RESUMEN
Background: Tuberculosis is a leading cause of mortality and morbidity in many countries across the world, including Pakistan. While systemic tuberculosis can involve any organ of the body, tubercular liver abscess is a rare presentation. Case Report: We report the case of an 8-year-old female from a developing country where tuberculosis poses a significant burden on the health care system. The patient presented with fever and weight loss for 6 months and abdominal pain for 14 days. On examination, she had tenderness and guarding over the right hypochondrium. Investigations revealed neutrophilic predominance in the complete blood count and elevated C-reactive protein. Imaging of the abdomen revealed ruptured liver abscess, extensive abdominal lymphadenopathy, and thrombus in the inferior vena cava. Gastric secretions were positive for Mycobacterium tuberculosis. Treatment included antitubercular and antithrombotic therapy. The patient was closely followed until she had completed the 1-year course of antitubercular therapy and was symptom-free. Conclusion: In tuberculosis-endemic countries, physicians should keep a high index of suspicion for tuberculosis in children who present with liver abscess and multisystem involvement.
RESUMEN
Mitral valve repair (MVr) secondary to degenerative anterior/bi-leaflet mitral valve disease is more challenging than posterior leaflet repair. However, conclusive evidence is needed to make decisions based on the outcomes rather than technical difficulties. This meta-analysis compares anterior/bi-leaflet MVr with isolated posterior leaflet repair in patients with mitral regurgitation (MR) due to degenerative mitral valve disease. The outcomes of interest were long-term (≥ 5 years) survival and freedom from re-operation and moderate-to-severe MR. Meta-analysis of 10 studies showed that there was no significant difference in long-term survival (risk ratio, RR: 1.00; 95% confidence interval, 95% CI 0.96-1.04), freedom from moderate-to-severe MR (RR: 0.95; 95% CI 0.87-1.03), and freedom from re-operation (RR: 0.96; 95% CI 0.90-1.02) between anterior/bi-leaflet MVr and posterior leaflet repair. As outcomes of anterior/bilateral repair were comparable with those of isolated posterior leaflet repair, our findings do not support the inclination towards replacement over repair for MR caused by anterior/bilateral degenerative mitral disease.
