Acute appendicitis caused by endometriosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Endometriosis is a well-recognized gynecological condition in the reproductive age group. Surgical texts present the gynecological aspects of the disease in detail, but the published literature on unexpected manifestations, such as appendiceal disease, is inadequate. The presentation to general surgeons may be atypical and pose diagnostic difficulty. Thus, a definitive diagnosis is likely to be established only by the histological examination of a specimen.</p> <p>Case presentation</p> <p>We report a case of endometriosis of the appendix in a 25-year-old Caucasian woman who presented with symptoms of acute appendicitis and was treated by appendectomy, which resulted in a good outcome.</p> <p>Conclusions</p> <p>We discuss special aspects of acute appendicitis caused by endometriosis to elucidate the pathologic entity of this variant of acute appendicitis.</p

Greater pQCT calf muscle density is associated with lower fracture risk, independent of FRAX, falls and BMD: a meta-analysis in the osteoporotic fractures in men (MrOS) study

We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72–1.0 and 0.78; 95% CI, 0.66–0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88–1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59–0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

Interaction between karst terrain and bauxites : evidence from Quaternary orebody distribution in Guangxi, SW China.

Research Article. Geology. 2017.Abstract available in PDF file

Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives:We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged-infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies.Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries.Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT(&gt; MIC) (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving beta-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of &gt;= 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025].Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections

Understanding the relationship between muscle and bone in older adults: an investigation of two cohorts

Bone and muscle are interconnected tissues forming the ‘muscle-bone unit’. Sarcopenia and osteoporosis are common conditions in older adults; the characterisation of the relationship between muscle and bone is fundamental to the development of potential novel preventive and therapeutic strategies that benefit both tissues. This thesis presents data from two cohorts, the Hertfordshire cohort study (HCS) and Southampton Longitudinal Study of Ageing (SaLSA) that consider relationships between muscle and bone in later life. Using existing data available from the Hertfordshire Cohort Study (HCS), the association between sarcopenia or/and osteoporosis with frailty was assessed. Co-existence of sarcopenia and osteoporosis were associated with a much higher risk of frailty than either condition alone, while sarcopenia and osteoporosis were both closely linked with multimorbidity. The overall prevalence of frailty was 8.1% with the risk increasing with age, while corresponding figures for pre-frailty were 57.5%, with the risk increasing with age only in females. Furthermore, possible determinants, such as demographic and anthropometric, of muscle density were considered and the relationships of muscle density measures to the clinical outcomes of falls and fractures were reported. Demographic and anthropometric (female sex, older age, and lower adiposity), rather than lifestyle factors such as physical activity and diet, were associated with lower muscle density, approximately 11 years later. Forearm muscle density was associated with previous fracture, rather than falls history. In addition, the relationships between other sarcopenia components including muscle size, strength and function were considered with the clinically important outcomes of falls and fractures in HCS. Observed relationships between muscle mass and strength but not function with falls and fractures were reported; sexual dimorphism was also described in the above-mentioned relationships. Finally, we present results from a new community-based cohort of older adults in Southampton, SaLSA. Initially we have investigated the impact of the COVID19 pandemic on lifestyle factors associated with musculoskeletal health in older adults living in their own homes. Greater nutritional risk and sarcopenia risk were associated with being in a worse category for change in diet quality in SaLSA during the 1st year of the pandemic. Investigating the factors leading to these changes, understanding whether they are reversible, and recognising the consequences to musculoskeletal health is required. Future work is described using this new cohort of older adults that will allow the investigation of muscle bone interrelationships in greater detail than has been previously possible. Given the interrelation between bone and muscle, future studies, such as SaLSA, might allow us to better understand muscle-bone crosstalk, with the aim of developing preventative strategies to retard or prevent deterioration of both tissues with age

Chemical and mineralogical characteristics of tourmaline in pegmatites from Vavdos, Chalkidiki peninsula, N Greece

Pegmatite veins crosscutting dunites and serpentinites of the ophiolitic complex of the Vavdos (Gioldaki and Loukoviti), northern Greece contain tourmalines with a wide variation in size and composition. Pegmatite veins mainly consist of quartz crystals, microcline, albite, perthitised-feldspars. The accessory minerals include mostly coarse to medium grained zoned tourmaline, and lesser amounts of sericite (only occasionally biotite). There are also trace amounts of some rare earth element minerals, such as morazite, xenotime and minerals of the bastnaesite group (epigenetic products of monazite). The pegmatite veins host also fine-grained tourmalile, which shows an orientation parallel to the schistosity of the rock. They are composed of quartz, low-T albite and K-feldspars. Hydroxy apatite, chlorite, Nb-bearing REE minerals (koragoite), garnet, zircon and talc are also present in lesser amounts