International Journal of Medical Science and Clinical Invention

Ultrasound-Guided Off-Plan Lumbar Seated Erector Spinae Plane Blocks : Are There Advantages?

Inklebarger J. — 2024-06-04

The erector spinae plane block (ESPB) has been widely used as a treatment strategy for a variety of acute and chronic painful conditions. ESPBs are typically performed under ultrasound guidance [USG] in an in-plane long axis approach, targeting the tip of the lumbar transverse process while the patient lies prone. Off-Plane Seated Injection Technique-ESPB [OPSIT-E] represents a useful alternative in situations where a standard prone spine injection would be technically challenged by circumstances which may include morbid obesity, orthopnoea, recent upper limbs surgeries, chest pain from recent pacemaker implant, and in a subjects were in-plane approaches may be complicated by skin lesions. A seated forward flexed off-plane injection position, may also flatten the lumbar lordosis, shift adipose tissue more anteriorly, lessening skin to target distance and facilitating bony landmark identification, in high BMI and hyperlordotic subjects. The relatively larger curved transverse arc radius of the curvilinear probe [GE G1-5] in comparison to its transverse arc, also appears to offer improved central field of skin-transducer contact, earlier needle visualization, improved acute angle trajectory visualization of deep structures, which may be due to less crepuscular beam dispersion in comparison to transverse probe orientation. Even with a linear probe, the orthogonal technique facilitates a more perpendicular vector, lessening needle transit to target distance, which may in turn decrease procedure time, and improve patient comfort. The OPSITE, may also be easier to teach, learn, and master, as other studies have generally reported a higher rate of off-lane injection success among novice vascular interventionists.

Concurrent Swellings of the Scrotum and the Left Knee; an Uncommon Presentation of Cystic Hygroma – Case Report

Patrick Opoku Manu Maison — 2024-06-21

Introduction: Cystic hygroma is a benign congenital lymphatic malformation, usually present in infancy and rare cases in adults. It can pose challenges in diagnosis and management.

Case Report: This is a case of cystic hygroma in a 4-year-old boy with painless swellings of the left knee and scrotum from birth, which have been increasing in size. The patient presented with his mother to an outreach program organized by the Ghana section of the International College of Surgeons (ICS) at Worawora Regional Hospital in the Oti region of Ghana. Examination revealed soft, fluctuant, non-tender and transilluminating swellings in the scrotum, the medial aspect and the suprapatellar region of the left knee. Bedside ultrasonography assessment revealed multiloculated cystic masses in the regions mentioned above. Our surgical team performed an excision biopsy of the swellings under general anaesthesia. We found multiple lobulated cystic masses in the scrotum, the medial aspect, and the suprapatellar regions of the left knee. Histopathology examination of the excised masses microscopically showed cystic spaces filled with eosinophilic material with areas of fibrous and fat lobules and also some blood vessels containing erythrocytes. A diagnosis of cystic hygroma was made. Excision was complete, and all wounds healed well over 6 'weeks' follow-up.

Conclusion: The occurrence of cystic hygroma found at multiple sites makes it an interesting case. The creation of awareness can help raise an index of suspicion among clinicians, especially when patients are seen with multiple swellings on any part of the body from childhood

Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-Resistant, Vancomycin-Resistant, and Panton-Valentine Leukocidin Positive Staphylococcus Aureus İn Nose Swaps of Sheep and Their Keepers Van, Türkiye

Ömer AKGÜL — 2024-06-11

Objectives: To observe the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant S. aureus (VRSA), and Panton-Valentine leukocidin (PVL)-positive S. aureus, this study was carried out in sheep and sheep keepers in Van, Türkiye.

Materials and methods: S. aureus strains were recovered from 200 privates nose swab samples from sheep and sheep keepers between July 2019 and June 2020. Methicillin resistance was determined by the oxacillin and cefoxitin disc diffusion method, the minimum inhibitory concentration (MIC) of oxacillin, and mecA gene detection. VRSA resistance was determined by the disc diffusion method, the MIC of vancomycin, and screening for the vanA and vanB genes. The PVL gene was also detected in MRSA strains.

Results: Fifteen of the 44 isolated strains of S. aureus were MRSA (2 of them were VRSA) and 29 were methicillin-sensitive S. aureus. All MRSA isolates were highly resistant to oxacillin (MIC 256 mg/mL). When compared with polymerase chain reaction (PCR), the sensitivity and specificity of the oxacillin disc diffusion method were 93.33% and 100% respectively; for the cefoxitin disc diffusion method and MIC of oxacillin both the sensitivity and specificity were 100%. Four (26.67%) MRSA isolates were positive for PVL genes which were also mecA positive. The MRSA strains were highly resistant to ciprofloxacin (93.33%), ceftriaxone (86.63%), azithromycin (73.33%), gentamycin (73.33%), and amoxiclav (66.67%). All (100%) MRSA strains were sensitive to linezolid and 86.67% were sensitive to vancomycin. The VRSA strains had an MIC 256 mg/mL for vancomycin and were positive for the vanB gene but negative for the vanA gene.

Emerging roles for the RXFP1 in myeloid series leukemia

Ayriana safari Baesmat — 2024-06-14

Purpose: The study investigates the role of Relaxin Family Peptide Receptor 1 (RXFP1) in myeloid leukemia cell function. It found that RXFP1 has been associated with cAMP, PI3K/Akt, NO/cGMP, MAPK and ERK1/2 signaling. High RXFP1 expression was associated with shorter cancer-specific survival RXFP1 mutated leukemia patients. The study suggests that RXFP1 may promote invasion and progression in both types of AML and CML.

Methods: The gene expression data were retrieved from Gene Expression Omnibus (GEO). Fold change, p.value t-test and David Functional analysis, hierarchical clustering was performed.

Conclusion: PCDH9, AREG, CTSG, RXFP1, CCDC152, ANXA, CD24 and VPREB1 gene expression alterations were identified depending on leukemia in human moocyte cells. Seven of these genes were identified as downregulated in leukemia groups in human monocyte cells and one of these genes were identified as upregulated in leukemia cells.Therefore, it is hypothesized that downregulation or upregulation of these genes may affect AML/CML pathogenesis by reducing cell proliferation. And it is predicted that RXFP1 mutation may be an important factor for myeloid leukemia.

Relationship between Troponin and Red Cell Distribution Width Levels and Mortality in Post-Covid Patients

Melek Doganci — 2024-06-11

Introduction: There are very few studies on the TR value, which expresses the simultaneous increase in Troponin and Red Cell Distribution Width (RDW), which are markers of myocardial damage commonly seen in Covid-19 disease. This study aims to show the relationship of troponin, RDW and TR values with mortality and prognostic factors post-Covid-19.

Methods: 204 patients diagnosed with Covid-19 who were admitted to the adult tertiary Covid ICU between April,2021 and March,2022 were included in the study. Demographic data, comorbidities, treatments, length of stay in intensive care and hospital, and laboratory parameters were evaluated. According to our hospital's reference ranges, RDW value over 16% and troponin value over 15ng/L were defined as high value. Patients with both troponin value over 15ng/L and RDW value over 16% were considered to have high TR.

Results: In the study, when the values checked at the time of discharge/before discharge were examined, it was seen that the intubation rate was higher and the duration of mechanical ventilation was longer in patients with high troponin and TR levels. In patients with high RDW and TR values, platelet, hemoglobin and hematocrit values were lower before discharge/discharge compared to those with low RDW and TR values.

Conclusion: In our study, it was found that the intubation rate was higher and mechanical ventilation durations were longer in patients with elevated troponin and TR. We are of the opinion that early intubation practices applied in our clinic for patients with high TR and desaturation are reduced mortality.

Eosinophilic Granulomatosis with Polyangiitis with ophthalmic involvement: A Case report and Literature Review

Ajim A — 2024-06-04

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome, is a systemic necrotizing vasculitis primarily affecting small blood vessels. It is characterized by extravascular eosinophilic granulomas, peripheral eosinophilia, and often coexists with asthma. This rare condition can affect individuals of any gender and age, presenting with a variety of multisystemic symptoms. Prognosis is largely influenced by cardiac involvement, evaluated using the Five-Factor Score (FFS) to guide treatment decisions. Respiratory manifestations, particularly severe and corticosteroid-dependent asthma, are common in EGPA and may aid in its early diagnosis. In this case report, we describe a patient with an uncontrolled asthma admitted for moderate asthma exacerbation. Clinical examination revealed ocular redness and skin lesions, along with hypereosinophilia on assessment and reticulo-micronodular infiltrates on chest CT scan. EGPA diagnosis was confirmed based on the ACR 1990 criteria, wich have been updated and substituted with more objective criteria in 2022. According to the FFS score, the patient underwent systemic corticosteroid therapy in conjunction with azathioprine, leading to an overall favorable outcome over a 3-year follow-up period.