Mycetoma trichophyton

A 2-year-old female child admitted to the hospital due to a palpable mass at her scalp referred by her parents. Her past medical history was clear. The clinical examination revealed edema, redness/erythema, blisters, tenderness and itching. No neurological changes were referred, no hair loss occurred and no other areas of the body were affected. The initial evaluation included X-rays, an ultrasonography and a magnetic resonance imaging (MRI) scan. The imaging findings were not pathognomonic but in combination with the clinical features, the differential diagnosis shrinked between mycetoma and pilomatrixoma (or calcifying epithelioma of Malherbe). For further evaluation, a small specimen of the scalp was obtained by scraping the skin with a scalpel. Cytological investigation revealed fungi infection caused by trichophyton species. So the final accurate diagnosis was mycetoma trichophyton. Patient was treated with miconazole nitrate (daktarin cream 2%), 1x3 for 15 days. First follow-up (day 15) showed improvement to complete cure. At the second follow up (day 30) there was no evidence of relapse. Mycetoma trichophyton must be differentiated from pilomatrixoma (which may appear with similar clinical and sonographic features), cutaneous tuberculosis, folliculitis, actinomycosis, chromomycosis, sporotrichosis, coccidioidomycosis, blastomycosis of the skin, botryomycosis etc. Dermatophyte infections usually occur in immuno compromised patients. In our case, the young patient was healthy and no medication administration had previously happened. A trichophyton infection mainly causes superficial lesions to the skin, nails and hair, deeper dermis and subcutaneous tissue anywhere on the body but most frequently at the lower extremities

Management of abdomen hydatidosis after rupture of a hydatid splenic cyst: a case report

We present a case of multiple hydatidosis in an 8-year-old boy that resulted from a ruptured hydatid cyst of the spleen and spread into the peritoneal cavity. We also present a new approach for managing these difficult and high-risk cases

Hematogenous infantile infection presenting as osteomyelitis and septic arthritis: a case report

The case of a 6-month old male infant presenting at the emergency department with fever and swelling at the left knee joint is discussed. Laboratory tests showed an inflammatory condition. Left knee plain radiograph demonstrated local soft tissue oedema. Percutaneous needle aspiration of articular fluid showed a positive culture for Staphylococcus aureus. The diagnosis of septic arthritis was confirmed. Because of inadequate response to treatment an MRI study was followed to evaluate possible abscesses. The presence of an abscess in the suprapatellar bursa was confirmed and an additional inflammatory process of the bone marrow was revealed, consistent with osteomyelitis. The pathophysiology, the imaging findings, the patient’s management and a review of septic arthritis and osteomyelitis coexistence are presented in this paper

Assessment of nutritional status and nutrition impact symptoms in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre nourish point prevalence study

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes

Preoperative nutrition intervention in patients undergoing resection for upper gastrointestinal cancer: Results from the multi-centre nourish point prevalence study:Results from the Multi-Centre NOURISH Point Prevalence Study

Background: Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated. Methods: The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded. Results: Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries (p 2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), p = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, p = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient −7.3, 95% CI −14.3, −0.3, p = 0.04). Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support

Use of Optical Coherence Tomography in MI with Non-obstructive Coronary Arteries

MI with non-obstructive coronary arteries (MINOCA) comprises an important minority of cases of acute MI. Many different causes have been implicated in the pathogenetic mechanism of MINOCA. Optical coherence tomography (OCT) is an indispensable tool for recognising the underlying pathogenetic mechanism when epicardial pathology is suspected. OCT can reliably identify coronary lesions not apparent on conventional coronary angiography and discriminate the various phenotypes. Plaque rupture and plaque erosion are the most frequently found atherosclerotic causes of MINOCA. Furthermore, OCT can contribute to the identification of ischaemic non-atherosclerotic causes of MINOCA, such as spontaneous coronary artery dissection, coronary spasm and lone thrombus. Recognition of the exact cause will enable therapeutic management to be tailored accordingly. The combination of OCT with cardiac magnetic resonance can set a definite diagnosis in the vast majority of MINOCA patients

Sinus node disease in subjects with type 1 ECG pattern of Brugada syndrome

AbstractBackgroundThe spectrum of phenotypes related to mutations of the SCN5A gene include Brugada syndrome (BS), long QT syndrome, progressive cardiac conduction defect, and sinus node disease (SND). The present study investigated the incidence of SND in subjects with type 1 electrocardiogram (ECG) pattern of BS.Methods and resultsThe study population consisted of 68 individuals (55 males, mean age 44.8±12.8 years) with spontaneous (n=27) or drug-induced (n=41) type 1 ECG pattern of BS. Twenty-eight subjects were symptomatic with a history of syncope (41.2%). SND was observed in 6 symptomatic subjects (8.8%), and was mainly attributed to sino-atrial block with sinus pauses. Two patients were initially diagnosed with SND, and received a pacemaker. Patients with SND displayed an increased P-wave duration in leads II and V2, PR interval in leads II and V2, QRS duration in leads II and V2, and increased QTc interval in lead V2 (p<0.05). AH and HV intervals as well as corrected sinus node recovery time (cSNRT) were significantly prolonged in subjects with SND (p<0.05). During a mean follow-up period of 5.0±3.6 years, five subjects with a history of syncope suffered appropriate implantable cardioverter defibrillator (ICD) discharges due to ventricular arrhythmias (7.4%). None of those diagnosed with SND suffered syncope or ICD therapies.ConclusionSND is not an uncommon finding in subjects with type 1 ECG pattern of BS. The occurrence of SND in relatively young patients may deserve meticulous investigation including sodium channel blocking test

Optic nerve sheath meningioma: a case report

A case of a 75-year old male with right-sided exopthalmos is presented. Outside proptosis of the right eye was initially observed 6 years ago. Opthalmological and endocrinological clinical examination as well as laboratory tests revealed no pathology from optic nerve disc, optic bulb and thyroid related hormones. MRI study demonstrated an optic nerve meningioma. The key imaging findings and the differential diagnosis were discussed in this present paper

The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives

Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic hyperglycaemia related to diabetes is associated with end organ failure. The clinical relationship between diabetes and atherosclerotic cardiovascular disease is well established. This makes therapeutic approaches that simultaneously target diabetes and atherosclerotic disease an attractive area for research. The majority of people with diabetes fall into two broad pathogenetic categories, type 1 or type 2 diabetes. The role of obesity, adipose tissue, gut microbiota and pancreatic beta cell function in diabetes are under intensive scrutiny with several clinical trials to have been completed while more are in development. The emerging role of inflammation in both type 1 and type 2 diabetes (T1D and T1D) pathophysiology and associated metabolic disorders, has generated increasing interest in targeting inflammation to improve prevention and control of the disease. After an extensive review of the possible mechanisms that drive the metabolic pattern in T1D and T2D and the inflammatory pathways that are involved, it becomes ever clearer that future research should focus on a model of combined suppression for various inflammatory response pathways