Pancreatic Divisum: An Unusual Cause of Chronic Pancreatitis in a Young Patient

Pancreatic divisum is a condition that occurs in 4-14% of the population. Pancreatic divisum occurs in development when the ventral bud and dorsal bud of the pancreas fail to fuse. Patients with this condition are usually asymptomatic, however, 25-38% of these patients experience recurrent pancreatitis that may further progress to chronic pancreatitis. This case is of a 20-year-old female presenting with abdominal pain in the left and right upper quadrants of the abdomen with a significant history of recurrent pancreatitis since the age of seven. The patient was examined with computed tomography (CT), which identified pancreatitis. Further magnetic resonance cholangiopancreatography (MRCP) assisted in the diagnosis of a type III pancreatic divisum, given the remnant of short communication between the dorsal and ventral duct

A Case of Persistent Asthma Resistant to Available Treatment Options: Management Dilemma

Asthma affects nearly 300 million people worldwide, with 250,000 associated deaths annually. An estimated 5%-10% of patients have severe asthma, while only 1%-2% presented with treatment-resistant or refractory asthma. Currently, the endotype of asthma is divided into T-helper type 2 (Th2) high and Th2-low inflammation endotypes. The Th2-high endotype is characterized by eosinophilic asthma, while the Th2-low endotype is associated with neutrophilia and a pauci-granulocytic profile. The Th2-low endotype carries a high resistance to corticosteroid and bronchodilator therapy, and these patients typically have a severe and acute-onset of symptoms. We present a 57-year-old nonsmoking female with recurrent intensive care unit (ICU) admissions for severe acute asthma exacerbations, resistant to bronchodilator and steroid treatment, requiring mechanical ventilation. Currently, the guidelines for treating neutrophil-predominant Th2-low inflammation asthma have not been established. This creates a management dilemma when encountered with such a patient in clinical practice. We aim to propose targeted treatment options for these severe and potentially fatal asthma patients, with reference to current literature

Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis

Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p\u3c0.001; I2=0%), and cardiovascular mortality (RR: 0.32 [0.23, 0.44]; p\u3c0.001; I2=0%). No significant difference between PMVR+OMT and OMT was noted in HF hospitalization (HR: 0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR: 1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality, and cardiovascular mortality in patients with HF and severe MR

Impact of Sporisorium scitamineum infection on the qualitative traits of commercial cultivars and advanced lines of sugarcane.

Whip smut disease of sugarcane, caused by Sporisorium scitamineum, is considered one of the main constraints in the successful cultivation of sugarcane. The pathogen infection can decrease the quantity and quality of the produce. Cultivation of resistant varieties is the most feasible strategy to combat the harms of this devastating disease. Development of varieties having disease-resistance together with improved important traits such as brix, pol, purity, CSS, and low fiber contents are desirable. Therefore, we documented the variances in quality traits of 104 sugarcane cultivars under disease pressure in split-plot design with 6 replications. The split ANOVA revealed a highly significant impact (p4.032) in brix, pol, purity, and CSS of more than 40% of the cultivars used, as compared to the uninoculated ones. On the other hand, the smut infection caused a highly significant (t>4.032) increase in fiber percentage of 41 cultivars. We found significant positive correlations between smut rating and reduction of brix, pol, purity, and CSS contents. The cultivars that were caught with greater disease severity, compromised a higher reduction of their useful contents. Similarly, a significant positive correlation was found between increased fiber percent and smut rating. Remarkably, cultivars that showed immune reactions to whip smut disease were not statistically different from uninoculated ones in brix, pol, purity, CSS, and fiber contents. Variable effects of whip smut infection to quality parameters of different cultivars depict the importance of further improvement through breeding programs