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Pediatrics in Review Sep 2023The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk...
The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk stratification to make the diagnosis. Cases have been concentrated in adolescents (ages 15-19 years), young adults (ages 20-24 years), men and transgender women who have sex with men, and those with a history of human immunodeficiency virus infection. Black adolescents experience a disproportionately high number of cases of proctitis due to an intersection of concentrated cases in sexual networks and delayed screening/diagnosis due to health care access barriers. Signs and symptoms include purulent discharge, bleeding, pain, tenesmus, pruritus, diarrhea or constipation, weight loss, or fever. Multisite sexually transmitted infection testing should be offered based on risk stratification (eg, history of condomless anal sex, oral intercourse, number of sex partners). Further management includes promotion of barrier protection and preexposure prophylaxis, routine surveillance, partner notification, and routine access to preventive immunizations.
Topics: Male; Young Adult; Adolescent; Female; Humans; Proctitis; Fever; Pruritus; Sexual Partners; Constipation
PubMed: 37653133
DOI: 10.1542/pir.2022-005862 -
European Archives of... Aug 2019Septal perforation (SP) is a rather uncommondisorder and the most frequent aetiology of SP is nasal surgery, but they can also be secondary to drug abuse, inhaled... (Review)
Review
INTRODUCTION
Septal perforation (SP) is a rather uncommondisorder and the most frequent aetiology of SP is nasal surgery, but they can also be secondary to drug abuse, inhaled substances, trauma, neoplasms, or inflammatory systemic diseases.
DISCUSSION
Despite some asymptomatic presentations, the majority of SPs cause intermittent epistaxis, nasal obstruction, crusting, dryness, purulent discharge, and/or nasal whistling. Patients who have SP and mild symptoms usually require medical treatment such as nasal irrigations and ointments. Septal buttons may also be used in these patients. No gold standard technique has been recognized for the surgical management of SPs. The literature describes many methods of closure of SP. Many endoscopic techniques are available for septal repair, and the choice depends on the osteo-cartilaginous support, characteristics of the perforation (size, location) and the experience of the surgeon.
CONCLUSION
This article provides a meticulous review focusing on the endoscopic approaches to repair SP. Furthermore; educational drawings and tips and tricks are also discussed.
Topics: Humans; Nasal Septal Perforation; Nasal Surgical Procedures; Natural Orifice Endoscopic Surgery
PubMed: 31187241
DOI: 10.1007/s00405-019-05490-w -
Revista Espanola de Enfermedades... Nov 2023.We present the case of a 46-year-old female with dysphagia to solids and retrosternal pain that worsened after eating. Due to mediastinal lymphadenopathies, she...
.We present the case of a 46-year-old female with dysphagia to solids and retrosternal pain that worsened after eating. Due to mediastinal lymphadenopathies, she underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) 3 weeks before, mentioning the complaints started afterwards. On physical examination she had fever (38.3ºC). Gastroscopy revealed three 10-20mm fistulous orifices with purulent discharge at 26-32cm from the incisors and another four partially covered by fibrin in the distal esophagus. EBUS-TBNA report was reviewed, mentioning 6 needle passes through the esophagus, due to failed endotracheal intubation, without immediate complications. A cervicothoracic CT scan identified 2 mediastinal abscesses, the largest with 9cm, communicating with the esophageal fistulas. She was admitted, underwent intravenous antibiotics and endoscopy-guided nasogastric tube placement. The histopathological analysis diagnosed Castleman's disease. There was clinical and imagological improvement during admission. After 16 days she was released. Upper endoscopy was repeated one month later showing complete closure of the fistulous orifices.
PubMed: 37929957
DOI: 10.17235/reed.2023.10025/2023 -
Theriogenology Oct 2020This study compares serum markers for systemic inflammation, and liver, mineral, and energy status in samples obtained -7, 1, 3, 5, 7, 14 ± 1, 21 ± 1, and 35 d...
This study compares serum markers for systemic inflammation, and liver, mineral, and energy status in samples obtained -7, 1, 3, 5, 7, 14 ± 1, 21 ± 1, and 35 d relative to calving from healthy dairy cows and those diagnosed with purulent vaginal discharge (PVD) or subclinical endometritis (SCE). Metabolites and markers measured in serum were total calcium, total protein, albumin, globulin, cholesterol, urea, glucose, gamma-glutamyl transferase, aspartate aminotransferase, glutamate dehydrogenase, β-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), haptoglobin (Hp), and insulin-like growth factor-1 (IGF-1). Holstein cows with no recorded clinical disease were classified healthy (neither PVD nor SCE; n = 38), PVD (n = 10) or SCE (n = 10) at 35 d postpartum. The cut-point for PVD was mucopurulent vaginal discharge or worse, measured with Metricheck, and for SCE > 5% endometrial polymorphonuclear cells (PMN). Purulent vaginal discharge and SCE were mutually exclusive categories. The association of each serum marker with reproductive tract health classification was fitted in mixed linear regression models, accounting for repeated measures, sampling day, parity, BCS, and interactions of reproductive tract status and day. Serum Hp concentrations were greater at 3, 5, 7, and 14 ± 1 d postpartum for SCE and at 7 and 35 d postpartum for PVD than in healthy cows. Albumin concentrations were lesser for PVD than healthy at 14 ± 1 d postpartum and lesser for SCE than healthy at 35 d postpartum. The week before calving, SCE had lesser total calcium than healthy cows, and at 7 and 14 ± 1 d postpartum PVD had lesser total calcium than healthy cows. At 14 ± 1 d postpartum, serum NEFA, BHB, and globulin were greater, and IGF-1 lower for SCE than PVD or healthy cows. For all other metabolites, no differences were found. Before diagnosis, PVD or SCE had more indication of postpartum systemic inflammation (high Hp and low albumin) than healthy cows, and markers of energy status were more compromised in SCE than in PVD or healthy cows. This supports the hypothesis that SCE is associated with maladaptation to postpartum metabolic demands and with metabolic inflammation.
Topics: Animals; Cattle; Cattle Diseases; Endometritis; Female; Lactation; Postpartum Period; Pregnancy; Vaginal Discharge
PubMed: 32622204
DOI: 10.1016/j.theriogenology.2020.06.005 -
Brazilian Journal of Otorhinolaryngology 2022Actinomycosis of the nasal cavity is very rare.
INTRODUCTION
Actinomycosis of the nasal cavity is very rare.
OBJECTIVE
The purpose of this study was to investigate the clinical features, treatment methods, and treatment results of actinomycosis of the nasal cavity in our hospital.
METHODS
We retrospectively enrolled 11 patients with histopathologically identified actinomycosis of the nasal cavity from January 2010 to May 2020.
RESULTS
This study included five males and six females. The most common symptom was purulent nasal discharge (36.4%). Nasal actinomycosis occurred in the maxillary sinus in 5 (45.5%) patients, the ethmoid sinus in two, the hard palate in two, the frontal sinus in one, and the nasal septum in one. After surgery, intravenous administration of antibiotics was performed on average for 7.4 days and oral antibiotics were prescribed for about 120.5 days. The clinical characteristics of the patients with nasal actinomycosis and the duration of antibiotic usage were not significantly different. Trauma was significantly associated with repeated nasal actinomycosis infections (p < 0.05).
CONCLUSION
Actinomycosis of the nasal cavity should be suspected when a patient with chronic sinusitis does not respond to medical therapy and has a history of dental treatment, local surgery or radiation therapy. Nasal can be sufficiently treated with antibiotics and endoscopic surgery.
Topics: Humans; Nasal Cavity; Retrospective Studies
PubMed: 34112606
DOI: 10.1016/j.bjorl.2021.05.003 -
Cureus Oct 2022Endophthalmitis is a condition of the eye caused due to complications in cataract surgery. The extent of this complication can be from minor to very serious, leading to... (Review)
Review
Endophthalmitis is a condition of the eye caused due to complications in cataract surgery. The extent of this complication can be from minor to very serious, leading to a permanent loss of light perception. It is generally an inflammation of the fluids present in the anterior and posterior chamber of the eye, consisting of vitreous and aqueous fluid. The inflammation is due to the infection of these fluids after their exposure during or after the cataract surgery. In today's situation, patient surgery is the most frequently preferred for the correction or treatment of the cataract. There are various factors causing endophthalmitis in cataract surgery. This condition occurs mostly by the entry of infective bacteria such as staphylococcus, gram-negative organisms, and streptococcus species. As well as fungi like aspergillus and candida. Cataract surgery has many risk factors that can be divided into preoperative, intraoperative, and postoperative phases. The most common symptom of this condition is pain in the eyes and redness, which sometimes leads to purulent discharge, causing decreased vision or loss of eyesight. The increasing inflammation of the vitreous fluid is the main identification of the condition. There is a surge of inflammatory cells in the space of the vitreous fluid. The condition can be classified into two types which are exogenous and endogenous. In these types, subtypes explain the postoperative complications of the disease. It is a rare condition, and the percentage of it occurring as a postoperative complication is very low. It generally targets the old age group of people. This narrative review article explains endophthalmitis as a postoperative complication of cataract surgery and its treatment modalities. The terms endophthalmitis, postoperative, cataract surgery, complications, and vitreous humor were used for the review article in PubMed.
PubMed: 36381712
DOI: 10.7759/cureus.30110 -
Laryngo- Rhino- Otologie Mar 2024Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic... (Review)
Review
Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic inflammation, possibly exhibiting acute exacerbation. Based on a literature review and descriptive clinical cases with histopathological correlations, this contribution summarises the most important information concerning epidemiology, aetiopathogenesis, composition, histology, and therapy of lacrimal concrements. Furthermore, factors known to affect lacrimal lithogenesis are addressed. Concrements of the lacrimal gland cause a swelling at the lateral canthus. With only mild pain, this manifests as circumscribed conjunctival hyperaemia. Histologically, the gland tissue is characterised by acute-erosive to chronic inflammation. The concrements consist of amorphic material. Inflammatory infiltration is dominated by neutrophil granulocytes. Canalicular concrements are highly correlated with chronic canaliculitis. Besides epiphora, patients present with purulent discharge at the affected canaliculus. Actinomyces are frequently found inside these deposits and form drusen-like formations. The surrounding tissue reacts with plasma-cellular and granulocytic inflammation. Dacryoliths (concrements of the lacrimal sac) are associated with dacryocystitis, whereby acute and chronic types are common. Stones can be found in up to 18% of patients undergoing dacryocystorhinostomy or dacryoendoscopy. Preoperative diagnostic testing is challenging, as many lacrimal sac stones cannot be reliably visualised by diagnostic procedures. Recurring episodes of epiphora, mucopurulent discharge, and dacryocystitis are common indicators of dacryoliths. Lacrimal syringing is often possible and shows that total blockage is not present. Histology of the lacrimal mucosa reveals lymphocytic infiltration and submucosal fibrosis. The immediate vicinity of the dacryoliths shows acute inflammation. Therapy consists of stone extraction and improving lacrimal drainage, as the latter is recognised as the main risk factor for dacryolith formation.
Topics: Humans; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Dacryocystorhinostomy; Nasolacrimal Duct; Dacryocystitis; Inflammation; Lacrimal Duct Obstruction
PubMed: 37989218
DOI: 10.1055/a-2192-3865 -
BJOG : An International Journal of... Apr 2022To construct evidence-based algorithms for the assessment and management of common amniotic fluid abnormalities detected during labour.
AIM
To construct evidence-based algorithms for the assessment and management of common amniotic fluid abnormalities detected during labour.
POPULATION
Low-risk singleton, term pregnant women in labour.
SETTING
Birth facilities in low- and middle-income countries.
SEARCH STRATEGY
We searched international guidelines published by the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetrics and Gynaecology (SOGC) and the World Health Organization (WHO). We also searched The Cochrane Library and MEDLINE up to 20 January 2020 using keywords for relevant systematic reviews and randomised trials.
CASE SCENARIOS
We developed evidence-based intrapartum care algorithms for four case scenarios: oligohydramnios; meconium-stained amniotic fluid; bloody amniotic fluid or vaginal bleeding; and purulent amniotic fluid or discharge. These conditions may be associated with fetal and /or maternal morbidity. Differential diagnosis includes uteroplacental insufficiency, fetal growth restriction, fetal distress, abruption, placenta or vasa praevia, uterine rupture and intra-amniotic infection, respectively. Algorithms include how to assess for, diagnose and manage these conditions.
CONCLUSIONS
Four algorithms are presented, to provide a systematic approach and guidance on the clinical management for the following amniotic fluid abnormalities: oligohydramnios; meconium-stained liquor; bloody amniotic fluid or vaginal bleeding; and purulent amniotic fluid or discharge. These algorithms may be beneficial in supporting clinical decision making, particularly in low-resource settings.
TWEETABLE ABSTRACT
Evidence based algorithms for management of common amniotic fluid abnormalities seen during labour.
PubMed: 35415944
DOI: 10.1111/1471-0528.16728 -
Pediatric Annals Jan 2023We present an 11-year-old pediatric patient with acute-on-chronic abdominal pain found to have a large intra-abdominal abscess with a concomitant dermoid cyst....
We present an 11-year-old pediatric patient with acute-on-chronic abdominal pain found to have a large intra-abdominal abscess with a concomitant dermoid cyst. Acute-on-chronic abdominal pain has one of the broadest and, in our case, ever-changing differential diagnoses. Exploratory laparoscopy revealed a severe pelvic inflammatory process with a large abscess and extensive omental and bowel adhesions, a left ovarian cyst, a shortened appendix with thickened tip, and purulent fluid in the cul-de-sac. These findings suggested a ruptured appendix leading to a large abscess with adjacent ovarian dermoid cyst, and an appendectomy was performed. Our patient responded well to continued intravenous antibiotics, and her drain was removed on the day of discharge. She was sent home with an additional 2 weeks of oral cefdinir and metronidazole. Follow-up ultrasound showed dramatic cyst resolution, and no further intervention was needed. .
Topics: Female; Humans; Adolescent; Child; Abscess; Dermoid Cyst; Abdominal Pain; Anti-Bacterial Agents; Appendectomy
PubMed: 36625800
DOI: 10.3928/19382359-20221114-05 -
Journal of Dairy Science Dec 2021Despite the rapid growth in popularity of the Jersey breed, most research on dairy cows in the United States has been done with the Holstein breed. Postpartum uterine... (Observational Study)
Observational Study
Despite the rapid growth in popularity of the Jersey breed, most research on dairy cows in the United States has been done with the Holstein breed. Postpartum uterine diseases negatively influence reproductive performance of dairy cows and limited data are available regarding predisposing factors for uterine diseases in Jersey cows. Our objectives were to determine the prevalence and risk factors for purulent vaginal discharge (PVD) and its effect on fertility of lactating Jersey cows. This was a retrospective observational study with data collected from 3,822 Jersey cows. The Metricheck device was used for PVD diagnosis, and positive cases (≥50% of pus in exudate) were further classified for severity using the following 4 categories based on the amount of pus observed: 50 to 60% pus in exudate, 60 to 90% pus in exudate, 90 to 100% pus in exudate, and 90 to 100% pus in exudate + uterine fluid detected by palpation per rectum. Univariable and multivariable regression analyzes were conducted to dissect the risk factors for PVD and severity of PVD in Jerseys cows. The major risk factors for PVD were calving-related problems, retained fetal membrane, metritis, and days in the close-up diet. A subgroup of cows (n = 740) was scored for body condition and locomotion scores and had blood sampled in the peripartum for determination of plasma concentrations of nonesterified fatty acids and β-hydroxybutyrate. In the multivariable analysis that considered data collected for the subgroup of cows, peripartum nonesterified fatty acids, postpartum β-hydroxybutyrate, and peripartum locomotion and body condition scores were not retained in the reduced model of predictors of PVD. Not surprisingly, pregnancy per artificial insemination following the first and second services was reduced in cows diagnosed with PVD compared with cows without PVD. In addition, PVD was associated with increased odds of pregnancy loss after the first service and reduced hazard of pregnancy by 305 d in milk. The stratification of PVD severity according to the amount of pus observed and the consistency of the uterus was meaningful, as observed by the differences in reproductive outcomes between cows with diverging amounts of pus in the retrieved exudate. Risk factors for PVD in Jersey cows was similar to previously reported for Holstein cows, and a strong detrimental effect of PVD on fertility was also observed in Jersey cows.
Topics: Animals; Cattle; Cattle Diseases; Female; Lactation; Pregnancy; Reproduction; Risk Factors; Vaginal Discharge
PubMed: 34482979
DOI: 10.3168/jds.2021-20502