A wandering spleen presenting as a pelvic mass: case report and review of the literature

Wandering spleens are rare clinical entities found more commonly in females. We report a young female patient found to harbour a pelvic spleen. The literature regarding this rare ectopia is reviewed. The wandering spleen should be considered in the differential diagnosis of pelvic masses

Intestinal malrotations: a review and report of thirty cases

Intestinal malrotation is a developmental anomaly affecting the position and peritoneal attachments of the small and large bowels during organogenesis in foetal life. It has been defined as absent or incomplete rotation and fixation of the embryonic gut around the superior mesenteric artery. In the present paper, we review the definition, history, embryology/aetiology, epidemiology, symptoms and signs, diagnosis and treatment of intestinal malformations. Moreover, we report the records of 30 cases of malrotation admitted to our department over a period of five years. The final intraoperative diagnosis of the cases presented was 53.3% pure malrotation, 33.3% malrotation with mid-gut volvulus, 6.7% malrotation with duodenal atresia, 3.3% malrotation with Meckel’s diverticulum and duodenal atresia, and 3.3% malrotation and biliary atresia. Preoperative imaging studies were performed for 27 cases and surgical management was successfully conducted without any mortality among the cases studied. This article provides an overview of basic and clinical aspects of intestinal malrotation. In addition, the signs and symptoms, imaging findings, and final intraoperative diagnoses presented by the subjects reported on are of potential use and clinical interest

Evaluation and optimization of chitosan derivatives-based gene delivery system via kidney epithelial cells

Purpose: Non-viral vectors have been widely proposed as safer alternatives to viral vectors, and cationic polymers have gained increasing attention because they can form self-assembly with DNA. Chitosan is also considered to be a good candidate for gene delivery systems, since it is already known as a biocompatible, biodegradable, and low toxic material with high cationic potential. However, low solubility and transfection efficiency need to be overcome prior to clinical trial. In this work, we focus on alkyl modified chitosan which might be useful in DNA condensing and efficient gene delivery. Methods: N, N- Diethyl N- Methyl (DEMC) and N- Triethyl Chitosan (TEC) were synthesized from chitosan polymer. In order to optimize the polymers for gene delivery, we used FITC-dextran (FD). Then the optimized polymer concentrations were used for gene delivery. Fluorescent microscope was used, in order to evaluate the polymers’ efficiency for gene delivery to human embryonic kidney epithelial cells (HEK 293T). Results: This modification increased chitosan’s positive charge, thus these chitosan derivatives spontaneously formed complexes with FD, green fluorescence protein plasmid DNA (pEGFP), red fluorescence protein plasmid DNA (pJred) and fluorescent labeled miRNA. Results gained from fluorescent microscope showed that TEC and DEMC were able to transfer FD, DNA and miRNA (micro RNA) to HEK cell line. Conclusion: We conclude that these chitosan derivatives present suitable characteristics to be used as non-viral gene delivery vectors to epithelial cells

Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome

The goal of this study was to clarify the role of body mass index (BMI) (weight divided by square of height; kg/m2) and hand anthropometric measurements as independent risk determinants in the development of carpal tunnel syndrome (CTS) and their relationship to the severity of CTS. A total of 131 patients with clinical symptoms of CTS and 131 normal subjects were enrolled, of whom 121 were female both in the CTS cases and the controls. All cases were electrodiagnostically confirmed and assigned to three severity groups. BMI, wrist ratio, shape index, digit index and hand length/height ratio were measured in all participants. Mean values for each item were compared between cases and controls and severity subgroups. A logistic regression analysis was performed to determine independent CTS risk factors. The mean values of BMI, wrist ratio and shape index were significantly higher in all CTS patients and females compared to controls, whereas in males only BMI and wrist ratio were higher. The patients in the mild severity subgroup had a significantly lower age and wrist ratio. BMI, wrist ratio and shape index were found to be independent risk factors of CTS development in all patients and females. Our study showed BMI, wrist ratio and shape index as independent risk factors for CTS. These findings are of potential anatomical and clinical importance and outline the risk factors of anatomical malfunction of the wrist in CTS. (Folia Morphol 2008; 67: 36-42

Fetus-in-Fetus: Our Case Series and Review of the Literature

Fetus in fetu is a rare condition commonly presenting as an epitomized pedunculated vertebrated fetiform mass in a newborn infant. Different kinds of presentation and locations have been reported in the hosts. Although numbers of instances have been reported the fascination and curiosity about other presentations and genesis of fetus in fetu remains confirmed. In Tabriz pediatric surgery ward we have had five different presentations of fetus in fetu. The aim of this case series and a subtle literature review is gathering these interesting presentations

The effects of an electromagnetic field on the boundary tissue of the seminiferous tubules of the rat: a light and transmission electron microscope study

Human beings are unavoidably exposed to ambient electromagnetic fields (EMF) generated from various electrical devices and from power transmission lines. Controversy exists about the effects of EMF on various organs. One of the critical issues is that EMF may adversely affect the reproductive system. In order to examine this 30 rat pups were exposed to 50 Hz EMF (non-ionising radiation) during in utero development (approximately 3 weeks) and postnatal life (5 weeks). Groups of exposed rats were subsequently left in an environment free of EMF in order to observe recovery, if any, from the changes induced by EMF on the boundary tissue of the seminiferous tubules. The materials were processed and observed under a light and a transmission electron microscope. In the experimental rats boundary tissue was found disrupted at various layers. This tissue showed infoldings, which were perhaps due to the loss of collagen and reticular fibrils from the inner and outer non-cellular layers. The outer non-cellular layer, which was thinner than that of the control, was stripped away from the myoid cell layer in multiple regions, giving a “blister-like” appearance. The myoid cells showed fewer polyribosomes, pinocytotic vesicles and glycogen granules. Most mitochondria were found to lack cristae. The connections between individual myoid cells were apparently lost. There were signs of recovery in the boundary tissue following withdrawal from EMF exposure. These results suggest that EMF exposure may cause profound changes in the boundary tissue of the seminiferous tubules. Therefore exposure to EMF may result in pathological changes that lead to subfertility and infertility

Diagnostic accuracy of twinkling artifact sign seen in color doppler ultrasonography in detecting microlithiasis of kidney

Background: Ultrasonography (US) is a safe and cost-efficient modality which is used to assess patients with urinary tract lithiasis. Objectives: In this study, we aimed to evaluate the accuracy of the twinkling artifact of color Doppler sonography in detecting renal stones smaller than 4 mm in diameter. Methods: Of all patients referring to a tertiary medical center with a probable diagnosis of urolithiasis during April 2019 to Septem-ber 2019, 99 patients with a renal stone smaller than 4 mm in non-contrast computed tomography (CT) scan entered our study. Both gray scale and color Doppler US were performed to assess the presence of any renal stones, the accompanying posterior shadowing, and the twinkling artifact for all patients. Results: Of 99 patients with confirmed renal stone on non-contrast CT scan, 91 patients had an echogenic focus on grayscale (sensi-tivity = 91.9), 70 patients had posterior shadowing sign (sensitivity = 70.7), and 76 patients had twinkling artifact on color Doppler US. The sensitivity, specificity, positive predictive value, and negative predictive value of this imaging finding for detecting renal stones smaller than 4 mm were 76.8, 100, 100, and 32.4, respectively. Conclusions: Our study revealed that twinkling artifact on color Doppler US is a reliable sign for detecting renal stones smaller than 4 mm. However, the sensitivity of this sign could be increased in combination with gray scale findings (echogenic focus and posterior shadowing). © 2020, Author(s)

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

<p>Abstract</p> <p/> <p>Background</p> <p>Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.</p> <p>Methods</p> <p>The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.</p> <p>Results</p> <p>Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.</p> <p>Conclusions</p> <p/> <p>Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.</p

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries