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  • Houston posted an update 7 months, 2 weeks ago

    We document inadequately diagnosed coagulopathy (potential to be life threatening) due to Ovophis monticola bite. Although its bites are common in the hills of Nepal, associated envenomations have not been documented elaborately. Herein, we present the clinical and treatment details of a proven O. find more monticola bite and areas where it may pose the risk of envenomations (suggesting huge populations in Asia to be vulnerable to its bites). Its envenomation was managed symptomatically with several non-evidence-based interventions. Since no specific pitviper antivenom is available in Nepal yet, managing coagulopathy associated to O. monticola envenomation is still challenging. This case emphasizes the need of developing the standard protocol for the diagnosis and management of pitviper bites and study of effectiveness of the available pitviper antivenoms until specific pitviper antivenom is available. Further, the demonstrated distribution localities of this species may have implications for snakebite prevention and designing and distribution of the effective antivenoms.A 29-year-old woman with a 5-year history of primary infertility underwent in vitro fertilization-embryo transfer (IVF-ET) treatment. Hemorrhagic shock caused by retroperitoneal hematoma after oocyte retrieval was treated promptly by the evaluation of diagnostic laparoscopy and angiography. The patient was recovered and discharged from the hospital 7 days later without any complications. She was later diagnosed with Von Willebrand disease by a hematologist.Cystic lymphangiomas are a rare entity in adults. It is commonly congenital due to obstruction in the lymphatic drainage. We report the case of a 45-year-old female who was admitted with complaints of a lateral neck swelling associated with multiple palpable cervical lymph nodes. Patient was evaluated and relevant investigations were carried out. Her radiological investigations reported conflicting results of lymphatic cyst, branchial cyst and infected cyst or abscess. However, after an excisional biopsy when the sample tissue was sent for histopathology, the results featured a lymphangioma, which is a rare finding in adults of this age.Chylous ascites (CA) is the leakage of triglyceride-rich fluid into the peritoneal cavity. This most commonly occurs due to trauma of the lymphatic system. Recently, lymphangiography with lipiodol have been used with promising results in managing refractory postoperative CA. We present the case of a 35-year-old man who developed massive refractory CA post simultaneous pancreas-kidney (SPK) transplant. After conservative management with diet modifications failed, the patient underwent lymphangiography and lymph angioembolization using lipiodol. In this case report, we describe the use of lymphangiography as both a diagnostic and therapeutic approach to successfully manage large volume CA following SPK.We surveyed Staphylococcus aureus contamination in 110 pork samples from 12 fresh meat markets in Nongchok district, Bangkok, Thailand, and performed antimicrobial susceptibility testing with the disk diffusion method. The prevalence of S. aureus was 28.18%, and 52 strains were isolated. Antimicrobial susceptibility testing using the disk diffusion method revealed that 80.77% of the isolates were resistant to tetracycline and 76.92% to ampicillin. All strains were 100% susceptible to cloxacillin, cefoxitin, gentamicin, and cefazolin. The high percentage of antibiotic resistance to tetracycline and ampicillin was attributed to their use in treating infections in farmed animals and their addition to animal food for disease prevention. Interestingly, the present study revealed the intermediate resistance of S. aureus (13.46% of S. aureus-positive pork samples) to vancomycin which is a common medicine for treating severe infection in humans, suggesting that the trend of resistance might increase and becoming a serious problem of public health for both humans and animals.Our aim was to analyse body core temperature and peripheral vascular microcirculation at skin hypothenar eminence of the hands and its relationship to symptoms in fibromyalgia syndrome (FMS). A total of 80 FMS women and 80 healthy women, matched on weight, were enrolled in this case-control study. Thermography and infrared thermometer were used for evaluating the hypothenar regions and core body temperature, respectively. The main outcome measures were pain pressure thresholds (PPTs) and clinical questionnaires. Significant associations were observed between overall impact [β = 0.033; 95% confidence interval (95%CI) = 0.003, 0.062; p = 0.030], daytime dysfunction (β = 0.203; 95%CI = 0.011, 0.395; p = 0.039) and reduced activity (β = 0.045; 95%CI = 0.005, 0.085; p = 0.029) and core body temperature in FMS women. PPTs including greater trochanter dominant (β = 0.254; 95%CI = 0.003, 0.504; p = 0.047), greater trochanter non-dominant (β = 0.650; 95%CI = 0.141, 1.159; p = 0.013), as well as sleeping medication (β = -0.242; 95%CI = -0.471, -0.013; p = 0.039) were also associated with hypothenar eminence temperature. Data highlighted that FMS women showed correlations among body core temperature and hand temperature with the clinical symptoms.The development of portal hypertension has serious implications in the natural history of liver cirrhosis, leading to complications such as ascites, hepatic encephalopathy and variceal bleeding. The management of acute variceal bleeding has improved in the last two decades, but despite the advances in endoscopic methods the overall prognosis remains poor, particularly within a subgroup of patients with more advanced disease. The role of Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is a well-established method of achieving haemostasis by immediate portal decompression; however, its use in an emergency setting as a rescue strategy is still associated with high mortality. It has been shown that ‘early’ use of TIPSS as a pre-emptive strategy in a patient with acute variceal bleed in addition to the standard of care confers superior survival outcomes in a subgroup of patients at high risk of treatment failure and death. The purpose of this review is to appraise the literature around the indications, patient selection, utility, complications and economic considerations of pre-emptive TIPSS.

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