A Case of Hemorrhagic Necrosis of Ectopic Liver Tissue within the Gallbladder Wall

Ectopic liver tissue is a rare clinical entity that is mostly asymptomatic and found incidentally. In certain situations, however, patients may present with symptoms of abdominal pain secondary to torsion, compression, obstruction of adjacent organs, or rupture secondary to malignant transformation. Herein, we report a case of a 25-year-old female that presented with acute onset of epigastric pain found to have ectopic liver tissue near the gallbladder complicated by acute hemorrhage necessitating operative intervention in the way of laparoscopic excision and cholecystectomy. The patient's postoperative course was uneventful. Gross pathology demonstrated a 1.2 × 2.8 × 4.5 cm firm purple ovoid structure that histologically revealed extensive hemorrhagic necrosis of benign ectopic liver tissue

Independent Predictors of One-Month Mortality in Patients with Intracranial Hemorrhage; a Cohort Study

Introduction: Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH). Objective: This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED). Methods: In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated. Results: One hundred seventy-seven patients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two (52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty (16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p < 0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serum level of potassium (p = 0.022). Conclusions: The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study

Prevalence of incidental thyroid malignancy on routine ¹⁸F-fluorodeoxyglucose PET-CT in a large teaching hospital

Purpose: To quantify incidental thyroid pathology including malignancy on routine 18F-FDG PET-CT scans To compare standardised uptake values (SUVmax) in thyroid malignancy subtypesMethods and materials: This is a retrospective study of all 18F-FDG PET-CT scans (n = 6179) performed in a teaching hospital between June 2010 and May 2019. RIS database search of reports for the word “thyroid” was performed. Studies with evidence of thyroid uptake were included. Patient age and gender, primary indication for PET scan (malignant or non-malignant), thyroid result on PET (diffuse or focal tracer uptake, SUVmax), ultrasound and FNAC results were recorded.Results: Incidental abnormal thyroid tracer uptake as a proportion of all 18F-FDG PET-CT scans was 4.37% (n = 270). Out of region patients (n = 87) whose records could not be obtained were excluded leaving a study group of n = 183. Ninety-four in this group had focal uptake, and 89 had diffuse uptake. Fifty-five patients in the focal group had undergone further investigations. Of these, 30 were thought to be benign on USS alone, and 25 patients underwent USS/FNAC. Thirteen (24%) malignancies were identified (5 papillary, 6 follicular, 1 poorly differentiated thyroid cancer, 1 metastatic malignancy). Mean SUVmax for papillary carcinoma was noted to be 8.2 g/ml, and follicular carcinoma was 12.6 g/ml.Conclusion: Incidental abnormal thyroid 18F-FDG PET-CT uptake in PET-CT scans of 4.37% is in keeping with the known limited literature. Rather similar number of patients was noted in the focal and diffuse tracer uptake categories in the final study group. Around quarter of the focal lesions were identified to be malignant, implying focal lesions should always be further investigated.</p

Diagnostic Value of D-dimer in Detecting Pulmonary Embolism in Patients with Acute COPD Exacerbation

BACKGROUND: Signs and symptoms of chronic obstructive pulmonary disease (COPD) exacerbation may overlap with pulmonary embolism. Patients with acute COPD exacerbations have higher level of D-dimer which may D-dimer lead to false detection of pulmonary thromboembolism (PTE). In this study diagnostic value of D-dimer for diagnosis of pulmonary embolism during acute exacerbation in patients with COPD was investigated. MATERIALS AND METHODS: This study was performed on 112 patients with acute COPD exacerbations. In all patients, Wells criteria and D-dimer serum levels were evaluated. Then, all cases were subjected to CT angiography (CTA) and ultrasonography. The diagnostic value of serum D-dimer level and Wells criteria and also their combination for PTE was compared to the gold standard method. RESULTS: Of 112 patients, 17, diagnosed with PTE using CTA. The D-dimer cut-off value in COPD patients was higher than 990 μg/L, which was higher than 3 for the Wells score while D-dimer alone showed no good diagnostic value for PTE diagnosis, but Wells score was acceptable (P-value = 0.019). Moreover, the combination of cut-off values, Wells score, and D-dimer level, as a new criterion, with a sensitivity and specificity rate of 47.37 and 88.17 respectively, had an acceptable diagnostic value in PTE diagnosis (AUC=0.678, P value=0.004). CONCLUSION: It is suggested that D-dimer concentration alone could not make a good PTE diagnosis, but the simultaneous combination of this test with the Wells criterion can detect the PTE risk with better confidence. To obtain more accurate findings and to get the best criterion, further studies are needed in this field

Green Infrastructure for Sustainable Urban Development: A Case Study from Tehran

The integration of green infrastructure (GI) in urban areas is vital for achieving sustainable development, and this article researches this interaction in Tehran, which accommodates more than 9 million inhabitants. In facing the critical challenge of balancing rapid urbanization with environmental sustainability, GI can play a key role, requiring a holistic approach encompassing diverse elements and location-specific strategies. The research adopts a case study approach to map and analyze the location of GI in District 2 of Tehran, which spans an area just west of the city center, stretching up to the northern border of the Tehran municipality. A novel Geographic Information Systems-based methodology is deployed to identify and assess eight distinct GI types, including parks, green roofs, and river corridors. The article concludes that this categorization of GI types can provide a methodology for the comprehensive analysis of GI distribution, which underscores the importance of location-specific GI strategies for mitigating air pollution and fostering urban sustainability. The study provides a valuable case example that can be used in cities with similar urban environments. By identifying spatial disparities in GI performance, context-specific solutions can be developed that can be integrated into the urban planning and development processes to create a network of green spaces that improve air quality, reduce the urban heat island effect, and promote biodiversity. GI can provide a framework for integrating green spaces, urban forests, green roofs, and other nature-based solutions into the urban fabric, thereby enhancing the overall sustainability and resilience of the urban environment

Comparison of Outcomes Following a Switch from a Brand to an Authorized vs. Independent Generic Drug

Authorized generics are identical in formulation to brand drugs, manufactured by the brand company but marketed as a generic. Generics, marketed by generic manufacturers, are required to demonstrate pharmaceutical and bioequivalence to the brand drug, but repetition of clinical trials is not required. This retrospective cohort study compared outcomes for generics and authorized generics, which serves as a generic vs. brand proxy that minimizes bias against generics. For the seven drugs studied between 1999-2014, 5,234 unique patients were on brand drug prior to generic entry and 4,900 (93.6%) switched to a generic. During the 12-months following the brand-to-generic switch, patients using generics vs. authorized generics were similar in terms of outpatient visits, urgent care visits, hospitalizations, and medication discontinuation. The likelihood of emergency department visits was slightly higher for authorized generics compared with generics. These data suggest that generics were clinically no worse than their proxy brand comparator

Gender Differences in COVID-19 Deceased Cases in Jahrom City, South of Iran

Objective: To evaluate the clinical and epidemiological features of deceased patients and comparing the discrepancies between male and female patients based on high prevalence of coronavirus disease 2019 (COVID-19), its irreversible effects and the rising mortality rate in Jahrom city. Methods: This is a descriptive-analytical retrospective study that was conducted from the beginning of March 2020 to the end of November 2020. The study population were included all patients with COVID-19 who admitted to Peymaniyeh Hospital in Jahrom and died of COVID-19. Clinical and demographic data were collected from medical records and analyzed by SPSS software. Results: In this study, 61 patients (57.54%) were men and 45 patients (42.36%) were women. The mean age was 68.7±18.33 in men and 68.82±14.24 in women. The mean hospitalization length was 9.69±7.75 days in men and 9.69±7.75 days in women patients. There was no statistically significant difference between men and women patients (p>0.05). The results showed that 17 (27.87%) men and 28 (45.9%) of women patients had hypertension and the prevalence of this disease was significantly higher in women than men (p=0.01). In this study, 7 (11.48%) men and 13 (21.31%) women had hyperlipidemia. The frequency of hyperlipidemia in women caseswas significantly higher than in men patients (p=0.024). Men cases’ diastolic blood pressure (mean=77.53) was significantly higher than women’s diastolic blood pressure at the same time with a mean of 71.42 (p <0.05). Conclusion: The findings of the study represented the mortality rate in men which is higher than women patients. The prevalence of underlying diseases such as hypertension and hyperlipidemia were higher in women than men. Despite higher mortality among women, symptoms such as fever and dyspnea were less common in women than men

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified