Catheter-Directed Thrombolysis in the treatment of acute Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient's clinical details, radiological findings, safety, and efficacy are reported. CASES PRESENTATION: Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. CONCLUSION: PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients.

Successful embolization of an anterior chest wall arteriovenous malformation using combined transfemoral and transradial approaches with onyx.

We present a case of successful embolization of an anterior chest wall arteriovenous malformation (AVM) in a 24-year-old male patient. This report aims to highlight the efficacy and safety of using the liquid embolic agent (onyx) as well as the combined approaches (trans-femoral and trans-radial) in managing rare complex chest wall AVMs.

Testis sparing surgery for Leydig cell tumor, surgical approach, and clinical outcome: A case report and review of literature.

Testicular Leydig cell tumors are rare neoplasms of the testes. These tumors are generally benign but malignancy and metastatic potential have been described. Here, we present a case of Leydig cell tumor in a 49-year-old male, incidentally discovered as a testicular mass. The patient had no significant previous medical history. Ultrasonography revealed a hypoechoic, well-defined, vascularized lesion measuring 7 × 7 × 4 mm adjacent to the tunica albuginea. The patient underwent testis sparing surgery, employing a modified approach including intraoperative ultrasound-guided localization, en-bloc wedge resection of the lesion with surrounding tunica albuginea and seminiferous tubules, and gubernaculum sparing surgery. Postoperatively, the patient had an uneventful recovery and was discharged on the same day. Histopathological examination confirmed the diagnosis of Leydig cell tumor, with no high-risk pathological features observed. Regular follow-up intervals were scheduled to monitor for potential recurrence, emphasizing the importance of vigilant postoperative surveillance in cases of testis-sparing surgery for Leydig cell tumors.

Enhanced Prairie Dog Optimization with Differential Evolution for solving engineering design problems and network intrusion detection system.

This paper introduces a novel hybrid optimization algorithm, PDO-DE, which integrates the Prairie Dog Optimization (PDO) algorithm with the Differential Evolution (DE) strategy. This research aims to develop an algorithm that efficiently addresses complex optimization problems in engineering design and network intrusion detection systems. Our method enhances the PDO's search capabilities by incorporating the DE's principal mechanisms of mutation and crossover, facilitating improved solution exploration and exploitation. We evaluate the effectiveness of the PDO-DE algorithm through rigorous testing on 23 classical benchmark functions, five engineering design problems, and a network intrusion detection system (NIDS). The results indicate that PDO-DE outperforms several state-of-the-art optimization algorithms regarding convergence speed and accuracy, demonstrating its robustness and adaptability across different problem domains. The PDO-DE algorithm's potential applications extend to engineering challenges and cybersecurity issues, where efficient and reliable solutions are critical; for example, the NIDS results show significant results in detection rate, false alarm, and accuracy with 98.1%, 2.4%, and 96%, respectively. The innovative integration of PDO and DE contributes significantly to stochastic optimization and swarm intelligence, offering a promising new tool for tackling diverse optimization problems. In conclusion, the PDO-DE algorithm represents a significant scientific advancement in hybrid optimization techniques, providing a more effective approach for solving real-world problems that require high precision and optimal resource utilization.

Spontaneous angiomyolipoma rupture: A case of hemorrhagic shock and urgent embolization.

This case report discusses a 64-year-old male with tuberous sclerosis complex (TSC), a genetic disorder characterized by benign tumor formation across multiple organ systems. The patient presented with a spontaneous hemorrhage from a right renal angiomyolipoma, a common and potentially life-threatening manifestation of TSC, particularly in patients with TSC2 mutations. The patient's significant comorbidities, including hypertension and dyslipidemia, further complicated his clinical course. Initial management involved aggressive fluid resuscitation and blood product transfusion, followed by urgent embolization to control active bleeding. Despite developing complications such as transfusion-associated circulatory overload (TACO), the patient was successfully stabilized. This case highlights the necessity for careful monitoring and prompt intervention in patients with TSC, given the high risk of hemorrhage from angiomyolipomas, especially those larger than 3 cm. We also emphasize the importance of differentiating TSC-associated angiomyolipomas from other renal masses, considering the variability in clinical presentation and the potential for late-onset symptoms. Additionally, it highlights the critical role of a multidisciplinary approach in managing TSC patients, addressing both acute complications and long-term surveillance to prevent recurrence and other systemic manifestations of the disease.

Knots of the umbilical cord: Incidence, diagnosis, and management.

Knot(s) of the umbilical cord have received emphasis because the clinical assessments and sonographic literature show a crucial role in fetal outcomes. The true umbilical cord knot could be a knot in a singleton pregnancy or an entanglement of two umbilical cords in monoamniotic twins. Clinical manifestations are almost silent, which can raise clinical challenges. They worsen outcomes, and the pathology can be easily missed during prenatal visits because ultrasonographers do not pay attention to the cord during an obstetric ultrasound scan. However, most medical centers now have ultrasound machines that improve fetal assessment. The umbilical cord should be routinely evaluated during a fetal assessment, and suspicion of an umbilical cord knot can be more frequently diagnosed and is detected only incidentally. Clinical outcome is usually good but depends on the knot's characteristics and if it is tight or loose. In this review, we discuss pathophysiology, the theories on formation, the main risk factors, ultrasound signs and findings, different opinions in the management, and features of pregnancy outcomes feature.

Awareness of Hepatitis B Virus (HBV) Screening Before Marriage and Pregnancy Among Adults in the Al-Baha Region, Saudi Arabia.

Background Hepatitis B is a global public health concern. Understanding the awareness, testing practices, and vaccination status of individuals is crucial for effective prevention and control strategies. This study aims to assess these aspects among participants in the Al-Baha region, Saudi Arabia. Methodology A cross-sectional study was conducted among 440 participants. Demographic data, awareness of hepatitis B, knowledge of transmission modes, symptoms, and complications were collected through a structured questionnaire. Participants' testing and screening practices, sources of information, and vaccination status were also assessed. Data were analyzed using descriptive statistics and associations were explored using chi-square tests. Results The majority of participants were females (51.8%) and aged 18-25 years (55.2%). While most participants had heard of hepatitis B (85.7%), only a small percentage correctly identified sexual contact as a mode of transmission (38.6%). Knowledge regarding symptoms and complications was moderate, with 52.3% correctly identifying symptoms and 69.8% recognizing liver damage and cirrhosis as complications. Although awareness of screening was high (84.8%), the actual practice was low (35.0%). Education was the least reported source of information, while the internet (46.7%) and health care provider (27.6%) were commonly mentioned. Approximately half of the participants reported receiving the hepatitis B vaccine (48.9%), but a significant proportion had not completed all vaccine doses (55.0%). Conclusion The study revealed moderate awareness of hepatitis B among the participants, but knowledge gaps existed regarding transmission modes and complete symptom recognition. Testing and screening practices were suboptimal, with low rates of screening despite high awareness. Vaccination uptake was moderate, but incomplete vaccine schedules were prevalent. Targeted educational campaigns are needed to address knowledge gaps, promote testing and completion of vaccination schedules, and enhance the role of healthcare providers in disseminating accurate information. Improving knowledge and practices related to hepatitis B can strengthen public health efforts, enhance prevention, and control strategies.

Fitterfly Diabetes CGM Digital Therapeutics Program for Glycemic Control and Weight Management in People With Type 2 Diabetes Mellitus: Real-world Effectiveness Evaluation.

BACKGROUND: Digital therapeutic platforms facilitate health care through patient-centered strategies based on multidisciplinary teams and shared decision-making. Such platforms can be used for developing a dynamic model of diabetes care delivery, which can help in improving glycemic control by promoting long-term behavior changes in people with diabetes. OBJECTIVE: This study aims to evaluate the real-world effectiveness of the Fitterfly Diabetes CGM digital therapeutics program for improving glycemic control in people with type 2 diabetes mellitus (T2DM) after the completion of 90 days in the program. METHODS: We analyzed deidentified data of 109 participants in the Fitterfly Diabetes CGM program. This program was delivered through the Fitterfly mobile app coupled with continuous glucose monitoring (CGM) technology. This program consists of 3 phases: the first phase is observation, wherein the patient's CGM readings are observed for 7 days (week 1); the second phase is the intervention; and the third phase aims at sustaining the lifestyle modification introduced during the second phase. The primary outcome of our study was the change in the participants' hemoglobin A1c (HbA1c) levels after program completion. We also evaluated the changes in participant weight and BMI after the program, changes in the CGM metrics in the initial 2 weeks of the program, and the effects of participant engagement in the program on improving their clinical outcomes. RESULTS: At the end of the 90 days of the program, the mean HbA1c levels, weight, and BMI of the participants were significantly reduced by 1.2% (SD 1.6%), 2.05 (SD 2.84) kg, and 0.74 (SD 1.02) kg/m2 from baseline values of 8.4% (SD 1.7%), 74.45 (SD 14.96) kg, and 27.44 (SD 4.69) kg/m2 in week 1, respectively (P<.001). The average blood glucose levels and time above range values showed a significant mean reduction by 16.44 (SD 32.05) mg/dL and 8.7% (SD 17.1%) in week 2 from week 1 baseline values of 152.90 (SD 51.63) mg/dL and 36.7% (SD 28.4%), respectively (P<.001 for both). Time in range values significantly improved by 7.1% (SD 16.7%) from a baseline value of 57.5% (SD 25%) in week 1 (P<.001). Of all the participants, 46.9% (50/109) showed HbA1c reduction ≥1% and 38.5% (42/109) showed weight loss ≥4%. The average number of times the mobile app was opened by each participant during the program was 108.80 (SD 127.91) times. CONCLUSIONS: Our study shows that participants in the Fitterfly Diabetes CGM program showed a significant improvement in their glycemic control and reduction in weight and BMI. They also showed a high level of engagement with the program. Weight reduction was significantly associated with higher participant engagement with the program. Thus, this digital therapeutic program can be considered as an effective tool for improving glycemic control in people with T2DM.

Managing Recurrent Rectal Variceal Bleeding Secondary to Portal Hypertension With Liquid Embolics.

Rectal variceal bleeding is one of the rarer manifestations of portal hypertension caused by chronic liver disease. The management of these varices is very challenging. Our patient had portal vein thrombosis and presented with chronic recurrent rectal bleeding requiring transfusion secondary to rectal varices. The patient was treated from trans-splenic access with liquid embolics (sclerotherapy and glue) without balloon occlusion, leading to the successful cessation of his bleeding. Access hemostasis was achieved using a vascular plug in the access tract. There are no clear guidelines for the management of these patients. If rectal varices cannot be managed by colonoscopy, this approach to embolization with liquid embolic is an excellent minimally invasive alternative.

Angiomatoid fibrous histiocytoma (AFH) unusual clinical presentation and unique radiological findings.

Angiomatoid fibrous histiocytoma (AFH) are rare soft tissue mesenchymal neoplasms that commonly affect children and young adults. They are classified as "intermediate tumours of uncertain differentiation". We present a case of an 8-year-old child with a left thigh AFH and antecedent history of minor trauma showing perilesional oedema and enhancement at MRI, leading to an initial working diagnosis of infected haematoma that contributed to the challenge in reaching the final diagnosis. Although most of the imaging features of AFH previously described in the literature are demonstrated in this case, the presence of arterial vascular channels within the tumour and feeding branch from the left profunda femoris artery is unusual and to our knowledge the first to be published in the literature.

Periorbital aesthetic concerns in patients seeking corneal refractive surgery.

PURPOSE: : To report the frequency of periorbital aesthetic abnormalities in patients undergoing refractive surgery and to report the ability of the patient and the refractive surgeon in picking up these findings compared to the oculoplastic surgeon. METHODS: Single-center, prospective observational case series. All patients underwent standard pre-operative work-up for refractive surgery, answered a study questionnaire, and underwent face photographs (with and without glasses). The patient, the refractive, and the oculoplastic surgeons evaluated the photographs to categorize the concerns as none, presence of ptosis, tear trough deformity, scleral show, and others. The findings of the oculoplastic surgeon were taken as the standard of reference. RESULTS: The photographs of 121 patients were analyzed. The mean age was 25.76 ± 3.75 years and 72% were males. The main indication for surgery was to eliminate dependency on glasses in a majority (76%) followed by cosmesis in 23%. The oculoplastic surgeon noted tear trough deformity in 14 (11.5%) cases, scleral show in 51 (42.1%), ptosis in 35 (28.9%), and other findings in 45 (37.1%). When the symmetrical scleral show was excluded, the patient picked up aesthetic concerns in only 8.26%, the refractive surgeon in 14% as compared to 39% by the oculoplastic surgeon (P < 0.01). CONCLUSION: Periorbital aesthetic significant findings were noted in 39% of the patients undergoing corneal refractive surgery when assessed by an oculoplastic surgeon. The refractive surgeon was able to pick up less than 50% of these. We recommend a basic aesthetic initial evaluation prior to refractive surgery and photographic documentation, especially in cosmetically aware patients.

Vitamin A levels are decreased but not influenced by glucose- or lipid-lowering medications in subjects with type 2 diabetes.

BACKGROUND AND AIM: Type 2 diabetes (T2D) is a complex polygenic disease with unclear mechanisms. Clinical studies on the association of vitamin A with T2D in humans are still controversial. Herein, we aimed to investigate the plasma levels of vitamin A, predictor factors, and its correlations with clinical phenotypes in Emirati population. The effect of glucose-and lipid-lowering medications on vitamin A levels was also studied. METHODS: A cross-sectional cohort comprised 158 T2D-subjects and 90 healthy controls were recruited from the United Arab Emirates National Diabetes Study (UAEDIAB). All anthropometric, clinical, and biomedical measurements were collected. Plasma levels of vitamin A were determined using ELISA assay. RESULTS: Levels of vitamin A were significantly lower in T2D-subjects compared to healthy control (p < 0.01). Vitamin A levels were unaffected by gender base and inversely correlated with age, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), waist circumference, triglycerides, and body mass index (BMI). Regression analysis revealed that HbA1c and age are predictors for vitamin A. Intake of glucose- or lipid-lowering medications showed no effect on vitamin A levels. CONCLUSION: HbA1c and age are predictors for low levels of vitamin A among Emirati-T2D subjects. No influence of glucose and lipid-lowering medications on the plasma levels of vitamin A.

A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India.

BACKGROUND AND AIMS: Uncontrolled diabetes has been associated with poorer clinical outcomes in COVID-19. We aimed to evaluate and assess the impact of COVID-19 pandemic on management of diabetes and challenges faced by people with diabetes in India during and after the lockdown phase. METHODS: A cross-sectional study based on an online questionnaire survey was designed. The questions collected socio-demographic details, medical and social history, and impact of the pandemic on medical and social life from 1582 participants. Linear regression was employed to evaluate association of different parameters with the change in glycemic levels. RESULTS: The frequency of clinical visits during the COVID-19 pandemic were reduced in 87.28% of participants. 92.45% of participants were able to monitor their blood glucose levels (BGLs) in which 78.42% (49.35%, 20.91%, and 8.16%) participants experienced an increase in BGL (mild, moderate, and severe respectively). Only 47.41% of participants possessed the digital glucometer at home. 69.07% of participants reported a decrease in physical activity while 46.88% reported an increase in food intake. 80.06% of participants were able to buy all medicines and 29.80% were gone for virtual consultations while 87.81% reported that they didn't have access to healthcare services. Overall, 89.47% participants experienced disruption in therapy. A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs. CONCLUSION: This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2.

SARS-CoV-2 infection presenting as colitis with chest and abdomen CT findings.

Most of reported symptoms of SARS-CoV-2 infection are related to the respiratory system. Extra pulmonary manifestations of this novel virus infection are being increasingly reported in the literature, with increased attention on the gastrointestinal symptoms which might be the only presenting symptoms in some patients. These GI symptoms are nonspecific and little reported cases in the literature of confirmed gastrointestinal manifestations of SARS-CoV-2 infection by imaging. Colitis related to SARS-CoV-2 is even less reported in the literature. We present a case of SARS-CoV-2 infection of a 40-year-old lady who presented with GI manifestations and features of colitis of the caecum and ascending colon on CT scan. The patient did not have respiratory symptoms but had incidental lung changes in the visualized lung bases. These features were completely resolved as evident clinically and on follow-up CT scan after only 2 weeks, with only supportive care for SARS-CoV-2 infection. GI symptoms, in general, are very common presenting complain for many patients visiting the emergency department; hence, early recognition and high index of clinical suspicion for SARS-CoV-2 infection with the presence of supporting laboratory and imaging findings are to be considered for early protective measures to be undertaken to help in reducing the spread of this virus; in particular, in the middle of global pandemic of this virus and the fact that GI symptoms could be the only presenting symptoms without any respiratory symptoms. More studies and further invasive investigations in patients with features of colitis in imaging are needed to further understand the pathogenesis and its relation to SARS-CoV-2 infection.

Prevalence of patients with end-stage renal disease on dialysis in the West Bank, Palestine.

This study was conducted to determine the point prevalence of patients with end-stage renal disease (ESRD) on dialysis in the West Bank, Palestine. As part of this study, the following parameters were studied: District, gender, age and presumed cause. This cross-sectional study was undertaken during the period 26-30 December 2010 at all dialysis units in the West Bank, and included all cases of ESRD on dialysis. The total prevalence of patients with ESRD on dialysis during the study period was 240.3 per million population (PMP). The highest prevalence was seen in Jericho city. There were 57.7% males and 42.4% females in the study. The majority of patients (62.3%) were living in villages, while 28.8% were living in cities and 8.9% were living in refugee camps. Most of the patients (45%) were aged between 45 and 64 years. The vast majority of patients were either diabetic (22.5%) or hypertensive (11.1%) or both at the same time (10.6%). There were a considerable number of patients in whom the cause was undetermined (27.6%). The majority of recorded cases of congenital causes were from the Hebron, Jenin and Tubas districts. The prevalence of ESRD noted in our study is comparable with other regional countries but far below the rate recorded in industrialized countries. In the Palestinian territories, there is a general lack of national statistics and surveys, particularly in the public health section. Increased efforts and awareness should be focused on the prevention and treatment of diabetes mellitus and hypertension as they are the main causes of ESRD. There should also be an additional enhancement and implementation of strategies for the registration of data in order to conduct periodic comparisons and analytical studies to improve the management and quality of life of ESRD patients.

Nonrigid image registration using an entropic similarity.

In this paper, we propose a nonrigid image registration technique by optimizing a generalized information-theoretic similarity measure using the quasi-Newton method as an optimization scheme and cubic B-splines for modeling the nonrigid deformation field between the fixed and moving 3-D image pairs. To achieve a compromise between the nonrigid registration accuracy and the associated computational cost, we implement a three-level hierarchical multiresolution approach such that the image resolution is increased in a coarse to fine fashion. Experimental results are provided to demonstrate the registration accuracy of our approach. The feasibility of the proposed method is demonstrated on a 3-D magnetic resonance data volume and also on clinically acquired 4-D CT image datasets.