Chest wall mass as a sign of ignored hepatocellular carcinoma in an alcoholic cirrhotic patient: a case report.

Bone metastasis of hepatocellular carcinoma (HCC) is usually seen in the course of advanced intrahepatic HCC. Isolated bone metastasis as an initial manifestation of HCC is uncommon. Case presentation: The authors report a case of a 68-year-old male with a history of chronic alcohol consumption who presented with epigastric pain, abdominal distension, and a hard, tender lump on the right posterolateral aspect of his back. Investigation revealed HCC with isolated metastasis to the posterior thoracic wall. Clinical discussion: HCC usually develops secondary to chronic hepatitis B and C infection in the background of chronic liver disease. Common presenting symptoms of bone metastasis include local pain, neurological manifestations, palpable subcutaneous masses, and pathological fractures. An immunohistochemistry analysis is important to differentiate HCC from non-HCC metastasis in patients without known underlying HCC. Treatment is often directed towards palliative care as the prognosis is poor. Conclusion: An isolated rib mass can be an initial presentation of metastatic HCC. Thus, HCC with bone metastasis should be considered in the differential diagnosis in patients presenting with painful swelling in the thoracic region.

Anaemia among Pregnant Women Visiting Obstetric Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Anaemia is one of the common health problems of pregnant women and children in developing countries. Anaemia in pregnancy is related to poor foetal and maternal outcomes contributing to significant morbidity and mortality. Anaemia is a treatable and preventable condition. The objective of this study was to find out the prevalence of anaemia in pregnant women visiting the Obstetric Department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the pregnant women visiting the Department of Obstetrics and Gynecology of a tertiary care centre for their antenatal checkup. The study was conducted from 2 November 2022 to 11 November 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 11(6-11)E2/079/080). Pregnant women with a history of blood transfusion, anaemia of chronic disease like chronic kidney disease, history of recurrent bleeding, and referral cases from other centres were excluded from the study. Serum haemoglobin was used for diagnosing anaemia according to criteria given by the World Health Organization. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 442 pregnant women, the prevalence of anaemia was 24 (5.43%) (3.32-7.54, 95% Confidence Interval). Conclusions: The prevalence of anaemia among pregnant women was lower in comparison to other studies done in similar settings. Keywords: anemia; maternal-child health services; prevalence.

Xanthogranulomatous Cholecystitis Mimicking Carcinoma Gallbladder.

Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and can mimic gallbladder carcinoma. Distinguishing XGC from gallbladder cancer preoperatively is challenging. We present a case of a 62-year-old male who presented with features of carcinoma gallbladder in the CECT abdomen and MRCP. Intraoperatively, there was a mass in the gallbladder and extension into the adjacent structures with involvement of the hepatic artery, 1st part of the duodenum, portal vein, and hepatic flexure of the colon, and thus a palliative cholecystectomy was done. The histopathological report came out as XCG. The case aims to outline the clinical presentation of XGC and differentiate it from carcinoma gallbladder.

Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center.

This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider-patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital-community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.

Splenic artery aneurysm with extrahepatic portal venous obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Splenic artery aneurysm is one of the most common visceral aneurysms. Patients are usually asymptomatic. Splenic artery aneurysm if untreated has the potential for rupture and is therefore life-threatening. Its association with extrahepatic portal vein obstruction is rare. CASE PRESENTATION: A 25-year female was incidentally diagnosed with a splenic artery aneurysm with extrahepatic portal vein obstruction with splenomegaly 8 years back during the 5th month of her second pregnancy. No intervention was done back then. Recently, she presented to the surgical gastroenterology outpatient department with an increasing abdominal mass. On examination, the patient was pale and splenomegaly was present. Hematological reports were suggestive of hypersplenism. The patient underwent splenectomy and aneurysmal resection with a proximal splenorenal shunt as the best course of treatment. DISCUSSION: Due to the rarity of the disease, the management is still challenging and needs further study. Diagnosis can be made clinically with support from imaging modalities. Surgical treatment has a good outcome in such patients. Even with the availability of less invasive procedures such as endovascular treatment, open surgery is preferred. CONCLUSION: Proximal splenorenal shunt is a well-accepted surgical procedure for extrahepatic portal vein obstruction. Splenectomy and aneurysmal resection can relieve hypersplenism and treat splenic artery aneurysm in patients with isolated splenic artery aneurysm at the splenic hilum.

Sleeve gastrectomy for multiple gastric perforations in a preterm: A case report.

Neonatal gastric perforation (NGP) is a rare life-threatening condition among preterm infants. NGP can occur secondary to necrotizing enterocolitis, distal obstruction, or as a result of gastric tube insertion. Sleeve gastrectomy can be a possible therapeutic option for multiple neonatal gastric perforations.