Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management.

Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment

Caudal cervical vertebral morphological variation is not associated with clinical signs in Warmblood horses

Background Variation in equine caudal cervical spine morphology at C6 and C7 has high prevalence in Warmblood horses and is suspected to be associated with pain in a large mixed-breed group of horses. At present no data exist on the relationship between radiographic phenotype and clinical presentation in Warmblood horses in a case-control study. Objectives To establish the frequency of radiographically visible morphologic variation in a large group of Warmblood horses with clinical signs and compare this with a group without clinical signs. We hypothesised that occurrence of morphologic variation in the case group would not differ from the control group, indicating there is no association between clinical signs and morphologic variation. Study design Retrospective case-control. Methods Radiographic presence or absence of morphologic variation of cervical vertebrae C6 and C7 was recorded in case (n = 245) and control horses (n = 132). Case and control groups were compared by univariable Pearson's Chi-square and multivariable logistic regression for measurement variables age, sex, breed, degenerative joint disease and morphologic variation at C6 and C7. Odds ratio and confidence intervals were obtained. A P <= 0.05 was considered statistically significant. Results Morphologic variation at C6 and C7 (n = 108/377 = 28.6%; Cases 58/245 = 23.7%; Control 50/132 = 38%) was less frequent in horses with clinical signs in univariable testing (OR 0.48, 95% CI 0.3-0.8, P = 0.001). Age, sex, breed and degenerative joint disease were not retained in the final multivariable logistic regression step whereas morphologic variation remained significantly less present in horses with clinical signs. Main limitations Possible demographic differences between equine clinics. Conclusions Morphologic variation in the caudal cervical spine was detected more frequently in horses without clinical signs. Therefore, radiographic presence of such variation does not necessarily implicate the presence of clinical signs

Management of Non-Classic Congenital Adrenal Hyperplasia in Pregnant Woman - Non-Referral Center Experience- Case Report

Congenital adrenal hyperplasia (CAH) is a rare autosomal recessive disorder with mutations in genes involved in cortisol and aldosterone production. Based on overall 21-OHase activity, CAH is divided into classic (C-CAH) and non-classic (NC-CAH). Females who suffered from NC-CAH have had increased infertility rates and higher miscarriage susceptibility. The treatment of CAH in pregnancy is still debatable. We present 22-years-old pregnant female (seventh week of gestation), who is currently under dexamethasone (DEX) since almost seven years for NC-CAH. At presentation, she is normotensive, non-obese, with no signs of hirsutism and Cushing syndrome. Seven days after the first visit, an endocrinologist makes informative talk with the patient and her mother about NC-CAH, pregnancy, and drugsassociated risks. Current Clinical Practice Guideline for CAH treatment suggests the use of protocols approved by Institutional Review Boards at Centers experienced in CAH treatment. In women with CAH who are planning a pregnancy, a close relationship between endocrinologist, reproductive gynaecologist and molecular biologist is of great interest. Prenatal management with DEX is advised in particular circumstances. In remaining, the switch from DEX to other glucocorticoids that do not penetrate placenta is advise

Why we should understand the patient experience: clinical empathy and medicines optimisation

Objectives To critically discuss the need for pharmacists to underpin their consultations with appropriate ‘clinical empathy’ as part of effective medicines optimisation. Methods Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Key findings Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. Conclusions We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients’ relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care

U wave: an Important Noninvasive Electrocardiographic Diagnostic Marker

Study of U waves exemplifies important clinical role of noninvasive electrocardiography in modern cardiology. Present article highlights significance of U waves with a clinical case and also summarizes in brief the history of the same

A framework model for a contextualized and integrated warfarin therapy case in a master of pharmacy program

© Copyright 2019 American Journal of Pharmaceutical Education.Objective. To develop and integrate a case study on warfarin into a clinical pharmacy workshop. Methods. A framework model was designed and used to create a case study on warfarin therapy. The case study was implemented in a third-year Master of Pharmacy course. Student feedback was obtained using an online questionnaire and two focus groups. Results. All students agreed that the case study successfully integrated the science of warfarin and concepts of pharmacy practice. The majority of students (94%) agreed that this approach helped them to understand the science of warfarin more than a traditional lecture would have. Students felt the time allocated to the workshop was too short. Conclusion. An integrated case study provides a learning environment that emphasizes the contextualization of chemistry and pharmacology into a clinical pharmacy setting.Peer reviewedFinal Published versio

Clinical proteomics for precision medicine: the bladder cancer case

Precision medicine can improve patient management by guiding therapeutic decision based on molecular characteristics. The concept has been extensively addressed through the application of –omics based approaches. Proteomics attract high interest, as proteins reflect a “real-time” dynamic molecular phenotype. Focusing on proteomics applications for personalized medicine, a literature search was conducted to cover: a) disease prevention, b) monitoring/ prediction of treatment response, c) stratification to guide intervention and d) identification of drug targets. The review indicates the potential of proteomics for personalized medicine by also highlighting multiple challenges to be addressed prior to actual implementation. In oncology, particularly bladder cancer, application of precision medicine appears especially promising. The high heterogeneity and recurrence rates together with the limited treatment options, suggests that earlier and more efficient intervention, continuous monitoring and the development of alternative therapies could be accomplished by applying proteomics-guided personalized approaches. This notion is backed by studies presenting biomarkers that are of value in patient stratification and prognosis, and by recent studies demonstrating the identification of promising therapeutic targets. Herein, we aim to present an approach whereby combining the knowledge on biomarkers and therapeutic targets in bladder cancer could serve as basis towards proteomics- guided personalized patient management

Photonuclear reactions with Zinc: A case for clinical linacs

The use of bremsstrahlung photons produced by a linac to induce photonuclear reactions is wide spread. However, using a clinical linac to produce the photons is a new concept. We aimed to induce photonuclear reactions on zinc isotopes and measure the subsequent transition energies and half-lives. For this purpose, a bremsstrahlung photon beam of 18 MeV endpoint energy produced by the Philips SLI-25 linac has been used. The subsequent decay has been measured with a well-shielded single HPGe detector. The results obtained for transition energies are in good agreement with the literature data and in many cases surpass these in accuracy. For the half-lives, we are in agreement with the literature data, but do not achieve their precision. The obtained accuracy for the transition energies show what is achievable in an experiment such as ours. We demonstrate the usefulness and benefits of employing clinical linacs for nuclear physics experiments

Puerperal Streptococcus pneumoniae endometritis : a case report and literature review

Streptococcus pneumoniae endometritis is an exceedingly rare clinical occurrence in the immunocompetent individual. This case report describes such an occurrence in an otherwise healthy woman 39 days post-normal vaginal delivery. The patient responded to prompt broad-spectrum intravenous antibiotics and made a full recovery. The clinical relevance of such a scenario, the likely pathogenesis of the event as well as a brief review of relevant clinical literature are discussed. Streptococcus pneumoniae genital infection was a well-documented clinical entity in the pre-antibiotic era with a high mortality rate – 26% for localised infection and 74% for peritonitis and sepsis. More recently, however, there have been only isolated reports of Streptococcus pneumoniae genital infection, with even less frequent accounts of this happening in immunocompetent individuals. In this report, we document a case of Streptococcus pneumoniae endometritis in a young, previously healthy female 39 days post-partum.peer-reviewe

Distributed Queries for Quality Control Checks in Clinical Trials

Operational Quality Control (QC) checks are standard practice in clinical trials and ensure ongoing compliance with the study protocol, standard operating procedures (SOPs) and Good Clinical Practice (GCP). We present a method for defining QC checks as distributed queries over case report forms (CRF) and clinical imaging data- sources. Our distributed query system can integrate time-sensitive information in order to populate QC checks that can facilitate discrepancy resolution workflow in clinical trials