ACCEPTANCE AND UTILIZATION OF MODERN FAMILY PLANNING METHODS AMONG WOMEN OF CHILD BEARING AGE IN RURAL COMMUNITIES OF NORTH-EASTERN NIGERIA

Introduction

Modern family planning is one of the most "health-promoting" and cost-effective activities in public health promotion and has the potential to avert approximately 30% of maternal and 10% of child deaths. Family planning is an important preventive measure against maternal and child morbidity and mortality. It is an essential component of primary health care and reproductive health. It confers important health and development benefits to individuals, families, communities, and the nation at large.

Objectives

The study examined the acceptance and utilization of modern family planning methods among women of childbearing age in Potiskum town of Yobe State, North-eastern Nigeria.

Methodology

A descriptive cross-sectional study design was adopted for the study. A semi-structured questionnaire was used to collect data from 271 respondents comprising women of childbearing age (15-49 years) residing in Bolewa 'B', Yerimaram, and DogoNini wards of Potiskum town, Yobe State. A multi-stage sampling technique was used to select the participants for the study.

Results

The findings of the study revealed that the women of child-bearing age in Potiskum town, Yobe State have a high level of knowledge on modern family planning methods (88.6%) with friends and relatives as the predominant source of information (60.4%). More than half of the respondents (54.2%) have good utilization of modern family planning with cultural and religious misconceptions playing vital roles. The unmet needs were found to be (37.4%). Established determinants of utilization of modern family planning services among the respondents include male noninvolvement, side effects, religion, and distance beyond 5km to a health facility.

Conclusion

In conclusion, despite a good level of knowledge of modern contraceptives among the respondents, only half utilize the services. It is recommended among others that, there is a need for the government, through the Ministry of Health, to revive and support family planning education at both household and community levels that targets the woman and her partner. This could be undertaken through community mobilization and engagement using print and mass media, traditional leaders, community resource groups, market places as well as newsletters, posters, and social media.

Patterns of Care and Outcomes of Rectal Cancer Patients from the Iowa Cancer Registry: Role of Hospital Volume and Tumor Location

BACKGROUND

Centralization of rectal cancer surgery has been associated with high-quality oncologic care. However, several patient, disease and system-related factors can impact where patients receive care. We hypothesized that patients with low rectal tumors would undergo treatment at high-volume centers and would be more likely to receive guideline-based multidisciplinary treatment.

METHODS

Adults who underwent proctectomy for stage II/III rectal cancer were included from the Iowa Cancer Registry and supplemented with tumor location data. Multinomial logistic regression was employed to analyze factors associated with receiving care in high-volume hospital, while logistic regression for those associated with ≥ 12 lymph node yield, pre-operative chemoradiation and sphincter-preserving surgery.

RESULTS

Of 414 patients, 38%, 39%, and 22% had low, mid, and high rectal cancers, respectively. Thirty-two percent were > 65 years, 38% female, and 68% had stage III tumors. Older age and rural residence, but not tumor location, were associated with surgical treatment in low-volume hospitals. Higher tumor location, high-volume, and NCI-designated hospitals had higher nodal yield (≥ 12). Hospital-volume was not associated with neoadjuvant chemoradiation rates or circumferential resection margin status. Sphincter-sparing surgery was independently associated with high tumor location, female sex, and stage III cancer, but not hospital volume.

CONCLUSIONS

Low tumor location was not associated with care in high-volume hospitals. High-volume and NCI-designated hospitals had higher nodal yields, but not significantly higher neoadjuvant chemoradiation, negative circumferential margin, or sphincter preservation rates. Therefore, providing educational/quality improvement support in lower volume centers may be more pragmatic than attempting to centralize rectal cancer care among high-volume centers.

Mechanistic insights from a multiparametric magnetic resonance imaging study regarding the role of sodium glucose co-transporter 2 inhibitors

Background

Type 2 diabetes (T2D) is associated with an increased risk of heart failure (HF) and cardiovascular (CV) mortality. Sodium–glucose-co transporter-2 (SGLT2) inhibitors reduce the risk of major adverse CV events and hospitalisation for HF in T2D patients with high cardiovascular risk, despite only a modest improvement in glycemic control. Restoring cellular energy homeostasis and reversing adverse cardiac remodelling in diabetes have been speculated as a potential metabolic modulatory effect of SGLT2 inhibitors leading to their beneficial CV outcomes. Myocardial energy deficient states can be detected non-invasively by 31-phosphorus magnetic resonance spectroscopy (31P-MRS).

Objectives

Utilising cardiovascular magnetic resonance imaging (CMR) and 31P-MRS in a single centre longitudinal cohort study, we aimed to investigate the effects of the selective SGLT2 inhibitor empagliflozin on myocardial energetics, function, perfusion, and myocardial cellular volume in patients with T2D.

Methods

Eighteen consecutive T2D patients who were commenced on empagliflozin in cardiometabolic optimisation clinics underwent CMR and 31P-MRS scans before and after twelve-week empagliflozin treatment, and plasma N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) levels were measured. Ten controls with no diabetes underwent an identical 31P-MRS and CMR protocol on a single visit.

Results

When compared to controls, patients with T2D showed: lower myocardial energetics (1.52±0.40 vs 2.20±0.5, p=0.0005), lower stress myocardial blood flow (1.60±0.50 vs 2.10±0.50, p=0.02) and lower left ventricular ejection fraction (52±13% vs 63±4%, p=0.01). Treatment with empagliflozin led to significant improvements in myocardial energetics (PCr/ATP: 1.52 to 1.76, p=0.009). This was accompanied by a relative 13% improvement in left ventricular ejection fraction (p=0.001), 3% improvement in global longitudinal strain (p=0.01), 61% reduction in NTproBNP (p=0.05), and 9% reduction in myocardial cell volume (p=0.04). No significant change in myocardial blood flow or diastolic strain was detected.

Conclusions

For the first time, we demonstrate that empagliflizon improves myocardial energetics and function, reduces myocardial cellular volume, and reduces NT-proBNP levels in patients with T2D.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation PCr/ATPLVEF

1408 Virtual Phone Call or Video Consultations: Patient and Clinician Preference During Covid-19

Aim

In response to COVID-19 and social distancing guidelines, healthcare services have evolved. Telehealth is part of this change and many services introduced virtual telephone clinics. The HSE recently approved a video conferencing tool, ‘Attend Anywhere’, however this is not widely used at present. We have received positive feedback from patients, but only a few studies provide information on overall satisfaction of virtual consultations. We aim to validate this by assessing preferences towards virtual telephone and video consultations.

Method

50 patients from the breast care clinic were included. Patients excluded were any new symptomatic patients or those with any incapacity. Questionnaires with Likert scales were used to assess patient and clinician attitudes towards ‘phone’ (PC) or ‘video’ consultations (VC).

Results

The majority of patients (64%) requested a PC rather than a VC (36%). More patients used technology regularly in the VC group (88%) than the PC group (69%), and 94% of VC patients had experience with video calls (47% PC). VC patients felt safe using ‘Attend Anywhere’(94%), said it was ‘more personal’ than a phone call (72%) but preferred face-to-face for future consultations as they ‘liked the reassurance of a physical exam’(78% VC; 59% PC). All clinicians felt the lack of examination in virtual clinics impacts the doctor-patient relationship and would prefer face-to-face consultations where possible.

Conclusions

Our findings demonstrate a positive patient and clinician attitude to virtual clinics, however face-to-face appointments are preferred by both groups. We will repeat this survey following COVID-19 restrictions to determine if attitudes have changed.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial

OBJECTIVE

To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage.

DESIGN

Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS).

SETTING

Twenty-eight UK NHS early pregnancy units.

SAMPLE

A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage.

METHODS

Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets.

MAIN OUTCOME MEASURES

Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs).

RESULTS

For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a QALYs difference of 0.04% (95% CI -0.01 to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost saving of £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is the current medical management strategy. However, the model-based evidence suggests that the intervention is a less effective but less costly strategy than surgical management.

CONCLUSIONS

The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage.

TWEETABLE ABSTRACT

The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages.

Sequencing batch reactor technology for landfill leachate treatment: A state-of-the-art review

Landfill has become an underlying source of surface and groundwater pollution if not efficiently managed, due to the risk of leachate infiltration into to land and aquifers. The generated leachate is considered a serious environmental threat for the public health, because of the toxic and recalcitrant nature of its constituents. Thus, it must be collected and appropriately treated before being discharged into the environment. At present, there is no single unit process available for proper leachate treatment as conventional wastewater treatment processes cannot achieve a satisfactory level for degrading toxic substances present. Therefore, there is a growing interest in examination of different leachate treatment processes for maximum operational flexibility. Based on leachate characteristics, discharge requirements, technical possibilities, regulatory requirements and financial considerations, several techniques have been applied for its degradation, presenting varying degrees of efficiency. Therefore, this article presents a comprehensive review of existing research articles on the pros and cons of various leachate degradation methods. In line with environmental sustainability, the article stressed on the application and efficiency of sequencing batch reactor (SBR) system treating landfill leachate due to its operational flexibility, resistance to shock loads and high biomass retention. Contributions of integrated leachate treatment technologies with SBR were also discussed. The article further analyzed the effect of different adopted materials, processes, strategies and configurations on leachate treatment. Environmental and operational parameters that affect SBR system were critically discussed. It is believed that information contained in this review will increase readers fundamental knowledge, guide future researchers and be incorporated into future works on experimentally-based SBR studies for leachate treatment.

Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers

INTRODUCTION AND OBJECTIVE

Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries.

MATERIALS AND METHODS

A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame.

RESULTS

Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4).

CONCLUSIONS

The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.

Paediatric cataract surgery in Hospital Kuala Lumpur - A 5-year review of visual outcomes

INTRODUCTION

Paediatric cataract surgery is challenging with reported post-operative visual acuity (VA) of 0.3LogMar or better varying between 33% to 68% of patients.

OBJECTIVE

The aim is to document the post-operative refraction, VA and complications of non-traumatic pediatric cataract surgery performed in a tertiary referral center in Malaysia.

METHODOLOGY

This retrospective study reviewed case notes of all consecutive patients aged 12 years and below who underwent cataract surgery from January 2010 to December 2015. Patients were recruited if they had a minimum of six months post-operative follow-up. Exclusion criteria included traumatic cataract, central nervous system abnormalities, incomplete medical records or pre-existing ocular pathology. Subjects were divided into two groups based on refraction at one month. Subjects with refraction within 1- dioptre of the targeted spherical equivalent were in the success group and the rest were in the failure group.

RESULTS

A total of 111 subjects were recruited (65 subjects in success group and 46 subjects in the failure group). Mean age at surgery was 33.14 (SD: 33.47) months. The success group had significantly longer axial length (p:0.0045, CI: 0.566-0.994, OR: 0.750). At final review, 44.1%(49/111) subjects had visual acuity of 0.3LogMar or better. The success group had better final mean VA in comparison to the failure group (p:0.034, CI:1.079-7.224, OR: 2.791).

CONCLUSION

The outcome of non-traumatic paediatric cataract surgery was acceptable with 58.6% achieved targeted refractive correction at 1-month post-operative period. Longer axial length was associated with better refractive outcome. Capsule related complications was the most common intra-operative complication.

Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial

Despite their proven efficacy for secondary fracture prevention, long-term adherence with oral bisphosphonates is poor.

INTRODUCTION

To compare the effectiveness of two interventions on long-term oral bisphosphonate adherence after an upper extremity fragility fracture.

METHODS

Community-dwelling participants 50 years or older with upper extremity fragility fractures not previously treated with bisphosphonates were randomized to either a multi-faceted patient and physician educational intervention (the active control arm) vs. a nurse-led case manager (the study arm). Primary outcome was adherence (taking > 80% of prescribed doses) with prescribed oral bisphosphonates at 12 months postfracture between groups; secondary outcomes included rates of primary non-adherence and 24-month adherence. We also compared quality of life between adherent and non-adherent patients.

RESULTS

By 12 months, adherence with the initially prescribed bisphosphonate was similar (p = 0.96) in both groups: 38/48 (79.2%) in the educational intervention group vs. 66/83 (79.5%) in the case manager arm. By 24 months, adherence rates were 67% (32/48) in the educational intervention group vs. 53% (43/81) in case managed patients (p = 0.13). Primary non-adherence was 6% (11 patients) in the educational intervention group and 12% (21 patients) in the case managed group (p = 0.07). Prior family history of osteoporosis (aOR 2.1, 95% CI 1.0 to 4.4) and being satisfied with current medical care (aOR 2.3, 95% CI 1.1 to 4.8) were associated with better adherence while lower income (aOR 0.2, 95% CI 0.1 to 0.6, for patients with income < $30,000 per annum) was associated with poorer rates of adherence. There were no differences in health-related quality of life scores at baseline or during follow-up between patients who were adherent and those who were not.

CONCLUSION

While both interventions achieved higher oral bisphosphonate adherence compared to previously reported adherence rates in the general population, primary non-adherence and long-term adherence to bisphosphonates were similar in both arms. Adherence was influenced by family history of osteoporosis, satisfaction with current medical care, and income.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT01401556.

Clinico-bacteriological profile of primary pyodermas in Kashmir: a hospital-based study

Pyodermas are a common group of infectious dermatological conditions on which few studies have been conducted. This study aimed to characterise the clinical and bacteriological profile of pyodermas, and to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in primary pyodermas in a dermatology outpatient department in Kashmir. Methods We conducted a hospital based cross-sectional study in the outpatient Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India. Patients presenting with primary pyodermas were included in the study. A detailed history and complete physical and cutaneous examination was carried out along with microbiological testing to find aetiological microorganisms and their respectiveantimicrobial susceptibility patterns. Antimicrobial susceptibility testing, including that for methicillin resistance, was carried out by standard methods as outlined in the current Clinical and Laboratory Standards Institute guidelines. Results In total, 110 patients were included; the age of the study population ranged from 3 to 65 years (mean age 28 years); 62% were male. Poor personal hygiene was noted in 76 (69%). Furunculosis (56; 51%) was the most common clinical presentation. Staphylococcus aureus was isolated in 89 (81%) of cases, and MRSA formed 54/89 (61%) of Staphylococcus aureus isolates. All MRSA strains were sensitive to vancomycin. Conclusion The prevalence of MRSA was high in this sample of communityacquired primary pyodermas. It is therefore important to monitor the changing trends in bacterial infection and their antimicrobial susceptibility patterns and to formulate a definite antibiotic policy which may be helpful in decreasing the incidence of MRSA infection.

Genetic heterogeneity in Pakistani microcephaly families revisited

Autosomal recessive primary microcephaly (MCPH) is a rare and heterogeneous genetic disorder characterized by reduced head circumference, low cognitive prowess and, in general, architecturally normal brains. As many as 14 different loci have already been mapped. We recruited 35 MCPH families in Pakistan and could identify the genetic cause of the disease in 31 of them. Using homozygosity mapping complemented with whole-exome, gene panel or Sanger sequencing, we identified 12 novel mutations in 3 known MCPH-associated genes - 9 in ASPM, 2 in MCPH1 and 1 in CDK5RAP2. The 2 MCPH1 mutations were homozygous microdeletions of 164,250 and 577,594 bp, respectively, for which we were able to map the exact breakpoints. We also identified four known mutations - three in ASPM and one in WDR62. The latter was initially deemed to be a missense mutation but we demonstrate here that it affects splicing. As to ASPM, as many as 17 out of 27 MCPH5 families that we ascertained in our sample were found to carry the previously reported founder mutation p.Trp1326*. This study adds to the mutational spectra of four known MCPH-associated genes and updates our knowledge about the genetic heterogeneity of MCPH in the Pakistani population considering its ethnic diversity.

An unusual cause of an anterior mediastinal mass

Mesothelioma is a rare tumour and its radiological growth pattern varies. We report the case of a biopsy proven Malignant Pleural Mesothelioma (MPM) presenting as an anterior mediastinal mass in a platinum miner. The prognosis for this aggressive tumour remains poor, despite combination treatment modalities.

Camel-related pancreatico-duodenal injuries: a report of three cases and review of literature

BACKGROUND

Human pancreatico-duodenal injuries caused by camels are extremely rare.

OBJECTIVE

We report three patients who sustained camel-related pancreatico-duodenal injuries and review the literature on this topic.

RESULTS

A 32-year camel caregiver was kicked by a camel which then stepped on his abdomen trying to kill him. The patient's abdomen was soft and lax. CT scan of the abdomen showed free retroperitoneal air. Laparotomy revealed a complete tear of the anterior wall of the second part of duodenum which was primarily repaired. A 40-year camel caregiver was directly kicked into his abdomen by a camel. He developed traumatic pancreatitis which was treated conservatively. A 31-year-old male fell down on his abdomen while riding a camel. Abdominal examination revealed tenderness and guarding. Abdominal CT Scan showed complete transection of the neck of the pancreas which was confirmed by laparotomy. The patient had distal pancreatectomy with preservation of the spleen. All patients were discharged home in good condition.

CONCLUSION

These cases demonstrate the misleading presentation of the camel-related pancreatico-duodenal injuries and their unique mechanism of injury.

Investigation of impact of environmental changes on precipitation pattern of Pakistan

In this paper, variability in precipitation pattern of Pakistan due to environmental and climatic changes has been studied. Maps have been generated to depict global precipitation variation. Precipitation data of 25 stations of Pakistan have been used. These data were taken from Meteorological Department, Islamabad, Pakistan. The results of two global climate models, namely Australia's Commonwealth Scientific and Industrial Research's third generation general circulation model and National Center for Atmospheric Research's first generation precipitation circulation model for A2 scenario have been applied to investigate the changes. It is observed that precipitation pattern will change significantly in the future. The occurrence of precipitation in all seasons for Pakistan is expected to increase with almost uniform distribution across a season. Average annual precipitation of the country will undergo an increase in the range of +57 to +71 % as compared to average of the base period.

Immune regulatory plasmacytoid dendritic cells selectively accumulate in perithyroidal lymph nodes of patients with Graves disease: implications for the understanding of autoimmunity

Endocrine orbitopathy (EO) is the most common extrathyroidal manifestation of Graves disease (GD) but the involvement of the underlying immunological dysregulations remains largely unknown. The major source for IFNa-production, plasmacytoid dendritic cells (PDC) are fundamentally involved in the integration of TH1 and TH2 immune responses but also implicated in the pathogenesis of autoimmune diseases such as lupus.

AIM

To establish whether PDC may play a role in GD autoimmune reaction and in the pathogenesis of EO.

MATERIAL AND METHODS

In a series of six sequential patients with GD as well as six further patients with multinodular goiter, cervical lymph nodes (LN) were sampled and preserved in the setting of thyroid resection. In parallel, peripheral blood samples were collected. The frequency of PDC from the peripheral blood and lymph nodes were determined. Mononuclear cells (MC) were enriched from lymph nodes and peripheral blood using Fiquoll-hypaque density gradient centrifugation. Mononuclear cells were stained using BDCA-2-PE and CD123-FITC monoclonal antibodies and their frequency subsequently analyzed using fluorescence activated cell sorting (FACS). Dead cells were excluded from analysis by appropriate gating strategies and propidium iodide (PI) staining.

RESULTS

In all patients with GD (with or without EO), PDC frequency was significantly increased in perithyroidal LN as compared to LN of patient not suffering form autoimmune diseases, e. g. patients with multinodular goiter (p < 0.01). The number of PDC infiltrating lymph nodes (LN-PDC) was also higher when compared to peripheral blood PDC (pB-PDC) of patients with multinodular goiter (p < 0.05). Finally, LN-PDC counts in perithyroidal lymph nodes of patients with GD were substantially increased when compared to pB-PDC of the same patients (p < 0.01) indicating a migration and accumulation of PDC in the draining LN.

CONCLUSIONS

We found evidence that PDC selectively accumulate in perithyoidal LN of patients with GD, but not other thyroid diseases such as multinodular goiter. Based on their central importance in the pathogenesis of autoimmune processes such as in lupus erythematoides, we suggest that the migration and accumulation of PDC in an anatomical joining point between the thyroid gland and orbita may be of critical importance for the initiation and maintenance of a chronic autoimmune stimulation. This implies a so far unknown role for PDC in GD and as putative cellular targets for new therapeutic approaches.

Smoothed particle hydrodynamics method applied to pulsatile flow inside a rigid two-dimensional model of left heart cavity

This paper aims to extend the application of smoothed particle hydrodynamics (SPH), a meshfree particle method, to simulate flow inside a model of the heart's left ventricle (LV). This work is considered the first attempt to simulate flow inside a heart cavity using a meshfree particle method. Simulating this kind of flow, characterized by high pulsatility and moderate Reynolds number using SPH is challenging. As a consequence, validation of the computational code using benchmark cases is required prior to simulating the flow inside a model of the LV. In this work, this is accomplished by simulating an unsteady oscillating flow (pressure amplitude: A = 2500 N ∕ m(3) and Womersley number: W(o)  = 16) and the steady lid-driven cavity flow (Re = 3200, 5000). The results are compared against analytical solutions and reference data to assess convergence. Then, both benchmark cases are combined and a pulsatile jet in a cavity is simulated and the results are compared with the finite volume method. Here, an approach to deal with inflow and outflow boundary conditions is introduced. Finally, pulsatile inlet flow in a rigid model of the LV is simulated. The results demonstrate the ability of SPH to model complex cardiovascular flows and to track the history of fluid properties. Some interesting features of SPH are also demonstrated in this study, including the relation between particle resolution and sound speed to control compressibility effects and also order of convergence in SPH simulations, which is consistently demonstrated to be between first-order and second-order at the moderate Reynolds numbers investigated.

Strategy of surgical treatment of giant presacral tumor - a case report

Presacral tumors are uncommon lesions that can be difficult to diagnose because of their nonspecific presenting signs and symptoms. Surgery is the mainstay of treatment as it establishes the diagnosis and prevents the adverse consequences associated with malignant degeneration and secondary bacterial infection. Large, highly vascularised pelvic tumors may pose intraoperative difficulties as bleeding and intraoperative tumor perforation. Cross-sectional imaging is essential in evaluating these lesions to determine the optimal surgical approach and the extent of resection. We emphasize a multidisciplinary expert individualized approach. We report a case of a presacral giant gastrointestinal tumor initially considered as unresectable but further on successfully managed by preoperative vascular embolization followed by resection via abdomino-perineal approach.

Laparoscopic removal of a copper intrauterine device from the sigmoid colon

Removal of a migrated intrauterine device by using minimally invasive procedures is indicated even in select asymptomatic patients.

IUD translocation to the sigmoid colon after uterine perforation is a rare but serious event. Removal of the IUD in such a situation has been recommended because of the risk of complication, such as fistula formation and colonic perforation. We present the case of a 43-year-old female with a copper T380A IUD embedded in the sigmoid colon, which was removed with minimally invasive techniques.

Solitary giant neurofibroma of the scalp with calvarial defect in a child

Neurofibroma of the scalp are mostly multiple as part of neurofibromatosis or other phakomatosis. De novo solitary types are less common and rarely erode the skull, unlike the intracranial counterpart. Skull erosion has been reported in adults with longstanding plexiform neurofibromas. We report a giant neurofibroma on the scalp of a five-year-old boy, managed in our center. Although this condition is a rare entity, it should be anticipated and the treatment strategy should include repair of the skull defect.