Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report review of the literature

Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax. The patient was successfully treated using conservative measures

Uticaj profesionalnog stresa na povrede na poslu i radnu sposobnost medicinskog osoblja

Introduction: Stress in the workplace in the health sector is in expansion. Objective: Assessment of the occupational stress index and types of stressors in certain areas of the health sector and their impact on the development of occupational injuries and at work ability. Methodology: The study group consisted of 448 health care personnel and control of 157 administrative workers. The application of the questionnaire were analyzed the presence and level of occupational stressors in their workplaces. The complete diagnostics of health status were performed. The data of the length of temporary incapacity for work, injuries at work and permanent work capacity were analyzed. Results: Total OSI was significantly higher in the examined group (69.24 ± 10.10) compared to the control group (39.38 ± 7.44) (t = 39.19, p <0.001). Total OSI was significantly higher among employees in institutions of secondary and tertiary health care levels (74.94 ± 7.43) compared to employees in institutions at the primary health care level (58.87 ± 4.47) (t = 24.891, p <0.001 ). Doctors are exposed to a significantly higher level of stress than the nurses (73.21 ± 10.13; 65.47 ± 8.52) (t = 8.725, p <0.001). Mental disorders, occupational disease and hypertension were significantly more present in the examined group compared to the controls (p = 0.043; Χ2 = 4.03; Χ2 = 31.30, p <0.001). Number of working days lost due to injuries at work, occupational and other diseases was significantly higher in the study than in the control group (p <0.001). Number of days lost due to illness, injury at work and occupational diseases was significantly higher among employees in institutions of secondary and tertiary health care levels in relation to employees in institutions at the primary health care level (z = 10.56, t = 6.44, t = 5.23; p <0.001). There was a significant correlation between OSI and workplace injuries, length of temporary work disability and complete permanent loss of working ability. The correlation is highly significant in health care personnel in surgical branches of medical activity. Conclusion: Professional stress have significantly effects on the development of the occupational injuries and at work ability of health care personnel, which needs the preventive measures

The effect of antihypertensive drugs on arterial stiffness and central hemodynamics: Not all fingers are made the same

Arterial stiffness and central hemodynamics attract increasing scientific interest within the hypertensive community during the last decade. Accumulating evidence indicates that aortic stiffness is a strong and independent predictor of cardiovascular events and all-cause mortality in hypertensive patients, and its predictive value extends beyond traditional risk factors. The role of central hemodynamics and augmentation index (a marker of reflected waves), remains less established and requires further investigation. Several lines of evidence indicate that antihypertensive therapy results in significant reductions of pulse wave velocity and central hemodynamics. However, beta-blockers seem to be the only exception with significant within-class differences. Conventional beta-blockers, although equally effective in reducing pulse wave velocity, seem to be less beneficial on central hemodynamics and augmentation index than the other antihypertensive drug categories, whereas the newer vasodilating beta-blockers seem to share the benefits of the other antihypertensive drugs. In conclusion, aortic stiffness seems ready for ‘prime-time’ in the management of essential hypertension, while further research is needed for central hemodynamics and augmentation index

A Promising Antigen-specific Immunotherapy for the Treatment of Myasthenia Gravis

Myasthenia gravis (MG) is a T cell-dependent, antibody-mediated, autoimmune disorder with well-established antigenic targets at the neuromuscular junction. MG autoantibodies mainly target the nicotinic acetylcholine receptor (AChR) and especially epitopes located in the extracellular domain of the α1 subunit (α1-ECD). Today, most therapeutic regimens for MG are non-specific and not curative, requiring chronic treatments that are associated with significant side effects. We aim to develop an antigen-specific therapeutic approach, based on reestablishing tolerance towards the AChR, the dominant autoantigen in MG. To this end, we used a soluble mutated form of the human α1-ECD, which incorporates a major fraction of MG autoreactive T cell epitopes and examined the therapeutic efficiency of intravenous administration in a rat experimental autoimmune MG model. We found that repeated intravenous administration of α1-ECD for up to 12 days led to a robust amelioration of disease symptoms in a dose and time-dependent manner. The observed therapeutic effect of α1-ECD was significantly better than the effect of two current mainstay drugs for MG treatment. There were no signs of toxicity in α1-ECD-treated animals and further studies are underway to fully elucidate the immunological mechanism underlying the treatment effect. Taken together, our preclinical data strongly suggest that intravenous administration of α1-ECD may represent an efficacious and safe strategy to treat MG and thus α1-ECD represents a new drug candidate for clinical application in MG.&nbsp

Superficial brachial artery traversing a median nerve loop in the arm associated with other vascular and muscular anomalies: case report and clinical implications

Knowledge of the various morphological patterns of the brachial artery and median nerve in the upper limb area is of considerable clinical and surgical importance to physicians intervening with these areas. In the current study, in the right upper limb of a male cadaver a rare variation of a superficial brachial artery associated with a median nerve loop in the upper arm is presented. The artery gave off a deep brachial artery in the arm and normally bifurcated in the cubital fossa. Additionally, a muscular bundle from the brachialis muscle was also present, overlapping the median nerve along with the deep brachial artery above the elbow. To the best of our knowledge such a combination of arterial, neural and muscular anatomical variations is extremely rare. Since brachial plexus and brachial artery variations are more prone to injury, their surgical, diagnostic and interventional importance are valuable to radiologists in interpreting images and to vascular surgeons, neurosurgeons and orthopedic surgeons involved in compressive peripheral neuropathy treatment. The relevant clinical and surgical implications are discussed as well

Guidelines for pre-clinical assessment of the acetylcholine receptor-specific passive transfer myasthenia gravis model - recommendations for methods and experimental designs.

Antibodies against the muscle acetylcholine receptor (AChR) are the most common cause of myasthenia gravis (MG). Passive transfer of AChR antibodies from MG patients into animals reproduces key features of human disease, including antigenic modulation of the AChR, complement-mediated damage of the neuromuscular junction, and muscle weakness. Similarly, AChR antibodies generated by active immunization in experimental autoimmune MG models can subsequently be passively transferred to other animals and induce weakness. The passive transfer model is useful to test therapeutic strategies aimed at the effector mechanism of the autoantibodies. Here we summarize published and unpublished experience using the AChR passive transfer MG model in mice, rats and rhesus monkeys, and give recommendations for the design of preclinical studies in order to facilitate translation of positive and negative results to improve MG therapies

Corneal Clarity and Visual Outcomes after Small-Incision Lenticule Extraction and Comparison to Femtosecond Laser-Assisted In Situ Keratomileusis

Purpose. To evaluate corneal clarity and visual outcomes after small-incision lenticule extraction (SMILE) and compare them to femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Materials and Methods. Fifty-eight myopic eyes of 33 patients who underwent SMILE were compared to 58 eyes of 33 patients treated with FS-LASIK. All procedures were performed using VisuMax® femtosecond laser and MEL 80® excimer laser (Carl Zeiss Meditec AG, Germany). Pentacam™ (Oculus, Germany) was used for pre- and 3-month postoperative corneal densitometry (CD) analysis. CD was evaluated at 3 optically relevant, concentric radial zones (0–2 mm, 2–6 mm, and 0–6 mm annulus) around the corneal apex and at 3 different anatomical corneal layers (anterior, central, and posterior). Associations of postoperative CD values with the lenticule thickness and ablation depth were examined. Preoperative and postoperative corrected distance visual acuity (CDVA) values were also compared. Results. After SMILE, the total CD (all corneal layers) at 0–6 mm annulus showed no significant change compared to preoperative values (P=0.259). After FS-LASIK, the total CD was significantly reduced (P=0.033). Three-month postoperative CD showed no significant differences between the 2 groups for all examined annuli (0–2 mm: P=0.569; 2–6 mm: P=0.055; and 0–6 mm: P=0.686). Total CD after SMILE at 0–6 mm annulus displayed a weak negative association with the lenticule thickness (P=0.079, R2=0.0532) and after FS-LASIK displayed a weak negative association with the ablation depth (P=0.731, R2=0.0015). Postoperative CDVA was similar for both groups (P=0.517). Conclusion. Quantification of corneal clarity using the Scheimpflug CD showed similar results before and 3 months after SMILE. Compared to FS-LASIK, no significant differences of corneal clarity and CDVA were found 3 months postoperatively

Catalytic Fast Pyrolysis of Kraft Lignin With Conventional, Mesoporous and Nanosized ZSM-5 Zeolite for the Production of Alkyl-Phenols and Aromatics

The valorization of lignin that derives as by product in various biomass conversion processes has become a major research and technological objective. The potential of the production of valuable mono-aromatics (BTX and others) and (alkyl)phenols by catalytic fast pyrolysis of lignin is investigated in this work by the use of ZSM-5 zeolites with different acidic and porosity characteristics. More specifically, conventional microporous ZSM-5 (Si/Al = 11.5, 25, 40), nano-sized (≤20 nm, by direct synthesis) and mesoporous (9 nm, by mild alkaline treatment) ZSM-5 zeolites were tested in the fast pyrolysis of a softwood kraft lignin at 400–600°C on a Py/GC-MS system and a fixed-bed reactor unit. The composition of lignin (FT-IR, 2D HSQC NMR) was correlated with the composition of the thermal (non-catalytic) pyrolysis oil, while the effect of pyrolysis temperature and catalyst-to-lignin (C/L) ratio, as well as of the Si/Al ratio, acidity, micro/mesoporosity and nano-size of ZSM-5, on bio-oil composition was thoroughly investigated. It was shown that the conventional microporous ZSM-5 zeolites are more selective toward mono-aromatics while the nano-sized and mesoporous ZSM-5 exhibited also high selectivity for (alkyl)phenols. However, the nano-sized ZSM-5 zeolite exhibited the lowest yield of organic bio-oil and highest production of water, coke and non-condensable gases compared to the conventional microporous and mesoporous ZSM-5 zeolites