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BMC Surgery Jan 2020Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute...
BACKGROUND
Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute pancreatitis. Collection usually occurs within the lesser sac of the omentum (near the pancreatic head and body region). But in 20-22% cases, that may be extra-pancreatic like in the mediastinum, pleura, in the peritoneal cavity including the pelvis. The pancreatic pseudocyst typically contains brownish fluid with necrotic tissue sludge which may get infected giving rise to infected pseudocyst or pancreatic abscess. The present case is an unusual condition of a young alcoholic subject who was finally diagnosed as a case of a pancreatic abscess within hepato-gastric ligament and was managed with operative intervention. To the best of the author's knowledge, it is the first-ever reported case of a pancreatic abscess within the hepato-gastric ligament in the world. Literature was reviewed to explore potential etiopathogenesis and therapeutic strategies of this extremely rare condition.
CASE PRESENTATION
A 38 years old gentleman, chronic alcoholic, having a previous history of acute pancreatitis 3 months back, presented with fever (102 degrees Fahrenheit) and a huge [20 cm (horizontal) X 15 cm (vertical)] severely painful swelling in the epigastric region. The swelling was round-shaped, intra-abdominal, fixed to deeper tissue, tense-cystic, poorly trans-illuminant, non-pulsatile and irreducible. Routine blood tests showed leucocytosis (14,500/mm) with neutrophilia and elevated plasma pancreatic amylase and lipase levels. USG and MDCT scan of the whole abdomen revealed a thick-walled echogenic cystic swelling of size 18 cm × 12 cm in the epigastric region. USG guided aspiration of the cyst revealed mixed purulent brownish fluid. The cyst fluid was negative for mucin stain and contained high amylase level with low CEA level, suggesting infected pancreatic pseudocyst. An open drainage procedure was considered through an upper midline laparotomy. Aspiration of the pus mixed cyst fluid along with tissue debris was done. Through irrigation of the cyst was done with normal saline. The cyst wall was de-roofed leaving a small part adherent to the inferior surface of the left lobe of the liver. Later the cyst fluid culture showed significant growth of Escherichia coli. He was put on IV antibiotics. The patient was discharged in a stable condition after 5 days. The histopathological examination confirmed pancreatic abscess. Six months after the operation, the patient is doing well, remaining asymptomatic and there is no sign of recurrence.
CONCLUSIONS
Due to extreme rarity, pancreatic abscess formation within hepato-gastric ligament may be a diagnostic dilemma and requires a high index of suspicion. Surgeons should be aware of this rare clinical entity for prompt management of potential morbidity.
Topics: Abscess; Acute Disease; Adult; Cysts; Drainage; Humans; Laparotomy; Ligaments; Liver; Male; Pancreas; Pancreatic Pseudocyst; Stomach; Tomography, X-Ray Computed
PubMed: 32000756
DOI: 10.1186/s12893-020-0688-0 -
Bioinformatics (Oxford, England) Jun 2023The UNited RESisdue (UNRES) package for coarse-grained simulations, which has recently been optimized to treat large protein systems, has been implemented on Graphical...
SUMMARY
The UNited RESisdue (UNRES) package for coarse-grained simulations, which has recently been optimized to treat large protein systems, has been implemented on Graphical Processor Units (GPUs). An over 100-time speed-up of the GPU code (run on an NVIDIA A100) with respect to the sequential code and an 8.5 speed-up with respect to the parallel Open Multi-Processing (OpenMP) code (run on 32 cores of 2 AMD EPYC 7313 Central Processor Units (CPUs)) has been achieved for large proteins (with size over 10 000 residues). Due to the averaging over the fine-grain degrees of freedom, 1 time unit of UNRES simulations is equivalent to about 1000 time units of laboratory time; therefore, millisecond time scale of large protein systems can be reached with the UNRES-GPU code.
AVAILABILITY AND IMPLEMENTATION
The source code of UNRES-GPU along with the benchmarks used for tests is available at https://projects.task.gda.pl/eurohpcpl-public/unres.
Topics: Protein Conformation; Proteins; Software; Physics
PubMed: 37338530
DOI: 10.1093/bioinformatics/btad391 -
The American Journal of Case Reports May 2017BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on...
BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on histology. It is often difficult to diagnose and is usually mistaken for other lung pathologies. We present an interesting case of AFOP with unusual radiologic findings and disease course. CASE REPORT A 56-year-old woman presented with a 1-day history of high-grade fever, chills, and profuse sweating. She was febrile to 101.2 degree Fahrenheit on presentation. On physical examination, she had decreased air entry in the left upper lobe of the lung. Laboratory testing showed a white cell count of 27,000 cells per microliter of blood with left shift. A chest radiograph showed a left upper lobe consolidation. Computed tomography (CT) of the chest without intravenous contrast showed advanced centrilobular emphysema and left upper lobe consolidation measuring 6.2×5.9 cm. The patient was started on antibiotics. She clinically improved and was discharged on oral antibiotics. After discharge, a trans-bronchial lung biopsy showed acute inflammatory cell infiltrate with intra-alveolar fibrin balls but no hyaline membrane formation or significant eosinophils. These findings were consistent with acute fibrinous and organizing pneumonia. However, she was subsequently lost to follow-up. CONCLUSIONS Our case adds to the literature a new and unusual finding of upper lobe infiltrates, in contrast to most cases presenting as bilateral lower lobe infiltrates. In our case, symptomatic improvement after antibiotic treatment suggests a possible role of antibiotics in management of this entity.
Topics: Chills; Female; Fever; Fibrin; Humans; Lung; Middle Aged; Pneumonia; Pulmonary Emphysema; Sweating
PubMed: 28502975
DOI: 10.12659/ajcr.903539 -
PloS One 2017Heat-not-burn tobacco products, battery powered devices that heat leaf tobacco to approximately 500 degrees Fahrenheit to produce an inhalable aerosol, are being...
Heat-not-burn tobacco products, battery powered devices that heat leaf tobacco to approximately 500 degrees Fahrenheit to produce an inhalable aerosol, are being introduced in markets around the world. Japan, where manufacturers have marketed several heat-not-burn brands since 2014, has been the focal national test market, with the intention of developing global marketing strategies. We used Google search query data to estimate, for the first time, the scale and growth potential of heat-not-burn tobacco products. Average monthly searches for heat-not-burn products rose 1,426% (95%CI: 746,3574) between their first (2015) and second (2016) complete years on the market and an additional 100% (95%CI: 60, 173) between the products second (2016) and third years on the market (Jan-Sep 2017). There are now between 5.9 and 7.5 million heat-not-burn related Google searches in Japan each month based on September 2017 estimates. Moreover, forecasts relying on the historical trends suggest heat-not-burn searches will increase an additional 32% (95%CI: -4 to 79) during 2018, compared to current estimates for 2017 (Jan-Sep), with continued growth thereafter expected. Contrasting heat-not-burn's rise in Japan to electronic cigarettes' rise in the United States we find searches for heat-not-burn eclipsed electronic cigarette searches during April 2016. Moreover, the change in average monthly queries for heat-not-burn in Japan between 2015 and 2017 was 399 (95% CI: 184, 1490) times larger than the change in average monthly queries for electronic cigarettes in the Unites States over the same time period, increasing by 2,956% (95% CI: 1729, 7304) compared to only 7% (95% CI: 3,13). Our findings are a clarion call for tobacco control leaders to ready themselves as heat-not-burn tobacco products will likely garner substantial interest as they are introduced into new markets. Public health practitioners should expand heat-not-burn tobacco product surveillance, adjust existing tobacco control strategies to account for heat-not-burn tobacco products, and preemptively study the health risks/benefits, popular perceptions, and health messaging around heat-not-burn tobacco products.
Topics: Electronic Nicotine Delivery Systems; Hot Temperature; Internet; Search Engine; Tobacco Products
PubMed: 29020019
DOI: 10.1371/journal.pone.0185735 -
Journal of Clinical and Experimental... Mar 2016Many infections are transmitted from a donor to a recipient through organ transplantations. The transmission of dengue virus from a donor to a recipient in liver...
Many infections are transmitted from a donor to a recipient through organ transplantations. The transmission of dengue virus from a donor to a recipient in liver transplantation is a rare entity, and currently, there is no recommendation for screening this virus prior to transplantation. We report a case of transmission of dengue virus from donor to recipient after liver transplantation. The recipient had a history of multiple admissions for hepatic encephalopathy and ascites. He was admitted in the ICU for 15 days for chronic liver disease, ascites, and acute kidney injury before transplantation. The donor was admitted 1 day before transplantation. The donor spiked fever on postoperative day 2 followed by thrombocytopenia and elevated liver enzymes. The donor blood test was positive for dengue NS1 antigen. The recipient also had a similar clinical picture on postoperative day 5 and his blood test was also positive for dengue NS1 antigen. Hence, the diagnosis for posttransplant donor-derived allograft-related transmission of dengue infection was made. Both recipient and donor were treated with supportive measures and discharged after their full recovery on postoperative days 9 and 18, respectively. The effect of immunosuppression on dengue presentation is still unclear and there is lack of literature available. In our case, the recipient developed dengue fever similar to general population without showing any feature of severe graft dysfunction. We have concluded that dengue virus can also be transmitted from donor to recipient, and immunosuppression did not have any adverse effect on the evolution of dengue fever within the recipient. Delhi being a hyperendemic zone, screening for donors (especially in season time) for dengue virus seems to be the best preventive method to control donor-derived transmission of dengue to recipient.
PubMed: 27194898
DOI: 10.1016/j.jceh.2016.01.005 -
Journal of Neurology May 2024Some people with multiple sclerosis (pwMS) avoid exercise due to overheating. Evidence from a variety of cooling treatments shows benefits for pwMS. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Some people with multiple sclerosis (pwMS) avoid exercise due to overheating. Evidence from a variety of cooling treatments shows benefits for pwMS.
OBJECTIVE
Conduct a randomized controlled trial of antipyretic treatment before exercise in pwMS.
METHODS
Adults over age 18 diagnosed with relapsing-remitting MS reporting heat sensitivity during exercise were randomly assigned to one of six sequences counterbalancing aspirin, acetaminophen, placebo. At each of three study visits separated by ≥ one week, participants received 650-millograms of aspirin, acetaminophen, or placebo before completing a maximal exercise test. Primary outcomes were body temperature change and total time-to-exhaustion (TTE), secondary outcomes were physiological and patient-reported outcomes (PROs).
RESULTS
Sixty participants were enrolled and assigned to treatment sequence; 37 completed ≥ one study visit. After controlling for order effects, we found that body temperature increase was reduced after aspirin (+ 0.006 ± 0.32 degrees Fahrenheit, p < 0.001) and after acetaminophen (+ 0.31 ± 0.35; p = 0.004) compared to placebo (+ 0.68 ± 0.35). TTE after aspirin (331.6 ± 76.6 s) and acetaminophen (578.2 ± 82.1) did not differ significantly from placebo (551.0 ± 78.4; p's > 0.05). Aspirin benefited all secondary outcomes compared to placebo (all p's < 0.001); acetaminophen showed broadly consistent benefits.
CONCLUSION
These results support antipyretic treatment as effective for reducing overheating during exercise in pwMS and failed to support antipyretics for increasing TTE in the context of a maximal exercise test. Benefits were shown for physiological markers of exercise productivity and PROs of fatigue, pain, and perceived exertion.
Topics: Humans; Male; Female; Adult; Antipyretics; Acetaminophen; Aspirin; Middle Aged; Exercise; Multiple Sclerosis, Relapsing-Remitting; Body Temperature; Double-Blind Method; Administration, Oral; Exercise Test; Treatment Outcome
PubMed: 38413464
DOI: 10.1007/s00415-023-12147-6 -
Journal of Complementary & Integrative... Aug 2019Background Though hot arm and foot bath (HAFB) is widely used, a precise physiological response is not reported. Hence, the present study was conducted to evaluate the...
Background Though hot arm and foot bath (HAFB) is widely used, a precise physiological response is not reported. Hence, the present study was conducted to evaluate the effect of HAFB on heart rate variability (HRV) and blood pressure (BP) in healthy volunteers. Materials and Methods Sixteen healthy male volunteers' aged 23.81 ± 5.27 (mean ± standard deviation) years were recruited. All the subjects underwent only one session of HAFB (104-degree Fahrenheit) for the duration of 20 min. Assessments such as Electrocardiography and BP were taken before and after the intervention. Results Results of this study showed a significant reduction in systolic-BP (SBP), diastolic-BP (DBP), mean arterial pressure (MAP), the mean of the intervals between adjacent QRS complexes or the instantaneous heart rate (RR interval), the number of interval differences of successive NN intervals greater than 50 ms (NN50), the proportion derived by dividing NN50 by the total number of NN intervals (pNN50), and high frequency (HF) band of HRV along with a significant increase in heart rate (HR), low-frequency (LF) band of HRV and LF/HF ratio compared to its baseline. Conclusions Results of this study suggest that 20 min of HAFB produce a significant increase in HR and a significant reduction in SBP, DBP, and MAP while producing parasympathetic withdrawal.
Topics: Adolescent; Adult; Arm; Baths; Blood Pressure; Foot; Healthy Volunteers; Heart Rate; Hot Temperature; Humans; Hydrotherapy; Male; Young Adult
PubMed: 31415237
DOI: 10.1515/jcim-2018-0181 -
Journal of Nepal Health Research Council Dec 2021Body Temperature is one of the most common and an important sign of health and disease. Considering the need of keeping physical distance, newer methods have evolved...
BACKGROUND
Body Temperature is one of the most common and an important sign of health and disease. Considering the need of keeping physical distance, newer methods have evolved such as; thermal imaging systems which have been used by several countries during epidemics. Therefore, the present study was conducted to compare body temperatures obtained with thermo graphic camera and commercially available thermal gun with reference to standard digital clinical thermometer.
METHODS
The study was comparative analytical in nature and quantitative method was used to collect data. Temperatures in degrees Fahrenheit were taken simultaneously using the three different thermometers in 101 patients at the outpatient fever screening clinic at Tribhuvan University Teaching Hospital, Kathmandu. The Bland Altman statistical test was used to assess the concordance by the 95% limits of agreement.
RESULTS
The thermo-graphic camera gave concordance (limits of agreement-0.0360 to 0.0440 °F) with standard digital clinical thermometer. Similarly, commercially available thermal gun gave the concordance (limits of agreement 0.0042 to 0.1293 °F) with standard digital clinical thermometer.
CONCLUSIONS
The results of the present study show that both thermo-graphic camera and thermal gun were found to be concordant compared to digital clinical thermometer. Therefore, it could be a preferable option for the screening of fever in mass number of individuals as part of an initial check at entry points.
Topics: Fever; Humans; Nepal; Temperature; Tertiary Care Centers; Thermometers
PubMed: 35140439
DOI: 10.33314/jnhrc.v19i3.3511 -
Case Reports in Critical Care 2022Methylenedioxymethamphetamine (MDMA) is a psychoactive substance that is used commonly as a recreational drug at rave music festivals. MDMA intoxication can cause a...
Methylenedioxymethamphetamine (MDMA) is a psychoactive substance that is used commonly as a recreational drug at rave music festivals. MDMA intoxication can cause a myriad of symptoms and side effects including the manifestation of hyperpyrexia in patients. Hyperpyrexia can mimic a heat stroke and ultimately lead to various forms of end-organ damage. The most common methods used in treating MDMA-induced hyperpyrexia focus on the rapid reduction of core body temperature. Various off-label medications have also been used in combating MDMA-induced hyperpyrexia. Dantrolene is one such medication, although its role in the treatment of MDMA intoxication remains uncertain. This case series preliminarily examines the efficacy of dantrolene in mitigating MDMA-induced hyperpyrexia and potentially reducing the risk of end-organ damage in patients suffering from MDMA overdose. This study focuses on nine patients who presented after ingesting various forms of MDMA at "rave" music events. All patients were found to be hyperthermic in the field with a maximum core body temperature of 109 degrees Fahrenheit. All patients were immediately managed by cooling measures, and seven patients additionally received dantrolene in the field before being transferred to Arrowhead Regional Medical Center. Upon arrival to the hospital, nearly every patient was found to have significantly decreased body temperatures when compared to previously measured body temperatures out in the field. However, nearly all patients in the study were also noted to have laboratory abnormalities consistent with various forms of end-organ damage. The degree and severity of end-organ damage observed in MDMA-induced hyperpyrexia seem to be a function of initial core body temperature. Higher core body temperature tends to correlate with more forms of end-organ damage and a higher severity of end-organ damage. Intervention with dantrolene and cooling measures appeared to have no effect on reducing the risk of developing end-organ damage in this patient population.
PubMed: 36065452
DOI: 10.1155/2022/5346792 -
Environmental Entomology Feb 2021As the mean temperature and the duration of the growing season decline with elevation, growth of immature insects should initiate at a lower temperature, but it should...
As the mean temperature and the duration of the growing season decline with elevation, growth of immature insects should initiate at a lower temperature, but it should also be faster to complete development prior to season's end. Although flightless, Mormon crickets migrate in large aggregations across broad spatial and elevational distances that might limit adaptations to local environments. In addition, selection to be active at cooler temperatures might limit selection to maximize growth rate. I measured growth rate in controlled environments for nymphs from three populations that vary in altitude (87-2,688 m) but are similar in latitude (43.2-45.7°N). Growth rate increased significantly with mean rearing temperature between 22 and 30°C. The intercept of the regression of growth rate on temperature increased with elevation, whereas the slope did not change significantly. For any given rearing temperature, growth rate increased with elevation, which suggests that selection to initiate growth at cooler temperatures did not compromise growth rate. Body mass did not differ between the two lower elevations, whereas the highest elevation population had smaller hatchlings and adults. Critical thermal minimum (base temperature) declined with elevation (0.7°C per 1,000 m), and the degree days were 509 across all elevations. For pest management, a base temperature from midelevation of 15.3°C (60°F) and growing degree days of 509 (equivalent to 916 Fahrenheit-based degree days) are reasonable estimates for applications from sea level to 2,700 m.
Topics: Acclimatization; Altitude; Animals; Gryllidae; Temperature
PubMed: 33219677
DOI: 10.1093/ee/nvaa151