Effect of first-line antifungal treatment on ocular complication risk in Candida or yeast blood stream infection

ObjectivesOcular candidiasis (OC) can complicate Candida bloodstream infection (BSI). Antifungal treatment improves the prognosis of patients with BSI, but the effects of choice and timing of first-line medication on OC risk are incompletely understood. We explored the early treatments, risk factors and ocular presentations in Candida BSI.Methods and analysisAll patients (n=304) with Candida BSI during 2008–2017 at Oulu University Hospital were included. Those patients in whom clinical condition was appropriate for ocular examination (OE), including biomicroscopy (n=103), were carefully analysed by ophthalmologists. Criteria for patient selection were considered. Candida and yeast species, antifungal medications, echocardiography, underlying diseases and clinical properties of the patients with Candida BSI were analysed.ResultsClinical condition in 103 patients had been considered appropriate for OE. OC was diagnosed in 33 of the 103 patients. Candida albicans was the most common finding (88%) in OC. Patients in intensive care, alcohol-related conditions or poor prognosis were less frequently examined. Persistent candidemia increased the risk of OC. Chorioretinitis and endophthalmitis were diagnosed in 94% and 48% of the patients with OC, respectively. Any early antifungal treatment decreased the endophthalmitis risk. Echinocandin lowered the OC risk in those with central venous catheters (CVCs) or abdominal malignancy.ConclusionCritical condition of patients with Candida BSI affects the selection and results of OE. OC was associated with C. albicans BSI especially among those with persistent candidemia, CVC or abdominal malignancy. Any early antifungal treatment reduced endophthalmitis risk. Early echinocandin treatment may reduce the risk of OC in selected patients.

Internal Tension Sutures in term of Wound Healing in Patients Undergoing Laparotmy

Objective: The aim of this study is to determine the effectiveness of internal tension sutures in term of wound healing in patients undergoing laparotomy. Study Design: Prospective cross sectional study Place and Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from 15th November 2020 to 15th May 2021. Methods: One hundred and fifty patients of both genders were presented this study. Patients were aged between 20-60 years of age. Patients’ detailed demographics including age, sex and body mass were recorded after taking informed written consent. Internal tension sutures technique were used for laparotomy among patients who had intestinal obstruction, fire arm injury or stab wound to abdomen, intra-abdominal malignancies, pancreatitis. Mean post-operative pain was measured by using VAS. Outcomes in terms of healing and complications were observed at the end of study. Complete date was analyzed by SPSS 27.version. Results: There were 115 (76.7%) patients were males and 35 (23.3%) were females. Mean age of the patients were 39.09±12.24 years with mean BMI 28.17±8.42 kg/m2. Among 150 cases, majority of the patients 120 (80%) were treated as elective and 30 (20%) were treated in emergency. Symptoms among patients were peritonitis, intestinal obstruction, trauma, mesenteric ischemia, intra-abdominal malignancy, pancreatitis and obstructive jaundice found. Effectiveness was found among 140 (93.3%) cases and only 10 (6.7%) adverse outcomes were found i.e. wound infection and incisional hernia. Patients’ satisfaction was 94.7% among all cases. Conclusion: We concluded in this study that use of internal tension sutures technique for laparotomy is an effective and safest technique in terms of less complications and wound infections with excellent outcomes. We observed that majority of the patients were satisfied by this technique. Keywords: Wound dehiscence, Internal tension sutures, Laparotomy, Incisional hernia

Extrarenal Wilms' Tumour of the Ovary

Wilms' tumour (nephroblastoma) is the most common abdominal malignancy in children. Extrarenal Wilms' tumour (ERWT) is rare, with limited reports in the literature. Hereby, we report a case of unilateral ovarian Wilms' tumour, which was diagnosed initially by closed biopsy and confirmed later by histopathology study of the excised tumour. We are discussing the unusual location and presentation of Wilms' tumour and showing the medical challenges in both the initial clinical impression and the pathological diagnosis. Demonstrating therapeutic plans and showing the good outcome achieved by using the classic renal Wilms’ tumour therapy protocols. Keywords: Extrarenal tumour; Wilms' tumour; nephroblastoma; Ovary; paediatric tumour.

Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer

Objectives Peritoneal tuberculosis can mimic advanced abdominal malignancy. We describe clinical and laboratory characteristics in a series of female patients with peritoneal tuberculosis who were referred to a tertiary cancer center with a diagnosis of suspected advanced ovarian/primary peritoneal cancer. Materials and Methods Details of clinical features, laboratory results including serum tumor markers, radiological findings, and ascitic fluid evaluation were retrospectively collected from hospital records for patients diagnosed to have peritoneal tuberculosis and reported descriptively. Statistical Analysis Descriptive statistics was performed using SPSS Statistics for Windows software, version 20.0 (SPSS, Chicago, Illinois). Results Between January 2009 and December 2017, 120 patients of peritoneal tuberculosis with a median age 41 years (range, 15–79 years) were identified. Of these 112 (93.3%; 95% CI 88.9–97.8%) patients had ascites and 63 (52.5%; 95% CI 43.6–61.4%) had adnexal mass at presentation. Mean serum cancer antigen 125 (CA-125) level was 666.9 (range, 38–18,554) U/mL. Ascitic fluid was negative for malignant cells in all patients and lymphocyte rich exudate was seen in 103 (91.9%; 86.9–97.0%) patients. Ascitic fluid adenosine deaminase (ADA) level was more than 40 U/L in 107 (95.5%; 95% CI 91.7–99.4%). Ascitic fluid Ziel–Neelsen staining was positive in 4/62 (6.5%; 95% CI 0.3–12.6%) patients while ascitic fluid culture examination for mycobacterium tuberculosis was positive in 7/59 (11.9%; 95% CI 3.6–20.1%) patients. The diagnosis of tuberculosis was based on image-guided biopsy in 44 (36.7%) patients, surgical biopsy in 8 (6.7%) patients, and a combination of clinicoradiological and laboratory features in 68 (56.7%) patients. All patients received standard antitubercular treatment. Conclusions The study results suggest that peritoneal tuberculosis has clinical, radiological, and serological profile which may mimic advanced ovarian/primary peritoneal cancer. Peritoneal tuberculosis should be considered in the differential diagnosis of advanced abdominal malignancy.

Diagnostic and Management Difficulty of Bleeding Aorto-Duodenal Fistula Associated with Hodgkin’s Lymphoma

Primary aorto-enteric fistula (AEF) resulting from abdominal malignancy is a rare and often fatal complication. The few reports to date are mostly secondary to solid tumors. We present a case of a patient with refractory Hodgkin’s lymphoma who developed life-threatening AEF. We describe the diagnostic and therapeutic efforts, requiring a multi-disciplinary team of interventional radiology, gastroenterology, and transfusion medicine, resulting in a favorable outcome. Importantly, we offer several insights regarding the identification and management of high-risk patients, with an emphasis on pre-treatment considerations and urgent diagnosis and intervention.

Imperforate hymen mimicking malignancy in adolescence

Imperforate hymen is a rare congenital abnormality. It often presents with abdominal mass associated with pain. Differential diagnosis includes abdominal malignancies. A thirteen years-old female was referred to our center with abdominal distention and pain with the presumptive diagnosis of abdominal malignancy. Serum levels of tumor markers were extremely high. Abdominal CT scan without contrast revealed an extremely large, cystic mass (hematocolpos) with thickened walls. Gynecologic examination revealed imperforated hymen. A midline vertical hymenal incision was performed. This case is unique in terms of high suspicion of malignancy in light of physical examination, CT scan characteristics and high levels of tumor markers. It emphasizes that gynecologic examination should be a part of routine physical examination in adolescent females presenting with abdominal mass.