Healthy Woman Research Articles

Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review

BackgroundCardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital.Case presentationA full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications.ConclusionsThe diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.

LITERARY REVIEW OF UDAVARTINI YONIVYAPADA

A healthy woman is a promise of a healthy family during different stages of her life, from puberty to menopause; the theory of healthy yoni has been mentioned in Ayurveda and modern science. In Ayurveda, women's healthcare is linked to a separate section, where the term Yonivyapada includes the majority of gynaecological disorders. Dysmenorrhea can be correlated with Udavartini Yonivyapada in Ayurveda. The main clinical characteristic of Udavartini is 'rajah Krichratha’(painful menstruation). Therefore, this study has attempted to conduct a conceptual study that covers almost all aspects of Udavartini Yonivyapada so that early diagnosis and treatment can be given.

Unusual site of echinococcosis: axillary hydatid cyst—a case report

BackgroundEchinococcosis is a multisystem disease that might affect all organs, especially the liver and the lungs among adults. Axillary hydatid cyst, an extremely uncommon disease, was rarely reported in the literature. We report herein a case of axillary hydatid cyst which revealed a disseminated hydatid disease among a previously healthy woman.Case presentationA previously healthy woman, aged 53 years old, presented with a painful mass in her right axillary region. Physical examination revealed a painful semi-mobile right axillary mass, of 12 cm in size. Thoracoabdominal computed tomography scan revealed numerous cystic lesions: right axillary, pulmonary, hepatic, pancreatic, splenic and intraperitoneal lesions. The diagnosis of disseminated hydatid disease was suspected in front of the cystic lesions and the positive serology result for hydatid disease. An excisional biopsy of the axillary mass lesion was performed, confirming the diagnosis of a hydatid cyst. The patient received albendazole after hospital discharge.ConclusionsAlthough axillary hydatid cyst is an extremely uncommon disease, the diagnosis should be rule out in front of the presence of a mass in the axillary region. Imaging results associated with serological tests might suspect the diagnosis, which can only be confirmed with parasitological or/and histopathological examination. Its management include surgical and medical therapy.

Intestinal Behçet's and suspected intestinal Behçet's disease: a report of four surgical cases.

Intestinal Behçet's disease (BD) is often associated with ulceration that requires surgery, including perforation and abscess formation. However, no consensus has been reached on the optimal extent of resection or treatment strategy. This study reviewed four cases of intestinal or suspected intestinal BD. In Case 1, a 74-year-old woman diagnosed with BD 2years earlier was treated with anti-tumor necrosis factor α antibody (Infliximab) and steroids. She had oral and pubic ulcers. After close investigation of abdominal pain, perforation of the gastrointestinal tract was suspected and surgery was performed. Multiple perforating ulcers and abscesses were found in the distal ileum, and the small intestine was resected. Postoperatively, the patient was treated with an increased steroid dose and symptoms have remained stable. Case 2 involved a 69-year-old woman with oral and pubic ulcers, ocular ulcer, and skin lesions. She experienced sudden onset of abdominal pain during treatment for lymphoma. She showed multiple perforating ulcers throughout the ileum and underwent resection of the small intestine and ileostomy. Upper abdominal pain appeared during postoperative treatment for high-output syndrome. The patient underwent omentoplasty after perforation of the upper gastrointestinal tract was diagnosed. Postoperatively, anti-interleukin-1 beta antibodies (canakinumab) was administered to control the disease. Case 3 involved an 81-year-old, previously healthy woman. She presented to her previous physician with complaints of pubic ulcer, hemorrhage and abdominal pain. Colonoscopy showed multiple ulcers throughout the entire colon. Steroid therapy was started, but bleeding proved difficult to control and total proctocolectomy was performed. Histopathology revealed multiple perforating ulcers and BD was diagnosed. Postoperatively, the patient remains under steroid control. Case 4 involved a 43-year-old man with abdominal pain who showed abscess formation in the ileocecal region. After excision of the ileocecal area, multiple ulcers were diagnosed. Two years later, abdominal pain recurred and free air was found in the abdomen on close imaging. Emergency anastomotic resection was performed due to ulceration and perforation of the anastomosis. Intestinal BD may flare up after surgical treatment and require multiple surgeries. Introducing pharmacotherapy as soon as possible after surgical treatment is important to control the disease.

Modeling of human placental capillaries by using a unique 3d reconstruction program

Purpose: Visualization of the three-dimensional structures is performed by examining two-dimensional sections in histology. It is not always possible to comprehend structure-function integrity. Therefore, it was planned to obtain three-dimensional (3D) models of the capillaries in the placenta terminal villus by using the program developed in the Başkent University’s laboratory and used in studies in different disciplines. The program’s suitability for histology studies will also be assessed.
 Materials and Methods: A term placenta tissue sample was obtained from a 33-year-old healthy woman. Following the plastic embedding procedure, semi-thin serial sections were taken from these blocks. The sections were stained using toluidine blue and examined and photographed by using a light microscope. The 3D modeling procedure was conducted on the light micrographs of serial sections in order to reconstruct villous capillaries. 
 Results: 3D images were obtained from two-dimensional light micrographs by using the same program. It was determined that the vessels running parallel to each other branched harmoniously, forming a capillary network in the terminal villus. Additionally, challenges encountered during the utilization of this program in histological studies are also presented in this study. 
 Conclusion: Fetal blood reaches every part of the terminal villus through the branching capillary network. This feature would increase the surface area of vasculo-syncytial membrane and facilitate feto-maternal exchange. This can be clearly visualized by using 3D models. Three-dimensional modeling helps to understand the structure of all organs and tissues. Given that the current program is freely accessible, it will not incur additional costs for researchers and is open to further improvement by the programmer (erhankiziltan@gmail.com).

Anti-Salmonella Defence and Intestinal Homeostatic Maintenance In Vitro of a Consortium Containing Limosilactobacillus fermentum 3872 and Ligilactobacillus salivarius 7247 Strains in Human, Porcine, and Chicken Enterocytes.

Limosilactobacillus fermentum strain 3872 (LF3872) was originally isolated from the breast milk of a healthy woman during lactation and the breastfeeding of a child. Ligilactobacillus salivarius strain 7247 (LS7247) was isolated at the same time from the intestines and reproductive system of a healthy woman. The genomes of these strains contain genes responsible for the production of peptidoglycan-degrading enzymes and factors that increase the permeability of the outer membrane of Gram-negative pathogens. In this work, the anti-Salmonella and intestinal homeostatic features of the LF3872 and LS7247 consortium were studied. A multi-drug resistant (MDR) strain of Salmonella enteritidis (SE) was used in the experiments. The consortium effectively inhibited the adhesion of SE to intact and activated human, porcine, and chicken enterocytes and reduced invasion. The consortium had a bactericidal effect on SE in 6 h of co-culturing. A gene expression analysis of SE showed that the cell-free supernatant (CFS) of the consortium inhibited the expression of virulence genes critical for the colonization of human and animal enterocytes. The CFS stimulated the production of an intestinal homeostatic factor-intestinal alkaline phosphatase (IAP)-in Caco-2 and HT-29 enterocytes. The consortium decreased the production of pro-inflammatory cytokines IL-8, TNF-α, and IL-1β, and TLR4 mRNA expression in human and animal enterocytes. It stimulated the expression of TLR9 in human and porcine enterocytes and stimulated the expression of TLR21 in chicken enterocytes. The consortium also protected the intestinal barrier functions through the increase of transepithelial electrical resistance (TEER) and the inhibition of paracellular permeability in the monolayers of human and animal enterocytes. The results obtained suggest that a LF3872 and LS7247 consortium can be used as an innovative feed additive to reduce the spread of MDR SE among the population and farm animals.

Pregnancy induces retinal microvascular changes indicating cardio-metabolic stress

We performed longitudinal examinations of the arterial retinal microvasculature using Adaptive Optics Retinal Imaging in a 30-year-old healthy woman with twin pregnancy from the 23rd week of gestation (wog) to three days postpartum. Two blinded graders recorded the average wall-to-lumen ratio (WLR) of the examined retinal artery. There was a significant increase in the mean WLR over the course of pregnancy followed by a decreasing WLR from the 37th wog. The demonstrated changes in WLR may be an expression of vascular remodeling and adaptation to volume load which indicates that pregnancy can be viewed as a cardiovascular stress test.

Giant pilomatricoma with coexisting angiomyxoid stroma histopathology: a case report

Introduction: Pilomatricoma, also known as benign calcifying epithelioma of Malherbe, is a follicular tumor originating from cells in the hair follicle matrix. It usually manifests as a firm subcutaneous mass up to 3 cm in size. Less commonly, it may measure >5 cm and in such cases is called giant pilomatricoma. We herein present a case of a subcutaneous lesion that was characterized by aggressive biological behavior and initially thought to be malignant but subsequently found to be a rare angiomyxoid variant of giant pilomatricoma. Case presentation: This case involved a young, healthy woman with a rapidly growing subcutaneous lesion on the distal lateral side of her right arm. An incisional biopsy was performed, and the lesion was diagnosed as hyperplasia of the epidermis and subcutaneous tissue, likely of reactive nature. After radical excision, analysis of the entire specimen led the pathologist to diagnose a rare variant of giant pilomatricoma with angiomyxoid stroma. Discussion: Classic pilomatricoma is an indolent, slow-growing lesion that is well defined and not fixed to the underlying tissue planes. However, after showing no signs of enlargement for 6 months, the lesion in the present case began to grow in a very unusual and concerning manner, suggesting a skin malignancy. The patient’s young age and the rapid development and large dimensions of the lesion led us to suspect a sarcoma. Conclusion: This case highlights the importance of cooperation between the dermatosurgeon and the pathologist to ensure thorough evaluation of such misleading cases. Such cooperation will guide appropriate management decisions and avoid overtreatment of benign lesions.

COVISHIELD vaccine-induced thyroiditis: a case report

BackgroundThe rapid development of coronavirus disease 2019 vaccines during the pandemic has left their long-term effects largely unknown. Instances of autoimmune and subacute thyroiditis showing features of autoimmune/inflammatory syndrome induced by adjuvants have been reported post-vaccination. This case report aims to highlight the autoimmune/inflammatory syndrome induced by adjuvants syndrome after coronavirus disease 2019 vaccination, drawing attention to a possible connection with thyroid dysfunction and urging for further thorough research.Case presentationWe present a case of thyroiditis induced by the COVISHIELD vaccine in a 37-year-old Indian woman. An apparently normal and healthy adult woman developed neck pain and easy fatigability 2 weeks after the second dose of COVISHIELD, which gradually increased and was associated with irritability, decreased sleep, excessive sweating, tremor, palpitation, and weight loss. She presented to the outpatient department after 1 week of symptoms and was evaluated with laboratory tests and imaging. She was diagnosed with thyroiditis due to the coronavirus disease 2019 vaccine and was treated with propranolol.ConclusionThis case report adds to the growing evidence of coronavirus disease 2019 vaccine-related thyroid issues. The development of thyroiditis is rare and underreported post-coronavirus disease 2019 vaccination; hence, research to evaluate the association of coronavirus disease 2019 vaccines with thyroid dysfunction needs to be done in the future.

Displacement of the maxillary third molar into the infratemporal fossa during extraction: A case report

A 34-year-old healthy woman was referred to our department for extraction of the right maxillary third molar. A rare complication happened during the procedure and management options were discussed with the patient; the agreement was to extract the tooth under general anaesthesia. Tooth extraction is a routine procedure performed in oral and maxillofacial surgery. However, complications may occur even with an experienced surgeon. Herein, we present a rare complication of the maxillary third molar displacement into the infratemporal fossa during extraction and its management.

Complete genome sequence of Cutibacterium acnes type II CCSM0331, isolated from a healthy woman's skin.

The complete genome sequence of Cutibacterium acnes Type II strain CCSM0331, which was isolated from the healthy facial skin, is reported. The assembled 2.5-Mbp genome comprised a single circular chromosome. These data will provide valuable information on the beneficial role of C. acnes as a skin commensal bacteria.

External iliac artery thrombosis as a result of acetabular fixation through the ilioinguinal approach: a case report

Introduction and importance: Acetabular fractures mostly occur in young people who are involved in high-energy trauma and they are treated by orthopedic trauma surgeons. Patients with acetabular fractures are at high risk for different kinds of complications. We report a case of postoperative thrombosis of the external iliac artery following fixation surgery performed by an ilioinguinal approach while receiving thromboprophylaxis during admission to the hospital. Case presentation: A 57-year-old healthy woman presented with a left both-column acetabular fracture and underwent acetabular fixation through the ilioinguinal approach. The patient was receiving antithrombotic prophylaxis medications in the course of treatment. Clinical discussion: During her convalescence, while at the hospital, she was diagnosed with left external iliac artery thrombosis, needing surgical thrombectomy. These severe and rare complications will lead to uncertainty about a commonly used ilioinguinal approach. Postoperative arterial thrombosis may be rare in patients undergoing acetabular fixation surgery but searching for signs and symptoms of this condition is always necessary. Conclusion: It is possible to prevent severe complications by performing a routine measurement of the distal arterial pressure after similar surgeries.

LIPID PROFILE CHANGES DURING DIFFERENT PHASES OF MENSTRUATED YOUNG AND PREMENOPAUSAL WOMEN

Background: Lipoprotein cholesterol measurements fluctuated across the menstrual cycle, corresponding to rising and declining concentrations of gonadotropins and ovarian steroid hormones levels in young women, whereas premenopausal women and those who inside the menopausal transition characterized by a poor ovarian response to high secretion of gonadotropin leading to low levels of ovarian steroids. Aims: To investigate the lipoprotein cholesterol changes and their interactions with sex steroid hormones during different phases of the menstrual cycle in menstruated young and old (premenopausal) women. Methods: The sample included thirty healthy women (aged 20-45 years) divided into two groups with 15 women /group according to their ages )20-25 years( (40-45 years). Blood samples were collected on the 8th, 16th, and 24th days of the menstrual cycle from both young and old menstruating women to compare the previous parameters between these days for each group and compare these parameters between similar days for the first and second groups. Lipid profile (Total cholesterol (TC), Triglyceride (TG), High density lipoprotein (HDL), Low density lipoprotein (LDL), and Very low density lipoprotein (VLDL) changes be assayed by Bio-Systems Kit components. Statistical analysis was carried out using one-way Analysis of Variance (ANOVA), followed by Duncan's test, and t-tests were used to assess differences between groups. Results: TC and TG levels did not significantly increase on the 8th day of the menstrual cycle, which represents the follicular phase, in comparison with the other days (16th and 24th days). However, LDL level increased significantly (p ? 0.05) on the 8th day compared to the other days. On the other hand, HDL and VLDL levels increased on the 16th day of the menstrual cycle, which represents the ovulatory phase. Discussion: TC, TG, and LDL levels increased during the follicular phase and were accompanied by high levels of FSH and estradiol, leading to a favorable lipid profile, whereas FSH and estradiol are considered regulators of cholesterol biosynthesis and a buffering capacity. HDL and VLDL levels rise during ovulation to meet the requirements of ovulation and ensure successful ovulation. Conclusions: Studying and evaluating changes in the lipid profile according to the menstrual cycle phase of the menstrual cycle represents an important issue in knowing the physiological and healthy woman state and preventing cardiovascular disease incidence.

Successful rehabilitation after multiple severe complications following orthognathic surgery: a case report

BackgroundComplications of orthognathic surgery are quite rare, but they cause suffering in affected individuals. The range of complications is broad and includes both hard and soft tissue.Case presentationWe here present a case of a fully healthy woman without signs of impaired healing capacity. The patient underwent bimaxillary orthognathic surgery and experienced multiple complications both peri- and post-operatively. During the post operative period, the patient also suffered from soft tissue complications after an orthopaedic injury. Therefore, we referred the patient to her general practitioner for further medical investigation. We also present the result after restorative surgery and endodontic and prosthodontic treatment resulting in a successful rehabilitation.ConclusionThis case report clearly shows the need for a good collaboration between different odontological and medical fields to achieve a good and predictable result. In situations where normal healing processes do not occur, in-depth analysis must be carried out.HighlightsOrthognathic surgery affects soft and hard tissue which can result in adverse healing and complications. It is of great importance to follow up performed surgery to see late complications. Be restrictive with early re-operations when there are signs of necrosis. Always use a multidisciplinary approach when handling complications after surgery.

Abstract 12535: Spontaneous Coronary Artery Dissection in Women: A New Role for Autoimmunity?

Introduction: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial infarction (MI) in women, with a still unclear pathophysiology. Autoantibodies targeting angiotensin-II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) (AT1R-AAs and ETAR-AAs, respectively) lead to endothelial dysfunction and have already been associated with aortic dissection. Hypothesis: We hypothesized that titers of AT1R-AAs and ETAR-AAs are higher in patients with SCAD compared to controls. Methods: Our case-control study was conducted at Padua University Hospital between January 2022 and June 2022. Female patients diagnosed at coronary angiography with MI and SCAD were consecutively enrolled. Ten women with SCAD and 20 age-matched controls (10 women with ST-elevation MI (STEMI) and 10 healthy women) were included. Serum levels for AT1R-AAs and ETAR-AAs were determined for each participant. Absolute autoantibody titers and seropositivity prevalence were compared between SCAD patients, STEMI patients, and healthy women. Seropositivity was defined according to the threshold value suggested by the manufacturer (>10 U/mL). Results: Six out of 10 (60%) women with MI and SCAD were seropositive for AT1R-AAs and ETAR-AAs. In contrast, only one (10%) healthy woman and one (10%) STEMI patient were seropositive for AT1R-AAs (p=0.03 and p=0.03, respectively). One STEMI patient was seropositive for ETAR-AAs, while none of the healthy women was found to be seropositive (p=0.03 and p=0.01, respectively). The median autoantibody titer was significantly higher in SCAD patients than in healthy women (p=0.01 for AT1R-AAs; p=0.02 for ETAR-AAs) and STEMI patients (p<0.001 for AT1R-AAs; p=0.002 for ETAR-AAs). Conclusions: AT1R-AAs and ETAR-AAs seropositivity is significantly higher in SCAD women than in healthy women or female patients with STEMI. Our findings suggest a possible role for AT1R-AAs and ETAR-AAs in the pathophysiology of SCAD in women with MI.

Gardnerella pickettii sp. nov. (formerly Gardnerella genomic species 3) and Gardnerella greenwoodii sp. nov. (formerly Gardnerella genomic species 8) isolated from female urinary microbiome.

During an ongoing female urinary microbiome research study, strains c17Ua_112T and c31Ua_26T isolated from urine samples of a patient diagnosed with overactive bladder and a healthy postmenopausal woman, respectively, could not be allocated to any Gardnerella species with valid names. In this work, we aimed to characterize these strains. The 16S rRNA gene sequences confirmed that these strains are members of the genus Gardnerella. Phylogenetic analysis based on cpn60 strongly supported two clades, one encompassing c17Ua_112T and nine other strains from the public database, and the other including c31Ua_26T and three other strains, which were distinct from currently recognized species of the genus Gardnerella. Likewise, the phylogenomic tree also showed that strains c17Ua_112T and c31Ua_26T formed independent and robust clusters. Average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values between c17Ua_112T and c31Ua_26T were 79.27 and 27.4 %, respectively. Strain c17Ua_112T showed the highest ANI (94.8 %) and dDDH values (59.8 %) with Gardnerella piotii UGent 18.01T, and strain c31Ua_26T revealed highest ANI (84.2 %) and dDDH (29.1 %) values with Gardnerella swidsinskii GS 9838-1T. Based on the data presented here, the two strains c17Ua_112T and c31Ua_26T represent two novel species of the genus Gardnerella, for which the names Gardnerella pickettii (c17Ua_112T=DSM 113414T=CCP 71T) and Gardnerella greenwoodii (c31Ua_26T=DSM 113415T=CCP 72T) are proposed.

Paracentral Acute Middle Maculopathy After COVID-19 Disease: Multimodal Evaluation.

To report the case and multimodal imaging findings of a healthy young woman who developed paracentral acute middle maculopathy (PAMM) 9 weeks after COVID-19 disease. Case report. Ultra-widefield fundus photography, macular spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and OCT-angiography (OCT-A) were performed. A 36-year-old woman who developed PAMM 9 weeks after SARS-CoV-2 infection. A 36-year-old woman went to the emergency department (ED) with sudden, painless, left eye (LE) vision loss. The only relevant past medical history was COVID-19 disease 9 weeks before. Best corrected visual acuity (BCVA) was 20/200, a LE relative afferent pupillary defect (RAPD) was present and superficial hemorrhages throughout the macular area and peripheral retina were found. Nearly four hours after admission, LE BCVA recovered to 20/20 without RAPD. Five days after presentation in the ED, the patient returned with recurrent LE vision loss, with spontaneous recovery within 12 hours. Macular SD-OCT revealed hyperreflectivity of the inner plexiform and inner nuclear layers and the diagnosis of PAMM was established. The patient started oral acetylsalicylic acid and oral prednisolone. The patient did not report any new episodes of vision loss and there was a progressive resolution of abnormal fundus findings. SARS-CoV-2 infection increases the risk of vascular thrombotic events with possible involvement of the retinal circulation, and PAMM may present as a possible complication. Ophthalmologists should be able to recognize it promptly through multimodal imaging findings.

Abstract 117: Digitally Subtracted Angiogram & Biopsy Negative Recurrent Spontaneous Bilateral Anterior Cerebral Artery Territory Intracranial Hemorrhage

Introduction Up to 18% of spontaneous intracerebral hemorrhages are cryptogenic despite a thorough workup, usually noted in a lobar location. Although undetected on DSA, a significant proportion of these represent ruptured micro‐AVM/AVF or cavernous malformations that ultimately are amenable to surgical resection if detected on biopsy. However, occult cerebral amyloid angiopathy can also present similarly, and their management is markedly different. Methods We present a case of recurrent bilateral medial frontal hemorrhage in a patient without known cerebrovascular disease that evaded diagnosis despite hematologic evaluation, MRI, CTA, two DSAs, three clot evacuations with pathology, and brain biopsy. Results The patient is a 60‐year‐old previously healthy woman who presented with sudden onset right hemiparesis and speech arrest. CT revealed a left parasagittal hemorrhage. She was brought to the OR for clot evacuation. Pathology from the clot revealed blood vessels of multiple sizes consistent with meningeal vessels or underlying AVM/AVF. A 6‐vessel cerebral angiogram as unremarkable. The patient’s inpatient course was complicated by new onset Afib with RVR and asymptomatic DVT with PE, however no etiology of coagulopathy was detected. MRI brain showed no evidence of cerebral microbleed or other underlying pathology, noting only DWI + FLAIR hyperintensity in the left ACA territory. The patient was diagnosed with ACA territory stroke complicated by PH2‐type hemorrhagic conversion. She was initially placed on IV Heparin, before transition to apixaban uneventfully. She continued to recover in the hospital and was eventually discharged to rehab. She re‐presented 1 month later with worsening behavioral arrest and right hemiparesis. CT head revealed recurrence of left parasagittal ICH. She underwent clot evacuation in the OR again and repeat pathology was unrevealing. A repeat MRI showed only the evident bleed and a subtle hyperintensity in the right occipital cortex suspicious for an interval subacute occipital lobe stroke with laminar necrosis, ostensibly from Afib. She improved clinically and was discharged to rehab with a diagnosis of recurrent hemorrhage attributed to anticoagulant use and recent stroke. She was discharged this time on no anticoagulant or antiplatelets. She re‐presented 1 month later with sudden onset speech arrest, but now with left hemiparesis. CT revealed a right parasagittal hemorrhage. She was brought to the OR for emergent clot evacuation and parenchymal biopsy – which was initially normal. A repeat 6‐vessel DSA was again unremarkable as was repeat brain MRI. The patient’s parenchymal biopsy was sent for specific congo‐red and immunohistochemistry for beta‐amyloid. IHC revealed beta‐amyloid plaques in the parenchyma and vessel walls, confirming a diagnosis of CAA. Conclusion Apparently cryptogenic lobar hemorrhage may be caused by both occult micro‐AVM/fistula and CAA. As in this case, when a patient experiences recurrent DSA negative lobar hemorrhages, biopsy should be pursued. This case was particularly challenging given the anatomical plausibility of parasagittal AVM/fistula given its midline location and venous drainage, considering the patient’s evident predisposition to systemic venous thrombosis hemorrhagic venous infarction mimicking lobar ICH is also possible. We present this case to raise awareness of the potential need for early biopsy, especially in patients who may also require anticoagulation or antiplatelet medications.

Positive Francisella tularensis meningitis outcome despite delayed identification: a case report

Francisella tularensis is a Gram-negative bacteria, that may cause a zoonotic disease, tularemia. Here, we describe a patient case, where a previously healthy young woman in Northern Finland contacted health care because of fever and headache. Due to the symptoms and lack of further diagnostic tools in primary health care, she was transferred to University Hospital (UH) where ampicillin and ceftriaxone was given empirically. A cerebrospinal fluid sample (CSF) was drawn showing small Gram-negative rods that grew on chocolate agar after 2 days of incubation. Matrix-assisted laser-desorption-ionization time of-flight (Maldi-tof) did not provide identification, but the bacteria was interpreted as sensitive to ciprofloxacin and the treatment was changed to ciprofloxacin. During the time the patient was infected, there were several positive tularemia samples found in the area. Therefore, an in house tularemia nucleic acid method (PCR) was used on the bacterial culture. Additionally, 16S rDNA sequencing was performed and these methods identified the bacteria as F. tularensis. Fortunately, the patient recovered completely with ciprofloxacin and was discharged without any complications. Our case underlines the need to understand the limits of specific diagnostic methods, such as Maldi-tof, used in clinical laboratory settings. It also highlights the need of both clinicians and laboratory staff to be aware of the many clinical presentations of tularemia when working in an endemic area.

Maternal and Newborn Characteristics-A Comparison between Healthy and Thrombophilic Pregnancy.

A thrombophilic woman is more likely to experience difficulties during pregnancy, difficulties that will also affect the development of the newborn. This study aims to compare maternal and newborn characteristics between healthy and thrombophilic pregnancy. The following characteristics were analysed: maternal characteristics (BMI- body mass index, haemostasis parameters, thrombophilia-specific treatment) and newborn characteristics (gestational period, birth weight, the Apgar score). This follow-up study spanning five years, from 2018 to 2022, focuses on a cohort of 500 women who underwent delivery hospitalization in the western region of Romania. The maternal characteristics influence the newborn: the greater the weight of the mother with thrombophilia, the more the chances that the fetus will have a lower birth weight; increasing the dose of LMWH (low molecular weight heparin), connected with the necessity to control the homeostasis parameters, the more likely the fetus will be born with a lower birth weight. A pregnant woman with thrombophilia, treated appropriately, having a normal weight, and not presenting other risk factors independent of thrombophilia, will have a newborn with characteristics similar to a healthy pregnant woman.