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Medicine Jun 2024Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical...
RATIONALE
Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst.
PATIENTS CONCERNS
A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension.
DIAGNOSES
Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction.
INTERVENTIONS
Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed.
OUTCOMES
The day after surgery, the patient was discharged without any complications.
LESSONS
Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.
Topics: Humans; Male; Urinary Tract Infections; Urachal Cyst; Infant; Intestinal Obstruction; Fever; Diagnosis, Differential; Ultrasonography
PubMed: 38875366
DOI: 10.1097/MD.0000000000038615 -
Frontiers in Cellular and Infection... 2024Serratia marcescens, as a Gram-negative opportunistic pathogen, is a rare cause of peritonitis and has worse clinical outcomes than Gram-positive peritonitis. In this... (Review)
Review
Serratia marcescens, as a Gram-negative opportunistic pathogen, is a rare cause of peritonitis and has worse clinical outcomes than Gram-positive peritonitis. In this case report, we describe a case of Serratia marcescens associated peritonitis that was successfully cured without catheter removal. A 40-year-old male patient with peritoneal dialysis who worked in the catering industry was admitted to the hospital for 16 hours after the discovery of cloudy peritoneal dialysate and abdominal pain. Ceftazidime and cefazolin sodium were immediately given intravenously as an empirical antibiotic regimen. After detecting Serratia marcescens in the peritoneal diasate culture, the treatment was switched to ceftazidime and levofloxacin. The routine examination of peritoneal dialysate showed a significant decrease in white blood cells, the peritoneal dialysate became clear, and the peritoneal dialysis catheter was retained. The patient was treated for 2 weeks and treated with oral antibiotics for 1 week. It is necessary to further strengthen the hygiene of work environment to prevent Serratia marcescens infection in peritoneal dialysis patients. We recommend that patients with Serratia marcescens associated peritonitis should be treated with a combination of antibiotics as early as possible empirically, and at the same time, the peritoneal dialysis fluid culture should be improved, and the antibiotic regimen should be timely adjusted according to the drug sensitivity results. For patients with clinical symptoms for more than 3 days, considering the strong virulence of Serratia marcescens, whether to use meropenem directly or not can provide a reference for clinical decision-making. Further clinical studies are needed to achieve more precise anti-infective treatment.
Topics: Humans; Serratia marcescens; Male; Peritonitis; Adult; Serratia Infections; Anti-Bacterial Agents; Peritoneal Dialysis; Treatment Outcome; Device Removal; Levofloxacin; Ceftazidime; Cefazolin
PubMed: 38873095
DOI: 10.3389/fcimb.2024.1373036 -
Virology Journal Jun 2024Infection with SARS-CoV-2 in high-risk groups such as kidney transplant and dialysis patients is shown to be associated with a more serious course of the disease. Four...
BACKGROUND
Infection with SARS-CoV-2 in high-risk groups such as kidney transplant and dialysis patients is shown to be associated with a more serious course of the disease. Four years after the start of the COVID-19 pandemic, crucial knowledge on the immune responses in these patient groups is still lacking. Therefore, this study aimed at investigating the humoral immune response after a SARS-CoV-2 infection compared to vaccination as well as the evolution of immunoglobulins over time.
METHODS
Kidney transplant recipients, patients on haemodialysis or on peritoneal dialysis and healthy controls were included in this longitudinal multicenter study. SARS-CoV-2 anti-RBD, anti-NP and anti-S1S2 immunoglobulin G (IgG) and A (IgA) as well as the neutralizing antibody capacity were measured.
RESULTS
Kidney transplant recipients had a significantly better humoral response to SARS-CoV-2 after infection (86.4%) than after a two-dose mRNA vaccination (55.8%) while seroconversion was comparable in patients on haemodialysis after infection (95.8%) versus vaccination (89.4%). In individuals without prior COVID-19, the IgG levels after vaccination were significantly lower in kidney transplant recipients when compared to all other groups. However, the IgA titres remained the highest in this patient group at each time point, both after infection and vaccination. A history COVID-19 was associated with higher antibody levels after double-dose vaccination in all patient categories and, while decreasing, titres remained high six months after double-dose vaccination.
CONCLUSION
Kidney transplant recipients had a more robust humoral response to SARS-CoV-2 following infection compared to a two-dose mRNA vaccination, while patients on haemodialysis exhibited comparable seroconversion rates. Notably, individuals with prior COVID-19 exhibited higher IgG levels in response to vaccination. Hybrid immunity is thus the best possible defence against severe COVID-19 disease and seems also to hold up for these populations. Next, it is not clear whether the higher IgA levels in the kidney transplant recipients is beneficial for neutralizing SARS-CoV-2 or if it is a sign of disease severity.
Topics: Humans; Kidney Transplantation; COVID-19; Immunoglobulin G; Male; Female; Immunoglobulin A; Middle Aged; Antibodies, Viral; SARS-CoV-2; Immunity, Humoral; Renal Dialysis; Transplant Recipients; Antibodies, Neutralizing; Vaccination; Aged; Adult; Longitudinal Studies; COVID-19 Vaccines; Spike Glycoprotein, Coronavirus
PubMed: 38872127
DOI: 10.1186/s12985-024-02410-1 -
Aging Jun 2024Gastric carcinoma (GC) is one of the most fatal human malignancies globally, with a median survival time less than 1 year. E-cadherin exerts a crucial role in the...
BACKGROUNDS
Gastric carcinoma (GC) is one of the most fatal human malignancies globally, with a median survival time less than 1 year. E-cadherin exerts a crucial role in the development and progression of GC as an adhesive, invasive suppressor gene. Whether reduced E-cadherin has an impact on prognosis, clinicopathological features for GC has been well studied, but no conclusive results has been obtained.
METHODS
Eligible studies and relevant data were obtained from PubMed, Elsevier, Embase, Cochrane Library and Web of Science databases until June 30, 2023. A fixed- or random-effects model was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI). Correlation of E-cadherin expression with overall survival (OS), clinicopathological features and risk factors were evaluated.
RESULTS
36 studies fulfilled the selected criteria. 9048 cases were included. This meta-analysis showed that patients with GC with reduced E-cadherin had unfavourable clinicopathological features and poor OS. The pooled ORs of one-, three- and five-year OS were 0.38 ( = 25 studies, 95%CI: 0.25-0.57, Z = 4.61, < 0.00001), 0.33 ( = 25 studies, 95% CI: 0.23-0.47, Z = 6.22, < 0.00001), 0.27 ( = 22 studies, 95% CI: 0.18-0.41, Z = 6.23, < 0.00001), respectively. Moreover, reduced E-cadherin expression significantly correlated with differentiation grade (OR = 0.29, 95% CI: 0.22-0.39, Z = 8.58, < 0.00001), depth of invasion (OR = 0.49, 95% CI: 0.36-0.66, Z = 4.58, < 0.00001), lymphatic node metastasis (OR = 0.49, 95% CI: 0.38-0.64, Z = 5.38, < 0.00001), distant metastasis (OR = 2.24, 95% CI: 1.62-3.09, Z = 4.88, < 0.00001), peritoneal metastasis (OR = 2.17, 95% CI: 1.39-3.39, Z = 3.40, = 0.0007), TNM stage (OR = 0.41, 95% CI: 0.28-0.61, Z = 4.44, < 0.00001), lymphatic vessel invasion (OR = 1.77, 95% CI: 1.11-2.82, Z = 2.39, = 0.02), vascular invasion (OR = 1.55, 95% CI: 1.22-1.96, Z = 3.58, = 0.0003), Lauren type (OR = 0.35, 95% CI: 0.21-0.57, Z = 4.14, < 0.0001), Borrmann classification (OR = 0.50, 95% CI: 0.25-0.99, Z = 1.97, = 0.048) and tumor size (≥5 cm vs. <5 cm: OR = 1.73, 95% CI: 1.34-2.23, Z = 4.19, < 0.0001; ≥6 cm vs. <6 cm: OR = 2.29, 95% CI: 1.51-3.49, Z = 3.87, = 0.0001). No significant association was observed between reduced E-cadherin expression and liver metastasis, perineural invasion, alcohol consumption, smoking status, familial history, Helicobacter pylori (HP) infection.
CONCLUSIONS
The reduced expression of E-cadherin is significantly correlated with poor OS and unfavourable clinicopathological features in GC. The expression level of E-cadherin not only serves as a predictor for disease progression and prognosis in GC but also emerges as a novel therapeutic target.
PubMed: 38870263
DOI: 10.18632/aging.205929 -
Tuberkuloz Ve Toraks Jun 2024Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB...
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB cases present as extrapulmonary TB. The diagnosis of extrapulmonary TB is often overlooked due to its atypical clinical and radiological manifestations. Differentiating TB from neoplastic conditions poses significant challenges. A 33-year-old female patient was admitted to the emergency clinic with shortness of breath, cough, and abdominal pain. Postero-anterior chest X-ray revealed massive pleural effusion leading to mediastinal shift. With a preliminary diagnosis of malignant pleural effusion, a pleural catheter was inserted, and the patient was referred for a positron emission tomography (PET/CT) to assess the primary site and the optimal location for a biopsy. The PET/CT revealed asymmetric soft tissue thickening on the left side of the nasopharynx, and increased fluorodeoxyglucose (FDG) uptake in the left cervical lymph nodes raised suspicion regarding primary nasopharyngeal cancer. Additionally, there was an increased FDG uptake observed in the mass lesion located in the right upper lobe, mediastinal lymph nodes, pleural surfaces in the left hemithorax, perihepatic areas, and peritoneum, indicating diffuse metastatic disease. Tuberculosis diagnosis was confirmed through biopsies demonstrating granulomatous inflammation in the lung and nasopharynx, along with culturing MTB from pleural effusion. Positron emission tomography played a crucial role in identifying sites of TB involvement. Despite its rarity, healthcare professionals should consider nasopharyngeal TB as a potential diagnosis when evaluating nasopharyngeal masses.
Topics: Humans; Female; Adult; Diagnosis, Differential; Positron Emission Tomography Computed Tomography; Tuberculosis; Fluorodeoxyglucose F18; Neoplasm Metastasis
PubMed: 38869209
DOI: 10.5578/tt.202402915 -
Cirugia Y Cirujanos 2024A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case...
A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case of a 56-year-old male patient with a history of laparoscopic gastric bypass, a computed tomography scan showed findings indicative of the condition. Extensive adhesiolysis was performed, and biopsies confirmed the presence of fusiform cells (D2-40 positive on immunochemistry) resembling fibroblasts, within dense collagenous peritoneal tissue sheets, typical of sclerosing encapsulating peritonitis. The prevalence of this condition is uncertain, and diagnosis typically requires a peritoneal biopsy due to the nonspecific clinical presentation.
Topics: Humans; Male; Middle Aged; Gastric Bypass; Intestinal Obstruction; Postoperative Complications; Peritoneal Fibrosis; Peritonitis; Syndrome; Tissue Adhesions; Tomography, X-Ray Computed; Intestine, Small
PubMed: 38862118
DOI: 10.24875/CIRU.22000335 -
Frontiers in Medicine 2024Brucella infection is uncommon among peritoneal dialysis (PD) patients in non-endemic areas, and the occurrence of both peritonitis and abdominal aortitis is rare.
BACKGROUND
Brucella infection is uncommon among peritoneal dialysis (PD) patients in non-endemic areas, and the occurrence of both peritonitis and abdominal aortitis is rare.
CASE PRESENTATION
In December 2023, a 63-year-old male patient undergoing PD was admitted to Shaoxing Second Hospital due to fever, abdominal pain, and cloudy dialysate. Upon physical examination, diffuse mild abdominal pain and tenderness were observed. Subsequent investigation into the patient's medical history revealed consumption of freshly slaughtered lamb from local farmers 3 days prior to the onset of symptoms. Various diagnostic tests, including routine blood tests, procalcitonin levels, and PD fluid analysis, indicated the presence of infection. Abdominal computed tomography (CT) imaging revealed localized lumen widening of the abdominal aorta with surrounding exudative changes. On the sixth day in the hospital, blood and PD fluid cultures confirmed infection. The patient was diagnosed with brucella-associated peritonitis and aortitis. Treatment was adjusted to include rifampin and doxycycline for 6 weeks, and the decision was made to keep the PD catheter. Remarkably, the patient exhibited resolution of peritonitis and abdominal aortitis within the initial week of the adjusted treatment. Currently, the patient continues to receive ongoing clinical monitoring.
CONCLUSION
Brucella is rare but can cause PD-associated peritonitis and arteritis. Prompt diagnosis and treatment can lead to a good outcome in PD patients. Dual therapy is effective, but the need for catheter removal is unclear. Consider international guidelines and patient factors when deciding on catheter removal.
PubMed: 38854664
DOI: 10.3389/fmed.2024.1393548 -
Cureus May 2024A spontaneous rupture of the urinary bladder (SRUB) is an exceedingly rare surgical emergency that might be misdiagnosed, resulting in a high mortality risk. Clinicians...
A spontaneous rupture of the urinary bladder (SRUB) is an exceedingly rare surgical emergency that might be misdiagnosed, resulting in a high mortality risk. Clinicians should be mindful that secondary peritonitis can occur as a result of a ruptured urinary bladder, which is frequently misdiagnosed and undertreated. The majority of cases are identified during laparotomy. We report a case of a 70-year-old woman who had irradiation for endometrial cancer 25 years ago and had a history of hypertension, diabetes, and recurring urinary tract infections. The current study sought to determine the etiology of SRUB as well as clinical aspects and diagnostic strategies. She was diagnosed with generalized peritonitis. An exploratory laparotomy discovered a perforated urinary bladder. Following further care, the patient was released with no further complaints.
PubMed: 38854308
DOI: 10.7759/cureus.60053 -
Clinical Kidney Journal May 2024Implementing eHealth requires technological advancement, universal broadband and internet access, and devices to conduct telemedicine and remote patient monitoring in...
Implementing eHealth requires technological advancement, universal broadband and internet access, and devices to conduct telemedicine and remote patient monitoring in end-stage kidney disease patients receiving home dialysis. Although eHealth was beginning to make inroads in this patient population, the COVID-19 pandemic spurred telemedicine usage when many regulations were waived during the Public Health Emergency to limit the spread of infection by endorsing social distancing. At the same time, two-way communication automatic peritoneal dialysis cyclers were introduced to advance remote patient monitoring. Despite the numerous advantages and potential benefits afforded by both procedures, challenges and untapped resources remain to be addressed. Continuing research to assess the use of eHealth and technological innovation can make eHealth a powerful tool in home dialysis. We review the past, present and future of eHealth and remote patient monitoring in supporting home dialysis.
PubMed: 38846414
DOI: 10.1093/ckj/sfae081 -
Cureus May 2024Background Postoperative complications (POC) are undesirable consequences of surgery and are a major area of concern adversely affecting the quality of surgical care and...
Background Postoperative complications (POC) are undesirable consequences of surgery and are a major area of concern adversely affecting the quality of surgical care and patient safety. Emergency surgery has been observed to have a higher incidence of different POC. The analysis of POC is of great importance due to their impact on the quality of life of patients and because they have become an indicator to measure the quality of hospital services. Objective This study aimed to describe the POC of emergency surgeries in patients from the general surgery department of a referral hospital in eastern Venezuela. Methodology A cross-sectional retrospective study was conducted, including patients undergoing emergency surgery at "Dr. Luis Razetti" University Hospital, Barcelona, Venezuela, between November 2022 and May 2023. Results Medical records of 178 patients were analyzed. Most were male (53.7%), with an average age of 34.98 and a standard deviation of 18.2 years. POC was registered in 28 (15.7%) patients, with surgical site infection being the most common in 21 (39.62%) patients. Those over 65 years old (21.4% vs. 6.4%, p=0.013), patients with a history of hypertension (25% vs. 6.3%, p=0.002), hypoalbuminemia (100% vs. 43.8%, p=0.027), diagnosed with peritonitis due to hollow viscus perforation (21.4% vs. 6%, p=0.007), trauma (25% vs. 9.3%, p=0.018), and those with a midline incision (75% vs. 31.3%, p<0.001) had a higher frequency of POC. There was a mortality rate of 2.8% with no significant difference based on the development of POC. Conclusion POC represents a significant cause of morbidity and mortality in patients undergoing emergency surgeries. The studied sample showed a similar frequency of POC compared to previous reports but with lower mortality. Complications were associated with higher frequencies of hypertension, midline approach, hypoalbuminemia, and emergency surgery for peritonitis due to hollow viscus perforation and trauma.
PubMed: 38846234
DOI: 10.7759/cureus.59805