When images don't explain reality: A case of an intravascular extension of an endometrial tumor.

Endometrial stromal sarcoma is a rare mesenchymal tumor with the potential for intravascular metastases. We present the case of a 52-year-old female patient with a history of previously resected endometrial sarcoma who was found to have an inferior vena cava thrombus with intracardiac extension. Pathological assessment following resection revealed intravascular extension of an underlying endometrial stromal sarcoma. This case demonstrates the aggressive nature and intracardiac metastatic potential of endometrial sarcomas.

The Integration of Artificial Intelligence Into Patient Care: A Case of Atrial Fibrillation Caught by a Smartwatch.

Artificial intelligence (AI) offers a wide range of applications in clinical practice, and new technologies are rapidly evolving the healthcare industry and enhancing outcomes. Smartwatches represent the most popular type of wearable AI device that can assist people in detecting cardiac arrhythmias via constant monitoring of heart activity. Numerous advantages result from integrating AI into healthcare systems, including improved patient care, lower rates of medical errors, better treatment recommendations, and more accurate diagnosis of diseases. However, doubts still remain regarding the adoption of AI into patient care due to the challenges it poses. In this paper, we report a case of atrial fibrillation (AF) in a young patient that was detected by his smartwatch. We also highlight some of the benefits and challenges of AI applications in healthcare.

Antimicrobial susceptibility of organisms isolated from sputum culture of Karachi, Pakistan.

Our study aims to contribute to developing antibiotics prescription guidelines at a national and a regional level directed by the antibiotics susceptibility patterns and rapidly emerging resistant organisms. This study is designed to observe the antimicrobial susceptibility in sputum culture isolates and drug resistance patterns against various antimicrobials. This was a retrospective cohort study; data was collected from two laboratories from 1st Jan to 15 July 2007. All laboratory reports were analyzed using SPSS version 19.0.The sputum culture was found positive for microbial growth in 217 reports out of 864 total (25.11%). The leading organisms were 25.8% Klebsiella pneumoniae, 23.5% Streptococcus pneumoniae, 18% Pseudomonas aeruginosa and 12.9% Staphylococcus aureus. S.pneumoniae and S.aureus were sensitive to the combination of beta lactam antibiotics and anti-beta lactamase while K.pneumoniae and P. aureginosa were susceptible to fluoroquinolones, macrolides and aminoglycosides. The total yield of sputum culture was 25.11%. The gram positive cocci which were isolated were mostly resistant to beta lactam antibiotics alone i.e. only 45% of S. pneumoniae and 33% of S. aureus were sensitive to Amoxicillin alone. Sensitivity to Co-amoxiclav was still high. 90% and 85% of S. pneumonia and S. aureus respectively were sensitive to Co-amoxiclav. The P. aeruginosa resistance to Amikacin in our study is 10%.

Venous Thromboembolism in Cancer: An Update of Treatment and Prevention in the Era of Newer Anticoagulants.

Cancer patients are at major risk of developing venous thromboembolism (VTE), resulting in increased morbidity and economic burden. While a number of theories try to explain its pathophysiology, its risk stratification can be broadly done in cancer-related, treatment-related, and patient-related factors. Studies report the prophylactic use of thrombolytic agents to be safe and effective in decreasing VTE-related mortality/morbidity especially in postoperative cancer patients. Recent data also suggest the prophylactic use of low molecular weight Heparins (LMWHs) and Warfarin to be effective in reducing VTEs related to long-term central venous catheter use. In a double-blind, multicenter trial, a new ultra-LMWH Semuloparin has shown to be efficacious in preventing chemotherapy-associated VTE's along with other drugs, such as Certoparin and Nadoparin. LMWHs are reported to be very useful in preventing recurrent VTEs in advanced cancers and should be preferred over full dose Warfarin. However, their long-term safety beyond 6 months has not been established yet. Furthermore, this paper discusses the safety and efficacy of different drugs used in the treatment and prevention of recurrent VTEs, including Bemiparin, Semuloparin, oral direct thrombin inhibitors, parenteral and direct oral factor Xa inhibitors.

Haemophagocytic lymphohistiocytosis (HLH): a rare but potentially fatal association with Plasmodium vivax malaria.

Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal syndrome that is caused by an abnormal activation of the immune system. It can present as the primary syndrome or occur secondary to a variety of conditions such as malignancy, autoimmune diseases and infections. We present a case of a man who developed HLH secondary to Plasmodium vivax infection. He presented with symptoms of fever, chills and myalgias. Physical examination revealed significant hepatosplenomegaly. The presence of pancytopaenia, elevated ferritin levels and haemophagocytosis on bone marrow biopsy confirmed the diagnosis of HLH (based on HLH-2004 criteria). There was a significant improvement after the initiation of intravenous antimalarials. No relapses were documented on follow-up. It is imperative that physicians should promptly recognise and treat this rare condition, as a timely intervention can be lifesaving.

Eales Disease.

Eales disease is an eponym after a British ophthalmologist Henry Eales. The aetiology behind Eales disease is ill-understood and stands controversial. Various systemic diseases associated with peripheral retinal revascularization and Retinal vasculitis could imitate the proliferative and inflammatory phases of Eales' disease, respectively. We present a case of a 30 years old female patient with Eales disease and discuss the clinical features, treatment plan and its outcome in our patient. Tuberculosis appears to be the cause of Eales disease but the relation is yet to be established and clinically proven. Steroid therapy is usually the main stay of treatment with tapering doses of systemic corticosteroids. Other interventions are vitrectomy, photocogulation or cryotherapy.

Perceptions and practices of fasting in Ramadan during pregnancy in Pakistan.

BACKGROUND: Islam clearly exempts fasting in Ramadan during sickness, pregnancy, and breastfeeding. Yet, some women prefer to fast despite realizing their increase in nutritional demand during pregnancy. Nurses and other healthcare providers face a difficult task of providing appropriate medical advice to Muslim women regarding the safety and impact of their fasting. The present study was conducted to examine the concepts and practices of maternal fasting during pregnancy in Pakistani Muslim women. MATERIALS AND METHODS: A cross-sectional study was done in 2008 on 353 females from gynecology departments of hospitals in major cities of two provinces of Pakistan. Non-probability convenient sampling technique was used and a questionnaire was used to collect data from females who had experienced pregnancy during Ramadan at least once in life. Questions related to perceptions and practices of fasting in pregnancy along with demographic data were asked. Analysis was done on SPSS version 16. Chi-square test was used to assess associations and P < 0.05 was considered statistically significant. All ethical considerations were taken into account for the respondents. RESULTS: Out of the total, 309 (87.5%) fasted during their pregnancies while 43 (12.5%) did not fast at all. Among those who fasted, 42.5% (n = 150) fasted for the whole month, 23.8% (n = 84) fasted on alternate days, 10.5% (n = 37) fasted only on weekends/holidays, and 10.8% (n = 38) fasted on particular special days. The majority perceived no harm and risk caused by fasting to them or to fetus during pregnancy. Although adverse effects during fasting were frequently reported, only 24% break their fast. A significant association was found between gravida and education with fasting (P w< 0.05). A total of 88% of women believed that fasting during pregnancy (in good health) is "obligatory" while 12% thought otherwise. CONCLUSION: Pakistani Muslim women showed a strong compassion for fasting in pregnancy despite overall decrease in maternal health indicators. There is a need for nurses and other healthcare providers in all Muslim countries and especially in non-Muslim countries with cultural diversity to be fully aware of the effects of fasting in pregnancy so that they can act promptly ensuring safe and healthy delivery.