A rare case of cerebral phaeohyphomycosis caused by Fonsecaea species in a renal transplant patient.

Cerebral phaeohyphomycosis (CP) is a serious form of phaeohyphomycosis. We report a case of CP caused by Fonsecaea species in a 66-year-old immunocompromised renal transplant recipient female. Craniotomy was performed on an irregularly enhancing right cerebellar hemisphere lesion and abscess and tissue samples collected for microbiological and histological evaluation, showing fungal elements and Fonsecaea species was isolated. Antifungal treatment with voriconazole & liposomal amphotericin B was initiated with a temporary improvement in the patient's condition. Deep vein thrombosis jeopardized patient's prognosis. Despite aggressive surgical and medical intervention, our patient succumbed to the disease. Historically, CP has been linked with fatality rates as high as 65 %, despite surgical intervention and systemic antifungal medication.

Updates in Endoscopic Bariatric and Metabolic Therapies.

The rising prevalence of obesity, and related morbidity and mortality, has necessitated the development of therapeutic weight loss strategies. Lifestyle modifications alone have only yielded modest benefit, and while bariatric surgery has shown significant short- and long-term results, only a minority of eligible patients end up receiving this treatment. Endoscopic bariatric and metabolic therapies (EBMTs) are a rapidly evolving field, which provides a less invasive middle ground treatment option for weight loss. Here we discuss the efficacy, as well as short- and long-term outcomes with restrictive, malabsorptive/metabolic and aspiration endoscopic techniques, and their effects on metabolic parameters.

Venous thromboembolism prophylaxis in traumatic brain injury patients: An audit of clinical practice in AlRass General Hospital, Saudi Arabia and proposal for future clinical practice.

OBJECTIVE: To review clinical practice with regards to venous thromboembolism prophylaxis in traumatic brain injury patients and to propose guidelines. METHODS: The retrospective study was conducted at Al Rass General Hospital, Saudi Arabia, and comprised medical records of all traumatic brain injury patients admitted to the Neurosurgery Department between November, 2017, and January, 2018. Data was noted using a proforma. Literature review was done to ascertain best clinical evidence and proposed guidelines for practice. RESULTS: Of the 26 patients, 23(88.5 %) were males, and 3(11.5 %) were females. The overall mean age was 32.2±13.4 years. Of the total, 8(30.8%) patients had mechanical venous thromboembolism prophylaxis, while 1(3.8%) received enoxaparin as chemoprophylaxis. There were no reported thromboembolic events or complications related to enoxaparin usage. CONCLUSIONS: The usage of venous thromboembolism prophylaxis was found to be low in clinical practice. A modified Parkland Model approach seemed the most appropriate to avoid venous thromboembolism related events.

Cerebral Venous Sinus Thrombosis Manifesting as a Recurrent Spontaneous Subdural Hematoma: A Case Report.

BACKGROUND: Diagnosing cerebral sinus venous thrombosis (CSVT) manifested as a spontaneous subdural hematoma (SDH) is challenging due to variability of its clinical features. The neuroradiological investigation is crucial to confirm the diagnosis. The management of SDH secondary to CVST is controversial and not well established. CASE DESCRIPTION: We present a case of an adult man with Down's syndrome who underwent a left-sided craniotomy and evacuation of spontaneous subdural hematoma. Post-surgery magnetic resonance venography (MRV) revealed venous sinus thrombosis in the right transverse sinus with loss of flow signal. He was started on Apixaban two weeks post-surgery. Three months later, the patient re-presented with recurrence of the SDH. His anticoagulation was discontinued, and he underwent craniotomy reopening and evacuation of the recurrent hematoma. The patient returned to his baseline following this procedure. The patient was followed up in the out-patient clinic regularly. Interval brain MRI and MRV performed at six months showed further resolution of the thrombosis of the right sigmoid sinus with restoration of the venous flow. CONCLUSION: The management of SDH complicating CVST remains controversial due to the rarity of its presentation and the hazards associated with the use of anticoagulation.

Translational AI and Deep Learning in Diagnostic Pathology.

There has been an exponential growth in the application of AI in health and in pathology. This is resulting in the innovation of deep learning technologies that are specifically aimed at cellular imaging and practical applications that could transform diagnostic pathology. This paper reviews the different approaches to deep learning in pathology, the public grand challenges that have driven this innovation and a range of emerging applications in pathology. The translation of AI into clinical practice will require applications to be embedded seamlessly within digital pathology workflows, driving an integrated approach to diagnostics and providing pathologists with new tools that accelerate workflow and improve diagnostic consistency and reduce errors. The clearance of digital pathology for primary diagnosis in the US by some manufacturers provides the platform on which to deliver practical AI. AI and computational pathology will continue to mature as researchers, clinicians, industry, regulatory organizations and patient advocacy groups work together to innovate and deliver new technologies to health care providers: technologies which are better, faster, cheaper, more precise, and safe.

Perceptions About Treatment Of Psychiatric Disorders By Faith Healers/ Psychiatrists Among General Public Of Urban And Rural Areas Of Rawalpindi District.

BACKGROUND: With the passage of time, there has been a drastic increase in psychiatric disorders in past few decades across the world. Due to lack of education and awareness in the rural community, a majority of people still have strong misconceptions about the causation of psychiatric disorders and hence serve as a barrier for their medical treatment. METHODS: A comparative cross-sectional study was conducted in the urban and rural areas of Rawalpindi district from March to August 2015, to find out the perception about treatment of psychiatric disorders among general public. Structured closed ended questionnaire was used to collect data from the participants and the results were analysed using SPSS. Chi square test was used to determine the association between categorical variables among urban and rural areas. RESULTS: The finding of our study confirmed that people of urban areas tend to choose and seek treatment by psychiatrists more (74%) as compared to those living in rural area that tends to select and believe in methodology and treatment provided by faith healers (55%). Lack of education, poor socioeconomic status, high treatment cost and most importantly false beliefs were the major contributory factors for people of rural areas in their inclination towards faith healers. CONCLUSIONS: The study concluded that most of the people of rural areas seek and trust the treatment by faith healers more as compared to psychiatrists. The importance of education and insight for the disorder cannot be denied for proper decision making about treatment choices.

Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The natural history of COPD is punctuated by exacerbations which have major short- and long-term implications on the patient and healthcare system. Evidence-based guidelines stipulate that early detection and prompt treatment of exacerbations are essential to ensure optimal outcomes and to reduce the burden of COPD. Several factors can identify populations at risk of exacerbations. Implementing prevention measures in patients at risk is a major goal in the management of COPD.

Chewing areca nut, betel quid, oral snuff, cigarette smoking and the risk of oesophageal squamous-cell carcinoma in South Asians: a multicentre case-control study.

Oesophageal cancer remains an important public health problem worldwide. This multicentre matched case-control study examined the chewing areca nut alone, betel quid with tobacco, oral snuff (snuff dipping) and cigarette smoking as the risk factors for oesophageal squamous-cell carcinoma. We enrolled 91 cases of oesophageal squamous-cell carcinoma and 364 matched controls from three tertiary-care hospitals in Karachi, Pakistan. A structured questionnaire was used to collect the data through face-to-face interview of the participants. Multivariable conditional logistic regression model showed that after adjusting for the effect of ethnicity, ever chewed areca nut alone (adjusted matched odds ratio (mOR(adj))=3.7; 95% confidence interval (CI): 1.6-8.5), ever chewed betel quid with tobacco (mOR(adj)=12.8; 95% CI: 6.3-26.2), ever practiced snuff dipping (mOR(adj)=4.3; 95% CI: 1.6-11.7) and ever smoked cigarettes (mOR(adj)=2.9; 95% CI: 1.4-5.9) were significantly and independently associated with oesophageal squamous-cell carcinoma status. The adjusted summary population attributable risk (PAR) percent for all four substances together was 67.0. Furthermore, despite incomplete synergy, there was manifold increase in the risk of oesophageal squamous-cell carcinoma, if the respondents ever smoked cigarettes and ever chewed betel quid with tobacco (mOR(adj)=21.4; 95% CI: 6.3-72.4) or if they ever smoked cigarettes and ever practiced snuff dipping (mOR(adj)=14.4; 95% CI: 2.3-91.1). The adjusted PAR (%) was higher for the dual practice of smoking cigarettes and chewing betel quid with tobacco (64.3) than the dual practice of smoking cigarettes and snuff dipping (32.2). Public awareness to curtail the addiction to these substances may result in a substantial reduction in the incidence of oesophageal squamous-cell carcinoma and related mortality in this and similar settings.

The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma.

BACKGROUND: A considerable body of evidence supporting the use of external drainage after evacuation of primary chronic subdural hematoma (CSDH) exists in the literature. However, no systematic study of the value of postoperative drainage in the treatment of recurrent CSDH has been published. The aim of the study was to investigate external drains and subdural-to-peritoneal conduit in the treatment of recurrent CSDH. METHODS: A retrospective review of cases of CSDH treated in our institution between October 2002 and October 2006 was conducted. RESULTS: During the study period, 408 patients had burr hole evacuation. Sixty-four patients (15.9%) had treatment for recurrence. One patient had craniotomy, and the remaining 63 had another burr hole evacuation: 36 without placement of a drain (BHO), 14 with external drainage (SED), and 13 with placement of subdural-peritoneal catheter (SPC). Fifteen patients (24%) developed a secondary recurrence requiring a third drainage procedure. Postoperative drainage (SED or SPC) was associated with a significantly lower secondary recurrence rate when compared to BHO: 3/27 (11%) versus 12/36 (33%) (χ(2), P=.040). There was no significant difference in recurrence rates between SED and SPC. Postoperative complications included acute subdural hematoma (2), subdural empyema (2), brain edema (2), pneumonia (3), and in-hospital death (2). None of the complications was associated with the use of a specific technique. CONCLUSIONS: The results indicate that, as in the treatment of primary CSDHs, the use of drain (SED or SPC) with burr hole evacuation is safe and is associated with lower recurrence rate. Further investigation is needed to clarify the indications of currently available surgical techniques in the treatment of recurrent CSDH.

Rapid development of glioblastoma at the site of atypical meningioma resection.

The authors describe symptomatic presentation of glioblastoma within six months of resection of an atypical meningioma, at the same frontal parafalcine cerebral location. The patient had neither prior nor adjuvant radiotherapy nor known genetic risk factors. Possible links between invasive meningioma and transformation of adjacent glial cells or precursors to malignant glioma are discussed.

Adaptive discriminant wavelet packet transform and local binary patterns for meningioma subtype classification.

The inherent complexity and non-homogeneity of texture makes classification in medical image analysis a challenging task. In this paper, we propose a combined approach for meningioma subtype classification using subband texture (macro) features and micro-texture features. These are captured using the Adaptive Wavelet Packet Transform (ADWPT) and Local Binary Patterns (LBPs), respectively. These two different textural features are combined together and used for classification. The effect of various dimensionality reduction techniques on classification performance is also investigated. We show that high classification accuracies can be achieved using ADWPT. Although LBP features do not provide higher overall classification accuracies than ADWPT, it manages to provide higher accuracy for a meningioma subtype that is difficult to classify otherwise.