Management of tubal ectopic pregnancy with methotrexate in the setting of symptomatic Coronavirus disease 2019 (COVID-19): A case report.

Background: Coronavirus Disease 2019 (COVID-19) represents a complex therapeutic challenge. As the pandemic progresses, patients are presenting with ectopic pregnancies (EPs) and symptomatic COVID-19. Objective: We present the management of a patient with multiple medical comorbidities and tubal EP in the setting of severe symptomatic COVID-19 infection where all management options were precluded. Methods: Case report with literature review of management of tubal EP in the setting of severe symptomatic COVID-19 infection. Result: After careful consideration of options, the patient underwent successful medical management with methotrexate while receiving supportive care for COVID-19. Conclusions: Methotrexate proved to be the safest therapeutic option in this patient. Management of patients with severe COVID-19 and gynaecologic emergencies should be individualised and carefully reviewed with evolving knowledge of COVID-19.

Mathematical modelling of respiratory syncytial virus (RSV): vaccination strategies and budget applications.

We propose an age-structured mathematical model for respiratory syncytial virus in which children aged <1 year are especially considered. Real data on hospitalized children in the Spanish region of Valencia were used in order to determine some seasonal parameters of the model. Weekly predictions of the number of children aged <1 year that will be hospitalized in the following years in Valencia are presented using this model. Results are applied to estimate the regional cost of paediatric hospitalizations and to perform a cost-effectiveness analysis of possible vaccination strategies.

Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study.

BACKGROUND: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. METHODS: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. RESULTS: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. CONCLUSIONS: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

Pseudothrombosis of the right ovarian vein. Pitfall of abdominal spiral CT.

We present the computed tomography (CT) findings of pseudothrombosis of the right ovarian vein. In two young multiparous women, pseudothrombosis was detected on early-phase spiral CT scans by the presence of retrograde flow of contrast medium down the left ovarian veins. Asymmetry of density seen in the ovarian veins in the early phase of spiral CT scanning related to reflux in the left ovarian vein should not be mistaken for right ovarian vein thrombosis.

CT of adult adrenal cortical carcinoma: six years experience.

During 1980 and through 1985, a total of three adult patients with adrenal cortical carcinoma were patients at the University of Mississippi Medical Center. All three of these patients with large tumors were evaluated with CT abdominal scans. The CT findings are described in each case. One patient had the unique findings of four separate tumors at the left upper quadrant, i.e. an adrenal cortical carcinoma, an ipsilateral renal cell carcinoma, an adjacent para-aortic neurofibroma, and a gastric leiomyoma. The only known cure for adrenal cortical carcinoma is complete excision. CT scanning should be utilized in all cases for diagnosis, for characterizing the tumor, for showing the presence of metastatic disease, for determining the overall extent of disease, and for determining the relationship to other organs. CT should be utilized in the follow-up with these patients after treatment, i.e. surgery and/or chemotherapy.

Accumulation of technetium-99m MDP in a cavernous hemangioma of the liver.

A cavernous hemangioma of the liver presented as an area of increased activity on an isotope bone scan. A review of the literature fails to reveal any previous reports of this phenomenon.

[The role of prostacyclin and thromboxane in the antihypertensive action of enalapril]. / Papel de la prostaciclina y tromboxano en la acción antihipertensiva del enalapril.

Enalapril produces an inhibition of the angiotensin-renin system, correlating the pre-therapy plasmatic renin activity with blood pressure decrease, during its administration. This does not always happen, data to the contrary existing in literature, suggesting that there are some other acting mechanisms. We studied 34 hypertensive patients, whose blood pressure levels were controlled by Enalapril at a mean dosage of 12.32 +/- 0.9. Determining plasmatic concentration of 6-keto PGF1a (a prostacyclin metabolite), T x B2 (a thromboxane A2 metabolite), their distribution, plasmatic renin activity and a radiological and biochemical study. We found a significant increase in their distribution and plasmatic renin at the end of the essay. The results suggest a possible double active mechanism: angiotension-renin and prostaglandins systems, owing to the imbalance occurring between prostacyclin and thromboxane, the first named being the most favoured. This, together with easy application and the lack of side effects, made this drug useful for treatment of blood hypertension.

Radiological seminar CCXLXII: CT of adrenal gland pheochromocytoma.

Herein, we have described our experience with CT and pheochromocytomas arising from the adrenal gland over a recent six year period. In all of our patients who underwent CT scanning, localization of the tumor was successful. CT remains an accurate means for localization of adrenal pheochromocytomas.

Radiological seminar CCXLXIII: percutaneous gastrojejunostomy--a interventional radiologic procedure.

The authors describe the recent emergence of an interventional radiologic procedure, percutaneous gastrostomy and gastroenterostomy. They present a case report, and discuss indications, methods, and advantages of the procedure for some patients.