Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen

Introduction: Ventriculoperitoneal shunt (VPS) is most commonly performed surgical treatment for hydrocephalus by draining excessive cerebrospinal fluid (CSF) in ventricles to peritoneal cavity. Despite significant improvement in shunt procedure and being a relatively simple procedure, shunt complications remain common. Aim: The aim of this paper is to report a case of perforated bowel presented with silence abdomen following VPS insertion. Case study: We report a case of protrusion of distal VPS catheter through anus with silent abdomen, managed successfully with minimal intervention. Patient, 11-months-old male infant, diagnosed with congenital communicating hydrocephalus and VPS placement was done at 6 months of life, presented with tip of VPS protruding from anus after 4 months of VPS insertion. Patient was scheduled for removal of VPS, where shunt was disconnected through superficial abdominal incision, distal portion removed through anus without resistance. Postoperative patient recovers well without abdominal complication. Results and discussion: Perforation of bowel by distal peritoneal catheter is rare and only accounts for 0.1%–0.7% of complication. The exact pathogenesis for spontaneous bowel perforation is unclear. Management of bowel perforation secondary to VPS is highly individualized, mainly depending on its clinical symptoms and signs. Conclusions: Although bowel perforation following VPS insertion is rare, it carries high mortality up to 15% especially if unrecognized and delayed in treatment. Early detection and appropriate management are key in reducing VPS related morbidity and mortality.

Kikuchi-Fujimoto disease: State of the art

Introduction: Kikuchi-Fujimoto disease (KFD), also called histiocytic necrotizing lymphadenitis, is a rare disease that occurs with swollen lymph nodes and associated fever. This disease occurs in both children and adults. Aim: The aim of our work was to review the literature and to remind family doctors, otolaryngologists, hematologists and rheumatologists about this rare disease that should be included in the differential diagnosis of long-term cervical lymphadenopathy. Material and methods: Current information on Kikuchi-Fujimoto disease was sought and presented based on literature that was published in reputable magazines in the period 2007–2020 in English. We searched for articles in the Medline, PubMed, and Scopus databases. Results and discussion: KFD occurs in both children and adults. This disease is found all over the world, most often in the Asian population. The etiology of Kikuchi-Fujimoto disease is not entirely known, however, two causal theories are suspected, which are discussed in detail in our article. The course of the disease is mild and usually disappears on its own. A biopsy of an involved lymph node presented as the standard for diagnosis. KFD treatment was causal – nonsteroidal anti-inflammatory drugs and/or glucocorticosteroids were used. Conclusions: There are few reports in the literature about Kikuchi-Fujimoto disease. KFD is associated with cervical lymphadenopathy and associated fever. If the diagnosis of the above-mentioned symptoms is not obvious, then in the differential diagnosis rarer diseases, such as KFD, should be included.

Endoscopic sinus surgery training courses: Benefit and problems – a multicenter evaluation

Introduction: Dissection courses are important for trainees and surgeons in mastering the skills required to perform endoscopic sinus surgery (ESS) which is a common surgery in otorhinolaryngology. Aim: To evaluate the benefits of ESS training courses and ways to improve training. Material and methods: In a prospective study using a structured questionnaire, participants of ESS courses in the United Kingdom, Malaysia, India and Thailand were asked on their experiences in these courses and suggestions on improving them. Results and discussion: The majority of the participants have experiences in performing ESS prior to joining the course. Infundibulotomy was considered the easiest dissection step in ESS while frontal sinus surgery was considered the most challenging by the majority of the participants. The motivation for most of the participants in joining the course is to improve their skills with almost all stating that their expectations of the course have been fulfilled with improvement of their surgical techniques, anatomical skills and on patient’s safety. Almost all the participants were satisfied with the course and would recommend attending it. Conclusions: ESS dissection courses are an integral part in the learning process of trainees in becoming a competent surgeon and for surgeons to improve their techniques. Continuous improvement should be made to ensure that the participants will benefit from attending the course.

Thermovision analysis of the surface of the lower limbs in patients with symptomatic lumbosacral discopathy before and after surgery

Introduction: The subject of the study is analyzing of the temperature distribution on the lower limbs in patients with discopathy of the lumbosacral spine requiring surgery. Aim: The answer to the question whether surgical treatment reduces temperature differences on the lower limbs of patients undergoing surgery. Material and methods: Thermograms of the lower limbs were performed before and on the second day after microdiscectomy or microdiscectomy with posterior lumbar interbody fusion. The study group consisted of 37 patients of the Neurosurgery Department, while the control group consisted of 18 healthy people. Comparative analyzes of temperatures on the lower limb with pain with the temperatures on the lower healthy limb in the same patient indicate significant statistical differences in temperature distribution. Based on the thermograms, two region of interest’s (ROI) of the same area were determined on the thigh and the lower leg. The maximum, minimum and average temperatures were determined for those areas. Results and discussion: Comparative analyzes showed statistically significant differences for both areas and all temperatures between healthy and affected limbs in the group of patients before surgery. In turn, after surgery, no statistically significant differences were observed between the respective limb temperatures for both ROI areas. The analysis of the temperature parameters determined for analogous ROIs in the control group did not show statistically significant differences for all measured temperatures. Conclusions: After selective surgical treatment of lumbar discopathy by microdiscectomy previous significantly statistical temperature differences between the lower limbs in analogical ROIs in those patients decreased to not statistically significant differences.

Extreme hyperbilirubinaemia associated with choledocholithiasis without ascending cholangitis

Introduction: Charcot’s triad was traditionally used to diagnose ascending cholangitis. However it is already proven that only minority of patients with ascending cholangitis who fulfill the triad of fever, jaundice and right hypochondriac pain. Aim: We would like to highlight the rarity of severe hyperbilirubinaemia secondary to benign cause as most of the incidence raised more suspicion for primary liver disease or malignancy. Case study: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Results and discussion: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Conclusions: Benign conditions such as common bile duct stones still can lead to severe hyperbilirubinaemia even though it is very rare. The usage of appropriate imaging is needed to exclude malignant causes.

Investigating the predictors of routine HIV screening behaviors in nurses based on theory of reasoned action

Introduction: Adequate awareness and a positive attitude of nurses about HIV/AIDS can lead to better care and the provision of accurate information to the general public. Misconceptions about HIV/AIDS infection can affect the attitudes of healthcare staff and inappropriately affect the quality of care. Aim: The present study aimed to investigate the factors predicting the routine HIV screening behaviors in nurses based on the theory of reasoned action. Material and methods: This descriptive-cross-sectional study was conducted on 131 nurses working in Vali-e-Asr hospital in Fasa, Iran. The samples were selected by simple random method. Three 75-item standard questionnaires were also used to collect data, including 15 questions on attitudes, 30 questions on the nurses’ knowledge, and 30 questions on the nurses’ performance. Results and discussion: In total, 30 male (22.9%) and 101 (77.1%) female nurses entered in the study. Also, 65.6% of participants were 18–29 years and 48.9% (64) were working in emergency department. The mean attitude and knowledge were calculated to be 20.69 ± 3.17 points and 20.98 ± 4.78 points, respectively. Also, the mean of performance, behavioral control, intention, and subjective norms were calculated to be 84.63 ± 8.06 points, 24.56 ± 2.29 points, 63.93 ± 6.68 points, and 30.53 ± 3.27 points, respectively. The results of the present study indicated a significant relationship between the work experience with their attitude (P = 0.03) and knowledge (P = 0.001) as well as between the age and performance (P = 0.002). Conclusions: In the present study, the mean score of attitude, knowledge and performance was found to be moderate; thus the educational intervention seems necessary.

The effect of cigarette smoking on serum levels of regulatory cytokines and molecules involved in atherogenesis during systemic treatment of psoriasis – results of a preliminary study

Introduction: Among the diseases associated with psoriasis linked to smoking are primarily cardiovascular diseases (including atherosclerosis) and metabolic syndrome. In addition, cigarette smoking also affects the effectiveness of systemic treatment of psoriasis. Aim: Assessment of the effect of cigarette smoking on biomarkers of atherosclerosis in patients with psoriasis treated with methotrexate and adalimumab. Material and methods: The serum levels of vascular cell adhesion molecule 1 (VCAM-1), E-selectin, oxidized low density lipoprotein (oxLDL) and anti-oxLDL antibodies, IL-10, IL-35, TGFß1, were assessed in 34 patients with psoriasis (15 smokers and 19 non-smokers), and 8 healthy, non-smoking volunteers. Results and discussion: Smoking patients had significantly higher body mass index, lower high density lipoprotein (HDL), higher risk of 10-year fatal cardiovascular disease, higher IL-10 levels and lower IL-35 levels at baseline compared to healthy, non-smoking volunteers. We observed decreases in IL-10, VCAM-1, E-selectin, and oxLDL levels during 12 weeks of methotrexate treatment and, a decrease in IL-35 during adalimumab treatment, based on enzyme-linked immunosorbent assays. Conclusions: Our results indicate the need for a holistic approach to psoriasis treatment that includes lifestyle modifications like smoking cessation to slow the development of atherosclerosis and increase the possibility of improving skin lesions.

Maternal outcomes following second stage caesarean section in a tertiary hospital in Malaysia: A 6-year retrospective review

Introduction: The trend for second stage caesarean section (SSCS) has been rising, and it carries a high rate of maternal and neonatal morbidity. Aim: To determine the prevalence of caesarean section (CS) performed during the second stage of labour and identify maternal outcomes and associated risk factors in these women. Material and methods: This retrospective study was performed in the Hospital University Sains Malaysia (HUSM). Medical records of 207 women with singleton cephalic pregnancies at term who underwent a SSCS between January 1, 2010 and December 31, 2015 were reviewed, and demographic and outcome data were collected. Results and discussion: During the study period, 8,197 (19.3%) out of 42,546 babies were delivered by CS, including 257 (4.1%) SSCSs. Nearly half (49.3%) the women were nulliparous, 182 (87.9%) experienced spontaneous labour and 123 (59.4%) received oxytocin augmentation. Furthermore, 26 (12.6%) of women had post-partum haemorrhage (≥1000 mL), of whom 22 (10.6%) required blood transfusion. Only 1 (0.5%) woman was admitted to the intensive care unit postoperatively, but 163 (78.7%) had an overall hospital stay length of 3 days. Furthermore, 38 (18.4%) and 33 (15.9%) of women experienced extended uterine tear and uterine atony, respectively. Parity (P < 0.001), attempted instrumentation (P < 0.001) and baby’s weight (P < 0.004) were statistically significantly associated with total blood loss. Parity (P < 0.012) and attempted instrumentation (P < 0.001) were risk factors for extended uterine tear. Conclusions: The overall outcomes from SSCS were better compared with studies performed in other centres. Current practices must be maintained or improved to provide the best patient caree.

The effective use of hyperbaric oxygen therapy (HBOT) in the management of air embolism – rare and potentially fatal acute complication of hemodialysis

Introduction: Air embolism is a rare and potentially fatal acute complication. Its causes are mainly iatrogenic. It requires rapid diagnostics and treatment, including hyperbaric oxygen therapy (HBOT). Aim: The main aim was to present the potential causes of air embolism during hemodialysis (HD) and show the importance of quick clinical diagnosis and therapy – on the base of clinical case. Case study: 65-years old male patient with diabetic nephropathy was treated with HD. The permanent dialysis catheters were used as vascular access due to the difficulties with formation of arteriovenous fistula. The massive air embolism occurred during one of the dialysis sessions. The clinical suspicion was confirmed by CT scan which showed the presence of gas bubbles in abdominal arteries. The cause of air embolism was sensor failure. The presence of patent foramen ovale (PFO) with reversed leakage caused the air ingress into arterial system. Patient was qualified for the immediate hyperbaric therapy. The quick improvement in the condition of the patient took place. Results and discussion: The massive air embolism may occur in HD patients, particularly in those who are dialyzed with use of catheters as vascular access. This rare complication should be considered in the case of sudden worsening of patient condition during HD procedure. The use of CT scan to confirm the air embolism suspicion and availability of HBOT are necessary for successful management of this complication. Conclusions: HBOT is a safe and effective method of air embolism treatment in HD patients.