Case Report Of A Rare Incidentaloma Of The Adrenal Gland-Schwannoma.

The Schwannoma is a benign growth of the nerve sheath cells most commonly seen in the vestibulocochlear nerve. Its prevalence in the adrenal gland is 1-3%. Here we discuss a case that presented as an incidentaloma of the right adrenal gland in a young male patient who had vague abdominal symptoms and a normal hormonal profile. He underwent an excisional biopsy of the right adrenal gland due to the large size of the lesion (more than 4cm). The histopathology report helped to establish the diagnosis of Schwannoma. Incidentaloma is defined as a lesion of the adrenal gland encountered on any radiological investigation carried out for symptoms that are not associated with adrenal pathologies. After discovering such lesions, it is imperative to perform radiological and hormonal investigations in an organised manner to plan further management of such cases.

A case report of an epidermoid inclusion cyst following repair of hypospadias.

INTRODUCTION AND IMPORTANCE: Epidermoid cysts also known as epidermal inclusion cysts are the most common type of cutaneous cysts. These are derived from ectoderm with a lining of stratified squamous epithelium. Penile epidermoid cysts however are very rare. We report a case of Fifteen years old male with complain of slow growing mass at ventral aspect of shaft of penis along with urethrocutaneous fistula following hypospadias surgery. Surgical excision was done of the cyst. Histopathology of the sample revealed an epidermoid cyst. CASE PRESENTATION: We report a case of a Fifteen years boy who underwent midshaft hypospadias repair at the age of five years. During postoperative period stent was removed and one week after that he developed a urethrocutaneous fisula. At seven years of age patient reported a small swelling on the penile shaft which gradually increased in size over the years, however, he seeks no medical care for it. CLINICAL DISCUSSION: At time of presentation swelling was separately appreciable from urehtrocuataneous fistula and extending from subcoroanal to midshaft of penis. We did excision of epidermal cyst and repair of urethrocutaneous fistula. CONCLUSIONS: Epidermal inclusion cyst as a complication of hypospadias surgery is a very rare situation. The diagnosis is made histologically and surgical excision is sufficient for treatment.

Demonstration of the synergistic effect of biochar and Trichoderma harzianum on the development of Ralstonia solanacearum in eggplant.

Soil degradation has been accelerated by the use of chemical pesticides and poor agricultural practices, which has had an impact on crop productivity. Recently, there has been a lot of interest in the use of eco-friendly biochar applications to enhance soil quality and sequester carbon in sustainable agriculture. This study aimed to determine the individual and combined effects of Leaf Waste Biochar (LWB) and the bio-control agent Trichoderma harzianum (BCA) on the development of bacterial wilt in eggplants (Solanum melongena) caused by Ralstonia solanacearum (RS). The effects of LWB and BCA on eggplant physiology and defense-related biochemistry were comprehensively examined. Inoculated (+RS) and un-inoculated (-RS) eggplants were grown in potting mixtures containing 3% and 6% (v/v) LWB, both with and without BCA. The percentage disease index was considerably reduced (90%) in plants grown in the 6% LWB+ BCA amended treatments. Moreover, the plants grown in LWB and inoculated with BCA had higher phenolics, flavonoids and peroxidase contents compared to the non-amended control. The level of NPK was significantly increased (92.74% N, 76.47% P, 53.73% K) in the eggplants cultivated in the 6% LWB + BCA composition. This study has shown that the association of T. harzianum with biochar improved plant growth and reduced R. solanacearum induced wilt. Furthermore, the combined impact of biochar and T. harzianum was greater in terms of wilt suppression and increase in plant physiological measurements when the biochar concentration was 6%. Biochar and bio-control agents triggered biochemical alterations, thus enhancing the management of disease-infested soils.

A Case of Grave's Thyrotoxicosis-Induced Takotsubo Cardiomyopathy Presenting with Cardiac Arrest After Winning the Lottery.

Takotsubo syndrome (TTS) is a nonischemic cardiomyopathy with transient apical ballooning of the left ventricle and reduced ejection fraction that can be caused by severe emotional or physical stress, with diverse clinical presentations. This case describes a patient who went into cardiac arrest at a casino after winning the lottery. She was found to have Takotsubo cardiomyopathy, in the setting of uncontrolled hyperthyroidism. This is a very unique case of TTS presenting with cardiac arrest, and is also an uncommon example of TTS triggered by a positive rather than negative emotional life event.

Acute Fulminant Cerebral Edema Caused by Influenza Type B in an 18-Year-Old Female: A Rare Case.

Most influenza B infections are self-limited, but in some instances, they can cause substantial morbidity and mortality due to complications. Acute fulminant cerebral edema (AFCE) is one of the rare complications. AFCE, a consequence of acute encephalitis, presents as acute onset of alteration in mental status, seizure, and/or headache followed by rapidly progressive encephalopathy, often leading to death. The exact pathophysiology of AFCE is unknown, but many pathomechanisms have been proposed. We present a case of an 18-year-old female in excellent physical condition who presented with respiratory insufficiency after being recently diagnosed with influenza B infection. Three days later, she developed acute encephalopathy, leading to brain death. To our knowledge, this rare case of AFCE developing following influenza B infection is the first reported case outside the pediatric population.

Fulminant Hepatic Failure With Minimal Alcohol Consumption in a 25-Year-Old Female With Hereditary Hemochromatosis: A Rare Case.

Hereditary hemochromatosis (HH) is an inherited disorder in which organ damage and other clinical manifestations are commonly seen in patients with a homozygous mutation involving C282Y of the HFE gene, causing increased iron absorption in the intestine. The liver is the primary site of iron deposition, and excessive iron overload can eventually lead to hepatic cirrhosis. Patients who drink significant amounts of alcohol are more likely to develop cirrhosis, and in females, it is commonly seen after menopause. We describe a young female with hereditary hemochromatosis who developed fulminant hepatic failure with minimal alcohol consumption at age 25.

Physiological and biochemical characterization of biochar-induced resistance against bacterial wilt of eggplants.

The abrupt variation in climatic patterns has become a global concern in terms of food security. Biochar, known to ameliorate climatic adversities by sequestering carbon and activating systemic resistance pathways in plants, has become increasingly relevant. Therefore, the study was aimed to characterize leaf waste biochar (LWB) by Fourier-transform infrared spectroscopy, scanning electron microscopy with energy dispersive X-ray (SEM-EDX) and X-ray diffraction analytical techniques as well as determination of its impact on the development of bacterial wilt (BW) in eggplant (Solanum melongena) caused by Ralstonia solanacearum (RS). The effect of LWB on the physiology and defence-associated biochemistry of eggplants was investigated thoroughly. Eggplants either inoculated (+RS) or uninoculated (-RS) were cultivated in potting mixture containing 3 and 6% (v/v) LWB separately. In comparison with substrate (soil only), percentage disease index was significantly reduced (71%) in plants grown in 6% LWB-amended treatments. Biochar-induced increase in level of total chlorophyll content as well as in biochemicals such as phenolics, flavonoids and peroxidases were evident on plants in terms of resistance response against BW. Moreover, biochar also significantly affected the level of NPK in the eggplants. In conclusion, biochar-triggered biochemical alterations played a pivotal role in the management of BW along with the curing of the disease-infested soils.

Helicobacter pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Presenting as Massive Gastrointestinal Bleed.

This case reports a patient that represents the minority of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma who do not have underlying Helicobacter pylori gastritis. Gastric MALT lymphoma is a type of primary gastric lymphoma (PGL), which are extremely rare gastric malignancies characterized by proliferation of B-cells and infiltration of lymphoid tissue leading to destruction of gastric glands. Development of gastric MALT lymphoma is associated with H. pylori gastritis. Patients typically present with a wide range of symptoms including but not limited to epigastric pain, weight loss, gastrointestinal bleeding and gastric wall perforation. Gastric MALT lymphoma presenting as a massive gastrointestinal bleed is quite rare and only a few cases have been documented. Our case demonstrates that it is important to recognize that acute presentations of this disease may also occur.

Application of Aspiration-Assisted Percutaneous Venous Removal of Right Atrial Thrombus in a Critically Ill Patient: A Case Study and Clinical Management Overview.

We herein present a complex case of a 50-year-old female with catheter-related atrial thrombus (CRAT). This patient with end-stage renal disease on hemodialysis presented with angioedema leading to respiratory failure. She was subsequently intubated, and the pre-procedural course was complicated by a cardio-respiratory arrest, and anoxic brain injury. The patient's hemodialysis catheter placement in the superior vena cava (SVC) potentially correlated with the development of the right atrial thrombus. The patient was treated percutaneously as she presented with complex morbidities. The mass was successfully removed via aspiration-assisted percutaneous right heart bypass, a procedure that utilizes a vacuum system to remove thrombi. Post-procedure, the patient remained stable and continued supervised care.

Utility of a Deep-Learning Algorithm to Guide Novices to Acquire Echocardiograms for Limited Diagnostic Use.

Importance: Artificial intelligence (AI) has been applied to analysis of medical imaging in recent years, but AI to guide the acquisition of ultrasonography images is a novel area of investigation. A novel deep-learning (DL) algorithm, trained on more than 5 million examples of the outcome of ultrasonographic probe movement on image quality, can provide real-time prescriptive guidance for novice operators to obtain limited diagnostic transthoracic echocardiographic images. Objective: To test whether novice users could obtain 10-view transthoracic echocardiographic studies of diagnostic quality using this DL-based software. Design, Setting, and Participants: This prospective, multicenter diagnostic study was conducted in 2 academic hospitals. A cohort of 8 nurses who had not previously conducted echocardiograms was recruited and trained with AI. Each nurse scanned 30 patients aged at least 18 years who were scheduled to undergo a clinically indicated echocardiogram at Northwestern Memorial Hospital or Minneapolis Heart Institute between March and May 2019. These scans were compared with those of sonographers using the same echocardiographic hardware but without AI guidance. Interventions: Each patient underwent paired limited echocardiograms: one from a nurse without prior echocardiography experience using the DL algorithm and the other from a sonographer without the DL algorithm. Five level 3-trained echocardiographers independently and blindly evaluated each acquisition. Main Outcomes and Measures: Four primary end points were sequentially assessed: qualitative judgement about left ventricular size and function, right ventricular size, and the presence of a pericardial effusion. Secondary end points included 6 other clinical parameters and comparison of scans by nurses vs sonographers. Results: A total of 240 patients (mean [SD] age, 61 [16] years old; 139 men [57.9%]; 79 [32.9%] with body mass indexes >30) completed the study. Eight nurses each scanned 30 patients using the DL algorithm, producing studies judged to be of diagnostic quality for left ventricular size, function, and pericardial effusion in 237 of 240 cases (98.8%) and right ventricular size in 222 of 240 cases (92.5%). For the secondary end points, nurse and sonographer scans were not significantly different for most parameters. Conclusions and Relevance: This DL algorithm allows novices without experience in ultrasonography to obtain diagnostic transthoracic echocardiographic studies for evaluation of left ventricular size and function, right ventricular size, and presence of a nontrivial pericardial effusion, expanding the reach of echocardiography to clinical settings in which immediate interrogation of anatomy and cardiac function is needed and settings with limited resources.

Deep Learning-Based Automated Echocardiographic Quantification of Left Ventricular Ejection Fraction: A Point-of-Care Solution.

BACKGROUND: We have recently tested an automated machine-learning algorithm that quantifies left ventricular (LV) ejection fraction (EF) from guidelines-recommended apical views. However, in the point-of-care (POC) setting, apical 2-chamber views are often difficult to obtain, limiting the usefulness of this approach. Since most POC physicians often rely on visual assessment of apical 4-chamber and parasternal long-axis views, our algorithm was adapted to use either one of these 3 views or any combination. This study aimed to (1) test the accuracy of these automated estimates; (2) determine whether they could be used to accurately classify LV function. METHODS: Reference EF was obtained using conventional biplane measurements by experienced echocardiographers. In protocol 1, we used echocardiographic images from 166 clinical examinations. Both automated and reference EF values were used to categorize LV function as hyperdynamic (EF>73%), normal (53%-73%), mildly-to-moderately (30%-52%), or severely reduced (<30%). Additionally, LV function was visually estimated for each view by 10 experienced physicians. Accuracy of the detection of reduced LV function (EF<53%) by the automated classification and physicians' interpretation was assessed against the reference classification. In protocol 2, we tested the new machine-learning algorithm in the POC setting on images acquired by nurses using a portable imaging system. RESULTS: Protocol 1: the agreement with the reference EF values was good (intraclass correlation, 0.86-0.95), with biases <2%. Machine-learning classification of LV function showed similar accuracy to that by physicians in most views, with only 10% to 15% cases where it was less accurate. Protocol 2: the agreement with the reference values was excellent (intraclass correlation=0.84) with a minimal bias of 2.5±6.4%. CONCLUSIONS: The new machine-learning algorithm allows accurate automated evaluation of LV function from echocardiographic views commonly used in the POC setting. This approach will enable more POC personnel to accurately assess LV function.

Rothia dentocariosa Endocarditis: An Especially Rare Case in a Previously Healthy Man.

Rothia dentocariosa is a rare gram-positive bacterial organism, one of the group of microbes that normally resides in the mouth and respiratory tract. R. dentocariosa rarely causes disease. Documented cases occur chiefly in patients with valvular or dental disease, or both. We report the case of a previously healthy 58-year-old man who presented with evidence of bacterial endocarditis caused by this organism-which originated from an elusive source. His endocarditis was successfully treated with mitral valve replacement and the administration of antibiotic agents.