Role of vitamin D in treating COVID-19-associated coagulopathy: problems and perspectives.

Aggressive inflammatory response leading to hypercoagulability has been found to be associated with disease severity in COVID-19 patients and portends bad treatment outcome. A state of acute disseminated intravascular coagulation (DIC), along with pulmonary embolism and/or deep vein thrombosis, has been observed in critically ill ICU patients. Autopsy reports of COVID-19 patients demonstrated microthrombi in lungs and in other organs, as well as marked inflammatory changes, characteristic clinicopathological features that exacerbate disease severity. Vitamin D supplementation was recommended by many clinicians across the globe to improve clinical symptoms of COVID-19 patients, mainly because of its immunomodulatory roles on immune cells. Furthermore, vitamin D and its associated molecules are also known to directly or indirectly regulate various thrombotic pathways. We propose that vitamin D supplementation not only attenuates the risk of Acute Respiratory Disease Syndrome (ARDS) but it also may have a role in reducing coagulation abnormalities in critically ill COVID-19 patients. The overarching goal of this review is to discuss the effects of vitamin D on coagulation pathways and other intertwined processes leading to thrombosis. Many clinical trials are currently investigating the efficacy of vitamin D supplementation in reducing the risk of COVID-19 infection. However, randomized placebo control clinical trials are also necessary to ascertain the effect of vitamin D supplementation on reducing the risk of coagulopathy in COVID-19 patients.

A Rare Urachal Cyst in a Case of Ketamine-induced Cystitis Provides Mechanistic Insights.

OBJECTIVE: To establish whether the urothelial ulceration observed in ketamine-induced cystitis is triggered by urinary or systemic factors. This was achieved with a rare case where an urachal cyst was found near the bladder dome in a patient undergoing cystectomy for unremitting pain following ketamine abuse. METHODS: Clinical investigations included cystoscopy, video urodynamic investigation, and computed tomography of the kidneys, ureters, and bladder. Histological staining was combined with immunoperoxidase labeling for markers of transitional epithelial differentiation. RESULTS: The urachus found near the dome of the bladder was observed to be a separate cyst, with no evidence of patency found during surgery or video urodynamic investigation. The urachus was lined by a mildly reactive metaplastic epithelium of mixed transitional and columnar morphologies. Evidence of widespread cytokeratin 13, basal p75(NTR), and sparse superficial uroplakin 3a immunoreactivity suggested the urachal epithelium was fundamentally transitional in nature. Near total loss of bladder urothelium was observed from regions in contact with urine, whereas the urachal epithelium (not exposed to urine) remained healthy. CONCLUSION: This study supports the hypothesis that urinary (and not systemic) factors are the main driver of urothelial ulceration in ketamine-induced cystitis. The most likely excreted factors responsible are ketamine and potentially its metabolites. This study reinforces the importance of complete cessation of ketamine use in patients with ketamine-induced cystitis.

[Umbilical cord cyst--should it concern us?].

INTRODUCTION: Advancements in sonographic technology have led to improved prenatal detection of fetal umbilical cord and placental anomalies. The prevalence of umbilical cord cystic masses detected in the first trimester is 0.4% to 3.4%. The second- and third-trimester umbilical cord cysts are a rare sonographic finding and its prevalence is unknown. There is a strong association between umbilical cord cysts and fetal anomalies but not in all cases. The main questions are: what are the implications of these findings and what is the prenatal follow-up that should be offered. CASE REPORT: In this study the authors present a case in which an umbilical cord cyst was diagnosed at 29 weeks of gestation following normal integrated test and anatomical sonographic survey. At 32 weeks of gestation, fetal karyotype was found to be normal. The outcome of the pregnancy was normal and so was the developmental follow-up during the first three years. DISCUSSION AND CONCLUSIONS: From the literature survey it appears that transient first-trimester cysts are not associated with chromosomal anomaLies, yet they might be associated with congenital maLformations, especially those of the abdominal wall and the urinary tract, and should lead to further detailed sonographic evaluation. Routine karyotype may not be necessary. Second and third trimester umbilical cord cystic masses accompanied by additional malformations are strongly associated with chromosomal anomalies, especially with trisomy 18. Second- and third-trimester umbilical cord cystic masses without additional abnormal findings were also found to be associated with chromosomal anomalies in some works. Therefore, these findings should be an indication for fetal karyotype. In the case of an isolated umbilical cord cyst with normal karyotype, serial sonographic evaluation is needed. If all these are normal, it may be presumed that the cyst is an isolated umbilical cord anomaly and that the fetal prognosis is good.

An infected urachal cyst containing an appendicolith: a case report.

We present a case of an 8-year-old girl with an infected urachal cyst containing an appendicolith found secondary to an appendico-urachal cyst fistula caused by perforated appendicitis. The clinical features and computed tomographic manifestations of this unusual case are discussed.

An unusual presentation of Crohn's disease.

The first case of an inflamed, discharging urachal remnant associated with granulomatous appendicitis in which the patient was subsequently found to have Crohn's disease is described.

Urachal-sigmoid fistula in an adult male without urachal cyst.

Urachal anomalies are uncommon defects arising either by incomplete obliteration of the urachus during the foetal period or by its reopening after postnatal regression. Five anomalies have been described: congenital patent urachus, urachal cyst, umbilical-urachal sinus, vesico-urachal diverticulum, and alternating sinus. Only congenital patent urachus is present at childbirth. The other forms are usually acquired disorders. Nevertheless, they commonly appear in children, being less common in the adult. Colic-urachal fistulas are quite uncommon findings. Only three cases have been reported thus far. The aim of this study is to report the fourth case of sigmoid-urachal fistula, and the first one appearing without an urachal cyst.

[Two cases of abdominal masses caused by foreign bodies which were preoperatively diagnosed as urachal abscess].

A 61-year-old man and a 59-year-old woman were referred to our hospital because of lower abdominal pain and discomfort, pollakisuria and a lower abdominal mass. In both patients, radiological studies and cystoscopy caused us to suspect a urachal abscess. We performed operations transperitoneally. In the male patient, fish bones were detected between the mass and ileum. A partial cystectomy was performed on the female patient, and the histological diagnosis was Sparganosis mansoni. In both cases, it was very difficult to make a correct diagnosis before the operations, but surgical treatment was successfully performed.

Urachal remnants in adults.

Urachal disorders are uncommon and present with varied appearances. Three cases of urachal disease, one congenital and two acquired, are reported. Each case is representative of the symptoms and findings of its respective category. A review of the literature is presented. A basic understanding of urachal development is necessary to suspect a diagnosis of urachal disease.

Uraco persistente en el adulto / Persisting urachus in the adult

Se presentan 2 casos de uraco persistente en el adulto. Un quiste y un uraco abierto a ombligo. Se discute la etiopatogenia. Ambos fueron resecados con éxito