A Rare Incidence of Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Heart.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths and the sixth most commonly diagnosed cancer worldwide due to several common risk factors, including hepatitis C virus (HCV), hepatitis B virus (HBV), and other causes of cirrhosis. In HCC, intrahepatic vascular invasion and a tumor thrombus are commonly observed. However, the extrahepatic spread of the tumor thrombus to the heart via the portal vein, hepatic vein, and inferior vena cava (IVC) is rarely reported and is considered a poor prognostic factor. In addition, rarely, there is a risk of cor pulmonale and thromboembolism of the pulmonary vessels. Our patient also presented with this rare complication of HCC. Our patient's clinical presentation was bilateral pedal edema, moderate ascites, and abdominal discomfort with raised jugular venous pressure. These signs and symptoms are related to an impairment of the right heart caused by intracardiac tumor thrombus metastasis, leading to diastolic dysfunction. Based on these findings, echocardiography and abdominal computed tomography (CT) scan were performed with the definitive diagnosis of hepatocellular carcinoma with tumor thrombus metastases in the hepatic vein, inferior vena cava, and right atrium. The management team agreed on a conservative treatment plan based on the advanced stage of the disease and the high risk associated with aggressive treatment modalities. Unfortunately, on day 7 of admission, the patient died from a possible pulmonary embolism that led to cardiopulmonary arrest. This case underscores the importance of screening patients with a high HCC tumor burden with abdominal ultrasound and echocardiography for early detection and timely management.

Effects of a long-term operation wetland for wastewater treatment on the spatial pattern and function of microbial communities in groundwater.

Constructed wetlands have been used globally for wastewater treatment owing to low energy inputs and operating costs. However, the impact of their long-term operation on groundwater microbial communities is still unclear. This study aims to investigate the effects and further reveal the linkage between a large-scale surface flow constructed wetland (in operation for 14 years) and groundwater. Changes in the characteristics of groundwater microbial communities and their potential influencing factors were studied based on hydrochemical analysis, Illumina MiSeq sequencing, and multivariate statistical analysis methods. Results show that the long-term operation wetland significantly elevated groundwater nutrient levels and increased the risk of ammonia nitrogen pollution compared to background values. An apparent heterogeneity of microbial communities exhibited in the vertical direction and a similarity in the horizontal direction. Wetland operations substantially altered the structure of microbial communities at 3, 5, and 12 m depths, particularly a reduced abundance of denitrifying and chemoheterotrophic functional genera. The formation and evolution of groundwater microbial community structure mainly subjected to the contributions of dissolved oxygen (33.70%), total nitrogen (21.40%), dissolved organic carbon (11.09%), and pH (10.60%) variations resulted from the wetland operation and largely differed in depths. A combined effect of these factors on the groundwater should be concerned for such a long-term running wetland system. This study provides a new insight into the responses of groundwater microbial community structure driving by wetland operation and a better understanding of corresponding variation of microbial-based geochemical processes.

Effects of Fe(II) and organic carbon on nitrate reduction in surficial sediments of a large shallow freshwater lake.

Nitrate-reducing ferrous [Fe(II)]-oxidizing (NRFO) has been reported from lake sediments as a natural reduction pathway. However, the effects of the contents of Fe(II) and sediment organic carbon (SOC) on the NRFO process still remain unclear. In this study, the influences of Fe(II) and organic carbon on nitrate reduction were analyzed quantitatively at two typical seasonal temperatures (25 °C representing summers and 5 °C for winters) by conducting a series of batch incubation experiments, using surficial sediments at the western zone of Lake Taihu (Eastern China). Results showed that Fe(II) greatly promoted NO3‾-N reduction by denitrification (DNF) and dissimilatory nitrate reduction to ammonium (DNRA) processes at high-temperature (25 °C, representing summer season). As Fe (II) increased (e.g., Fe(II)/NO3‾ = 4), the promotion effect on NO3‾-N reduction was weakened, but on the other side, the DNRA process was enhanced. In comparison, the NO3‾-N reduction rate obviously decreased at low-temperature (5 °C, representing the winter season). NRFO in sediments mainly belongs to biological rather than abiotic processes. A relatively high SOC content apparently increased the rate of NO3‾-N reduction (r = 0.023-0.053 mM/d), particularly on the heterotrophic NRFO. It is interesting that the Fe(II) consistently remained active in the nitrate reduction processes no matter whether SOC was sufficient in the sediment, particularly at high-temperature. Overall, the combining effects of both Fe(II) and SOC in surficial sediments made a great contribution towards NO3‾-N reduction and N removal in a lake system. These results provide a better understanding and estimation of N transformation in sediments of the aquatic ecosystem under different environmental conditions.

Corona Virus Disease-19 Clinical And Laboratory Characteristics Associated With Disease Severity In Patients Presenting At A Tertiary Care Hospital Of Peshawar.

BACKGROUND: Coronavirus disease-19 has a wide range of clinical presentations and varied outcomes. It is a new disease and researchers are trying to explore its clinical presentation and outcome to know more about the course of the disease. The objective of the present study was to determine the clinical and laboratory characteristics of Coronavirus disease-19 associated with severity of the disease. METHODS: This cross-sectional study was conducted at Rehman Medical Institute, Peshawar from April to August 2020. All patients presented to the hospital and were diagnosed as COVID-19 were enrolled in this study. Disease characteristics and clinical outcomes were noted in both mild and severe cases. Patients were divided into 2 groups based on the disease severity and a comparison was made between these groups in terms of demographics, lab parameters and outcomes. Data were analysed by using SPSS version 24. RESULTS: Out of 227 patients, 80.2% (n=182) were males while 19.8% (n=45) were females. The mean age of the patients was 54.44±14.35 yrs. 61.2% (n=139) had co-morbidities with diabetes being the most common. 26.9% (n=61) had severe disease and 18.1% (n=41) died.20.7% (n=47) had lymphopenia, 48.45% (n=110) had leucocytosis and thrombocytopenia was seen in 11.89% (n=27). CRP, D-dimers, ferritin and LDH were raised in 83.25% (n=189), 80.17% (n=182), 81.05% (n=184), 77.09% (n=175) of the patients respectively. Comparing our designated patient groups revealed that old age, comorbidities, leucocytosis, lymphopenia, raised inflammatory markers were associated with severe disease and that mortality was high in the severe disease group. CONCLUSION: Middle-aged males with comorbidities were the most affected subset of patients. Disease severity was associated with old age, comorbidities and certain lab abnormalities. The outcome was poor in case of severe disease. However, no gender correlation was found with disease severity.