Annals of Medicine and Surgery最新文献

Introduction: The global incidence of benign prostatic hyperplasia (BPH) is rising, with bacterial causes of lower urinary tract symptoms (LUTS) being a common factor contributing to complications in these patients.

Aim: To identify the prevalence of bacteriuria and treatment response in patients with symptomatic BPH.

Materials and methods: This 1-year prospective study included all patients presenting with LUTS due to BPH who met the inclusion criteria. Urine samples were collected and analyzed for microscopy, culture, and sensitivity following standard protocols. Bacterial growth in urine specimens and International Prostate Symptom Score (IPSS) of LUTS were recorded before and after antibiotic therapy.

Results: A total of 131 patients with symptomatic BPH were studied. Escherichia coli (47.6%) was the most commonly isolated bacteria, followed by Klebsiella pneumoniae and Pseudomonas species. E. coli and Klebsiella showed the highest sensitivity to nitrofurantoin. After 1 week of antibiotic therapy, 69% of patients had sterile urine cultures, while 31% remained E. coli positive. Significant improvement in IPSS scores was observed after 1 week of therapy (P<0.05), and there was no significant change in urine culture (P=0.854).

Conclusion: Bacteriuria is a common finding in patients with symptomatic BPH in our setting. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated organisms, with sensitivity to nitrofurantoin and cefixime. A week of antibiotic therapy significantly reduced IPSS scores but did not reduce bacteriuria.

Introduction and importance: Severe pre-eclampsia is a medical condition that affects women during the last two trimesters of pregnancy. Hemorrhagic hepatic infarction is a hepatic complication and is rarely encountered in women with severe pre-eclampsia. This case report aims to present the characteristics of hemorrhagic hepatic infarction in a pregnant woman with severe pre-eclampsia.

Case presentation: A 27-year-old pregnant woman with a 30-week gestation of amenorrhea was admitted with a blood pressure of 160/100 millimeters of Mercury (mmHg), headaches, dizziness, and oedema in the lower limbs.

Clinical discussion: These complaints with clinical and paraclinical examinations led to the diagnosis of severe pre-eclampsia, and she underwent an emergency cesarean section, but 6 h later, she presented with hypovolemic shock, and this led to a new surgery. A surgery that made it possible to develop or discover a diffuse hepatic infarction with hemorrhagic infiltration of the gallbladder and the falciform ligament without active bleeding in the liver. Emergency management of pre-eclampsia was adopted, and the postoperative course was simple, with a good clinical outcome when the patient was discharged.

Conclusion: Severe pre-eclampsia and hemorrhagic hepatic infarction are complications of pregnancy, which require emergency treatment, and above all, these medical conditions require the termination of the pregnancy.

Background: Radiation exposure is a concern in today's world, given the widespread use of electronic devices and medical procedures involving ionizing and non-ionizing radiation. Radiations may cause male infertility by inducing oxidative stress in testicular tissue. Melatonin has antioxidant properties.

Methods: The authors systematically reviewed the literature for the studies that have investigated the effects of melatonin therapy on radiation-induced oxidative stress in rodents' testicular tissue. PubMed, Scopus, and Web of Science were searched for relevant animal trials. Standardized mean difference and 95% CIs were used to pool the data. Subgroup and sensitivity analyses were done. The risk of bias was assessed using SYRCLE tool.

Results: Outcomes: histopathology and sperm analyses (testicular apoptotic cells, Johnsen's testicular biopsy score, seminiferous epithelial height, tubular diameter, sperm motility, viability, count, and morphology, concentration of spermatid, spermatocyte, and spermatogonia), body and testes weights (absolute and relative body and testicular weights), reproductive hormones (serum prolactin, FSH, and testosterone), and oxidative stress tissue markers (TBARS, CAT, GSH, GSH-Px, MDA, SOD, and XO, and total antioxidant capacity). Rats and mice were exposed to electromagnetic radiations (gamma, roentgen, microwave, radiofrequency, and high-power line energy) and particle waves (radioiodine and carbon-ion). Melatonin therapy was significantly associated with improved male reproduction.

Conclusion: Radiation exposure harms male fertility, but melatonin, as an antioxidant, is potentially associated with improved male reproductive function in rodents. Inconsistencies in research require further investigations.

Introduction: Spinocerebellar ataxias (SCA) are a diverse group of neurodegenerative disorders with autosomal dominant inheritance, primarily affecting the cerebellum and its connections. Diagnosis typically involves genetic testing, but in resource-limited settings, clinical and neuroimaging assessments become critical. This case report highlights the role of nongenetic methods in diagnosing SCA and outlines management strategies in such settings.

Case presentation: A 41-year-old male presented with a 2-year history of progressive gait imbalance, headache, and abnormal speech. He had a family history of similar symptoms in two siblings, but no significant past medical history. Clinical examination revealed scanning speech, dysmetria, and a broad-based gait. Clinical and neuroimaging findings, including cerebellar atrophy, led to a diagnosis of SCA in the absence of genetic testing. Patient management with speech, occupational, and physical therapies, showed gradual improvement.

Discussion: SCA, characterized by cerebellar atrophy and a range of clinical symptoms, is typically diagnosed through genetic testing, but clinical and imaging assessments are crucial when genetic resources are limited. This case illustrates that a comprehensive clinical evaluation, including neuroimaging, can support the diagnosis of SCA even without genetic testing. Strategic management emphasizing symptomatic relief and functional improvement through a multidisciplinary approach, including regular follow-up and personalized therapy, are crucial, as evidenced by the timely improvement observed in our case.

Conclusion: In resource-limited settings, a comprehensive clinical and neuroimaging assessment is essential for diagnosing spinocerebellar ataxia when genetic testing is not feasible. Effective management through multidisciplinary therapies can improve patient outcomes, underscoring the need for innovative strategies to enhance diagnostic and treatment capabilities in such environments.

Introduction and importance: Odontoid fractures of the second cervical vertebra (C2) are categorized into three types, with type III extending into the body of the axis. These fractures, often resulting from high-energy trauma, can cause significant instability and neurological issues. This case report discusses a 43-year-old male with a type III odontoid fracture and C1-C2 fracture dislocation, demonstrating the effectiveness of traditional neurosurgical techniques in managing such complex injuries.

Case presentation: A 43-year-old male presented with upper cervical pain and right upper limb weakness following a road traffic accident. Imaging revealed a type III odontoid fracture with posterior displacement and atlanto-axial (C1-C2) joint dislocation. The patient underwent a two-stage surgical procedure. The first stage involved transoral decompression to address the retropulsed odontoid fragment and relieve spinal cord compression. The second stage involved posterior craniocervical fixation using an autologous iliac bone graft for stabilization. The patient showed postoperative improvement and was discharged on the third day, with a stable condition at a one-month follow-up.

Clinical discussion: Managing type III odontoid fractures with C1-C2 dislocation is challenging, requiring a strategic approach to ensure spinal stability and neurological recovery. Transoral decompression provides direct access for effective decompression, while posterior fixation ensures robust stabilization. The use of an autologous iliac bone graft enhances fusion and long-term stability. This case illustrates the successful integration of traditional neurosurgical techniques with modern surgical principles.

Conclusion: This case underscores the importance of traditional neurosurgical techniques in managing complex odontoid fractures. The two-stage approach of transoral decompression followed by posterior craniocervical fixation proved effective, highlighting the relevance of these techniques in achieving positive outcomes in contemporary neurosurgical practice.

Introduction and importance: There are few cases of multiple simultaneous anterior communicating artery (AComA) aneurysms with A2 triplication and AComA duplication.

Cases presentation: (1) A fenestrated AComA with a saccular aneurysm (neck diameter 9 mm; dome height 8 mm) projecting superiorly from the distal AComA branch, as well as an anomalous artery arising from the posterior surface of the same AComA. (2) A duplicate AComA with a saccular aneurysm (neck diameter of 5 mm; dome height of 9 mm) projecting superioposteriorly from the distal AComA branch, as well as an anomalous artery arising from the anterior surface of the same AComA was diagnosed. Both were treated by microsurgical titanium clip occlusion.

Clinical discussion: Anatomical variations are believed to enhance the risk of anterior communicating artery (AComA) aneurysms, accounting for ~30% of all intracranial aneurysms. In such circumstances, the goal is to occlude the aneurysmal lesions safely while preserving the patency of other branches.

Conclusion: AComA aneurysms accompanied by anomalous triplicated A2 and fenestrated AComA are rare and challenging. Such complex cases response best using microsurgery using titanium clip occlusion with durable favorable outcomes.

Background: Chemotherapy-induced cardiotoxicity (CIC) is a significant challenge in cancer treatment, leading to heart failure and myocardial infarction. With rising cancer survival rates, the long-term cardiovascular health of survivors has gained importance. While several cardioprotective medications have been studied to mitigate chemotherapy's harmful effects on the heart, more research is needed to confirm their effectiveness and optimal use.

Methodology: This review synthesizes evidence on cardioprotective drugs in managing CIC. The authors conducted a comprehensive literature search of peer-reviewed articles, clinical trials, and meta-analyses published between January 2000 and May 2024. Studies were selected based on relevance, quality, and focus on mechanisms, efficacy, and clinical outcomes of cardioprotective agents such as beta-blockers, ACE inhibitors, ARBs, statins, and dexrazoxane.

Results and discussion: Cardioprotective medications show potential in alleviating the impact of chemotherapy on heart function. Beta-blockers and ACE inhibitors effectively reduce heart failure incidence and improve cardiac outcomes. Statins, with their anti-inflammatory and antioxidative properties, and dexrazoxane, which reduces anthracycline-induced cardiotoxicity, also show promise. However, variability in study designs, patient groups, and chemotherapy treatments complicates the establishment of standardized treatment protocols.

Conclusion: Cardioprotective drugs hold significant promise in managing CIC and improving cardiac outcomes for cancer patients. Current evidence supports the efficacy of beta-blockers, ACE inhibitors, statins, and dexrazoxane. Further research is needed to establish standardized protocols, evaluate long-term safety, and optimize treatment timing. Integrating cardioprotective strategies into oncological care can enhance the quality of life and prognosis for cancer survivors.

Background: Acute diarrhea (AD), which is defined as frequent passing of liquid stools compared to normal, is a serious and worrying problem and remains a concern for healthcare systems because of its high mortality cause in children under 5 years old. The authors' study aimed to present the prevalence and to describe the clinical manifestation of AD among under-5 children.

Methods: From June 2022 to May 2023, the authors conducted a retrospective, descriptive and cross-sectional study including all patients aged 0-5 years hospitalized for AD.

Results: Out of 512 patients, only 197 (38.5%) children with AD were selected for our study. The average age is 25.5 months, and the sex ratio is 1.11. Some families (75.1%) have clean latrines, and 21.8% use water from the river. Inaccessibility to clean water and intolerance or food poisoning were the causes of acute diarrhea in children. Major signs and symptoms are fever, dehydration and vomiting. Weight loss and malnutrition are the major complications of AD in children. The treatment of AD is provided by oral rehydration solutions and antibiotics.

Conclusion: The study highlights the significant prevalence of acute diarrhea among under-5 children underscores the importance of preventive measures and government intervention, such as the introduction of rotavirus vaccination. However, conclusions regarding prevalence rates should be interpreted with caution due to the lack of detailed population data.