Infective endocarditis with embolic renal infarct presenting as acute abdomen.

Infective endocarditis (IE) is a disease that is rare but potentially fatal and challenging to diagnose. A 28-year-old man with sickle cell trait and a history of intravenous drug use presented with abdominal pain and hematuria mimicking a surgical abdomen. The preliminary diagnosis was cholecystitis or perforated viscus. The chest radiograph was indicative of pulmonary septic emboli. Computed tomography was initially thought to show pyelonephritis, but further review of images revealed renal infarct. The patient was found to have endocarditis which resulted in an embolic renal infarct. The patient recovered remarkably well after 60 days of intravenous antibiotics. This case demonstrates that a surgical abdomen may also be a sign of endocarditis, and multiple imaging studies may be required to confirm the diagnosis. In patients such as intravenous drug users with an increased risk of IE, unexplained flank pain should raise a suspicion of acute renal infarction.

The diagnostic utility of placental growth factor in ectopic pregnancy.

PURPOSE: Ectopic pregnancy is a condition of enormous gynaecological priority. It occurs when fertilized ovum implants outside the uterine cavity. Ectopic pregnancy is estimated to be 1-2% of all-natural conception. This study aims to evaluate the role of the placental growth factor in the diagnosis of ectopic pregnancy. METHODS: A case-control study was conducted in (Baghdad) teaching hospital in (Baghdad, Iraq) over one year. The study includes 240 women: 120 women with first trimester (5-10) weeks viable intrauterine pregnancy, and 120 women with ectopic pregnancy. RESULTS: There is a significant association observed in the placental growth factor mean (PLGF), which is lower in ectopic pregnancy than in intrauterine pregnancy. The range of PLGF was less than 50 pg/mL in ectopic pregnancy, while it was up to 800 pg/mL in intrauterine pregnancy. In an ectopic pregnancy with a cut-off PLGF level of ≤ 15.5 pg/mL, the PLGF had a sensitivity of (92.5%), a specificity of (82.5%), a positive predictive value of (91.8%), a negative predictive value of (83.5%), and an accuracy of (90%). Different factors can affect PLGF, like the parity and body mass index. CONCLUSION: The serum level of the placental growth factor seems to be a promising biomarker for diagnosing ectopic pregnancy because a highly significant difference was found between healthy and ectopic pregnancy.

The utility of the speed bump sign for diagnosing acute appendicitis.

BACKGROUND: Acute appendicitis is the most common abdominal complaint in the emergency department. This study was made in order to determine whether there is any evidence to support the practice of inquiring about pain over speed bumps in patient suspected to have acute appendicitis and to discover its predictive power as a diagnostic sign. METHOD: A prospective study was conducted in the emergency department of Al Ain Hospital over one year. A convenient sample of 100 consecutive adult patients over the age of 15 years who presented with an abdominal pain and symptoms suggestive of acute appendicitis were recruited over the study period. They all underwent questionnaire of whether they had pain, or their pain increased while they travelled over speed bumps. RESULTS: The study shows that 80 of the 90 participants were "speed bump positive." Eighty-five had a confirmed diagnosis of appendicitis, 77 of whom had worsened pain over speed bumps, giving a sensitivity of 90.5% and a specificity of 40%. The positive predictive value was 96.25% and the negative predictive value was 20%. The likelihood ratios were 1.5 for a positive test result and 0.23 for a negative result. CONCLUSION: The pain over speed bump can be considered as a significant "rule out" criterion of appendicitis due to the high sensitivity observed in this study. However, with its low specificity, many patients with this sign would not undoubtedly have appendicitis, meaning it is a poor "rule-in" test.