Median arcuate ligament syndrome with post stenotic pancreaticoduodenal aneurysm: case report

Background: Median arcuate ligament syndrome (celiac artery compression syndrome, Dunbar syndrome) is an infrequent form of chronic mesenterial ischemia. The culprit for a sub optimal celiac blood flow is a lowpositioned median arcuate ligament which is an arch of fibrous tissue connecting the diaphragmatic crura. Symptomatic patients complain of postprandial pain situated in the epigastrium. Still, most of the individuals proven to have some form of celiac artery compressions report no complaints at all. The gold standard for diagnosis is a CT angiography and treatment is surgical. The median arcuate ligament is transacted with or without additional endovascular treatment. Case study: We present the case of a 50-year-old male patient with a radiologically confirmed diagnosis of median arcuate ligament syndrome treated surgically at our institution. An open approach was used since the patient had a previous median laparotomy scar. Due to a post stenotic pancreaticoduodenal aneurysm coil embolization was additionally performed. On follow up the patient had no further complaints. Conclusion: Patients with chronic postprandial pain require a systematic approach. In the differential diagnosis of abdominal angina, although uncommon, median arcuate ligament syndrome is to be remembered. The diagnosis is rather straightforward once clinical suspicion is established and treatment-wise minimally invasive surgery is performed whenever possible

Hemoptysis as an Early Symptom of Abdominal Actinomycosis with Thoracic Extension Ten Years after Cholecystectomy with Retained Gallstone

Abstract Background: Thoracoabdominal actinomycosis is rare, especially in the context of readily available medical facilities. Methods: Case report and review of the literature. Case Report: A 54-year-old male patient was admitted because of hemoptysis and a pulmonary infiltrate in the left lower lobe. His history was unremarkable except for chronic gastritis and an elective laparoscopic cholecystectomy performed 10 years earlier. Following persistent hemoptysis, elevated inflammatory markers, and a non-revealing bronchoscopy, a computed tomography scan of the thorax and upper abdomen revealed a tumor in the upper part of the left kidney spreading directly to the adjacent diaphragm and left lower lobe. Laparotomy revealed a granulomatous mass containing a gallstone, as well as orange granular content. The treatment involved surgical removal of the mass, splenectomy, excision of the infiltrated part of the left hemidiaphragm, and decortication of the left lower lobe. Because of a prolonged post-operative low-grade fever and radiologically confirmed encapsulation in the lingula, the patient was given ceftriaxone. Repeat bronchoscopy revealed Actinomyces meyeri. The initial antibiotic therapy was replaced with amoxicillin-clavulanic acid, after which the patient's health improved. Conclusion: Actinomycosis is still a highly intriguing disease, as initial symptoms often mislead clinicians. It is important to consider the disease whenever we are challenged diagnostically or when risk factors are present

PSYCHOLOGICAL EFFECTS OF "DOUBLE CRISIS" (COVID-19 PANDEMIC AND EARTHQUAKES) ON CROATIAN MEDICAL STUDENTS

Introduction: In 2020. the COVID-19 pandemic presented an additional source of stress and anxiety not just to the general population but also to medical students who are, even under normal circumstances, constantly under pressure due to demanding student duties. In addition, they experienced a series of devastating earthquakes in and around the Zagreb region which altogether could have had compromised their psychological well-being. The aim of this review was to evaluate the psychological effects of these two natural disasters on the mental health of Croatian medical students. Results: According to standardized questionnaires for depression and anxiety evaluation, 75.3% of students were anxious and 65.2% were depressive during to outcomes was observed regarding genders, but it was found that first year students had a significantly higher anxiety score than older ones. Conclusion: In such stressful situations, we should emphasize the importance of mental health not just of healthcare workers, but also of medical students in order to prevent serious psychological consequences and to alleviate the negative motivation and their educational process

PSYCHOLOGICAL EFFECTS OF "DOUBLE CRISIS" (COVID-19 PANDEMIC AND EARTHQUAKES) ON CROATIAN MEDICAL STUDENTS

Introduction: In 2020. the COVID-19 pandemic presented an additional source of stress and anxiety not just to the general population but also to medical students who are, even under normal circumstances, constantly under pressure due to demanding student duties. In addition, they experienced a series of devastating earthquakes in and around the Zagreb region which altogether could have had compromised their psychological well-being. The aim of this review was to evaluate the psychological effects of these two natural disasters on the mental health of Croatian medical students. Results: According to standardized questionnaires for depression and anxiety evaluation, 75.3% of students were anxious and 65.2% were depressive during to outcomes was observed regarding genders, but it was found that first year students had a significantly higher anxiety score than older ones. Conclusion: In such stressful situations, we should emphasize the importance of mental health not just of healthcare workers, but also of medical students in order to prevent serious psychological consequences and to alleviate the negative motivation and their educational process

Adverse Events in Continuous-Flow LVAD Recipients: Gastrointestinal Bleeding is Still Notable?

Background: The etiology and risk factors associated with gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVADs) are currently unknown. Therefore, we sought to assess the risk factors for GIB in these patients. Design and Methods: This was a retrospective, non-randomized, non-controlled study at a single center. Between 2012 and 2014, 65 men and 6 women (mean age = 55 ± 12 years) underwent CF-LVAD implantation at our institution. Overall, 23.9% of patients (17/71) had at least one GIB episode. Endoscopy confirmed GIB in 13/17. Arteriovenous malformation was the major GIB source in 8/13 (61%). There was no significant difference in incidence of GIB with regard to INTERMACS profile, blood type, or device type—HeartWare vs. HeartMateII. All our patients with GIB were men, most had hyperlipidemia, and most likely had ischemic cardiomyopathy (65%) and peripheral vascular disease (24%). The only significant risk factor for GIB was chronic kidney disease (odds ratio= 3.95; 95% confidence interval of 1.21 to 12.84; p=0.02). At the time of the first GIB, mean hemoglobin was 7.38 ± 1.06 g/dl, international normalized ratio was 2.08 ± 0.69 IU, and mean arterial pressure was 75 ± 12 mmHg. Ten patients (59%) required hospital admission for treatment. Conclusion: In our patients GIB was often a single event and often occurred within first month after implantation. Prevention strategies should be focused on this vulnerable period, especially in patients with chronic kidney disease

SALMONELLA IN WILD BOARS (SUS SCROFA): INFLUENCE OF HUNTING AND DRESSING PROCEDURES ON MEAT SAFETY

Salmonella spp. is considered as a high-priority foodborne hazard for control in wild boar meat. This comprehensive study about Salmonella spp. in population of wild boars in Serbia was conducted with an aim to assess the influence of hunting and dressing procedures on the spread of Salmonella on wild boar carcasses and to examine the molecular similarities of strains isolated from wild boars. Samples from wild boars from twelve hunting estates in South-West Vojvodina, Serbia, were taken from 425 hunted animals, which was 25.3% of the total wild boar population in all hunting estates. Three samples were taken from each animal’s skin swabs, feces, and carcass meat swabs. A total of 1,275 samples were examined using standard ISO protocols. Subtyping of the isolates was performed and compared using Pulsed-field gel electrophoresis (PFGE). Salmonella prevalence was 4.2%, and Salmonella Enteritidis was the dominant serotype (74.5%). Carcass meat contamination originated from the feces of the same animal. Two or more entrance wounds, damage of the abdominal cavity caused by non-expert shooting were factors found to increase Salmonella contamination on the skin and/or on carcass meat. Rain during the hunting and practice of diaphragm and peritoneum removal and the evisceration being performed on the ground/floor or in hanging position did not lead to increase in Salmonella contamination on the meat. Although the determined prevalence was not high in wild boars compared to farm pigs, it is possible that Salmonella entered the food chain through contaminated meat. Therefore, the importance of good hunting and hygiene practice in handling and dressing wild boar carcasses should not be underestimated

Transcatheter Aortic Valve Implantation in a Patient with Unicuspid Aortic Valve

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valves has been successfully performed, but there is a lack of published experience in percutaneous treatment of patients with unicuspid valves and severe aortic stenosis. We describe a case of TAVR in such a patient. A 31-year-old woman with Turner syndrome—who had undergone coarctation repair via subclavian flap at age 7 days and an aortic valvotomy at age 6 weeks—presented with severe symptomatic aortic stenosis. She was deemed inoperable because of her severe pulmonary hypertension and numerous comorbidities; consequently, a 20-mm Edwards Sapien 3 Transcatheter Heart Valve was offered for compassionate use. Postdeployment angiography and transesophageal echocardiography and aortography revealed no aortic insufficiency. Transcatheter aortic valve replacement for unicuspid aortic valve stenosis is technically feasible. Before implantation, particular attention should be paid to the interplay between the large single leaflet, coronary ostia, and stented valve, to select the correct size and position of the device. Some degree of intraoperative aortic migration should be anticipated