A rare presentation of hydatid cyst, involvement of uncommon sites with sparing of typical locations

A Case Series of Isolated Primary Hydatid Cyst of the Spleen

Hydatid disease is endemic mainly in Asia and other sheep-raising areas. In India, hydatid disease has been a very common disease because of its close association with livestock rearing. Hydatid disease is a parasitic infestation caused by Echinococcus granulosus. The usual location of infestation is in the liver sinusoids, lungs, and spleen. Hydatid disease in humans is rare, and a hydatid cyst of the spleen without involving the liver is very rare. The rarity of splenic hydatid disease may pose a diagnostic challenge for clinicians, especially in non-endemic areas. The diagnosis of hydatid disease is based on the epidemiological background of patients, clinical grounds, or noninvasive screening procedures. With this background, we aimed to study the presenting symptomatology and various clinical manifestations of isolated spleen hydatid disease and analyze the morbidity and mortality of hydatid disease. Different surgical modalities and their complications were studied. Three patients operated on for splenic hydatid at our institute were studied retrospectively.

Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

BACKGROUND

Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes.

METHODS

PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate (I2 = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds -1.34 [95% CI: -2.61; -0.08]) that favored telemedicine (GRADE, low).

CONCLUSIONS

No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.

Hydatid Cyst in Left Sub-Mandibular Space, an Unusual Location

Hydatid cysts in the neck area are considered as very rare and few cases have been reported in endemic areas. In the present study, we reported a 38-year-old female that underwent surgical operation for extraction of simple cyst in the submandibular area and the diagnosis of hydatid cyst was established by laboratory examinations. The patient was later diagnosed with hepatic hydatid cyst and received systemic treatments. We recommend that physicians should pay more attention to the possibilities of hydatid cysts in unusual areas in endemic regions especially Middle East.