Foreign bodies in the rectum: Three case reports of sexual violence.

Background: Sexual violence is one of the worst forms of violence with long-term physical and psychological effects on victims. It has been stated that sexual stimulation was responsible for 78% of clinically relevant foreign rectal bodies. About 10% of the cases were due to sexual assault. A problem commonly encountered in patients with RFB is the delay in presentation. While patients may be reluctant to disclose the cause of their presentation. Cases presentations: All the patients were males with a mean age of 41.1 years old. On average, they presented 2 days after the rape, Diagnosis was made in all 3 patients with a history and abdominal x-ray.The cause of the foreign body in each patient was violence and retaliatory behavior. Foreign objects included bottles, lamps, and water pipes. In 2 patients the foreign bodies were removed through Trans-anal procedure and in one patient laparotomy and colostomy need to be done for removing the Foreign object. Conclusion: Despite the urgency in the treatment of these patients, which involves the removal of a foreign body, special attention should be paid to psychological trauma and its long-term effects on patients' wellbeing. In stable, non-perforated patients, tans-anal approach under sedation is a good approach. If it fails, the patient needs to go to operating room for further anesthetic and surgical interventions.

Modulation of astrocyte activity and improvement of oxidative stress through blockage of NO/NMDAR pathway improve posttraumatic stress disorder (PTSD)-like behavior induced by social isolation stress.

BACKGROUND: It has been well documented that social isolation stress (SIS) can induce posttraumatic stress disorder (PTSD)-like behavior in rodents, however, the underlying mechanism is remained misunderstood. In the current study, we aimed to elucidate the role of NO/NMDAR pathway in PTSD-like behavior through modulating of astrocyte activity and improvement of oxidative stress. METHODS: Male NMRI mice were used to evaluate the memory function by using Morris water maze (MWM) and fear memory extinction by using freezing response. We used MK-801 (NMDAR-antagonist), L-NNA (NOS-inhibitor), NMDA (NMDAR-agonist), and L-arginine (NO-agent) to find a proper treatment. Also, immunohistochemistry, RT-PCR, and oxidative stress assays were used to evaluate the levels of astrocytes and oxidative stress. We used five mice in each experimental task. RESULTS: Our results revealed that SIS could induce learning and memory dysfunction as well as impairment of fear memory extinction in MWM and freezing response tests, respectively. Also, we observed that combined treatment including blockage of NOS (by L-NNA, 0.5 mg/kg) and NMDAR (by MK-801, 0.001 mg/kg) at subeffective doses could result in improvement of both memory and fear memory. In addition, we observed that SIS significantly increases the GFAP expression and astrocyte activity, which results in significant imbalance in oxidative stress. Coadministration of MK-801 and L-NNA at subeffective doses not only decreases the expression of GFAP, but also regulates the oxidative stress imbalance CONCLUSION: Based on these results, it could be hypothesized that blockage of NO/NMDAR pathway might be a novel treatment for PTSD-like behavior in animals by inhibiting the astrocyte and regulating oxidative stress level.

Primary versus delayed primary skin closure in operated patients due to perforated peptic ulcer disease: a randomized controlled clinical trial.

PURPOSE: Perforated peptic ulcer (PPU) is a life-threatening complication of peptic ulcer disease. This condition is characterized by a dirty abdomen that predisposes to postoperative wound infection. Delayed primary skin closure is occasionally preferred over primary closure to reduce the risk of surgical site infection in dirty abdominal wounds. In primary skin closure, the skin is sutured immediately after surgery. Meanwhile, in delayed primary skin closure, the incision is left open, and sutured after 2-5 days. The current research aimed to compare the risk for surgical site infection, length of hospitalization, and mortality rate between primary versus delayed primary skin closure among patients who underwent surgery for PPU. METHODS: This single-blind randomized clinical trial included 120 patients who were randomly allocated into the primary and delayed primary closure groups. A research assistant who was blinded to the study examined the wounds for surgical site infection based on the 1992 Center for Disease Control criteria. The outcomes were mortality rate and duration of hospitalization. RESULTS: The delayed primary and primary closure groups did not significantly differ in terms of postsurgical wound infection occurring on the 3rd, 7th, 14th, and 30th days after surgery, mortality rate, and duration of hospitalization. CONCLUSION: In patients who underwent surgery for PPU, delayed primary closure is not recommended over primary closure due to the risk of postoperative surgical site infection.

COVID-19 Diagnosis Using Capsule Network and Fuzzy C-Means and Mayfly Optimization Algorithm.

The COVID-19 epidemic is spreading day by day. Early diagnosis of this disease is essential to provide effective preventive and therapeutic measures. This process can be used by a computer-aided methodology to improve accuracy. In this study, a new and optimal method has been utilized for the diagnosis of COVID-19. Here, a method based on fuzzy C-ordered means (FCOM) along with an improved version of the enhanced capsule network (ECN) has been proposed for this purpose. The proposed ECN method is improved based on mayfly optimization (MFO) algorithm. The suggested technique is then implemented on the chest X-ray COVID-19 images from publicly available datasets. Simulation results are assessed by considering a comparison with some state-of-the-art methods, including FOMPA, MID, and 4S-DT. The results show that the proposed method with 97.08% accuracy and 97.29% precision provides the highest accuracy and reliability compared with the other studied methods. Moreover, the results show that the proposed method with a 97.1% sensitivity rate has the highest ratio. And finally, the proposed method with a 97.47% F1-score rate gives the uppermost value compared to the others.

Spontaneous perforation as a fatal presentation of esophageal tuberculosis: A case report.

INTRODUCTION: Tuberculosis is a multisystematic disease and is the most common cause of infectious disease-related mortality worldwide. Gastrointestinal tract is an uncommon site for extrapulmonary tuberculosis (TB). Esophageal TB is exceedingly rare. PRESENTATION OF CASE: We report a 22-years-old male with esophageal TB that presented in septic shock from esophageal perforation. Despite all measures including surgical intervention and aggressive support in the intensive care unit, patient passed away. DISCUSSION: The most common mechanism for esophageal involvement is secondary to direct spread from mediastinal structures and/or spreading the inoculation of swallowed sputum, or hematogenous or lymphatic spread. Once the diagnosis of TB is established, antibiosis is the cornerstone of treatment. Surgery is reserved only for complications of TB such as fistula, abscess, strictures or perforation. Less than 50% of cases are diagnosed within 24 h, and delay in diagnosis lead to significant increases in the mortality. CONCLUSION: In countries with high prevalence of TB, this diagnosis should be considered in those with esophageal perforation with no underlying etiology and medical treatment for TB should be initiated in addition to conventional treatment in appropriate group of patients.

Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones.

AIM: This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography (MRCP) and intra-operative cholangiography (IOC) methods in patients suspicious to gall stones. BACKGROUND: According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography. PATIENTS AND METHODS: In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared. RESULTS: The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods. CONCLUSION: According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients.

Current incidence of peripheral arterial embolism and role of echocardiography.

We reviewed the incidence and outcome of all cases of upper and lower limb embolism surgically treated in our vascular unit, from January 2001 to June 2006, to assess the role of transthoracic and transesophageal echocardiography in defining the source of the embolus. Transthoracic echocardiography was carried out postoperatively, and patients in whom the embolic source was not found underwent transesophageal echocardiography. There were 85 patients (mean age, 69 years) who underwent embolectomy: 58 for lower and 27 for upper limb ischemia. The source or potential source of thrombus was demonstrated in 17 (20%) patients after transthoracic echocardiography. Fifty-three patients had transesophageal echocardiography, the source of embolism was found in 85%, and the subsequent management was changed in 47% of them. Arterial limb emboli are still prevalent in developing countries. Transthoracic echocardiography is a good screening tool for detecting a potential cardiac source of peripheral embolism, with transesophageal echocardiography being reserved for specific indications.

Rare presentation of pancreatic schwannoma: a case report.

INTRODUCTION: Schwannoma is a rare tumor among pancreatic neoplasms. Schwannomas vary in size, and most of them are cystic, mimicking pancreatic cystic lesions. Generally, a definitive diagnosis is made at the time of histological analysis. The mainstay treatment is surgical resection. CASE PRESENTATION: We report an unusual presentation of pancreatic schwannoma with abdominal pain and several episodes of cholangitis in a 54-year-old Caucasian (Iranian) man. The condition was not diagnosed pre-operatively and Whipple's procedure was performed. CONCLUSION: Pancreatic schwannoma is an important clinical entity to include in the differential diagnosis of pancreatic lesions. Pre-operative diagnosis is difficult but computed tomographic findings may be helpful. The tumor may also have atypical and rare presentations, such as cholangitis and weight loss. For benign tumors, simple enucleation is usually adequate, whereas malignant tumors require standard oncological resection.

Surgical management of deep venous insufficiency caused by congenital absence of the infrarenal inferior vena cava.

Congenital absence of the inferior vena cava (CAIVC) is a rare vascular defect, commonly reported as a fortuitous finding because patients are typically asymptomatic of the condition itself but are symptomatic of associated conditions such as congenital heart disease, polysplenia, asplenia, and inversion of bowel viscera. The presence of CAIVC is probably underestimated because CAIVC may not be detected by compression B-mode ultrasonography. By use of computed tomography, we diagnosed a case of CAIVC in a young athletic patient with disabling venous stasis symptoms of the lower limbs. Venous prosthetic reconstruction of the infrarenal vena cava provided with early subsiding of edema and healing of stasis ulcers. An intracaval web was found as potentially responsible for the condition. We present and propose our surgical method for this rare disabling condition.

Cross pectoral nerve transfer following free gracilis muscle transplantation for chronic brachial plexus palsy: a case series.

In an eight year period, 12 patients were treated by the contra-lateral medial pectoral nerve as motor nerve innervation of the transplanted free gracilis muscle to the paralytic upper limb. The gracilis muscle was used for both elbow and digital flexion. Results were assessed by the MRC grading system and success was defined as muscle strength of M4 and M3 which was observed in seven patients (58%). The motor level of the muscle in two patients was M0 and in two it was M1 to M2. The donor pectoral muscle of these 12 patients showed no deficit in motor and sensory functions. This method can be used for treatment of brachial plexus palsy, regaining useful function of the reconstructed limb.