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The Pancreatitis Exercise Scoring Program Predicts Clinical Outcomes throughout Individuals With Infected Pancreatic Necrosis.
ase. Conclusion Screening and management of anxiety and depression is an essential part of the care of patients with coronary artery disease. People with triple-vessel disease need the most attention and appropriate management of anxiety and depression.Background Urinary incontinence among women is a widespread clinical condition that is frequently associated with marked physical, social, and psychological adverse impact that significantly worsens their quality of life. This study is conducted to identify the prevalence of urinary incontinence and associated risk factors among Saudi women in Asir Region, Saudi Arabia. Methods Following a cross-sectional design, 1,964 healthy non-pregnant females aged above 13 years attending primary healthcare centers in Asir Region, Saudi Arabia were included. A self-administered semi-structured questionnaire was used, which included sociodemographic and clinical characteristics, questions related to voiding habits, and the validated Arabic version of the International Consultation on Incontinence Questionnaire (ICIQ). Results Almost half of the participants (47.5%) had urinary incontinence, of which 26.8% was slight, 16.3% was moderate, and 4.3% was severe. About 15.2% used to leak urine once a week or less, 3.6% used to ered significantly according to the presence of associated diabetes mellitus and renal/urinary tract diseases (p = 0.001 for both). Conclusions Urinary incontinence is common among Saudi females. Older age, multiparty, and menopause are significant risk factors for urinary incontinence.Sarcoma is a rare type of tumor that can arise in the different types of connective tissues. Symptoms vary depending on the size, type, and location of the tumor. Management and surgery should be performed in a referral sarcoma center with a molecular biology platform and a dedicated medical staff. A preoperative percutaneous core needle biopsy (CNB) is required to tailor the medical and surgical strategies. In this report, we describe the case of a well-differentiated retroperitoneal liposarcoma (WD LPS) discovered in the context of recurrent cystitis on an abdominal CT scan, synchronously occurring, with another different type of sarcoma, undifferentiated pleomorphic sarcoma (UPS) developing in the thigh, discovered because of sciatic pain. This extremely rare condition was confirmed by the molecular analysis and justifies a specific strategy taking account of the differential risk. This event should also encourage genetic counseling.Introduction High-dose local stereotactic robotic radiosurgery (RRS) is a non-invasive alternative to surgery in renal masses and selected patients. We have, so far, limited its use to the elderly and patients at high risk from surgery. In this study, we matched patients with renal tumors who were treated with single fraction RRS to patients who underwent open partial nephrectomy (OPN). Methods Between January 2009 and December 2017, we included 571 consecutive patients undergoing OPN and 99 patients who underwent RRS in this retrospective analysis. Patients had to have a follow-up of at least six months and we were able to match 35 with a propensity score. Matching criteria were Eastern Cooperative Oncology Group (ECOG) status, age, clinical tumor, nodes, and metastases (TNM), and tumor diameter. Tumor response, renal function, survival, and adverse events were evaluated every three months until progression or death. Results Median age was 65 years for RRS (range 58-75) and 71 (range 56-76) for OPN (p=0.131). Median diameter of renal tumors was 2.8 cm (range 2.4-3.9) for RRS and 3.5 cm (2.8-4.5) for OPN, p=0.104. Median follow-up was 28.1 months (range 6.0-78.3 months). Local tumor control nine months after RRS and OPN was 98% (95% CI 89-99%). Renal function remained stable with a median creatinine clearance (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) at baseline of 76.8mlmin/1.73m2 (range 25.3-126.3) and 70.3ml/min/1.73m2 (range 18.6-127.3) at follow-up (p=0.89). Median overall survival was not reached. No difference in overall survival (OS) was seen in RRS compared to OPN (p=0.459). Conclusions Single fraction RRS is an alternative to OPN in patients unfit for surgery. Oncological and functional results are comparable to those of OPN. Further studies are needed to determine long-term results and limits of RRS in this setting and in younger patients.A sixty-year-old man with ulcerative colitis and polymyalgia rheumatica, for which he was receiving prednisolone, visited the emergency department complaining of a gradual worsening of pain in the right buttock. Physical examination revealed mild redness and tenderness at the right side of the anus. Ultrasound revealed an approximately 38-mm long, avascular subcutaneous collection with heterogeneous echogenicity in the tender region. A perianal abscess was diagnosed, the lesion was punctured, and pus was drained, after which the pain improved. Point-of-care ultrasonography was effective in the prompt diagnosis and subsequent treatment of this patient's perianal abscess.We report the case of a transgender woman with HIV (CD4 349), shortness of breath, and chest pain, who was found to have multiple mycotic aortic aneurysms by point-of-care ultrasound (PoCUS). This report highlights the utility of point-of-care ultrasonography in the diagnosis and management of this rare clinical entity.Multiple mycotic aortic aneurysms and purulent pericarditis are uncommon. They have high morbidity and mortality and are associated with immunocompromised states (e.g., HIV). Diagnosis of the mycotic aneurysm, and its precursor, infectious aortitis, can be challenging, and delays in care can lead to poor outcomes. Often, as described in this case report, making the diagnosis requires a high clinical suspicion, multiple imaging modalities, and laboratory studies.Thyrotoxic periodic paralysis (TPP) is an unusual complication of hyperthyroidism that may cause diagnostic difficulties due to its clinical feature that may be similar to other diseases. However, TPP can be detected early based on the weakness presentation, which generally affects the lower extremity with proximal muscle involvement, and, additionally, the ECG findings presenting hypokalemia characteristics. This case illustrates a young Indonesian male presenting in the emergency department with paralysis and typical ECG findings suggesting TPP. Early identification of TPP is necessary for executing proper treatment and reducing complications.Introduction Palliative radiotherapy (PRT) during the last month of life (PRT30) should be avoided because relevant clinical benefits are unlikely to occur. While traditional short-course fractionation regimens are suitable for most patients, a minority may derive gains from higher doses of PRT. Compared to older regimens such as 13 fractions of 3 Gy, more hypofractionated, non-ablative concepts with reduced overall treatment time are not well studied. Methods Retrospective analysis (2017-2020) of 107 patients treated to metastatic lesions (one or two target volumes per patient) with traditional >2 weeks regimens or newer ≤2 weeks regimens, e.g. seven fractions of 5 Gy or five fractions of 6 Gy. Results Failure to complete radiotherapy was registered in 8% of patients (traditional fractionation) and 1%, respectively (p=0.12). Moderate rates of PRT30 were observed (11% and 6%, respectively, p=0.44). PRT30 was more likely in patients irradiated for brain or lymph node metastases. Utilization of newer ≤2 weeks regimens was highest in 2020, presumably as a result of the coronavirus disease 2019 (COVID-19) pandemic. Conclusion The implementation of newer fractionation regimens for selected patients has resulted in acceptable rates of non-completion and PRT30. Optimal selection criteria remain to be determined. Established, guideline-endorsed short-course regimens such as five fractions of 4 Gy and 8-Gy single fractions continue to represent important PRT approaches.Rectal variceal bleeding is one of the rarer manifestations of portal hypertension caused by chronic liver disease. The management of these varices is very challenging. Our patient had portal vein thrombosis and presented with chronic recurrent rectal bleeding requiring transfusion secondary to rectal varices. The patient was treated from trans-splenic access with liquid embolics (sclerotherapy and glue) without balloon occlusion, leading to the successful cessation of his bleeding. Access hemostasis was achieved using a vascular plug in the access tract. There are no clear guidelines for the management of these patients. If rectal varices cannot be managed by colonoscopy, this approach to embolization with liquid embolic is an excellent minimally invasive alternative.The use of statins has been increasing over the past decade for the primary and secondary prevention of cardiovascular disease worldwide. Subsequently, various side effects have also been unfolding. DLThiorphan Muscle-related side effects secondary to statins range from myalgia to rhabdomyolysis and need close monitoring for early detection. Statin-induced necrotizing autoimmune myopathy (SINAM) in particular is unique given its pathophysiology, trigger factor, genetic predisposition, and aggressive management strategy. We present two cases of SINAM and discuss the clinical aspects of diagnosis, investigation, and management. Statin-induced necrotizing autoimmune myopathy usually presents with proximal myopathy along with increased creatinine kinase (CK) levels which do not resolve with only statin discontinuation. Diagnosis should be made with biopsy and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody detection. The investigation should also be directed to rule out other etiology of proximal myopathy. In most cases, rechallenge with a statin is unsuccessful and immunosuppressive treatment is essential.Fournier's gangrene and emphysematous pyelonephritis are rare necrotizing infections of the genitourinary system. Many cases of this rapidly progressive infection occur from abscesses and urinary tract infections; however, Fournier's gangrene secondary to emphysematous pyelonephritis is seldom discussed in the literature. Emphysematous pyelonephritis is defined as a gas-forming, necrotizing infection of the renal parenchyma or its surrounding tissue. Emphysematous pyelonephritis has been observed in high-risk individuals, including those with poor glycemic control and urinary tract obstruction. We present a 61-year-old male with emphysematous pyelonephritis arising from a perinephric hematoma with tracking of the infection to the scrotum, resulting in Fournier's gangrene. The perinephric hematoma most likely developed from increased intrarenal hydrostatic pressure during nephroureteral stent placement. Broad-spectrum antibiotic therapy and surgical debridement of the retroperitoneum, groin, and scrotum were performed ultimately requiring left orchiectomy. We conclude that an existing hematoma can precipitate emphysematous pyelonephritis with tracking from the retroperitoneum to scrotum, causing Fournier's gangrene. High-risk patients with perinephric hematomas can be susceptible to this pathologic transformation.Background Malnutrition is a change in body composition as a result of inadequate nutrient intake or malabsorption. It has a significant effect on morbidity and mortality as a result of increased catabolism in acute and/or chronic diseases of many systems or organs. This study was conducted in a chest diseases branch hospital; applicants to the nutritional clinic are mostly patients with acute or chronic respiratory failure. This study aimed to evaluate the nutritional status of patients at the time of admission to the nutritional clinic and the relationship between nutritional support treatment and mortality. Materials and methods The data of 750 patients who applied to the nutritional clinic and consulted clinics, services, and intensive care units were retrospectively analyzed. The patients' demographic data, diagnoses, body mass indexes (BMI), Nutritional Risk Screening (NRS-2002) scores were determined to evaluate malnutrition risks, nutritional support treatments were recorded as enteral, total parenteral, oral enteral supplementation, and nutritional follow-up was initiated.
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