence.ConclusionsWe report a rare case of a primary SFT originating in the gallbladder. Clinicians should be aware that SFT can be found in the gallbladder, and when it is difficult to make a preoperative diagnosis, surgical treatment should be considered.

Cytologic features of gastric-type endocervical adenocarcinoma: Three cases report and literature review.

Cervical gastric-type adenocarcinoma shows gastric differentiation, and the tumor cell morphology appears benign and unrelated to human papillomavirus, which makes cervical gastric-type adenocarcinoma highly susceptible to misdiagnosis as normal glandular epithelium in cytologic diagnosis. We present 3 cases of gastric-type adenocarcinoma, with the first being a 57-year-old female with abnormal uterine bleeding and fluid drainage. The second patient was a 63-year-old female, and the third was a 59-year-old female with irregular vaginal bleeding after menopause. The 3 patients were diagnosed with cervical gastric-type adenocarcinoma by combining their history, clinical data, cytopathology, histopathology, and immunohistochemistry. Patient 1 underwent total hysterectomy and adnexectomy, but refused radiotherapy and chemotherapy. Patient 2 received a chemotherapeutic regimen, and patient 3 was treated with traditional Chinese medicine. Patient 1 was followed-up for 9 months and is currently in good general condition, while patients 2 and 3 were not followed-up. The "drunken honeycomb" cell arrangement is diagnostically important in liquid-based cytology, especially when three-dimensional spheroids are present, and may be a characteristic cytological finding of well-differentiated cervical gastric-type adenocarcinoma.

Initial Clinical and Cone-Beam Computed Tomography (CBCT) Outcomes of Enamel Matrix Derivative-Based Regenerative Therapy in Vertical Bone Defects.

Background and objective Enamel matrix derivatives (EMD) arebiomaterials extracted from porcine dental germs. They consistof amelogenins (90%), ameloblastine, enamelin, and amelotin. New evidence has shown that all these proteins can be absorbed onto hydroxyapatite crystals and collagen fibers on the root surface of teeth and initiate regeneration of root cementum as well as stimulate periodontal cell proliferation. Currently, the most preferred method of periodontal regenerative therapy in clinical dental practice involves EMD, thanks to its facilitated surgical protocol and the many postoperative complications associated with guided tissue regeneration. There is scarce dataregarding when the first and earliest signs of healing occur after the application of this method. Hence, this study focused on the evaluation and analysis of clinical outcomes and cone-beam CT (CBCT) results at sixmonths after the application of the EMD technique. It aimed to evaluate the efficacy of regenerative therapy with EMDin vertical bone defects six months post-surgical intervention. Material and methods The study was conducted between August 2022 and July 2023 in the Faculty of Dental Medicine, the Medical University - Varna, using the University Medical-Dental Center as a base. The study included 12 cases characterized by bilateral, trilateral, or a combination of the mentioned vertical bone defects. The participants were aged between 31 and 57 years, of both genders, with satisfactory personal oral hygiene. They were in good general condition with no established systemic diseases and gave prior written informed consent. Between the sixth and eighth weeks after the hygiene phase was completed, the patients were re-evaluated, a new periodontal status was recorded, and a CBCT examination was ordered. Three clinical (probing pocket depth, gingival margin level, andclinical attachment level) and three radiographic parameters (A, B, and C) were evaluated in areas of vertical bone defect. Six months after the regenerative therapy using EMD, the same parameters were again recorded in all patients. Finally, after statistical processing of the results, an analysis of the data was performed regarding the early effectiveness of EMD application in regenerative therapy of vertical bone defects. Results The clinical results observed at the six-month mark following regenerative therapy using EMDin vertical bone defects indicated an average reduction in probing depth of 4.50 mm, an average apical migration of the gingival margin by 0.5 mm, and an average clinical attachment level of 4.00 mm. Bone filling was noted on the CBCT, corroborated by the following parameters: A - an average decrease of 1.51 mm; B - an average decrease of 0.50 mm; and C - an average decrease of 0.24 mm. Conclusions The results of our study confirm the remarkable effectiveness of EMD as a regenerative biomaterial. Furthermore, both clinical and CBCT studies demonstrated a very good healing process at an extremely early stage after the surgical intervention.

TRANSPOSIÇÃO LATERAL E DISTAL DA TUBEROSIDADE TIBIAL NO TRATAMENTO DA LUXAÇÃO MEDIAL DE PATELA GRAU II ASSOCIADA À PATELA ALTA EM CÃO – RELATO DE CASO

The objective was to report the diagnosis and treatment of a mixed breed dog, 3 years old, with high patella and grade II medial patellar dislocation in the right pelvic limb. The patient was seen complaining of lameness in the affected limb and, after orthopedic examination, a grade II medial dislocation of the patella was diagnosed, possibly associated with patella alta. Patellar chondropathy and osteoarthrosis were also suggested due to the presence of crepitus in the joint on examination. Radiographs confirmed the diagnosis and enabled surgical planning. Surgery included trochleoplasty, medial desmotomy, lateral imbrication, lateral and distal transposition of the tibial tuberosity and tenotomy of the rectus femoris muscle. Two weeks after the procedure, there was an improvement in patellar stability and locomotion, with slight residual lameness. Upon return after 30 days, no lameness, patellar dislocation and joint pain were observed. One year after the procedure, a virtual reassessment was carried out with videos sent by the tutor, demonstrating the absence of lameness and the patient's good general condition. It is concluded that the recommended surgical treatment was effective in correcting patellar dislocation and patella alta, resulting in an improvement in the patient's quality of life due to the good clinical results presented.

Pregnancy-associated triple-negative breast cancer: A case report and literature review.

The incidence of pregnancy-associated breast cancer (PABC) is relatively low, but it has been increasing in recent years. The onset of PABC causes serious harm to the fetus and the mother due to the unique physiological characteristics of pregnancy, which poses a particular challenge to clinicians. This article reports a case of pregnancy-associated triple-negative breast cancer and describes the patient characteristics and systematic treatment of this type of breast cancer. A 33-year-old woman was admitted to hospital with a left breast mass that had appeared more than a year earlier. She was a second-time pregnant woman with a single live intrauterine fetus at 23 + 4 weeks of gestation. During the examination of the left breast, a 6 by 8 cm sized mass can be observed on the upper outer quadrant. Pregnancy-associated triple-negative breast cancer. The patient underwent a breast ultrasound which showed a left breast mass and the diagnosis was confirmed by a puncture biopsy of the left breast mass. The pregnancy was terminated after multidisciplinary discussion, taking into account the wishes of the patient and her family. After termination of the pregnancy, all treatments were given according to the standard triple-negative breast cancer (TNBC) treatment protocol. The patient was treated with neoadjuvant chemotherapy with epirubicin in combination with docetaxel (TE) in cycles of 21 days. After 3 cycles of TE, a modified radical mastectomy for left breast cancer was performed, and the appropriate radiotherapy and chemotherapy treatments were carried out in sequence. After the surgery, the disease-free survival for the patient was 3 months until local metastases were diagnosed. Thus the radiotherapy and chemotherapy were carried out, and then the patient was in good general condition with no recurrence or metastases. Clinicians need more research into the diagnosis, treatment and prognosis of PABC. Improving the rate of early diagnosis and using standardized and individualized comprehensive treatment plans will minimize fetal damage and improve survival and quality of life for patients.

Transfusion-related acute lung injury (TRALI) following intravenous immunoglobulin infusion in a rituximab immunosuppressed patient with long-shedding SARS-CoV-2

BackgroundTransfusion-related acute lung injury (TRALI) is a rare life-threatening complication of blood product transfusion. Intravenous immunoglobulin (IVIG)-related TRALI is scarcely reported.Case presentationA 63-year-old male patient suffering from multiple sclerosis treated with half-yearly rituximab infusions, was hospitalized due to dry cough, daily fever and shivering for seven days despite antibiotic therapy. Because of the history of COVID-19 one month prior without the symptoms having improved since, persistent bilateral multifocal areas of ground glass opacities in chest computed tomography and positive SARS-CoV-2 PCR from bronchoalveolar lavage with a cycling time of 30.1 COVID-19 due to long-shedding SARS-CoV-2 under immunosuppression with rituximab was diagnosed. He received treatment with nirmatrelvir und ritonavir and because of diagnosed IgG deficiency additionally a single dose of 20 g IVIG. During the IVIG infusion, the patient acutely developed tachycardia, hypotension, fever, chills, and hypoxemic respiratory failure due to pulmonary edema. TRALI was promptly diagnosed, and the patient was transferred to the intensive care unit for non-invasive ventilation for less than 24 h. The patient was discharged home from regular ward 72 h later in a good general condition and no remaining symptoms of TRALI.ConclusionIVIG-related TRALI is a rare but life-threating condition and prompt recognition is lifesaving. Due to an increased use of IVIG not only in long-shedding SARS-CoV-2, an increase of TRALI incidence is expected.

A retrospective evaluation of therapeutic efficacy and safety of chemoradiotherapy in older patients (aged ≥ 75 years) with limited-disease small cell lung cancer: insights from two institutions and review of the literature.

The standard treatment for patients in good general condition with limited-disease small cell lung cancer (LD-SCLC) is concurrent platinum/etoposide chemotherapy and thoracic radiotherapy (TRT). However, the efficacy and safety of chemoradiotherapy (CRT) in older patients with LD-SCLC has not been fully explored; moreover, the optimal treatment for this patient group remains unclear. This study aimed to investigate the feasibility and efficacy of CRT in older patients with LD-SCLC. From April 2007 to June 2021, consecutive older patients (aged ≥ 75 years) with stage I to III SCLC who received concurrent or sequential CRT at two institutions were retrospectively evaluated for efficacy and toxicity of CRT. A total of 32 older patients underwent concurrent (n = 19) or sequential (n = 13) CRT for LD-SCLC. The median ages of the patients in the concurrent and sequential CRT groups were 77 (range: 75-81) years and 79 (range: 76-92) years, respectively. The median number of chemotherapeutic treatment cycles was four (range, 1-5), and the response rate was 96.9% in all patients (94.7% in concurrent and 100% in sequential CRT groups). The median progression-free survival (PFS) and median overall survival (OS) for all patients were 11.9 and 21.1 months, respectively. The median PFS was 13.0 and 9.0 months in the concurrent CRT and sequential CRT groups, respectively, with no statistically significant difference (p = 0.67). The median OS from the initiation of CRT was 19.2 and 23.5 months in the concurrent and sequential CRT groups, respectively (p = 0.46). The frequencies of Grade ≥ 3 hematological adverse events were as follows: decreased white blood cell count, 20/32 (62.5%); decreased neutrophil count, 23/32 (71.9%); anemia, 6/32 (18.8%); decreased platelet count, 7/32 (21.9%); and febrile neutropenia, 3/32 (9.4%). Treatment-related deaths occurred in one patient from each group. Although hematological toxicities, particularly reduced neutrophil count, were severe, CRT showed favorable efficacy in both concurrent and sequential CRT groups. However, concurrent CRT may not be feasible for all older patients with LD-SCLC; accordingly, sequential CRT may be considered as a treatment of choice for these patients. Further prospective trials are warranted to identify optimal treatment strategies for this patient group.

Management of Ellis Class II Fracture in Young Permanent Maxillary Central Incisor

Background: Tooth fracture is a condition of missing or lost fragments of a complete tooth. Tooth fracture usually occurs simultaneously with another oral injury. Objective: This case report discussed the management of Ellis class II fractures on an immature permanent central incisor of a patient who reported to Jenderal Achmad Yani University (Unjani) Dental Hospital. Case: An 11-year-old girl revealed a broken upper left tooth, sensitive to cold drinks that interfered with her appearance one year ago. The patient had a good general condition, no abnormalities during an extraoral examination, and a history of pain on the lower back tooth since a year ago. Case Management: Management of Ellis class II fracture in young permanent central incisor was conducted by using a class IV composite resin restoration. Conclusion: The management of Ellis class II fracture should be conducted holistically and systematically with subjective, intraoral, extraoral, and adjunctive examinations which should be performed correctly and considering the child’s psychology.

Acuut hemorragisch oedeem van de kinderleeftijd bij een 9 maanden oude jongen

Acute hemorrhagic edema of infancy in a 9-month-old boy This case report discusses the medical history of a 9-month-old boy with acute hemorrhagic edema of infancy (AHEI). AHEI is an acute cutaneous vasculitis that typically occurs in young children aged 4 to 24 months. Its clinical presentation is characterized by a low-graded fever, non-pitting edema and pronounced purpura. The contrast between the unsettling rash and swelling, and the children’s good general condition is a hallmark of AHEI. It is a benign, self-limiting disease in which complications are rare. As a pediatrician, it is important to recognize AHEI to avoid unnecessary investigations and therapy. In addition, it is crucial to rule out other serious illnesses and to be aware of potentially severe complications.

Determining the health status of natural monument trees using acoustic tomography method

Areas with natural beauty and rich biodiversity have had a different significance for people since ancient times. With the latest developments in industry, technology, and urbanization, the demand for natural areas has increased considerably. Accordingly, the need to protect such private areas has become even more significant. In order to protect areas with such natural characteristics effectively, problems and threat factors must be correctly revealed. For this purpose; a study was conducted to determine the health status of some trees, which are natural monuments in the Eastern Black Sea Region of Türkiye, using the acoustic tomography method. The general appearance of six trees in the study area was examined, and measurements were made with the Arbor Sonic 3D Acoustic Tomography device. In the research, it was found that the trunk of one of the natural monument trees was hollow. The other five trees were found to be in good general condition. According to the results of the tomography, it was determined that one of the six trees measured was in good health, three of them had partial hollows and decay, and two of them were completely hollow. According to the data obtained, it has been revealed that the acoustic tomography method is an effective tool in determining the health status of nature monument trees.

This is a successful removal of more than 450 pieces of metal objects from a patient’s stomach: a case report

BackgroundIngestion of foreign bodies may be seen unconsciously or intentionally in patients with mental health problems. Most cases pass through the esophagus slowly; however, in some cases, the tumor may be located in narrower areas of the digestive tract that require endoscopic or surgical intervention. This study describes a rare case of successful removal of more than 450 pieces of metal objects from the stomach of a 36-year-old man via ingestion of foreign bodies at Imam Khomeini Hospital in Ahvaz.Case presentationA 36-year-old male patient (Aryan race) presented with complaints of chronic abdominal pain, frequent vomiting, and intolerance to liquids and food. The patient’s companions mentioned a history of gradual ingestion of small metal objects 3 months prior. The patient was conscious and had stable vital signs. In the patient’s X-ray and endoscopy, multiple metal objects inside the patient’s stomach were observed, causing gastric outlet obstruction. The patient underwent gastrostomy surgery, and 452 screws, nuts, keys, stones, and other metal parts weighing 2900 g were removed from the stomach. Five days after the operation, the patient was transferred to the psychiatric service in good general condition and was diagnosed with psychosis, and her condition returned to normal at follow-up.ConclusionSuccessful removal of this foreign body is rare. In chronic abdominal pain, especially in the context of psychiatric disorders, attention should be given to the ingestion of foreign bodies. In swallowing large amounts of sharp and metallic foreign objects, surgical intervention is necessary, especially in cases of obstruction, and saves the patient’s life.

Pleomorphic adenoma in an adolescent, about a clinical case

Introduction: salivary gland tumors in children represent a low percentage of pediatric head and neck tumors; most of them are diagnosed in association with the Parotid salivary gland and present a higher proportion of malignancy than in adults. Objective: to present a case with a diagnosis of Pleomorphic Adenoma: clinical symptoms, complementary examinations, treatment and evolution. Case presentation: female patient, 13 years old, from a rural background and white race, attended the Maxillofacial Surgery consultation, in good general condition, accompanied by her parents, due to an increase in volume of a hard consistency, not fixed to deep planes ( mobile), asymptomatic, of 7 months of evolution and 3 cm in length located in the left parotid region. Ultrasound of soft tissues and neck was indicated, as well as contrast-enhanced facial mass tomography, which showed a mass in relation to the left parotid gland that captured contrast. In addition, complementary examinations and a fine needle aspiration biopsy (FNAB) were performed, resulting in a benign parotid gland tumor (Pleomorphic Adenoma). Superficial parotidectomy was performed with preservation of the facial nerve. The patient progressed satisfactorily and continues to be followed up by consultation. Conclusions: pleomorphic adenomas are discovered in practice as slowly growing asymptomatic masses; the size is variable and will always depend on the stage at which it is detected.

A 5-Year Clinical Experience of Pediatric Ophthalmic Ambulatory Surgery Under General Anesthesia From a Chinese Tertiary Children's Hospital

PurposeAmbulatory surgery (same-day or day surgery) is an efficient medical practice. However, there were few reports regarding the safety of ophthalmic ambulatory surgery for children under general anesthesia. This study aims to explore its clinical complications. DesignA retrospective observational study. MethodsThe clinical data of pediatric patients who received ambulatory ophthalmic surgery under general anesthesia at the Children’s Hospital of Fudan University from January 2015 to December 2019 were analyzed retrospectively. Postoperative complications, unplanned reoperation, delayed discharge, and other adverse events were analyzed. FindingsConsecutive patients (N = 4,616) had an average age of 4.6 ± 2.6 years. The primary surgical procedures included chalazion incision and curettage (62.89%), strabismus surgery (18.98%), trichiasis surgery (14.36%), eyelid or orbital mass resection (2.49%), blepharoptosis surgery (0.91%), and other procedures (0.37%). The average operative time was 25.28 ± 20.45 minutes (n = 2,698), while the average length of hospital stay was 8.45 ± 2.61 hours. No serious adverse events or death happened. One case had delayed postoperative hemorrhage, one had a postoperative infection, and two had delayed discharge. The rate of unplanned reoperation was 0.39% 90 days after surgery, with recurrence of chalazion and postoperative complications of ptosis as the primary reasons. ConclusionsPediatric ophthalmic ambulatory surgery under general anesthesia is a feasible and efficient operation mode with few complications for simple procedures with good general conditions. Further randomized controlled studies are needed to provide strong evidence of the safety and socioeconomic efficacy of this mode.

Butyricimonas faecihominis: an atypically resistant bacterium implicated in abscess formation - a case report

BackgroundThis case report presents a unique instance of abscesses with an uncommon pathogen isolated from blood cultures.Case presentationWe present the case of a perianal abscess in a 50-year-old man with a history of cocaine abuse and bilateral hip replacements. The rapid progression led to septic shock and multi-organ failure, requiring intensive care unit admission, surgery including protective transversostomy. Blood cultures showed growth of Butyricimonas spp. with resistance to penicillin and piperacillin-tazobactam. The immediate switch to meropenem led to a significant improvement in the patient’s condition. The patient was discharged after 40 days of hospitalization in good general condition and the reversal of the transversostomy was performed six months later.ConclusionThe identification of Butyricimonas faecihominis, a rarely reported pathogen, emphasizes the challenges of diagnosing and treating unusual infections. This case emphasizes the importance of rapid microbiological diagnosis, interdisciplinary collaboration, and targeted antibiotic therapy in the treatment of abscesses and sepsis.

Unicentric Mesenteric Castleman Disease in an Adolescent: A Case Report

Introduction: Castleman's disease is a rare nonclonal lymphoproliferative disorder of unknown etiology that most commonly affects the mediastinum. It is classified into two clinical subtypes: A localized (unicentric) subtype and a multifocal (multicentric) subtype. This case report presents an adolescent with unicentric mesenteric Castleman's disease, which is very rare. Case Presentation: A 14-year-old girl presented to our center with chronic left flank pain. She also reported frequent episodes of small-volume vaginal bleeding outside her menstrual period. Initially, she was treated for several weeks with a possible diagnosis of dysmenorrhea due to an ovarian cyst. However, due to the lack of response to treatment and persistent symptoms, further investigation was conducted. Abdominal and pelvic ultrasonography revealed a round, hypoechoic, and heterogeneous mass measuring 22 × 35 mm in the left mesentery with regular margins. Pathological examination confirmed Castleman's disease of the hyaline-vascular type. The patient was discharged in good general condition and with stable vital signs. During follow-up, her abdominal symptoms and bleeding resolved, and no lesions were detected on ultrasonography and CT scans at 6 and 12 months. Conclusions: Mesenteric Castleman's disease is rare and presents a diagnostic challenge. This disease should be included in the differential diagnosis of abdominal tumors, even in symptomatic cases. The treatment of choice for unicentric cases is surgery.

Management of Severe Odontogenic Infection: Case Report

Introduction: Submandibular abscess caused by odontogenic infection is a frequent case, but in some cases it can be deadly because it spreads and blocks the respiratory tract. The purpose of this study is to described a case of fatal submandibular abscess with early management effective. Case report: A 46 years old male patient with complaints of left submandibular, submental, left buccal and left temporal swelling. History of systemic disease was denied. Patients complain of tightness and changes in voice. Therapeutic intervention consists of Covid- 19 screening, complete blood lab, abscess decompression under local anesthesia, left submandibular and submental through and through drainage incisions, drainage incisions in the buccal area as well as multiple tooth extractions and penrose drain applications both extra oral and intra oral carried out in general narcotics, and swab culture sensitivity and antibacterial resistance tests were carried out. The antibiotics given were ceftriaxone and metronidazole. The patient was followed up and showed good general condition and decreased swelling. Conclusion: Odontogenic infections that spread and block the respiratory tract can be deadly. The abscess can expand even more quickly during preparation for surgery. Decompression of an abscess can be an effective treatment so that the abscess does not spread further and can reduce the risks of the operation being carried out. The management carried out must be complete and comprehensive, in this case a drainage incision and extraction of the focal infection are carried out. Initially, broad spectrum antibiotics can be given, but if the results of the antibacterial resistance test are obtained, it is very important to give more specific antibiotics. Submandibular abscess with poor prognostic consequences obstructed respiratory tract must be treated immediately and closely monitored. Keywords: Abscess, Odontogenic infection, Decompression

Coagulopathies Related to COVID-19 Infection in Pregnant Woman: A Case Report

Introduction: COVID-19 infection in pregnant women can increase the risk of complications, particularly coagulation disorders and mortality. Case Presentation: We reported a case of a 32-year-old pregnant woman infected with COVID-19. One day after admission for COVID-19 treatment, she underwent a cesarean section (C/S). About 30 hours after the C/S, the patient's hemoglobin levels dramatically dropped. An emergency ultrasound revealed abundant free fluid in the abdomen. Based on the ultrasound findings, the patient underwent a diagnostic laparotomy. During the laparotomy, two liters of blood with clots were found in the abdomen, but the source of the bleeding was inconclusive. Following the laparotomy, the patient was transferred to the intensive care unit (ICU) and received necessary blood products such as packed cells, antihemophilic factor, and fresh frozen plasma (FFP). After five days, the patient was discharged in good general condition. Conclusions: Early diagnosis of bleeding, prompt and skilled interventions, and careful monitoring of recently operated pregnant women with COVID-19 reduce the risk of hemorrhagic shock, maternal complications, and mortality.

Clinical Study and Microbiological Analysis of Periodontopathogenic Microflora Analyzed among Children and Adolescents with Cardiovascular Diseases Compared to Group with Good General Status.

Periodontal diseases, as an important part of oral pathology, present different characteristics when affecting children and adolescents or young adults. Studies have shown that adolescence and childhood are closely related to a high risk of periodontal disease, but the follow-up for periodontal health or damage at this age has been insufficiently appreciated until now. The aim of this study was to identify subgingival microorganisms using a real-time polymerase chain reaction (PCR) in a group of children and adolescents aged 7-17 years with and without cardiovascular disease. The group of 62 subjects with gingival inflammation and poor hygiene was divided into two groups according to general condition: 31 subjects with carduivascular disease (group A) and 31 subjects without cardiovascular disease (group C). Subjects were examined in the initial consultation, the state of hygiene and periodontal inflammation was assessed using the plaque index (PI) and gingival index (GI), and samples were taken from the gingival sulcus using sterile paper cones to determine nine subgingival microorganisms. Nine subgingival microorganisms were identified: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythias (Tf), Prevotella intermedia (Pi), Peptostreptococcus (Micromonas) micros (Pm), Fusobacterium nucleatum (Fn), Eubacterium nodatum (En), and Capnocytophaga gingivalis (Cg). The patients were included in a specialist treatment program which aimed to relieve the inflammatory condition, remove local irritative factors, and train the patients to perform proper oral hygiene at home by using primary and secondary oral hygiene products. Subjects were reevaluated 3 months after treatment, when measurements for the PI and GI and microbiological determinations were repeated. The results showed a predominance of subjects aged 16-17 years (12.4%). Among the subjects with marked gingival inflammation, the male gender was predominant (58.06%). The PI values changed considerably after treatment, with lower values in patients presenting a general condition without cardiovascular disease (PI = 8.10%) compared with the patients with cardiovascular disease (PI = 13.77%). After treatment, the GI showed considerable changes in both groups. Red, orange, and purple complex microorganisms were found before treatment and decreased considerably after treatment in both groups. The highest values were found for Treponema denticola (140,000 (1.4 × 105)) in patients with cardiovascular disease and generalized gingival inflammation. Of the pathogenic microorganisms, the most common was Tannerella forsythia in 52 patients before treatment, and red microorganisms considerably appeared in only 10 patients after treatment. Capnocytophaga gingivalis remained constant both in the diseased state and after treatment and was consistent with periodontal health. Children with cardiovascular diseases had a higher prevalence of gingival manifestations. The composition of the subgingival microbial plaque was directly influenced by the degree of oral hygiene, but the response to specialized treatment was also influenced by the general health status. The results of this study support the conclusion that periodontal pathogens appear and multiply in the absence of proper hygiene in childhood after the eruption of permanent teeth, and their action leads to the initiation of periodontal diseases.

Neutrophil Oxidative Burst Profile Is Related to a Satisfactory Response to Itraconazole and Clinical Cure in Feline Sporotrichosis.

Despite the central role of cats in the transmission and amplification of Sporothrix, studies regarding immune response in feline sporotrichosis are scarce. In cats with sporotrichosis, neutrophil-rich lesions are usually associated to good general condition and lower fungal burden. However, the role of neutrophils in anti-Sporothrix immunity has been little explored in cats. Thus, the aim of this study was to evaluate the neutrophil oxidative burst in the blood of cats with sporotrichosis. Cats with sporotrichosis included in the study were treated with itraconazole (ITZ) alone or combined with potassium iodide (KI). The neutrophil oxidative burst was evaluated through a flow-cytometry-based assay using dihydrorhodamine 123 (background) and stimulation with Zymosan and heat-killed Sporothrix yeasts. The cure rate was 50.0% in cats under treatment with ITZ monotherapy and 90.9% in cats treated with ITZ + KI (p = 0.014), endorsing the combination therapy as an excellent alternative for the treatment of feline sporotrichosis. Higher percentages of Sporothrix-stimulated neutrophils were associated with good general condition (p = 0.003). Higher percentages of Sporothrix- (p = 0.05) and Zymosan-activated (p = 0.014) neutrophils before and early in the treatment were related to clinical cure in ITZ-treated cats. The correlation between oxidative burst and successful use of KI could not be properly assessed given the low number of failures (n = 2) in this treatment group. Nasal mucosa involvement, typically linked to treatment failure, was related to lower percentages of activated neutrophils in the background at the treatment outcome (p = 0.02). Our results suggest a beneficial role of neutrophils in feline sporotrichosis and a positive correlation between neutrophil activation and the cure process in ITZ-treated cats.