Prompt Diagnosis Research Articles

Diagnostic Performance of Serum MicroRNAs for ST-Segment Elevation Myocardial Infarction in the Emergency Department.

Prompt diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for initiating timely treatment. MicroRNAs have recently emerged as biomarkers in cardiovascular diseases. This study aimed to evaluate the discriminatory capacity of serum microRNAs in identifying an ischemic origin in patients presenting with chest discomfort to the Emergency Department. The study included 98 participants (78 with STEMI and 20 with nonischemic chest discomfort). Significant differences in the expression levels of miR-133b, miR-126, and miR-155 (but not miR-1, miR-208, and miR-208b) were observed between groups. miR-133b and miR-155 exhibited 97% and 93% sensitivity in identifying STEMI patients, respectively. miR-126 demonstrated a specificity of 90% in identifying STEMI patients. No significant associations were found between microRNAs and occurrence of major adverse cardiovascular events (MACE). However, patients with MACE had higher levels of interleukin (IL)-15, IL-21, IFN-γ-induced protein-10, and N-terminal pro B-type natriuretic peptide compared to non-MACE patients. Overall, there were significant associations among the expression levels of microRNAs. However, microRNAs did not demonstrate associations with either inflammatory markers or cardiovascular risk scores. This study highlights the potential of microRNAs, particularly miR-133b and miR-126, as diagnostic biomarkers for distinguishing patients with STEMI from those presenting with nonischemic chest discomfort to the Emergency Department.

Severe hypothyroidism as the cause of rhabdomyolysis and acute kidney injury – a case report

Hypothyroidism is a set of clinical symptoms associated with a deficiency of thyroid hormones. Musculoskeletal symptoms, i.e. stiffness, pain or muscle fatigue, are among the many manifestations of the disorder. Rhabdomyolysis, a syndrome accompanying muscle tissue damage, which leads to acute kidney injury, may be a complication of hypothyroidism. In this paper, we present a case of a 35-year-old patient with hypothyroidism due to Hashimoto’s disease, with a 4-year history of diagnosis for periodic pain and muscle weakness in the lower extremities. The patient presented to the hospital due to the recurring symptoms. One month before admission, she had discontinued thyroid hormone supplementation. Laboratory tests showed unquantifiable low levels of free thyroid hormones, elevated creatine kinase levels, and elevated kidney function parameters. Non-compliance can lead to potentially life-threatening complications in hypothyroid patients. Prompt diagnosis and implementation of treatment can lead to symptom resolution.

Prompt treatment-seeking behaviour varies within communities among guardians of children with malaria-related fever in Malawi

BackgroundIn Malawi, malaria is responsible for 40% of hospital deaths. Prompt diagnosis and effective treatment within 24 h of fever onset is critical to prevent progression from uncomplicated to severe disease and to reduce transmission.MethodsAs part of the large evaluation of the malaria vaccine implementation programme (MVIP), this study analysed survey data to investigate whether prompt treatment-seeking behaviour is clustered at community-level according to socio-economic demographics.ResultsFrom 4563 households included in the survey, 4856 children aged 5–48 months were enrolled. Out of 4732 children with documented gender, 52.2% were female and 47.8% male. Among the 4856 children, 33.8% reported fever in the two weeks prior to the survey. Fever prevalence was high in communities with low socio-economic status (SES) (38.3% [95% CI: 33.7–43.5%]) and low in areas with high SES (29.8% [95% CI: 25.6–34.2%]). Among children with fever, 648 (39.5%) sought treatment promptly i.e., within 24 h from onset of fever symptoms. Children were more likely to be taken for prompt treatment among guardians with secondary education compared to those without formal education (aOR:1.37, 95% CI: 1.11–3.03); in communities with high compared to low SES [aOR: 2.78, 95% CI: 1.27–6.07]. Children were less likely to be taken for prompt treatment if were in communities far beyond 5 km to health facility than within 5 km [aOR: 0.44, 95% CI: 0.21–0.92].ConclusionThe high heterogeneity in prevalence of fever and levels of prompt treatment-seeking behaviour underscore the need to promote community-level malaria control interventions (such as use of long-lasting insecticide-treated nets (LLINs), indoor residual spraying (IRS), intermittent preventive therapy (IPT), presumptive treatment and education). Programmes aimed at improving treatment-seeking behaviour should consider targeting communities with low SES and those far from health facility.

Clinical, Radiological, and Histopathological Findings of Post-Exenterated Mucormycosis Specimens

Introduction: A sharp upsurge in the number of coronavirus disease-associated mucormycosis cases was noted during the second wave of coronavirus disease in India. The fungal hyphae spread from the nasal mucosa, orbit to the brain, hence otherwise called rhino-orbito-cerebral mucormycosis (ROCM). Prompt diagnosis and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome. This study is done to enumerate the clinical, radiological, and histopathological findings of post-exenterated specimens of ROCM. Methods: This is a non-randomized cross-sectional study conducted at a tertiary care center. Ten post-exenterated specimens were examined histopathologically for the involvement of the central retinal artery, superior ophthalmic vein (SOV), optic nerve, muscle, and orbital fat showing necrosis. Clinical findings of these 10 patients were studied retrospectively for visual loss, proptosis, extraocular movements for muscle involvement, scleral necrosis, and fundus findings for artery or vein occlusions. Preoperative magnetic resonance imaging (MRI) findings like the number of orbital quadrants showing soft tissue thickening or tissue enhancement, diffusion restriction in the optic nerve, soft tissue enhancement seen at the orbital apex or superior orbital fissure, loss of flow void in the left internal carotid artery, enlargement of the SOV containing filling defect on post-contrast images were noted. Results: Optic nerve involvement was seen in 100% patients clinically, 70% on MRI, and 50% on histopathological examination (HPE). Muscle involvement was seen in 100% patients clinically, 90% on MRI, and 80% on HPE. None of the patients had scleral necrosis clinically. Scleral tenting was seen in 20% patients on MRI and 20% on HPE. Clinically, central retinal artery involvement was seen in 40%, and cilioretinal artery involvement was seen in 10%. MRI could not give much information on artery involvement. Clinically, none of them had central retinal vein occlusion. 20% had an enlarged SOV seen on MRI. HPE showed vascular involvement in 90% of the specimens. Conclusion: Clinical, radiological, and histopathological findings play a major role in the diagnosis, staging, and follow-up of ROCM.

WTP7.8 Adult Bowel Intussusception: A Case Report and new insights

Abstract Introduction Intussusception in adults is rare and constitutes 1-5% of small bowel obstructions. This rarity along with atypical presentation make diagnosis difficult, sometimes delayed and makes cross-sectional imaging mandatory for correct management. Prompt diagnosis and treatment are essential to prevent serious complications like perforation, peritonitis etc. Usually, lead points have been thought to be caused by neoplastic polyps but recently, non-malignant causes (lipomas or nodal masses) are coming to the forefront. Postoperative histology review is important to plan for further management. Here we present an adult patient with intussusception who needed surgical intervention but no post procedure treatment. Case report Our 78- year-old patient was admitted with sudden onset severe generalised abdominal pain for a day. Examination revealed a soft abdomen with a tender mass palpable in her right lower abdomen. CTAP revealed long segment ileocolic intussusception with a 3cm lipoma as the lead point. She underwent a laparotomy where oedematous bowel with irreducible intussusception and possible ischaemia were found; a right hemicolectomy was carried out. Histology revealed the intussuscipiens to be a lipoma. She made an uneventful recovery. Discussion It is important to consider intussusception in the differential diagnosis in adult patients with abdominal pain even in absence of typical obstructive symptoms. Adult cases are usually associated with neoplasm but there is increasing evidence of nonmalignant causes such as benign polyps, nodal masses or lipomas which act as the lead point in adult intussusception. Postoperative histology review is important to plan further management.

Herlyn-Werner-Wunderlichov sindrom s piohematokolposom

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare malformation syndrome of the women reproductive tract characterized by uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. We report here a case of a 20 year-old patient presented to the emergency department with pain in the right lower quadrant. The clinical exam showed a vaginal fluctuant painful mass obliterating the right part of the vagina. Transvaginal ultrasound showed uterus didelphys, the right uterus was dilated with a dense fluid collection which corresponded to pyohematometra. It also revealed a dense vaginal collection which corresponded to pyohematocolpos. Abdominal ultrasound showed the absence of a right kidney. The laparoscopy showed uterus didelphys with a large right uterus. We performed the resection of the vaginal septum to reconstruct one vagina. The first follow-up visit revealed a healthy wound with no adhesion of the vaginal wall. Prompt and accurate diagnosis of female reproductive tract disorders, including HWWS, is necessary to prevent complications and preserve future fertility.

Cardiovascular Disorder Detection with a PSO-Optimized Bi-LSTM Recurrent Neural Network Model

The medical community is facing ever-increasing difficulties in identifying and treating cardiovascular diseases. The World Health Organization (WHO) reports that despite the availability of numerous high-priced medical remedies for persons with heart problems, CVDs continue to be the main cause of mortality globally, accounting for over 21 million deaths annually. When cardiovascular diseases are identified and treated early on, they cause far fewer deaths. Deep learning models have facilitated automated diagnostic methods for early detection of these diseases. Cardiovascular diseases often present insidious symptoms that are difficult to identify in a timely manner. Prompt diagnosis of individuals with CVD and related conditions, such as high blood pressure or high cholesterol, is crucial to initiate appropriate treatment. Recurrent neural networks (RNNs) with gated recurrent units (GRUs) have recently emerged as a more advanced variant, capable of surpassing Long Short-Term Memory (LSTM) models in several applications. When compared to LSTMs, GRUs have the advantages of faster calculation and less memory usage. When it comes to CVD prediction, the bio-inspired Particle Swarm Optimization (PSO) algorithm provides a straightforward method of getting the best possible outcomes with minimal effort. This stochastic optimization method requires neither the gradient nor any differentiated form of the objective function and emulates the behaviour and intelligence of swarms. PSO employs a swarm of agents, called particles, that navigate the search space to find the best prediction type.This study primarily focuses on predicting cardiovascular diseases using effective feature selection and classification methods. For CVD forecasting, we offer a GRU model built on recurrent neural networks and optimized with particle swarms (RNN-GRU-PSO). We find that the proposed model significantly outperforms the state-of-the-art models (98.2% accuracy in predicting cardiovascular diseases) in a head-to-head comparison.

Peripheral vascular trauma - basic management, diagnosis and treatment.

Peripheral vascular injuries occur in 1-3% of all traumas in civilian settings. The management of these injuries is often based on experience derived from war medicine where these injuries are more common. The goal of this article is to summarize basic guidelines for the diagnosis and treatment of vascular injuries. Western Trauma Association (WTA) and Eastern Association for the Surgery of Trauma (EAST) both have their own guidelines for vascular trauma management. Vascular injuries occur both in penetrating and blunt traumas. Complete vessel disruption occurs more frequently in penetrating traumas. In the case of blunt trauma, intimal defects are more common, resulting in dissection, false aneurysm, or intramural hematoma. The limb is mostly endangered due to ischemia, reperfusion injury and the compartment syndrome. Prompt diagnosis and treatment are paramount. Vascular trauma management is part of the ATLS protocol and life-over-limb principle. The primary goal is to stop the massive external bleeding. Clinical examination and CT angiography are the most helpful for the diagnosis. Surgical revision is indicated when hard signs are present. This can be a damage control surgery with the primary goal to stop the bleeding as quickly as possible. A shunt can be used for temporary reperfusion of the limb. Definitive treatment can take the form of a simple suture, patches or graft interposition; both prosthetic and autologous grafts are used. Sufficient debridement and fasciotomy are important steps in the therapy. In some cases, endovascular treatment can be used. Over the last century, the treatment strategy changed dramatically. Data from recent military conflicts show a decrease in amputation rates, and limb salvage has become a standard.

Sexually transmitted infections and HIV in ophthalmology

The ocular and periocular manifestations of sexually transmitted infections are heterogeneous in etiology, manifestations, and complications. Etiologic agents include bacteria, viruses, parasites, and protozoa, which are most frequently transmitted via direct ocular contact with an active lesion or infected bodily fluid, autoinoculation, or dissemination from a distant site. Vertical transmission most commonly occurs perinatally during vaginal delivery. The complications of ophthalmia neonatorum can be severe, with the potential for permanent blindness or life-threatening systemic involvement if untreated. Clinical features, diagnostic modalities, and therapeutic regimens vary based on etiology and are summarized in this review. Prompt diagnosis is imperative, given the severe sequelae that may result from ocular involvement in these infections, including permanent vision loss. A multidisciplinary approach, involving both ophthalmology and dermatology, to diagnosis and management is essential to mitigate the risk of morbidity associated with sexually transmitted infections resulting in eye disease.

SDPS-43 OUTCOMES OF SUPRATENTORIAL FOCAL ENHANCING LESIONS CONCERNING FOR LEPTOMENINGEAL METASTASES

Abstract Leptomeningeal metastasis (LM) is an aggressive cancer complication with poor prognosis. Prompt diagnosis based on clinical findings, neuroaxis imaging, and cerebrospinal fluid (CSF) cytology- critical for appropriate, timely management. However, diagnosis is often challenging- as imaging lacks specificity and CSF cytology lacks sensitivity. Classic LM imaging findings include cerebellar folia, cranial nerve, and cauda equina enhancement. Of 103 patients with solid tumor brain metastasis referred to Neuro-Oncology at MD Anderson Cancer Center from 2016-2022 for evaluation of suspected LM on stereotactic radiosurgery (SRS) planning MRI, 15 had limited (≤5) nodular or linear focal enhancement in supratentorial sulci, without classic LM imaging. Upon initial workup, none had symptoms, neurologic deficits, or spine imaging consistent with LM; 10 underwent ≥1 lumbar puncture (median 1; range, 0-4) of which 2 (13%) had CSF cytology-confirmed disseminated LM. Majority were female (n=10); median age 60 years (range, 29-87). Most had lung (n=6) or breast (n=5) cancer. Five (33%) had history of craniotomy and resection of metastasis, with 1 resection cavity near supratentorial findings subsequently confirmed as LM. Both patients with confirmed LM received whole-brain radiation (WBRT)- instead of planned SRS- and intrathecal chemotherapy. One died 10.5m following diagnosis; the other continues therapy 11.6m later. In the remaining 13, the suspicious LM findings were determined to represent parenchymal/dural metastasis, treatment effect, or vascularity. Six were dispositioned to SRS, 3 to WBRT. One was ultimately diagnosed with LM (cytology-confirmed) 10m following WBRT. Nine subsequently received systemic therapy for intracranial and/or systemic disease. Median OS was 11 months (range, 4-37) from LM suspicion; 6 remain alive. In this small series, a minority of patients with supratentorial focal enhancing lesions without classic imaging findings were diagnosed with disseminated LM. Further study is needed to better stratify patients by LM risk and thus appropriateness of workup and intervention.

Septic Arthritis of the Elbow in a Premature Neonate: An Uncommon Disease in an Uncommon Location.

Septic arthritis (SA) is an infrequent diagnosis in the neonate. This case illustrates the presentation of SA within the elbow, an atypical location for neonatal SA. SA should be considered in any neonate with joint swelling, as symptoms are often subtle. Constitutional symptoms of infection, including fever, may not be present in the neonate. Staphylococcus aureus is the most common etiologic organism, and neonatal SA is often caused by hematogenous spread partially due to unique neonatal intraosseous anatomy. Joint aspiration can provide a definitive diagnosis and aid in targeted antimicrobial therapy. Other laboratory tests, including C-reactive protein and erythrocyte sedimentation rate, can aid in diagnosis. Ultrasound and magnetic resonance imaging can demonstrate joint effusion along with osteomyelitis, which is often seen concurrently with neonatal SA. There are no definitive guidelines for the treatment of neonatal SA. Conservative therapy with antimicrobials along with surgical intervention are the mainstays of treatment. Prompt diagnosis and treatment are crucial to decrease permanent joint damage. [Pediatr Ann. 2023;52(8):e292-e296.].

Diagnostic challenge of tuberculosis in systemic lupus erythematosus: a case report and literature review.

Patients with systemic lupus erythematosus (SLE) are at increased risk of tuberculosis (TB) infection due to immune dysfunction and immunosuppressive therapy. We present a case study of a 40-year-old woman with systemic lupus erythematosus (SLE). Initially, she was diagnosed with a lupus flare based on her clinical symptoms and laboratory results. However, upon further investigation, positive polymerase-chain reaction results for M. tuberculosis in the cerebrospinal fluid and lung parenchymal changes on chest computed tomography scan were indicative of TB infection. There was initial uncertainty regarding whether TB had triggered a flare-up of SLE or if TB was merely mimicking the symptoms of a SLE flare-up. However, as increasing the prednisolone dose did not have a positive effect and the patient's condition improved significantly with anti-TB treatment alone, it became clearer that the deterioration observed upon admission was primarily due to TB progression rather than an SLE flare-up. Additionally, we review the current literature on TB and SLE, including risk factors, diagnostic challenges, and treatment considerations, highlighting the importance of considering TB infection in patients with SLE who present with overlapping manifestations. Prompt diagnosis and treatment are essential for improving outcomes in these patients.

Therapeutic Plasma Exchange in Crisis Myasthenia Gravis with Pregnancy

Myasthenic Crisis (MC) is a clinical diagnosis defined by respiratory failure in patients with Myasthenia Gravis (MG). As MG symptoms worsen, the weakness of the respiratory muscles or upper airway can increase so much that it causes difficulty swallowing or breathing, resulting in respiratory distress. One of the triggers for a myasthenic crisis is pregnancy. In this case, the patient was undergoing a second pregnancy with a gestational age of 28-29 weeks and had been diagnosed with MG 4 years ago. The female patient, 27 years old, had complaints of shortness of breath, difficulty chewing, and weakness in the extremities. During her stay in the hospital, the patient's condition worsened and she experienced a myasthenic crisis. Therapeutic Plasma Exchange (TPE) was administered to the patient 3 times and the patient's had clinical improvement. The patient was discharged with pyridostigmine and methylprednisolone therapy. Therapeutic plasma exchange is a safe and effective procedure for the management of myasthenia gravis during pregnancy. Prompt diagnosis and proper management can reduce morbidity in myasthenia gravis, especially those in crisis.

A STUDY OF NON TRAUMATIC SMALL BOWEL PERFORATION

Objective: Non-traumatic small bowel perforation is a rare but potentially life-threatening condition. It is important to understand the causes, clinical features, surgical procedures, complications, and outcomes associated with this condition. This study aims to investigate these aspects within a specific hospital setting.
 Methods: A retrospective analysis of medical records was conducted to identify cases of non-traumatic small bowel perforation. Data on patient demographics, etiological factors, clinical presentations, surgical procedures, complications, and outcomes were collected and analyzed. Statistical methods were employed to examine the relationships between variables.
 Results: Small bowel perforation causes vary based on development status, with typhoid and tuberculosis more common in developing countries, and Crohn's disease and malignancies prevalent in developed countries. Patients present with symptoms like abdominal pain, vomiting, and fever. Diagnosis is challenging, with laparotomy being the primary method, and mortality rates remain high, reaching up to 42%.
 Conclusion: Non-traumatic small bowel perforation is a serious condition with potentially life-threatening complications. Prompt diagnosis and aggressive surgical intervention are crucial for improving patient outcomes. Understanding the causes, clinical features, and surgical management of this condition can guide effective treatment strategies and reduce morbidity and mortality rates.

The species distribution and antimicrobial resistance profiles of Nocardia species in China: A systematic review and meta-analysis.

Nocardia species can cause local or disseminated infection. Prompt diagnosis and appropriate treatment of nocardiosis are required, because it can cause significant morbidity and mortality. Knowledge of local species distribution and susceptibility patterns is important to appropriate empiric therapy. However, knowledge on the epidemiology and antimicrobial susceptibility profiles of clinical Nocardia species remains limited in China. The data of isolation of Nocardia species were collected from databases such as Pubmed, Web of Science, Embase as well as Chinese databases (CNKI, Wanfang and VIP). Meta-analysis was performed using RevMan 5.3 software. Random effect models were used and tested with Cochran's Q and I2 statistics taking into account the possibility of heterogeneity between studies. In total, 791 Nocardia isolates were identified to 19 species levels among all the recruited studies. The most common species were N. farcinica (29.1%, 230/791), followed by N. cyriacigeorgica (25.3%, 200/791), N. brasiliensis (11.8%, 93/791) and N. otitidiscaviarum (7.8%, 62/791). N. farcinica and N. cyriacigeorgica are widely distributed, N. brasiliensis mainly prevalent in the Southern, N. otitidiscaviarum mainly distributed in the east coastal provinces of China. Totally, 70.4% (223/317) Nocardia were cultured from respiratory tract specimens, 16.4% (52/317) from extra-pulmonary specimens, and 13.3% (42/317) from disseminated infection. The proportion of susceptible isolates as follows: linezolid 99.5% (197/198), amikacin 96.0% (190/198), trimethoprim-sulfamethoxazole 92.9% (184/198), imipenem 64.7% (128/198). Susceptibility varied by species of Nocardia. N. farcinica and N. cyriacigeorgica are the most frequently isolated species, which are widely distributed in China. Pulmonary nocardiosis is the most common type of infection. Trimethoprim-sulfamethoxazole can still be the preferred agent for initial Nocardia infection therapy due to the low resistance rate, linezolid and amikacin could be an alternative to treat nocardiosis or a choice in a combination regimen.

Leucocytes, thrombocytes and immature platelets in patients with dengue hemorrhagic fever

Diagnosis of Dengue Hemorrhagic Fever (DHF) is based on clinical and supporting examinations, including leukocytes and platelets examinations and antigen and antibody tests for the dengue virus. Examining leucocytes, thrombocytes, and immature platelets is a routine protocol in DHF patients. Leucocytes, thrombocytes, and immature platelets in dengue hemorrhagic fever have their characteristics and roles in relation to the disease severity. Prompt and early diagnosis will reduce the risk of disease severity. This review described the characteristics and role of leucocytes, thrombocytes, and immature platelets in dengue hemorrhagic fever.

Ectopic Cushing’s Syndrome as the First Presenting Sign of Small Cell Lung Carcinoma

A 67-year-old man with a history of hypertension, hyperlipidemia, coronary artery disease, and former smoking presented with fatigue, lower extremity edema, and a new tremor over the course of one month. Workup was notable for hypokalemia, metabolic alkalosis, and extremely elevated adrenocorticotropic hormone (ACTH) and cortisol levels. He was ultimately diagnosed with ectopic Cushing’s syndrome (CS) secondary to new metastatic small cell lung carcinoma. About 5-10% of CS cases are caused by ectopic ACTH production. The most commonly implicated malignancies are small cell lung cancer (SCLC) and neuroendocrine tumors, with SCLC accounting for up to three-fourths of cases. ACTH production is a poor prognostic sign in SCLC, associated with more extensive disease and decreased response to first-line treatment. Tumor-associated ACTH production is often so rapid that patients do not have time to develop classic Cushingoid physical exam findings, instead presenting with acute-onset hyperglycemia, pseudohyperaldosteronism, and generalized weakness. Prompt diagnosis and treatment are essential to improve outcomes.

Evaluation of management of Cesarean Scar Pregnancy (CSP).

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material & Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 1 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient’s 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of <5.1IU was achieved. 16.66 percent patients underwent D&C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy.

An Unusual Case of Enoxaparin-Induced Localized Skin Necrosis

Enoxaparin is a low-molecular-weight heparin (LMWH), i.e., widely used for prophylaxis and therapy of venous thromboembolism. Skin necrosis after subcutaneous injection is an uncommon and possibly underreported complication of LMWH. We report a case of enoxaparin-induced localized skin necrosis. Prompt diagnosis, discontinuation of LMWH, and work-up to rule out heparin-induced thrombocytopenia, a potentially life-threatening condition goes a long way in improving the outcome.

A Cross-Sectional Study of Dermatologic Manifestations in Patients with Chronic Renal Failure on Hemodialysis

Background: Chronic renal failure patients undergoing dialysis suffer from various side effects and complications where skin ailments are one of them. Skin is the largest and one of the most dynamic organs of the body and can be used as a window since it is easily accessible for observation and reflects changes seen in multiple organs including kidneys. Objective: The objective of this study is to describe various cutaneous manifestations in chronic kidney disease patients undergoing hemodialysis. Materials and Methods: A hospital-based, cross-sectional, observational study was conducted in the department of dermatology, venereology, and leprosy at a tertiary care center from November 2019 to May 2021. The demographic details and clinical manifestations were recorded. Data were recorded as numbers and percentages. For categorical data, the number and percentage were used in the data summaries, and data were analyzed by the Mann‒Whitney U test for the comparison of two data. Results: A total of 94 patients were included in the study. The most common manifestation observed was pruritus (85.1%), followed by xerosis (84%). Other findings seen in the study were mainly nonspecific changes such as pallor (59.57%), diffuse hyperpigmentation (3.2%), and ecchymosis (16%). Nail changes (56.38%) observed were half-and-half nails (22.6%), onycholysis (11%), and Beau’s lines (9%). Mucosal changes (36.17%) included depapillated tongue (12.8%) and macroglossia (8.5%). Other findings such as skin infections and keloid were also noted. New finding such as angina bullosa hemorrhagica was seen in one patient. Specific change like Kyrle’s disease was seen in 6.4% of the study group and 50% of these patients had concomitant diabetes mellitus. Conclusion: Patients on hemodialysis present with an array of cutaneous manifestations. The most common include pruritus and xerosis. Prompt diagnosis and early treatment help alleviate many of the cutaneous manifestations posed due to hemodialysis.