Management of a rare symptomatic retrocaval ureter: a case report with review of literature.

Retrocaval ureter is a rare congenital vascular anomaly with an incidence of 0.13%, leading to the passage of the right ureter behind the inferior vena cava and then turning around it to attain its lateral position. The condition is usually associated with obstruction in the right kidney and proximal ureter leading to symptoms like dull aching pain in the flanks, recurrent episodes of urinary tract infections, and recurrent stone formation. The patient presented with recurrent episodes of burning micturition and pain in the right flank for the past 6 months. A contrast-enhanced computed tomography kidney-ureter-bladder was done to diagnose the condition. The patient was managed by open pelviureteric anastomosis lateral to the inferior vena cava, thus eliminating the obstruction on the ureter. The patient has had an uneventful postoperative follow-up. Retrocaval ureter is a rare condition and should be clinically suspected in cases of hydronephrosis where other causes have been ruled out. Different approaches can be used to correct the anomaly. In this case report, an open transperitoneal intraabdominal approach has been used.

Multi-medium residues and ecological risk of herbicides in a typical agricultural watershed of the Mollisols region, Northeast China.

The widespread use of herbicides impacts non-target organisms, promotes weed resistance, posing a serious threat to the global goal of green production in agriculture. Although the herbicide residues have been widely reported in individual environmental medium, their presence across different media has received scant attention, particularly in Mollisols regions with intensive agricultural application of herbicides. A systematic investigation was conducted in this study to clarify the occurrence of herbicide residues in soil, surface water, sediments, and grains from a typical agricultural watershed in the Mollisols region of Northeast China. Concentrations of studied herbicides ranged from 0.30 to 463.49 µg/kg in soil, 0.31-29.73 µg/kg in sediments, 0.006-1.157 µg/L in water, and 0.32-2.83 µg/kg in grains. Among these, Clomazone was the most priority herbicide detected in soil, sediments, and water, and Pendimethalin in grains. Crop types significantly affected the residue levels of herbicides in grains. Clomazone posed high ecological risks in soil and water, with 86.4 % of water samples showing high risks from herbicide mixtures (RQ > 1). These findings aid in enhancing our comprehension of the pervasive occurrence and potential ecological risks of herbicides in different media within typical agricultural watersheds, providing detailed data to inform the development of targeted mitigation strategies.

Occurrence, distribution and ecological risk assessment of herbicide residues in cropland soils from the Mollisols region of Northeast China.

The first systematic and comprehensive investigation of herbicide residues was conducted by identifying their spatial distribution, influencing factors and ecological risk in cropland soils from the Mollisols region covering 109 million hm2 in Northeast China. Fifty-six herbicides were detected with total herbicide concentrations ranging from 1.01 to 1558.13 µg/kg (mean: 227.45). Atrazine, its degradates deethyl atrazine (DEA) and deisopropyl atrazine (DIA), trifluralin and butachlor were the most frequently detected herbicides, while DEA, clomazone, nicosulfuron, fomesafen, and mefenacet exhibited the highest concentrations. Despite being less frequently reported in Chinese soils, fomesafen, nicosulfuron, clomazone, and mefenacet were found widely present. Although most of the compounds posed a minimal or low ecological risk, atrazine, nicosulfuron and DEA exhibited medium to high potential risks. The key factors identified to regulate the fate of herbicides were soil chemical properties, amount of herbicides application, and the crop type. The soybean soils showed highest herbicide residues, while the soil mineral contents likely adsorbed more herbicides. This study provides a valuable large-scale dataset of herbicide residues across the entire Mollisols region of China along with fine-scale characterization of the ecological risks. Mitigation and management measures are needed to reduce the herbicide inputs and residues in the region.

Multivariate Analysis of Effective Dose and Size-Specific Dose Estimates for Thorax and Abdominal Computed Tomography.

The study aimed to compute the effective dose (E) and size-specific dose estimate (SSDE) of routine adult patients undergoing thorax and abdominal computed tomography (CT) imaging and to present their multivariate analysis. All adult thorax and abdominal CT examinations conducted from March 2022 to June 2022 were prospectively included in this study. The Water Equivalent Diameter (Dw) and SSDE of all the examinations were computed from CT dose index volume (CTDIvol) and Dose length product (DLP) displayed on the dose report in the CT console. The multivariate statistical analysis was performed to investigate the correlation of SSDE and E on CTDIvol, Dw area of the region of interest (ROI) (AreaROI), body mass index (BMI), conversion factor (fsize) and hounsfield (HUmean) number in the ROI at 95% level of significance (P < 0.05). The linear regression analysis was performed to investigate the dependence of SSDE and E on other parameters for both abdominal and thorax patients. A total number of 135 (Abdomen = 61 and Thorax = 74) measurements were performed. The mean value of effective dose for abdomen and thorax patients was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv, respectively. The SSDE was observed to be 13.24 ± 3.61 and 13.04 ± 3.61 mGy for thorax and abdomen respectively. The multivariate analysis suggests that SSDE for abdominal CT is found significantly dependent on CTDIvol, Dw and fsize with P < 0.05 and E is found to be significantly dependent on DLP, AreaROI, Dw and fsize at 95% level of confidence for abdominal CT imaging. SSDE for thorax CT was found significantly dependent on BMI, CTDIvol, HUmean, Dw and fsize at 95% level of confidence. Furthermore, E was observed dependent on DLP at P < 0.05. The linear regression analysis also shows that E is strongly correlated with DLP (r = 1.0) for both thorax and abdominal CT, further the SSDE was observed strongly correlated with CTDIvol with r = 0.79 and r = 0.86 for abdomen and thorax CT respectively. A strong correlation was observed between BMI and for Dw abdominal CT imaging (r = 0.68). The mean value of SSDE for thorax is slightly greater than abdomen. The average value of effective dose for abdomen and thorax measurements was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv and , correspondingly. SSDE for both abdomen and thorax CT is significantly dependent on CTDIvol, Dw and fsize at 95% level of confidence. The strong correlation was also observed E on DLP and SSDE on CTDIvol for both Abdomen and Thorax CT. The strong dependence of Dw on BMI (r = 0.68) is due to the excessive fat concentration around the stomach and abdomen.

Crimean-Congo Hemorrhagic Fever Presented in Dengue Epidemic: A Case Report.

In Pakistan, hemorrhagic diseases, including dengue and Crimean-Congo hemorrhagic fever (CCHF), are common. Therefore, an accurate diagnosis is challenging in the early stages of sickness owing to geographic overlap and early clinical similarities between the two disorders. A 35-year-old man who had previously experienced hematemesis and high-grade fever presented to our hospital. Despite receiving supportive care for a preliminary diagnosis of dengue hemorrhagic fever, the patient's condition worsened. The results of the dengue IgM antibody test were negative. On the fourth day of admission, a qualitative polymerase chain reaction test for CCHF virus RNA was performed, and the result returned positive. All medical personnel and attendants who had contact with the patient had to receive ribavirin prophylaxis, which required significant investment in resources. Because CCHF can have long-term financial and health repercussions for contacts, including healthcare personnel in developing nations, it is essential to identify and treat it as soon as possible. It is necessary to keep track of dengue and CCHF cases more closely to develop predictors of disease diagnosis that are reasonably trustworthy, affordable, and quick. These predictors can aid in directing future choices regarding the care of similar situations. Ultimately, such an approach might result in improved cost control in environments with limited resources. Consideration should also be given to patients who receive ribavirin prophylaxis.

Empathy Levels in Medical Students: A Single Center Study.

Objectives To determine the level of empathy in medical students and to determine the difference in empathy levels between the two genders in a single center. Materials & methods This qualitative study was conducted at a medical college in Peshawar from March 2021 to July 2021. Institutional ethical committee approval was taken (RMI/RMI-REC/Approval/83) before commencing the study. All students admitted into the medical college in the current academic year 2020 to 2021 were included in the study. Any students that did not fill out the questionnaire completely were excluded. The Toronto Empathy Questionnaire (TEQ) was used in this study. The questionnaire was uploaded on google forms for data collection. All the resulting scores were entered into IBM SPSS version 23.0. The mean TEQ score was calculated. Box and whisker plots were made for respective years. An Independent sample t-test was used to determine the association between mean TEQ scores and gender. Results Of 367 students, 347 (94.6%) participated in this study, with a slight female predominance (53%). The mean age of the students was 21.44 (SD = 1.751) years. The participation rate was ≥70% from each class. Most participants across the years have an above-average empathy score (49.9%). Among the participants, the year I (67.6%) showed most participants with high empathy. Year IV (40.6%) has the highest proportion of below-average empathy scores. The mean empathy score of female students was 49.08 (S.D = 7.588), while the empathy score for male students was 44.59 (S.D = 7.58). Conclusion Empathy levels decline as medical education is progressed through the years. Females show a greater sense of empathy than their male counterparts. A slight increase in empathy levels is seen in the final year of medical school after a decline over the initial years.

Recurrent solitary fibrous tumor of eyelid: A rare entity.

Orbital and adnexal solitary fibrous tumors (SFT) are rare entities. The clinico-radiological and histologic features overlap with those of other spindle cell variants, and hence the use of immunohistochemical stains helps in making an accurate diagnosis. Furthermore, a thorough surgical resection is imperative to prevent tumor recurrences. We report a rare case of SFT arising primarily from the eyelid with multiple recurrences.

Long-term outcomes of transcutaneous retrobulbar amphotericin B in COVID-19-associated mucormycosis.

Purpose: To describe the long-term outcomes of transcutaneous retrobulbar amphotericin B (TRAMB) in COVID-19-associated mucormycosis. Methods: In total, 18 cases of COVID-19-associated mucormycosis were reviewed. In addition to the recommended treatment protocol, all patients were to be given 3.5 mg/ml/day of TRAMB for five days. Results: Of the 18 patients, 2 presented with stage 3a disease, 13 had stage 3c disease, and 3 patients had central nervous system (CNS) involvement (stage 4a and 4c). In addition to planned retrobulbar doses, five patients were given more while two patients received fewer injections (i.e., <5). At the last mean follow-up of 34.67 (±8.88) weeks, 11 patients were in radiological regression and 4 had stable disease while 2 patients had to undergo exenteration; one mortality was observed because of disease progression. Clinical regression in terms of visual and ptosis improvement was seen in seven and nine patients, respectively. Conclusion: Rhino-orbito-cerebral mucormycosis is a serious condition which warrants an aggressive treatment strategy. In unprecedented situations witnessed recently, TRAMB turned out to be an effective and economical alternative. Though large randomized studies are needed to establish its efficacy, TRAMB still manages to halt progression and salvage the globe in significant number of patients, and hence its use should be encouraged on a case-to-case basis especially in developing countries with limited resources.

Albright hereditary osteodystrophy: Delay in the diagnosis of a rare disorder due to restricted medical services.

A teenage Afghan girl presented with seizure. Clinical features and laboratory investigations revealed elevated serum parathormone, high phosphate levels with low serum calcium. In third-world countries, diagnosis of rare disorders, such as Albright hereditary osteodystrophy (AHO), can usually be delayed due to scarcity of standard medical and diagnostic services.

Risk factors associated with esophageal cancers, diagnosed at tertiary level in Afghanistan: a descriptive cross-sectional study.

BACKGROUND: Worldwide, esophageal cancer (EC) is a common cancer in term of incidence and mortality and is the 4th common cancer in Afghanistan. Current study aimed to evaluate the profile of risk factors for EC among patients diagnosed at tertiary level in Afghanistan. METHODOLOGY: A descriptive cross-sectional study was carried out between January 2019 up to February 2021 including all esophageal cancers diagnosed at pathology department of French Medical Institute for Mothers and Children, Afghanistan. RESULT: 240 diagnosed cases were analyzed, in which 59.40% of squamous cell carcinoma and 41.07% Adenocarcinoma. Both histopathological type of were predominantly diagnosed in males. The majority of the patients were residents of rural areas. More than 80% of the patients were illiterate with only less than 2% completing higher education. Majority of the patients were laborers and farmers while less than 10% were employed. According to income assessment, more than 80% were from low-income household, the rest from middle-income and none from high-income family. Oral snuff consumption was noted in 33.9% of squamous cell carcinoma patients and 40% adenocarcinoma patients whereas, family history of esophageal cancer was observed in 37.8% and 36.7% in both types of carcinomas, respectively. More than 60% of both types of carcinomas patients were hot tea drinkers. CONCLUSION: Current study demonstrated that most patients diagnosed with esophageal cancers were male, uneducated, belongs to low-income groups, lives in rural areas. These findings suggest distribution of esophageal cancer in specific socioeconomic groups, clearly demonstrating the need further analytical study.

FNAC study of giant cell tumor of tendon sheath (localized tenosynovial giant cell tumor): Clinico-radiological correlation and cytopathological features.

BACKGROUND: Localized tenosynovial giant cell tumor (GCT) or giant cell tumor of tendon sheath (GCTTS), is a benign nodular lesion that arises from the synovium of the tendon sheath of the hands and foot. GCTTS is characterized by the presence of multinucleated giant cells and proliferation of synovial-like mononuclear cells. A clinical diagnosis of GCTTS is kept as a differential when a firm, nodular mass shows decreased signal intensity on both T1-and T2-weighted MR imaging. Treatment is usually marginal excision of the mass. MATERIAL AND METHODS: It is a retrospective study, observed in the past 3 years at a tertiary care hospital. Those cases were included in the study in which histopathological confirmation was available or if clinico-radiological features were confirmatory of the diagnosis of GCTTS when correlated with cytological features. RESULTS: There was a total of 24 cases, out of which 16 were females and 8 males. The tumor was located in the upper limb in 21 cases and in 3 cases the tumor was present in the lower limb. In the upper limb, 18 cases were on the right side and three cases were on the left side. In the lower limb, 1 case was present on the left and 2 on the right side. The cytomorphology consisted of mononuclear stromal cells, multinucleated giant cells, and hemosiderin-laden macrophages in variable numbers. CONCLUSION: It is important to accurately diagnose and categorize giant cell-containing lesions because their prognosis depends on the exact categorization of the tumor.

Cinnamaldehyde and eugenol attenuates collagen induced arthritis via reduction of free radicals and pro-inflammatory cytokines.

BACKGROUND: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease which leads to bone and cartilage erosion. Oxidative stress and pro-inflammatory cytokines plays crucial role in the pathophysiology of RA. Cinnamaldehyde and eugenol have a long history of medical use in various inflammatory disorders. PURPOSE: The drugs available for the treatment of RA are associated with various side effects. The present study was conducted to evaluate the anti-arthritic effects of cinnamaldehyde and eugenol in rat model of arthritis. METHODS: Type II collagen was intradermally injected to rats for the induction of arthritis. Cinnamaldehyde (10 and 20 mg/kg/day) and eugenol (10 and 20 mg/kg/day) were given orally for 15 days, starting from day 21 to 35. Dexamethasone treated rats served as positive control. Histological, radiological and scanning electron microscopic analysis were done to monitor the effect of compounds on collagen induced arthritis (CIA). Reactive oxygen species (ROS) formation, nitric oxide and antioxidant status were also determined. The markers of biomolecular oxidation (protein, lipid and DNA) and activities of enzymatic antioxidants (superoxide dismutase, glutathione peroxidase, catalase and glutathione reductase) were also evaluated in the joint homogenate and plasma of rats. For detecting inflammation, levels of TNF-α, IL-6 and IL-10 were monitored by ELISA. RESULTS: Our results showed anti-oxidant and anti-inflammatory effects of cinnamaldehyde and eugenol in arthritic rats. Scanning electron microscopy, histopathological and radiological findings also confirmed the anti-arthritic effects of cinnamaldehyde and eugenol. Both the compounds were effective in bringing significant decrease in the levels of ROS, nitric oxide, markers of biomolecular oxidation and increase in enzymatic and non-enzymatic antioxidants. The levels of TNF-α, IL-6 and IL-10 were also ameliorated by cinnamaldehyde and eugenol treatment. Between the two phytochemicals used, eugenol was found to be more effective than cinnamaldehyde in reducing the severity of arthritis. CONCLUSION: Cinnamaldehyde and eugenol were effective in ameliorating oxidative stress and inflammation in arthritic rats. These findings indicate that cinnamaldehdye and eugenol have a great potential to be used as an adjunct in the management of RA.

Solitary fibular metastasis from nonsmall cell lung carcinoma.

Solitary bone metastasis to fibula in patients of lung carcinoma is a rare entity, with only four cases reported in literature. We, hereby, present a case of a 50 year-old-male who was given three cycles of chemotherapy for lung carcinoma with no distant metastasis but presented 2 months later with a fusiform, painful swelling around the knee that was clinically suspected to be inflammatory in nature but proved to be fibular metastasis on cytology. There was no evidence of skeletal metastasis on initial bone scan. He was given palliative radiotherapy for this with symptomatic relief.

Intraventricular migration of an isolated fourth ventricular cysticercus following cerebrospinal fluid shunting.

BACKGROUND: Isolated intraventricular neurocysticercosis (NCC) is less frequently seen and can be missed on plain magnetic resonance imaging (MRI). Three-dimensional constructive interference in steady state (CISS) sequence is an extremely helpful sequence in identifying the lesion but is rarely used routinely. CASE DESCRIPTION: Here, we report a case of young male adult who presented with diminution of vision and headache. MRI of the brain revealed hydrocephalus, and on using CISS sequence only, the lesion could be identified in the fourth ventricle. He was treated with medical management, and ventriculoperitoneal shunting of cerebrospinal fluid was done to relieve the hydrocephalus. It resulted in immediate relief with aggravation of headache few days later. Repeat MRI revealed intraventricular migration into the left foramen of monro leading to left lateral ventricle dilatation necessitating endoscopic removal of the lesion. CONCLUSION: CISS sequence is definitely the sequence of choice in identifying intraventricular NCC. Ventriculoperitoneal shunting can result in the intraventricular migration of the cyst due to sudden decompression necessitating repeat surgery. Endoscopic removal of NCC has a high success rate with limited complications.

Chronic pain along the lateral condyle of humerus.

[No Abstract Available].

Comparison of Magnetic Resonance Imaging Findings between Pathologically Proven Cases of Atypical Tubercular Spine and Tumour Metastasis: A Retrospective Study in 40 Patients.

STUDY DESIGN: Retrospective study. PURPOSE: To note the magnetic resonance imaging (MRI) differences between pathologically proven cases of atypical spinal tuberculosis and spinal metastasis in 40 cases. OVERVIEW OF LITERATURE: Spinal tuberculosis, or Pott's spine, constitutes less than 1% of all cases of tuberculosis and can be associated with a neurologic deficit. Breast, prostate and lung cancer are responsible for more than 80% of metastatic bone disease cases, and spine is the most common site of bone metastasis. Thus, early diagnosis and prompt management of these pathologies are essential in preventing various complications. METHODS: We retrospectively reviewed 40 cases of atypical tuberculosis and metastasis affecting the spine from the year 2012 to 2014, with 20 cases each that were proven by histopathological examination. MR imaging was performed on 1.5 T MR-Scanner (Magnetom Avanto, Siemens) utilizing standard surface coils of spine with contrast injection. Chi-square test was used for determining the statistical significance and p-values were calculated. RESULTS: The most common site of involvement was the thoracic spine, seen in 85% cases of metastasis and 65% cases of Pott's spine (p=0.144). The mean age of patients with tubercular spine was found to be 40 years and that of metastatic spine was 56 years. The following MR imaging findings showed statistical significance (p<0.05): combined vertebral body and posterior elements involvement, skip lesions, solitary lesion, intra-spinal lesions, concentric collapse, abscess formation and syrinx formation. CONCLUSIONS: Tuberculosis should be considered in the differential diagnosis of various spinal lesions including metastasis, fungal spondylodiskitis, sarcoidosis and lymphoma, particularly in endemic countries. Spinal tuberculosis is considered one of the great mimickers of disease as it could present in a variety of typical and atypical patterns, so proper imaging must be performed in order to facilitate appropriate treatment.

Interactive effects of phosphorus and Pseudomonas putida on chickpea (Cicer arietinum L.) growth, nutrient uptake, antioxidant enzymes and organic acids exudation.

Phosphorus (P) availability in alkaline soils of arid and semi-arid regions is a major constraint for decreased crop productivity. Use of plant growth promoting rhizobacteria (PGPR) may enhance plant growth through the increased plant antioxidation activity. Additionally, PGPR may increase nutrient uptake by plants as a result of induced root exudation and rhizosphere acidification. The current study was aimed to investigate combined effects of P and Pesudomonas putida (PGPR) on chickpea growth with reference to antioxidative enzymatic activity and root exudation mediated plant nutrient uptake, particularly P. Half of the seeds were soaked in PGPR solution, whereas others in sterile water and latter sown in soils. Plants were harvested 8 weeks after onset of experiment and analyzed for leaf nutrient contents, antioxidant enzymes activities and organic acids concentrations. Without PGPR, P application (+P) increased various plant growth attributes, plant uptake of P and Ca, soil pH, citric acid and oxalic acid concentrations, whereas decreased the leaf POD enzymatic activity as compared to the P-deficiency. PGPR supply both under -P and +P improved the plant growth, plant uptake of N, P, and K, antioxidative activity of SOD and POD enzymes and concentrations of organic acids, whereas reduced the rhizosphere soil pH. Growth enhancement by PGPR supply was related to higher plant antioxidation activity as well as nutrient uptake of chickpea including P as a result of root exudation mediated rhizosphere acidification.

Coexistent borderline serous cystadenoma with multifocal hydatidosis in a young female: lessons learnt.

Hydatid disease (HD) is a commonly occurring zoonotic disease caused by tapeworms of the genus Echinococcus. It is endemic in many parts of the world and can involve almost any organ of the body. Although HD of the liver and lungs is quite common, ovarian involvement is rare. We present a case of a 24-year-old female patient who was diagnosed with multifocal hydatidosis involving the liver and bilateral ovaries on imaging. Postoperative histopathology confirmed the hydatid disease in the liver and one ovary. However, the cystic lesion in the other ovary turned out to be a borderline serous cystadenoma. This case highlights the limitation of imaging in differentiating between simple hydatid cysts and serous cystadenomas of the ovaries. Another point we learnt is that even in the presence of multifocal hydatidosis in endemic regions, serous cystadenoma needs to be considered in imaging differential diagnosis.