COVID 19 in a traumatic thoracic aortic injury patient

The number of traumatic thoracic aortic injuries being treated by endovascular procedures is on the rise. Coronavirus (COVID-19) has affected healthcare systems worldwide and was declared a global pandemic by the world health organization (WHO) in March 2020. In this study, we discuss a 37-year-old man with thoracic aorta trauma caused by a motor–vehicle accident that underwent Thoracic endovascular aortic repair (TEVAR) and was incidentally diagnosed with concurrent COVID-19. During this pandemic period, physicians should be on the lookout for COVID-19 with low thresholds for testing, as a timely diagnosis will improve patient outcomes and reduce the risk of transmission. A delay in diagnosis puts the patients at risk of not receiving effective treatment and may result in the transmission of infection to hospital staff, environment (i.e. operating rooms and equipment), and other members of the community

Inguinal Canal Hydatidosis Presenting as Irreducible Inguinal Hernia: A Case Report

Background: Hydatidosis is a parasitic infestation caused by Echinococcus granulosus. This tapeworm commonly affects liver and lungs. Its diagnosis in unusual locations may be make some challenges for practicing physicians.Case Report: A 45-year-old man presented with bulging and discomfort in the right lower quadrant from 2 years ago. Computed tomographic examination showed an oval cyst measuring about 7 cm × 15 cm in the inguinal area. In the operating room, after sealing the area with appropriate amounts of gauze soaked in silver nitrate the cyst punctured and clear fluid aspirated from the cyst; then, the cyst was sterilized using silver nitrate and opened. Daughter cysts were extracted from the cyst, the cyst was carefully freed from surrounding structures, and total excision of the cyst was performed. Post-operative period was uneventful, and no recurrence was encountered during the 6-month follow-up period.Conclusions: In this case, we present a patient with swelling in the inguinal area, which turns out to be hydatid cyst. To our knowledge, there has been no case of hydatid cyst arising primarily from inguinal canal. Hydatid disease can present with many different symptoms, and in this case, we present one the rare presentations of this disease. So that for a surgeon who works in the endemic areas, it is important to be aware about the varying presentations of the disease so that in the operation room should do required preparations to prevent unwanted serious problems such as spillage of intracystic materials

Comparing Subcuticular and Transdermal Appendectomy Repairs: A Randomized Clinical Trial

Background: Appendectomy is one of the most common abdominal operations. The prevalence of appendicitis increases with increased lymphatic tissue with the maximum prevalence at the beginning of adulthood. Owing to the high prevalence of appendectomy, patients will be benefited from a better method with improvement of surgical site and management of postoperative pain and infection. Subcuticular repair method due to better scar formation and less pain is preferred to the routine repair method, if the infection rate is comparable.Methods: The current study was conducted on appendectomy candidates in 2017. After providing the necessary explanations, the interested patients signed the informed consent forms and voluntarily participated in the study. The subjects were randomly assigned into two groups of randomized clinical trial with parallel design and 1:1 ratio. The sample size was 120 individuals based on previous studies. Subjects were assigned into two groups of 105 subjects each: the first group as subcuticular and the second group as transdermal accordingly. Then, they were studied and followed up.Results: One week after operation, 8.5% of subcuticular and 5.7% of transdermal repairs developed localized infection, and no significant difference was observed between the two groups. One week after surgery in the first group, 10% had no pain, 36% mild pain, 27% moderate pain, and 27% severe pain. In the second group, 7% had no pain, 36% mild pain, 30% moderate pain, and 27% severe pain. Therefore, there was no significant difference between two groups in this regard.Conclusion: There was no significant difference in the surgical wound infection rate between two methods. Accordingly, subcuticular repair was suggested as the preferred method owing to its better scar formation

Prevalence and Management of Gastric Leakage After Laparoscopic Sleeve Gastrectomy: A Case Study in Modarres Hospital, Tehran, Iran

Background: Sleeve gastrectomy is an effective procedure for weight loss. However, some serious complications may occur during this operation such as strictures, bleeding, and leak. According to previous studies, the rate of leak was 1.06%. Using endoscopic stents have been hampered by some drawbacks the most important of which is repeated migration. The current study aimed to discuss the prevalence and management of leak after laparoscopic sleeve gastrectomy operated at Modarres Hospital, Tehran, Iran.Methods: This cross-sectional study was conducted on patients with morbid obesity undergone laparoscopic sleeve gastrectomy at Modarres Hospital, Tehran, Iran. In addition to the patients’ demographic data; their leak complications, first symptoms and signs, WBC count, and method of management were extracted and collected from their medical files. Results: A total number of 1263 patients were enrolled in this study. Of them 8(0.63%) patients suffered from leak after the operation. The mean (SD) age of patients with leak was 32.33(6.02) year. The mean (SD) BMI of patients with leak was 45.75(2.07) kg/m2. The mean (SD) of WBC count of the patients with leak was 13680(7272.68). The symptoms of the patients began on different days (3-240 day). Management of the patients was different but most of the patients underwent endoscopic stent.Conclusion: It seems that stent insertion is a useful method for treatment of leak after sleeve gastrectomy, especially in immediate leak

Computed Tomography Angiography-Based Evaluation of Anatomical Variations of the Celiac Trunk and Renal Arteries

Background: The abdominal aorta and its main branches, such as the celiac trunk and the renal arteries are manipulated during various radiologic, surgical, and oncologic procedures. This study aimed at evaluating the anatomical pattern of these vessels to assist surgeons and radiologists reduce the risk of intra- as well as postoperative complications. Methods: A retrospective analysis of 536 Computed Tomography Angiography (CTA) studies of living potential kidney donors was conducted from January 2012 to December 2018.Results: The anatomical variations of the celiac trunk was found in 9.5% of the cases. Among these cases, the most frequent variation was the Left Gastric Artery (LGA) as the first branch of the celiac trunk (80.4% of the cases). Gender was not overall significantly associated with the variations of the celiac trunk (P=0.670); however, there was a significant correlation between male gender and the most prevalent form of the celiac trunk variation (P=0.004). Variations of the renal artery occurred in 22.94% of the cases, with the left accessory renal artery being the most common variant (28.45% of the cases). Gender and the involved side (right / left) were not significantly related to the renal artery variations (P=1.000 & P=0.546, respectively). No concomitant variation of the celiac trunk and the renal artery was detected in our study. Conclusion: The anatomical variations of the celiac trunk and the renal arteries occur commonly; thus, the branching pattern of these arteries should be assessed prior to any procedure concerning them

Post Helicobacter pylori Treatment Histopathological Findings in Laparoscopic Sleeve Gastrectomy Specimens

Background: Obesity nowadays becomes a major medical and social problem in the world. Obesity is a pandemic health problem recognized as a disease of time and is also an important cause of morbidity and mortality. The aim of this study was to investigate the persistent histopathologic changes after Helicobacter pylori (H. pylori) treatment in laparoscopic sleeve gastrectomy (LSG) specimens and correlation between high body mass index (BMI) and histopathological findings. Materials and Methods: Asymptomatic 520 patients were candidate for laparoscopic sleeve gastrectomy (2017-2019) who had not symptom of Helicobacter pylori infection, visually normal endoscopy and had positive H. pylori urease recently. They treated with triple regimen (clarithromycin, amoxicillin for 2 weeks and proton-pump inhibitor (PPI) for 2 month). Eradication was confirmed by urea breath test (UBT). After operation specimens were evaluated histopathologically. Results: Females were 58.3% of the patients. Mean BMI were 44.2 (females) and 46.3 (males). Normal LSG specimens were 58.3%. Most common abnormal histopathology findings were; chronic mild active and inactive gastritis (21.3%), chronic moderate active and inactive gastritis (16.0%), chronic severe active and inactive gastritis (3.3%), had not follicular gastritis, lymphoid aggregates (0.6 %), intestinal metaplasia (0.2%) and PPI effect (0.2%). Significant correlation was observed between the higher patients BMI (BMI>45) with abnormal histopathology findings specially moderate and severe degree of chronic active and inactive gastritis. Conclusion: Patients with higher BMI was at more risk for post H. pylori treatment abnormal pathology like chronic active gastritis which is the risk factor for atrophic gastritis may lead to preventable gastric cancer. Patients with higher BMI (≥45) and H. pylori positive urease test with visually normal endoscopy, mainly candidate for the laparoscopic Roux-en-Y gastric bypass (LRYGB). Permanent endoscopic follow up in these patients are impossible, therefore, endoscopic random tissue mapping even after H. pylori treatment is appropriate

Viral Outbreaks of SARS-CoV1, SARS-CoV2, MERS-CoV, Influenza H1N1, and Ebola in 21st Century; A Comparative Review of the Pathogenesis and Clinical Characteristics

 Throughout the past twenty years, humankind had its fair share of challenges with viral epidemics. In late December 2019, a zoonotic member of the coronaviruses was responsible for the COVID-19 outbreak of viral pneumonia in Wuhan, China. As a worldwide crisis, meanwhile, conclusive prevention or therapy has yet to be discovered, the death toll of COVID-19 has exceeded 278000 by May 11th, 2020. Alike other members of Coronavirus family such as MERS and SARS-CoV-1, SARS-CoV-2 provokes influenza-like syndrome which might further progress to the severe state of acute respiratory disease in some patients. Comparably, in 2009 the H1N1 influenza outbreak affected countless people by manifestations of respiratory system involvement. Additionally, Ebolavirus, as a member of the Filoviridae family, had also made a global catastrophe by causing hemorrhagic diseases in the past twenty years.  The unknown intrinsic nature of SARS-CoV-2, as a great missing piece of this pandemic puzzle, has had physicians to empirically test the possibly efficacious agents of the former viral epidemics on the COVID-19 cases. Here, the current knowledge in SARS-CoV-2 clinical features, transmissibility, and pathogenicity are all summed up as against the other emerging viruses in the last two decades, and the data crucially required for a better management of the illness has been spotlighted

Comparing the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter

Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter. Methods: This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury. Results: A total of 101 patients were enrolled in this trial. Early dysfunction (blind group = 5), a need for catheter exchange (blind group = 2), pneumothorax (blind group = 2), vascular injury (blind group = 1) were recorded but the difference between the two groups was not statistically significant (P > 0.05). Conclusion: We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended

COVID-19-Related Spontaneous Pneumomediastinum: An Atypical Manifestation

COVID-19 is has been an emerging healthcare challenge during the last months. Herein we explain two cases with spontaneous pneumomediastinum as an atypical manifestation of COVID-19 disease; these two patients had confirmed COVID-19, leading to spontaneous pneumodeiastimun as an atypical manifestation during the course of hospital stay, presenting by abrupt deterioration in O2 saturation and symptoms. Spontaneous pneumomediastinum should be considered as a potential reason for the disease exacerbation in patients without previous history of mechanical ventilation. &nbsp

Therapeutic Options and Critical Care Strategies in COVID-19 Patients; Where Do We Stand in This Battle?

A pandemic of COVID-19 made an appearance in Wuhan, China, in late December 2019 and rapidly became a serious concern worldwide, with killing more than 238000 people until 3rd May 2020. Given the fact that a vaccine against the virus probably won’t be available anytime in the near future, the therapeutic strategies have become more prominent. Many supposedly effective drugs are under evaluation which may hinder the replication of SARS-CoV-2, and subsequently the infection. Lately on 1th may 2020, FDA authorized the use of experimental drug, Remdesivir for "emergency purpose" in COVID-19 cases. Chloroquine and hydroxychloroquine, among the very first under-trial drugs, have been revealed to have promising impacts in treatment of SARS-CoV2. Broad-spectrum antivirals as well as HIV protease-inhibitors are still subject to assessment. Particularly angiotensin-converting enzyme 2 (ACE2) inhibitors are increasingly taken into consideration because of ACE2 being recognized as a host-cell receptor for COVID-19. Immune-Enhancement therapy by Interferons and Intravenous immunoglobulin (IVIG) has been shown to be effective in some cases. Moreover, Convalescent Plasma Therapy and auxiliary blood purification were considered as the treatment of SARS-CoV2 infection. Among the critically ill patients, Oxygen-therapy, timely usage of inflammatory inhibitors, and controlling viral shedding by antivirals may reduce the mortality and morbidity of COVID-19