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Introduction Cytomegalovirus (CMV) is the most common viral pathogen affecting patients undergoing solid organ transplantation. It is often the most important infection for patients who have undergone kidney transplantation. Clinical presentations of cytomegalovirus infection range from asymptomatic infection to organ-specific involvement. This study aimed to determine the frequency of cytomegalovirus-associated colitis in kidney transplant recipients (KTRs) presenting with lower gastrointestinal bleeding. Methods After the approval of the ethical review committee of the Sindh Institute of Urology and Transplantation (ERC-SIUT), this cross-sectional study was conducted at the Department of Hepatogastroenterology at the Sindh Institute of Urology and Transplantation from January 2021 to December 2021. All the KTRs (six months after the transplantation) of either gender and aged between 18 and 65 years, presenting with lower gastrointestinal (GI) bleeding as per the operational definition, were enrolled in the study. Those patients who were either unfit for the endoscopy or refused to give consent were excluded from the study. Colonic biopsies were reviewed by a consultant histopathologist for the features of CMV infection. Results A total of 95 renal transplant recipients of either gender or age above 18 to 65 years with lower GI bleeding were included in the study. Among them, 84 (88.4%) were males, while 11 (11.6%) were females. The mean age of the patients included in the study was 37±11 years. The most common presenting complaint was fresh bleeding per rectum, which was observed in 73 (76.8%). The most common findings observed on colonoscopy in KTRs with bleeding per rectum were colonic ulcers and erosions noted in 41 (43.1%) and 36 (37.3%) patients, respectively. On histopathology, CMV colitis was noted in 21 (22.1%) patients. On comparison of different baseline variables, the presence of fresh bleeding per rectum and the presence of both ulcers and erosions on colonoscopy were the factors significantly associated with CMV colitis in KTRs. Conclusion CMV colitis is a prevalent condition in KTRs, presenting with lower GI bleeding. Despite the significant occurrence, the levels of CMV viremia were not associated with CMV colitis, suggesting that diagnosis should rely on histopathological confirmation. Prophylaxis during periods of high immunosuppression is crucial to reducing the incidence of CMV infections and improving both graft function and patient survival.
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Cardiac involvement as the initial presentation of lymphoma is a rare occurrence. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma (DLBCL), which often affects the right atrium. Cardiac lymphoma can either be mediastinal DLBCL invading the heart or primary cardiac lymphoma. We describe the case of an 84-year-old female who presented with an eight-week history of dyspnea. Computed tomography angiography (CTA) of the chest showed a right-sided pleural effusion with collapse of the right middle and lower lobes as well as a large mass-like density within the anterior pericardium, compressing the right atrium and right ventricle and encasing the right coronary artery. A transthoracic echocardiogram (TTE) showed a multilocular hypoechoic mass in the right atrium with invasion into the wall of the right atrium. The patient underwent diagnostic and therapeutic thoracentesis. Pleural fluid cytology revealed diffuse large B-cell lymphoma, with positive stains for CD20, PAX5, CD10, BCL6, and Mum-1. Fluorescence in situ hybridization (FISH) revealed an abnormality of BCL2/18q (16%). A staging positron emission tomography (PET) scan showed a large mediastinal mass involving the right pericardium, focal uptake in the left thyroid lobe, left skull base, and musculature around the proximal left femur. Chemotherapy was initiated with R-mini-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). PET scans after three cycles of chemotherapy showed a complete metabolic response with the resolution of previously noted hypermetabolic lesions. The patient completed all six cycles of chemotherapy without issues. The differential diagnosis of a right atrial cardiac mass should include lymphoma. TTE is usually the initial imaging test, and a tissue biopsy is required for a definitive diagnosis. DLBCL is highly aggressive and carries a poor prognosis if untreated. Early diagnosis and treatment with standard chemotherapy are crucial for favorable outcomes.
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Angiofibroma also called juvenile nasopharyngeal angiofibroma are tumors of adolescence and the commonest site is the nasopharynx. Extra nasopharyngeal sites include upper respiratory and digestive tracts, oral cavity, tonsils, larynx, trachea, and esophagus. Intraosseous angiofibroma is the rarest of a rare entity.
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Ameloblastic fibroma is a rare mixed odontogenic benign tumor that can occur in either mandible or maxilla but mostly it is found in posterior region of mandible. It can present either peripherally or centrally with a majority of the cases predominantly occurring in first two decades of life and mostly affects male patients. It is characterized by epithelial islands and cords submerged in ectomesenchyme that bear resemblance to the dental papilla and enamel organ but without actual hard tissue formation. Ameloblastic fibroma is a rare odontogenic tumor consisting of neoplastic epithelial and mesenchymal tissues. Recent reports have suggested that this lesion has the potential for high recurrence (18%) and greater chances of recurrent Ameloblastic fibroma transforming into Ameloblastic fibrosarcoma (45%). A 34-year-old male patient presented with pain and swelling in right mandibular posterior region. Intraorally expansion of buccal cortical plate with tenderness over swelling was present. Extraoral examination revealed facial asymmetry on right side. In view of imaging and clinical findings, provisional diagnosis of Odontogenic Keratocyst or Recurrent Ameloblastoma was considered. After obtaining informed consent and general systemic evaluation, the lesion was enucleated under general anesthesia and biopsied which confirmed the diagnosis of Ameloblastic fibroma. Ameloblastic fibroma is a mixed odontogenic tumor composed of odontogenic ectomesenchyme resembling dental papilla with epithelial strands and nests similar to the dental lamina and enamel organ, but with no dental hard tissue formation. Odontogenic tumors, Ameloblasts, Ameloblastoma, Jaw neoplasm.
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The histopathological examination of mineralized tissues requires decalcification of teeth which is an essential and important step during tissue processing. In the present study we attempted to decalcify teeth using strong and weak acids and a chelating agent with various methods to identify completion of decalcification along with the observance of weight loss percentage of a tooth. Aim: To compare decalcification with conventional decalcification method with strong acid, weak acids and a chelating agent with respect to preservation of tissue structure, efficacy of staining in association with weight change. Materials and methods: A total of 64 multi-rooted and single rooted teeth were used, with group of 16 teeth, (16 molars, 16 pre-molars, 16 canines and 16 incisors) for each of the solution as Chelating agent (10% EDTA), Strong acid(10%HNO3), Weak acid (5% Tri Carboxylic acid) and Von Ebner's solution (hydrochloric acid & sodium chloride), were used in the study respectively. The efficacy of decalcifying agents was evaluated by recording the time taken by particular acid to decalcify the tooth completely and the weight change was observed at set intervals till the completion of decalcification. The endpoint of decalcification was also confirmed with radiographic and chemical methods. The decalcified teeth were then routinely processed, sectioned, and stained with haematoxylin and eosin stains. Different methods were used to confirm the completion of decalcification. After decalcification, all the teeth were examined macroscopically and microscopically. Results: At 70-80% of weight change of a tooth decalcification is complete. 10% EDTA was best suited to the soft and hard tissues in comparison to other solutions. 5% TCA was fair in staining quality and maintenance of hard tissue structures was satisfactory to 10%HNO3 and Von Ebner's solution. Conclusion: The final impression led to the proposition that EDTA was indeed the best decalcifying agent available if the results required are not urgent. For situations where time constraint is there, 5% Tri Carboxylic Acid can be used.
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Since the discovery of graphene and other two-dimensional (2D) materials in recent years, heterostructures composed of multilayered 2D materials have attracted immense research interest. This is mainly due to the potential prospects of the heterostructures for basic and applied applications related to the emerging technology of energy-efficient optoelectronic devices. In particular, heterostructures of graphene with 2D materials of similar structure have been proposed to open up the band gap to tune the transport properties of graphene for a variety of technological applications. In this paper, we propose a heterostructure scheme of band-gap engineering and modification of the electronic band structure of graphene via the heterostructure of graphene-boron nitride (GBN) based on first-principles calculations. For a comparative analysis of the properties of the proposed GBN heterostructure, we employ Kohn-Sham density functional theory (DFT) using local density and generalized gradient approximations within Perdew-Burke-Ernzehof parameterization. To account for weak interlayer van der Waals interactions, we employ the semi-empirical dispersion-corrected DFT scheme of Grimme, called the DFT-D2 approximation. In the vertical stacking arrangement of boron-nitride-doped graphene with hexagonal boron nitride, we predict a band-gap opening of 1.12 eV which, to our knowledge, is the largest value attained for this kind of system. The impact of interlayer spacing on the band-gap opening arising from the interlayer coupling effect is also analyzed. The band-gap enhancement supports the widely proposed promise of GBN heterostructure in design of high-performance optoelectronic devices such as field-effect transistors for potential applications.
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We present a robust, continuous molecular decelerator that employs high magnetic fields and few optical pumping steps. CaOH molecules are slowed, accumulating at low velocities in a range sufficient for loading both magnetic and magneto-optical traps. During the slowing, the molecules scatter only seven photons, removing around 8 K of energy. Because large energies can be removed with only a few spontaneous radiative decays, this method can in principle be applied to nearly any paramagnetic atomic or molecular species, opening a general path to trapping of complex molecules.
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RATIONALE, AIMS AND OBJECTIVES: We aimed to determine the effect of Clinical Practice Guideline (CPG) implementation on length of hospital stay of children and adolescents with diabetic ketoacidosis (DKA). METHODS: This was a 6-year (2008-2014) case-control retrospective study conducted at King Khalid University Hospital, Riyadh, that compared patients with DKA managed using CPG with those treated before CPG implementation. RESULTS: There were 63 episodes of DKA in 41 patients managed using CPG compared with 40 episodes in 33 patients treated before implementation of CPG. Baseline characteristics of the 2 groups were similar (age, sex, newly diagnosed patients, recurrent DKA, DKA severity, and mean glycosylated hemoglobin). The mean length of hospital stay (±SD) was 68.6 ± 53.1 hours after implementation of CPG compared with 107.4 ± 65.6 hours before implementation (P < .001). The reduction in length of hospital stay equals to 1700 bed days saved per year per 1000 patients. CONCLUSIONS: Implementation of CPG for DKA decreased the length of hospital stay.
Subject(s)
Diabetic Ketoacidosis/therapy , Hospitals, University/standards , Length of Stay/statistics & numerical data , Practice Guidelines as Topic , Adolescent , Child , Female , Glycated Hemoglobin , Guideline Adherence , Humans , Male , Retrospective Studies , Saudi Arabia , Severity of Illness IndexABSTRACT
Tong Nibong is a Bidayuh village located at Sarawak Kalimantan border. Since the year 2004 to 2009, a total of 537 cases of malaria were recorded in Serian District of which 14 cases were reported from Kampung Tong Nibong. Community empowerment programme for malaria infection prevention showed tremendous improvement in implementation. This intervention study aims to gauge the effectiveness of community empowerment approach in malaria elimination programme in Kampung Tong Nibong Serian. An intervention study was conducted with pre and post data collection. Data was collected using validated questionnaire by face to face interview. Universal sampling method was used to select respondents from head of household and post data was collected after intervention activities were carried out within a year of study period. The study showed significant difference on level of knowledge of respondents on vector of malaria between pre and post data with a P < 0.05. There was significant difference between pre and post data on practices on control and prevention of malaria with a P < 0.05. The same goes to level of positive attitude of respondents towards malaria control. In conclusion, the study can be considered successful because there is significant difference in knowledge, attitude and practice among the respondents between pre and post data. This indicates that community empowerment (voluntary participation) measures can be implemented in high risk or endemic areas where malaria is a persistent problem to the community and health institutions faces many limiting factors.
