Choriocarcinoma metastatic to both kidneys presenting with spontaneous renal hemorrhage: Case report.

INTRODUCTION: Choricocarcinoma is a highly malignant tumor. It metastasize commonly to the lungs. Metastasis to the kidney is uncommon, and bilateral metastasis is described rarely. Initial presentation with spontaneous bleeding of the renal metastatic tumor is scarce in the literatures. Here we present a case report of a choriocarcinoma patient with bilateral renal metastasis, presenting with spontaneous renal hemorrhage. CASE PRESENTATION: A 22 years old female presented to our emergency department with sudden onset of left flank pain. She has history of spontaneous abortion 02 years back with biopsy from the manual vacuum aspiration (MVA) showing molar pregnancy. Up on evaluation, patient was anemic. CT scan showed left renal bleeding tumor. Exploratory laparotomy and radical nephrectomy was done with the impression of bleeding renal cell carcinoma. The biopsy revealed choriocarcinoma. On her follow up, CT scan showed right renal and brain metastasis. She was given multi agent chemotherapy and her serum beta-hCG became undetectable after 01 year. DISCUSSION: Choriocarcinoma can be gestational or nongestational. The commonest route of metastasis is hematogenous. Presenting symptoms of renal metastasis can be hematuria, pain or more commonly incidental finding during work up. Choriocarcinoma is highly chemo sensitive. CONCLUSION: Bilateral renal metastatic choriocarcinoma is uncommon. Spontaneous renal hemorrhage as an initial presentation is even rare, and it can mimic a bleeding renal cell carcinoma. High index of suspicion is needed in a young women with recent history of spontaneous abortion.

Post catheterization Fournier's gangrene involving the entire anterior urethra: case report.

INTRODUCTION AND IMPORTANCE: Fournier's gangrene is necrotizing fasciitis involving the penis, scrotum, or perineal region. This is to report necrosis of the entire anterior urethra by necrotizing infection even though the involvement of the urethra by Fournier's is a very rare presentation. A high index of suspicion is important for early intervention. The main Mode of treatment for Fournier's gangrene is debridement. CASE PRESENTATION: This is a case report for a 58-year-old male patient who presented with penile and scrotal swelling after he was catheterized with NG tube for acute urinary retention. The physical finding shows swollen scrotum with ulcerated necrotic glans penis anteriorly. Laboratory result shows leukocytosis and urine analysis is positive for urinary tract infection and ultrasound shows bladder diverticula with normal prostate volume. He underwent debridement up to the level of membranous urethra and suprapubic catheterization was done. He was treated with antibiotics and wound care and finally, the wound closed. Post-operative cystourethrography was done 9 months later and we offered staged urethroplasty but he decided for permanent SPC. DISCUSSION: Fournier's gangrene is a fatal rapidly spreading infection that occurs in the perineal area. Involvement of urethra by necrotizing infection following catheterization is very rare presentation and diagnosis is mostly clinical. Once it is diagnosed the management is surgical debridement. CONCLUSION: Fournier's gangrene with urethral involvement is a very rare presentation and a high index of suspicion is important for early diagnosis and management. Following the standard procedural steps of catheterization is important to avoid this complication.

Isolated renal hydatid cyst.

INTRODUCTION AND IMPORTANCE: Hydatid disease, is a parasitic disease caused by the larval stage of the cestode Echinococcus granulosus. The Liver and lungs are the commonly affected organs but rarely kidney can be affected. Patient with primary renal hydatid may present with nonspecific symptoms or may be diagnosed incidentally. Imaging and serology are useful for diagnosis. The best therapy is surgery. CASE PRESENTATION: This case is reported to discuss a 35-year-old female presented with complaints of left side flank pain and swelling. The abdominal US and CECT show renal cyst, which was nonspecific. She underwent an open surgical exploration and cystectomy plus partial pericystectomy done. Post-operative serology test show Echinococcus IgG positive. Postoperatively, the patient had an uneventful recovery and discharged with Albendazole therapy for 8 weeks. CLINICAL DISCUSSION: Renal hydatid cyst is rare, accounting for less than 2 to 3 % of all hydatid disease. Renal hydatid cysts can remain asymptomatic for many years and then can be discovered incidentally. The diagnosis and staging of renal hydatid cysts rely heavily on imaging and serology. Hydatid disease is primarily treated surgically. CONCLUSION: A high index of suspicion should be maintained, especially in endemic areas, to ensure timely and accurate diagnosis of renal hydatid cyst. Surgical excision remains the treatment of choice, with appropriate preoperative and postoperative anthelminthic therapy. Long-term follow-up is crucial to monitor for recurrence and associated complications.

Formulating the best Helbat: A Tigraian semi-liquid fasting condiment.

Helbat (hl'bət), a fasting semi-liquid condiment, is a popular indigenous traditional fermented product in Tigrai (a.k.a. Tigray), Ethiopia. It is formulated using Vicia faba flour prepared from mildly roasted dry beans. Despite its dietary, nutritional, religious, and cultural significance, the condiment is yet not exposed to scientific study. Hence, this research was carried out to: (a) ascertain the best faba bean variety for preparing high quality Helbat, (b) develop the formulation and preparation protocol of high quality Helbat, (c) determine the effects of fermentation and storage temperature and time on the physicochemical characteristics, proximate and mineral compositions, microbiological properties, and sensory qualities of Helbat, and (d) determine the shelf life of Helbat as the function of storage time and temperature. To this end, three faba bean varieties used in preparing Helbat as well as fermenting and stored Helbat products were studied using standard physicochemical, microbiological, and sensory evaluation procedures. Quantitative data were processed using inferential statistical methods and mean (±SD) values were compared at a priori set p-value of ≤0.05. The study showed that: (a) the best faba bean variety for making high quality Helbat was Megulat; (b) the best Helbat formulation constituted 400 wt units of bean flour, 7 wt units of garlic, 6 wt units of ginger, 5 wt units fenugreek, 5 wt units of corrorima, 8 wt units of red pepper, and 3 wt units of black mustard; (c) the best Helbat formulation was nutritionally rich to supplement fasting consumers with proteins, fats, and minerals; (d) the Helbat formulation remained safe for up to eight weeks while maintaining its attractive sensory qualities when stored at 11-15 °C, and (e) increasing the fermentation and storage times led to changes in its physicochemical properties (i.e., temperature, pH, total titratable acidity, and total soluble solute) and depletion of many nutritionally vital components such as fats, proteins, and minerals. Thus, unless production and storage conditions are somehow modified, Helbat needs to be consumed fresh after three to seven days of fermentation. But further research may be required to make this recommendation conclusively. Exploring into its antioxidant properties and lactic acid bacteria (LAB) may highlight its qualities further.

A case report on the atypical presentation of Renal tuberculosis as emphysematous pyelonephritis.

INTRODUCTION AND IMPORTANCE: Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection, that causes gas to build up in the collecting system, renal parenchyma, and perirenal tissues (Mahmood et al., 2020). Uncontrolled diabetes mellitus and urinary tract obstruction are the two main risk factors. We report the second case report of tuberculosis as a causative pathogen of EPN. CASE PRESENTATION: In this case report, a 60-year-old lady with poorly controlled type 2 diabetes was admitted to the emergency room due to left flank pain, a low-grade temperature, nausea, and vomiting. Emphysematous Pyelonephritis was diagnosed based on gas seen in the renal parenchyma on a CECT scan (EPN). She underwent conservative management, including the insertion of a nephrostomy tube and antibiotics. There is no growth detected in the nephrostomy drain's culture. She underwent a simple nephrectomy after deciding that she had not improved clinically after receiving conservative treatment. A biopsy of the specimen revealed a tuberculosis abscess. She received the proper care and made clinical progress over the course of a six-month anti-TB medication regimen. CLINICAL DISCUSSION: The majority of EPN patients are female (2:1) and diabetic (90 %) with a mean age of presentation of 55 years (El Rahman et al., 2011). The preferred method of diagnosis for EPN is CT (El Rahman et al., 2011). E. coli, Klebsiella, and Pseudomonas were the most prevalent species in many of the reported cases (Khaira et al., 2009). In contrast to prior investigations, we discovered a case of EPN caused by tuberculosis invasion. CONCLUSION: An essential lesson to learn from such cases is the importance of considering genitourinary tuberculosis when emphysematous pyelonephritis does not improve with conservative treatment, especially in areas with a high tuberculosis endemicity.