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To improve the management of patients with chronic endometritis (CE) by using a molded sorbent-modified by polyvinylpyrrolidone (FSMP).
This prospective study included 70 patients with CE divided into two groups group 1 (n=23) received traditional antibiotic therapy (from days 3 to 10 of the menstrual cycle); group 2 (n=47), received antibiotics and FSMP was inserted from days 5 to 10.
At the end of therapy, group 1 had massive growth of pathogenic microflora in 21.7%, moderate growth in 69.6%, and no growth in 8.7% of cases. In group 2, after combined therapy, massive growth was observed in 4.3%, moderate growth in 44.7%, and no growth in 51.0%. In group 2 after 5days, serum levels of interleukin-1β (IL-1β) were 1.9 times, of IL-6 were 7.0 times, and of IL-8 and IL-1 receptor antagonist were 1.3 times lower than in group 1. In uterine cavity aspirates, IL-1β decreased around 4.8 times, IL-6 by 11.8 times, IL-8 by 3.2 times, tumor necrosis factor-α by 3.9 times, and IL-1 receptor antagonist by 2.1 times in comparison to group 1.
Combined therapy of FSMP with antibiotics is more effective in treating CE, because it contributes to the almost complete elimination of pathogens and toxins from the uterine cavity, blocking the local pro-inflammatory cascade.
Combined therapy of FSMP with antibiotics is more effective in treating CE, because it contributes to the almost complete elimination of pathogens and toxins from the uterine cavity, blocking the local pro-inflammatory cascade.
To evaluate the role of the placenta accreta index (PAI) score in predicting placenta accreta spectrum (PAS).
In this prospective study, the PAI was applied to 100 third-trimester pregnant women with at least one previous cesarean delivery (CS) and anterior low-lying placenta or placenta previa. PAI score was calculated based on placental location, number of CS, abnormal placental lacunae, sagittal smallest myometrial thickness (SSMT), and bridging vessels. Histopathologic confirmation was obtained if hysterectomy was performed. Outcome measures were area under the receiver-operating characteristics curve (AUC-ROC) and the best cut-off point of PAI. Regression analysis of the PAI parameters was performed.
The PAI had an AUC of 0.84 (95% confidence interval [CI] 0.75-0.91). The best cut-off point of PAI was 5.37, with a sensitivity of 83.9%, a specificity of 76.3%, a positive predictive value of 85.2%, a negative predictive value of 74.3%, and an accuracy of 81%. PAI parameters showed a significant association with histopathologically proven PAS (n=23). The highest odds ratio (OR) was achieved with lacunae grades 2 and 3 (OR 9.22, 95% CI 2.02-42) and the lowest OR with SSMT <1.5mm (OR 3.78, 95% CI 1.3-10.6).
The PAI appears to be a promising predictor of PAS in high-risk women who required hysterectomy.
The PAI appears to be a promising predictor of PAS in high-risk women who required hysterectomy.Streptomyces belongs to the Actinomycetes group of bacteria which are gram-positive non acid-fast bacilli, widely recognised for their potential to produce antimicrobials active against bacterial, mycobacterial, parasitic and fungal infections. They commonly cause cutaneous infections following traumatic inoculation. Visceral infections are relatively rare and limited to immunocompro-mised hosts. We describe a case of Streptomyces pneumonia in a healthy immunocompetent female, who when investigated for voluntary kidney donation, resulted in the isolation of Streptomyces species from bronchial wash cultures. Streptomyces, a potential pathogen in immunocompetent hosts is frequently underdiagnosed. Once isolated, both physicians and microbiologists should pay attention to differentiate true infection from contamination.Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant syndrome. It is also known as Hornstein-Knickenberg syndrome. It is an inherited disorder culminating in mutations in folliculin coding gene (FLCN). The clinical exhibitions of the syn-drome are multi-systemic, comprising of a constellation of pulmonary, dermatologic and renal system manifestations. The most common presentations include fibrofolliculomas, renal cell carcinomas, lung cysts and spontaneous pneumothorax. The treatment is conservative with regular monitoring of the renal and lung parameters. Fibrofolliculomas may require surgical excision and recurrent events of pneumothorax may warrant pleurodesis. We reported a case series of 2 patients presenting with symptoms of progressive breathlessness along with dermatological manifestations and subsequently showing radiological manifestations of Birt-Hogg-Dubé syndrome in the form of lung cysts.Emphysema sequentially leads to the loss of gas exchanging surface and an abnormal shape of the diaphragm generating dyspnea refractory to standard medical therapy. Lung volume reduction surgery (LVRS) is a surgical treatment option for patients with severe emphysema whose symptoms are uncontrolled on standard therapy. Bronchoscopic LVR (bLVR) is a process by which lung volume reduction is achieved in a minimally invasive manner using bronchoscopy-guided insertion of valves, coils, sealants, or by thermal vapour ablation like techniques. These therapies have developed over the last few years and have variable results in patients. We have summarized the current evidence available on each of these methods in this review.As no definitive therapy or vaccine is yet available for COVID-19, in a desperate attempt repurposed drugs are being explored as an option. A drug repurposing study identified Ciclesonide as a potential candidate. We reviewed the available evidence and clinical trials on the use of Ciclesonide in COVID-19. At present the evidence is limited to a report of three cases. However, five clinical trials are underway, and their results will help in elucidating the role of Ciclesonide in COVID-19.Takayasu arteritis (TA) poses a diagnostic challenge as it may have a myriad of clinical presentations. Dyspnea, as an index presentation in TA, may be secondary to the involvement of the aorta, myocardium, and/or the pulmonary vessels, or can present as a manifestation of pulmonary infection with tuberculosis. Significant lymphadenopathy cannot be attributed to TA and serves to point towards a different diagnosis or concomitant infection. Tuberculosis has been associated with TA and has considerable pathogenic and therapeutic implications. We present a case of a young female with extensive intra-thoracic tubercular lymphadenopathy compressing the trachea and right main bronchus resulting in dyspnea. The patient was subsequently found to have active TA and improved after treatment with anti-tubercular therapy and steroids. We review the causes of dyspnea and mediastinal lymphadenopathy in a patient with TA.
One important concern during the management of COVID-19 pneumonia patients with acute hypoxemic respiratory failure is early anticipation of the need for intubation. ROX is an index that can help in identification of patients with low and those with high risk of intubation. So, this study was planned to validate the diagnostic accuracy of the ROX index for prediction of COVID-19 pneumonia outcome (the need for intubation) and, in addition, to underline the significant association of the ROX index with clinical, radiological, demographic data.
Sixty-nine RT-PCR positive COVID-19 patients were enrolled. The following data were collected medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment.
All patients with severe COVID-19 infection (100%) were intubated (50% of them on the 3rd day of admission), but only 38% of patients with moderate COVID-19 infection required intubation (all of them on the 3rd day of admission). The ROX index on the 1st day of admission was significantly associated with the presence of comorbidities, COVID-19 clinical classification, CT findings and intubation (p ≤ 0.001 for each of them). Regression analysis showed that sex and ROX.1 are the only significant independent predictors of intubation [AOR (95% CI) 16.9 (2.4- 117), 0.77 (0.69-0.86)], respectively. Cut-off point of the ROX index on the 1st day of admission was ≤ 25.26 (90.2% of sensitivity and 75% of specificity).
ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia.
ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia.Iidiopathic pulmonary fibrosis (IPF) diagnosis and treatment during this COVID-19 pandemic have been affected. COVID-19 has not only impacted the prognosis of these patients but also the approach to these patients. find more Pulmonary function tests (PFT) and lung biopsies are less encouraged now. Traditional antifibrotics used in IPF should be encouraged irrespective of patient lung function and in those with non-definite usual interstitial pneumonia in high resolution computed tomography.Primary pleural synovial sarcoma (PPSS) is a rare malignant pleural tumor comprising less then 1% of all primary lung malignancies. Primary pleural mesothelioma (PPM) has many similar features that may cause a diagnostic dilemma due to overlapping clinical and histopathological features. We present the case of a young male with recurrent hemorrhagic pleural effusion without any obvious lung mass who was diagnosed with PPSS. This rare entity must be considered with a high index of suspicion while evaluating pleural tumors.
Botulinum neurotoxin type A (BoNT/A) injections are the established treatment in cervical dystonia (CD). But clinical practice regarding the choice of muscles into which injections are made varies between centres. Until now, there have been no dose-per-muscle recommendations based on 'searching the dose' clinical trial data.
We therefore examined the dosages under real world conditions at seven international movement disorders centres, using an identical clinical approach.
We examined 305 patients with CD (55.6 ± 13.2 years, 204 female). The most commonly injected muscles were the splenius capitis (84.9%), sternocleidomastoid (80.3%), trapezius (59.7%), levator scapulae (49.8%), semispinalis capitis (39%), and obliquus capitis inferior (36.7%). The mean total dose per treatment session with aboBoNT/A was 652.5 (SD = 285.5), with onaBoNT/A it was 159.5 (SD = 62.4), and with incoBoNT/A it was 173.4 (SD = 99.2) units. The doses injected into each muscle in the ona- or incoBoNT/A groups were between 19.7 anasis for recommendations and further investigations.
In April 2012, the Manitoba Home Cancer Drug Program (HCDP) was introduced to allow 100% coverage for eligible oral anticancer agents (OAA) and supportive medications for Manitobans with cancer requiring these therapies.
What is the extent of use and cost of OAAs among outpatients in Manitoba from 2003/04 to 2015/16? Did the HCDP change OAA user and prescription patterns?
This was a retrospective, population-based study using administrative data to measure the prevalence of drug utilization over time and the impact of HCDP on OAA use and prescriptions using generalized linear models. Manitobans with cancer who filled an OAA or supportive medication covered by HCDP from 2003/04 to 2015/16 were included.
This study included 22,393 people with cancer who filled an OAA prescription. The prevalence of OAA use increased from 222 per 100,000 to 328 per 100,000 from 2003/04 to 2015/16. Hormone therapy for breast cancer was the most common class of OAA used (increased from 154 per 100,000 to 231 per 100,000). We observed a 2.
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