Para­testicular arteriovenous malformation: A case report and mini­review of the literature.

Arteriovenous malformations from para-testicular structures are very rare, with only a limited number of cases reported in the literature. The present study reports a rare case of para-testicular arteriovenous malformation. A 6-year-old boy presented with painless swelling in the scrotum for 6 months. Upon examination, a non-tender and non-pulsatile cystic swelling was observed in the right hemi-scrotum below the testis. A scrotal ultrasound revealed a separate cystic lesion with a normal texture and the vascularity of both testes. Under general anesthesia, via a small scrotal incision, a cystic, blood-filled mass was excised. The results of a histopathological examination were suggestive of vascular malformation. The case described in the present study aims to shed light on vascular malformations. A number of vascular malformations are incorrectly referred to as hemangiomas, and numerous patients undergo inappropriate therapy due to this misclassification. Although para-testicular arteriovenous malformation is a very rare condition, it should be included in the differential diagnosis of para-testicular lesions.

VAAFT PROCEDURE (Video-assisted Anal Fistula Treatment) versus open method in the treatment of high fistula in ano

Background: A common acquired anorectal condition is anal fistula. The treatment approaches that have been employed have been linked to erratic outcomes and sometimes life-threatening consequences. Video-assisted anal fistula treatment (VAAFT), a minimally invasive method, was introduced for adult patients in 2011. Objective: To know the efficacy of the VAAFT procedure in treating high anal fistulas and to compare it to open methods in the Basrah province. Methods: The present study was performed on 200 patients with high fistulas in ano in Basrah province. We divided the patients into 2 groups: Group A: treated by the VAAFT technique and Group B: treated by open fistulotomy Results: The patients treated with VAFFT revealed no occurrence of the following postoperative complication: Infection, incontinence, recurrence, anal stenosis, and bleeding. There was lower incidence of pain, short time for wound healing, rapid return to work, and more patient satisfaction compared with open fistulotomy Conclusion: An innovative method for managing ano fistula is VAAFT. Compared with traditional methods, it has a lot of benefits. It is day case surgeryno open wound.no damage to anal sphincter and no risk of incontinence, it is more affordable.it allow for clear identification of internal office, whole tract and its associated branches and cavity. The instrument can be used for multiple patients after good sterilization and disinfection. (AU)

Impact of the coronavirus pandemic on mental prosperity of medical care laborers in tertiary consideration hospital: A case report.

Since the outbreak of the Corona pandemic in December 2019, many people affected, especially medical care laborers, who deal with the treated cases. Coronavirus disease 2019 not only affects the body parts, but also extends to the psychological symptoms. The purpose of this research is to explore the impact of the pandemic on the mental prosperity of the laborers. Clinical staff members from the administration emergency clinic, Lahore, were enlisted. A poll was used to collect data on the segment information, a sleeping disorder, despondency and stress manifestations. Correlation of the segment information and the mental factors were done among the sleeping and non-sleeping disorder samples. All 356 medical service laborers were selected for this investigation. There were manifestations of misery in 222 (62.35%), nervousness in 227 (64.76%), stress in 197 (55.33%) and sleep deprivation in 190 (53.37%) of members. Gentle to extreme side effects of melancholy (91.65% vs 28.9%), nervousness (83.1% vs 41.6%) and stress (84.26% vs 22.22%) were seen predominately in the sleep deprivation gathering (P < .001). Insomnia was more pronounced in the members with low training levels (78.08%) versus post-advanced education (30.9%). Paramedics, attendants, and medical service laborers in confinement/serious consideration units were more inclined to the sleep deprivation (P < .001). Mental prosperity of medical care laborers was influenced because of Coronavirus pandemic. Attendants, paramedics, and those working in the detachment unit showed a critical sleeping disorder. The results and indicators have proven that there is a relationship between the infection with the Corona pandemic and occurrence of disorders in psychological behavior. Therefore, the psychological rehabilitation sessions must be conducted for those infected and those in contact with the Corona cases to relieve the burden of that patients to raise their psychological conditions and support the immune system such that resist against the infection.

A 59-Year-Old Woman with Extensive Deep Vein Thrombosis and Pulmonary Thromboembolism 7 Days Following a First Dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine.

BACKGROUND The COVID-19 pandemic is an ongoing cause of the current global healthcare crisis. Several vaccines were approved for use by emergency vaccination campaigns worldwide. At present, there are very few reports of COVID-19 vaccine-induced immune-thrombotic thrombocytopenia, a variant of heparin-induced thrombocytopenia (HIT), in comparison to the massive number of vaccinated people worldwide. CASE REPORT A 59-year-old woman presented to the Emergency Department with a 3-day history of sudden-onset left leg pain 7 days after receiving her first dose of BNT162b2 mRNA COVID-19 (Pfizer-BioNTech). She was diagnosed with deep vein thrombosis (DVT) and pulmonary embolism (PE) and found to have a positive HIT screen with optical density (OD) of 0.6 via ELISA test. She was hospitalized for 4 days and discharged home with an oral anticoagulant (rivaroxaban). CONCLUSIONS This case report describes a possible link between BNT162b2 mRNA COVID-19 (Pfizer-BioNTech) vaccination and thromboembolism. However, further data are needed to support such an association.

Mycobacterium tuberculosis PPE10 (Rv0442c) alters host cell apoptosis and cytokine profile via linear ubiquitin chain assembly complex HOIP-NF-κB signaling axis.

Tuberculosis caused by Mycobacterium tuberculosis infection remains one of the top ten causes of deaths worldwide. M. tuberculosis genome devoted 10% capacity for highly repeated PE/PPE genes family. To explore the role of PPE10 in host-pathogen interaction, PPE10 encoding gene Rv0442c was heterologously expressed in the nonpathogenic M. smegmatis strain. PPE10 altered the bacterial cell surface properties, colony morphology, and biofilm formation. Ms_PPE10 showed more resistance to stress conditions such as diamide, and low pH, as well as higher survival within the macrophage. Moreover, the host's cell apoptosis was regulated via decreased expression of caspases, IL-1, IL-6, and TNF-α through the Linear Ubiquitin Chain Assembly Complex (LUBAC) HOIP-NF-κB signaling axis. The study revealed novel insights into the mechanism of action of the PPE family.

Mycobacterium tuberculosis Rv0580c Impedes the Intracellular Survival of Recombinant Mycobacteria, Manipulates the Cytokines, and Induces ER Stress and Apoptosis in Host Macrophages via NF-κB and p38/JNK Signaling.

The Mycobacterium tuberculosis (M. tb) genome encodes a large number of hypothetical proteins, which need to investigate their role in physiology, virulence, pathogenesis, and host interaction. To explore the role of hypothetical protein Rv0580c, we constructed the recombinant Mycobacterium smegmatis (M. smegmatis) strain, which expressed the Rv0580c protein heterologously. We observed that Rv0580c expressing M. smegmatis strain (Ms_Rv0580c) altered the colony morphology and increased the cell wall permeability, leading to this recombinant strain becoming susceptible to acidic stress, oxidative stress, cell wall-perturbing stress, and multiple antibiotics. The intracellular survival of Ms_Rv0580c was reduced in THP-1 macrophages. Ms_Rv0580c up-regulated the IFN-γ expression via NF-κB and JNK signaling, and down-regulated IL-10 expression via NF-κB signaling in THP-1 macrophages as compared to control. Moreover, Ms_Rv0580c up-regulated the expression of HIF-1α and ER stress marker genes via the NF-κB/JNK axis and JNK/p38 axis, respectively, and boosted the mitochondria-independent apoptosis in macrophages, which might be lead to eliminate the intracellular bacilli. This study explores the crucial role of Rv0580c protein in the physiology and novel host-pathogen interactions of mycobacteria.

Differential Isoniazid Response Pattern Between Active and Dormant Mycobacterium tuberculosis.

Isoniazid (isonicotinic acid hydrazide, INH) is an effective frontline antituberculosis drug. INH targets several Mycobacterium tuberculosis processes, including mycolic acid biosynthesis, DNA synthesis, and redox potential. M. tuberculosis responds to INH stress by altering the expression level of crucial genes involved in various pathways. In this study, we summarize the induced gene expression pattern of active M. tuberculosis upon INH exposure. Most genes triggered by INH are involved in processes such as mycolic acid biosynthesis, a compensatory response, stress response, and drug efflux. These patterns are absent in dormant M. tuberculosis. The differential INH response pattern can inform future novel measures against M. tuberculosis.

Methylation in Mycobacterium-host interaction and implications for novel control measures.

Methylation epigenetically regulates many pivotal biological processes. Mycobacterium tuberculosis, the pathogen of tuberculosis, can modulate host methylome. The methylated genes, sites, signaling pathway, chromatin remodeling, especially the immune related genes such as cytokines and chemokines, drug resistance and vaccines efficacy relevant genes were summarized in this paper. The results showed that methylation plays important roles in immune evasion, pathogenesis, persistence, disease progression, active, drug responder and non-responder. This will inform better practice for the development of new drugs and vaccines to eradicate tuberculosis.

Comparative study of hypercoagulability change in steady state and during vaso-occlusive crisis among Sudanese patients living with sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is an inherited blood disorder that affects red blood cells. (SCD) is characterized by recurrent vaso-occlusive crisis (VOC). MATERIAL AND METHODS: This was a descriptive cross sectional study conducted through the period from July 2015 to July 2017 in which a total of seventy two blood specimens were collected in 'EDTA' and citrated vacutainers from Sudanese patients with SCD attending "Fath Elrhman Albasheer" Centre. Both sexes' with different ages were included. Among these samples 49 (68.1%) were in steady state while the remained 23 (31.9%) were in VOC. All samples were tested for coagulation profile. RESULT: There was increase in fibrinogen and D-dimer levels in most patients 67% and 71%, respectively. Significant increase in D-dimers was observed in patients with (VOC) compared with steady state (P. value = 0.006). Protein S was significantly increased in males in comparison with females P. value = 0.017. The results of prothrombin time (PT), international normalized ratio (INR) and thrombin time (TT) were within normal range. CONCLUSION: Significant increase in levels of D-dimer during VOC indicating abnormal coagulation and fibrinolysis activation. Reduced levels of natural anticoagulants proteins C and S can be consider as predictive markers indicate hepatic dysfunction in patients with SCD.

Obesity and associated risk factors among students of health colleges of King Saud University, Saudi Arabia: A cross-sectional study.

OBJECTIVE: To determine the prevalence of obesity and associated risk factors among medical students in Saudi Arabia. METHODS: The cross-sectional study was conducted from December 2012 to March 2013 at King Saud University, Riyadh, Saudi Arabia. Using stratified sampling technique, undergraduate students of either gender from the health colleges were included. Information was collected through a pretested questionnaire. Measurements of the height and weight were noted and body mass index for all the subjects was calculated. RESULTS: Of the 292 students, 146(50%) were males and 146(50%) were females. Obesity was found in 40(13.7%)students. It was more prevalent among males than females (p<0.05) and among those who had chronic diseases (p<0.001). Family history of obesity was significantly associated with obesity (p=0.016). No significant association was found between physical activity and obesity (p=0.863). CONCLUSIONS: There was considerable prevalence of obesity among the medical students. Being male, having family history of obesity, and having chronic diseases were important risk factors.