Primary Tuberculous Abscess of the Spleen in an Immununocompetent Patient Diagnosed by Biochemical Markers and Radiologic Findings

Tuberculous splenic abscess in an immunocompetent patient is extremely rare. We came across a case of middle aged immunocompetent female who presented with abdominal distension, weight loss, and low grade fever. Abdominopelvic computed tomography showed multiple low density lesions in the spleen with ascites. Interferon-gamma release assay was positive and adenosine deaminase level of ascites was significantly high. No primary focus of infection was detected. The patient was diagnosed as having primary multiple tuberculous splenic abscesses with tuberculous peritonitis causing ascites. Follow up computed tomography, after completion of six month course of anti-tubercular therapy, showed splenic abscess and ascites completely disappeared

Myocardial Infarction Thought to be Provoked by Local Epinephrine Injection During Endoscopic Submucosal Dissection

Due to its hemostatic effect, local epinephrine has been used to minimize mucosal bleeding during endoscopic submucosal dissection (ESD), but its clinical benefit remains unclear. On the other hand, several adverse events deemed to be caused by epinephrine have been observed during ESD. A 73-year-old woman developed myocardial infarction after ESD for a large rectal adenoma, and an 80-year-old woman developed abrupt chest tightness during ESD. In both patients, changes on electrocardiogram and elevated cardiac markers provided evidence of myocardial ischemia. The patients were transferred to the cardiac care unit and recovered completely. Up to our knowledge this is the first report of myocardial infarction thought to be provoked by submucosal epinephrine injection during ESD

Development of Pseudomembranous Colitis Four Months after Initiation of Rifampicin

Pseudomembranous colitis (PMC) may develop with long-term antibiotic administration, but is rarely reported to be caused by antitubercular agents. We present a case of PMC that occurred 120 days after starting rifampicin. A 74-year-old man was diagnosed with pulmonary tuberculosis and started on a standard HERZ regimen (isoniazid, ethambutol, rifampicin, pyrazinamide). After 4 months of HERZ, he presented with frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain. Sigmoidoscopy revealed multiple whitish plaques with edematous mucosa that were compatible with PMC. Biopsies from these lesions showed ulcer-related necrotic and granulation tissue. We stopped antitubercular treatment and started the patient on oral metronidazole. His symptoms completely resolved within 2 weeks. Antitubercular treatment was restarted by replacing rifampicin with levofloxacin. The patient did not present with diarrhea or bloody stool throughout the rest of treatment

Primary Medullary Hemorrhage Associated with Hypertension

Spontaneous primary medullary hemorrhage is a rare event. A 64-year-old man was admitted for sudden-onset vertigo and vomiting. His clinical features were similar to those of lateral medullary syndrome. The patient had no anticoagulant therapy, vascular malformation, or a caudal extension of a pontine hemorrhage. The patient had multiple hypertensive changes, including retinopathy, left ventricular hypertrophy on electrocardiography, multiple cerebral microbleeds, and small-vessel changes on MRI. T2*-weighted gradient echo MRI performed 3 months prior to admission and contrast-enhanced MRI showed no evidence of vascular malformation. We concluded that the patient had uncontrolled hypertension that may have lead to primary medullary hemorrhage

Better oral hygiene is associated with a reduced risk of osteoporotic fracture: a nationwide cohort study

BackgroundThe aim of this study was to examine the longitudinal association between oral health parameters and osteoporotic fracture.MethodsThe study included participants who received oral health screening by dentists from the National Health Screening cohort database of Korea between 2003 and 2006. The primary outcome was osteoporotic fracture occurrence, which was defined using specific international classification of diseases-10 codes; vertebral fracture (S22.0, S22.1, S32.0, S32.7, T08, M48.4, M48.5, and M49.5), hip fracture (S72.0 and S72.1), distal radius fracture (S52.5 and S52.6), and humerus fracture (S42.2 and S42.3). The presence of periodontitis and various oral health examination findings, such as missing teeth, caries, frequency of tooth brushing, and dental scaling, were analyzed using a Cox proportional hazard model to assess their association with osteoporotic fracture occurrence.ResultsThe analysis included a total of 194,192 participants, among whom 16,683 (8.59%) developed osteoporotic fracture during a median follow-up of 10.3 years. Poor oral health status, including periodontitis (adjusted hazard ratio [aHR]: 1.09, 95% confidence interval [CI]: 1.01–1.18, p = 0.039), a higher number of missing teeth (≥15; aHR: 1.59, 95% CI: 1.45–1.75, p < 0.001), and dental caries (≥6; aHR: 1.17, 95% CI: 1.02–1.35, p = 0.030), was associated with an increased risk of osteoporotic fracture. On the other hand, better oral hygiene behaviors such as brushing teeth frequently (≥3 times per day; aHR: 0.82, 95% CI: 0.78–0.86, p < 0.001) and having dental scaling within 1 year (aHR: 0.87, 95% CI: 0.84–0.90, p < 0.001) were negatively associated with the occurrence of osteoporotic fracture.ConclusionThe study found that poor oral health, such as periodontitis, missing teeth, and dental caries, was associated with an increased risk of osteoporotic fracture. Conversely, good oral hygiene behaviors like frequent teeth brushing and dental scaling within 1 year were associated with a reduced risk. Further research is needed to confirm this association

Removal of Pb(II) from aqueous solution by a zeolite–nanoscale zero-valent iron composite

The effectiveness of nanoscale zero-valent iron (nZVI) to remove heavy metals from water is reduced by its low durability, poor mechanical strength, and tendency to form aggregates. A composite of zeolite and nanoscale zero-valent iron (Z–nZVI) overcomes these problems and shows good potential to remove Pb from water. FTIR spectra support nZVI loading onto the zeolite and reduced Fe0 oxidation in the Z–nZVI composite. Scanning electron micrographs show aggregation was eliminated and transmission electron micrographs show well-dispersed nZVI in chain-like structures within the zeolite matrix. The mean surface area of the composite was 80.37 m2/g, much greater than zeolite (1.03 m2/g) or nZVI (12.25 m2/g) alone, as determined by BET-N2 measurement. More than 96% of the Pb(II) was removed from 100 mL of solution containing 100 mg Pb(II)/L within 140 min of mixing with 0.1 g Z–nZVI. Tests with solution containing 1000 mg Pb(II)/L suggested that the capacity of the Z–nZVI is about 806 mg Pb(II)/g. Energy-dispersive X-ray spectroscopy showed the presence of Fe in the composite; X-ray diffraction confirmed formation and immobilization of Fe0 and subsequent sorption and reduction of some of the Pb(II) to Pb0. The low quantity of Pb(II) recovered in water-soluble and Ca(NO3)2-extractable fractions indicate low bioavailability of the Pb(II) removed by the composite. Results support the potential use of the Z–nZVI composite in permeable reactive barriers

Removal of Pb(II) from aqueous solution by a zeolite–nanoscale zero-valent iron composite

The effectiveness of nanoscale zero-valent iron (nZVI) to remove heavy metals from water is reduced by its low durability, poor mechanical strength, and tendency to form aggregates. A composite of zeolite and nanoscale zero-valent iron (Z–nZVI) overcomes these problems and shows good potential to remove Pb from water. FTIR spectra support nZVI loading onto the zeolite and reduced Fe0 oxidation in the Z–nZVI composite. Scanning electron micrographs show aggregation was eliminated and transmission electron micrographs show well-dispersed nZVI in chain-like structures within the zeolite matrix. The mean surface area of the composite was 80.37 m2/g, much greater than zeolite (1.03 m2/g) or nZVI (12.25 m2/g) alone, as determined by BET-N2 measurement. More than 96% of the Pb(II) was removed from 100 mL of solution containing 100 mg Pb(II)/L within 140 min of mixing with 0.1 g Z–nZVI. Tests with solution containing 1000 mg Pb(II)/L suggested that the capacity of the Z–nZVI is about 806 mg Pb(II)/g. Energy-dispersive X-ray spectroscopy showed the presence of Fe in the composite; X-ray diffraction confirmed formation and immobilization of Fe0 and subsequent sorption and reduction of some of the Pb(II) to Pb0. The low quantity of Pb(II) recovered in water-soluble and Ca(NO3)2-extractable fractions indicate low bioavailability of the Pb(II) removed by the composite. Results support the potential use of the Z–nZVI composite in permeable reactive barriers