Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients

paythelady.612 shared this article with you from Inoreader Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2238-2246. doi: 10.12998/wjcc.v9.i10.2238. ABSTRACT BACKGROUND: Four-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population. AIM: To compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG. METHODS: A total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score. RESULTS: Although there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01). CONCLUSION: Three-liter PEG shows satisfacto ry bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients. PMID:33869599 | PMC:PMC8026841 | DOI:10.12998/wjcc.v9.i10.2238 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports

paythelady.612 shared this article with you from Inoreader Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2326-2333. doi: 10.12998/wjcc.v9.i10.2326. ABSTRACT BACKGROUND: Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis (XDR-TB). Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk. However, there is no recommendation or guideline on bedaquiline administration beyond 24 wk, which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics. CASE SUMMARY: This paper reported 2 patients with XDR-TB (a female of 58 years of age and a female of 18 years of age) who received bedaquiline for 36 wk, as local experience to be shared. The 2 cases had negative cultures after 24 wk of treatment, but lung imaging was still positive. After discussion among experts, the consensus was made to bedaquiline prolongation by another 12 wk. The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals. CONCLUSION: Longer regimen, including 36-wk bedaquiline treatment, might be an option for patients with XDR-TB. More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of this novel drug. PMID:33869610 | PMC:PMC8026830 | DOI:10.12998/wjcc.v9.i10.2326 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Turner syndrome with positive SRY gene and non-classical congenital adrenal hyperplasia: A case report

paythelady.612 shared this article with you from Inoreader Turner syndrome with positive <em>SRY</em> gene and non-classical congenital adrenal hyperplasia: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2259-2267. doi: 10.12998/wjcc.v9.i10.2259. ABSTRACT BACKGROUND: Co-morbidity of SRY gene turner syndrome (TS) with positive SRY gene and non-classical congenital adrenal hyperplasia (NCAH) is extremely rare and has never been reported to date. CASE SUMMARY: In this article, we present a 14-year-old girl who was referred to our hospital with short stature (weight of 43 kg and height of 143 cm, < -2 SD) with no secondary sexual characteristics (labia minora dysplasia). Laboratory tests indicated hypergonadotropic hypogonadism with significantly increased androstenedione and 17-hydroxyprogesterone (17-OHP) levels. This was accompanied by the thickening of the extremity of the left adrenal medial limb. The patient's karyotype was 45,X/46,X, +mar, and cytogenetic analysis using multiplex ligation-dependent probe amplification and high-throughput sequencing indicated that the SRY gene was positive with compound heterozygous mutations in CYP21A2 as the causative gene for congenital adrenal hyperplasia. The sites of the suspected candidate mutations were amplified and verified using Sanger sequencing. The patient was finally diagnosed as having SRY positive TS with NCAH. The patient and her family initially refused medical treatment. At her most recent follow-up visit (age = 15 years old), the patient presented facial hair, height increase to 148 cm, and weight of 52 kg, while androstenedione and 17-OHP levels remained high. The patient was finally willing to take small doses of hydrocortisone (10 mg/d). CONCLUSION: In conclusion, upon evaluation of the patient mentioned in the report, we feel that 17-OHP measurement and cytogenetic analysis are necessary for TS patients even in the absence of significant virilization signs. This will play a significant role in guiding diagnosis and treatment. PMID:33869601 | PMC:PMC8026834 | DOI:10.12998/wjcc.v9.i10.2259 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

paythelady.612 shared this article with you from Inoreader Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2334-2343. doi: 10.12998/wjcc.v9.i10.2334. ABSTRACT BACKGROUND: Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively, despite the use of advanced diagnostic methods by experienced clinicians. CASE SUMMARY: A 59-year-old G2P2 woman, with chronic pelvic pain, underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm × 34 mm × 36 mm, with irregular borders, heterogeneous echogenicity, no color Doppler vascularization and without acoustic shadowing. Normal ovarian tissue was visualized in contact with the lesion, and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe. Ascites, peritoneal metastases or other alterations were not observed. With the international ovarian tumor analysis ADNEX model, the lesion was classified as a malignant tumor (the risk of malignan cy was 27.1%, corresponding to Ovarian-Adnexal Reporting Data System category 4). Magnetic resonance imaging confirmed the presence of a right adnexal mass, apparently an ovarian tumor measuring 65 mm × 35 mm, without signs of invasive or metastatic disease. During explorative laparotomy, normal morphology of the internal reproductive organs was noted. A solid mobile lesion involved the entire appendix. Appendectomy was performed. Inspection of the abdominal cavity revealed no signs of malignant dissemination. Histopathologically, the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm (LAMN). CONCLUSION: The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature (benign vs malignant) and origin (gynecological vs nongynecological) of the lesion. Radiologists, gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific. The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention. PMID:33869611 | PMC:PMC8026829 | DOI:10.12998/wjcc.v9.i10.2334 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bilateral retrocorneal hyaline scrolls secondary to asymptomatic congenital syphilis: A case report

paythelady.612 shared this article with you from Inoreader Bilateral retrocorneal hyaline scrolls secondary to asymptomatic congenital syphilis: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2274-2280. doi: 10.12998/wjcc.v9.i10.2274. ABSTRACT BACKGROUND: Retrocorneal hyaline scrolls are a rare phenomenon. We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis. CASE SUMMARY: A 71-year-old woman presented with blurred vision due to cataracts. Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea. The patient was positive for syphilis-specific antibodies, with no ocular or systemic evidence of congenital or acquired syphilis. Binocular cataract, retrocorneal scroll, and corneal endothelial gutta were considered. The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin-eosin staining and scanning electron microscopy. The cornea of the right e ye remained transparent, and the residual scroll seemed stable, however, the corneal endothelial density declined at 13 mo after surgery. In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium, with enlarged endothelial cells in both eyes. Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet's membrane were observed. The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure. CONCLUSION: Occult congenital syphilis could induce corneal endothelial gutta and the formation of retrocorneal scrolls without other signs of ocular syphilis. PMID:33869603 | PMC:PMC8026840 | DOI:10.12998/wjcc.v9.i10.2274 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Granulomatosis with polyangiitis presenting as high fever with diffuse alveolar hemorrhage and otitis media: A case report

paythelady.612 shared this article with you from Inoreader Granulomatosis with polyangiitis presenting as high fever with diffuse alveolar hemorrhage and otitis media: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2344-2351. doi: 10.12998/wjcc.v9.i10.2344. ABSTRACT BACKGROUND: Granulomatosis with polyangiitis is a necrotizing inflammation of small and medium-sized vessels accompanied by formation of granuloma, involvement of primary granulomatous upper and lower respiratory tracts, glomerulonephritis, and vasculitis of small vessels. CASE SUMMARY: Herein, we described a case of a 52-year-old man admitted with pulmonary nodules and high fever. Autoantibody workup revealed that the patient was positive for c-anti-neutrophil cytoplasmic antibodies and proteinase-3 anti-neutrophil cytoplasmic antibodies. Pulmonary biopsies revealed a local granulomatous structure. The patient received therapy with methylprednisolone and intravenous immunoglobulin, and his clinical symptoms improved. CONCLUSION: Intravenous immunoglobulin may act on granulomatosis with polyangiitis similar to immunosuppressants. PMID:33869612 | PMC:PMC8026843 | DOI:10.12998/wjcc.v9.i10.2344 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adult onset type 2 familial hemophagocytic lymphohistiocytosis with PRF1 c.65delC/c.163C>T compound heterozygous mutations: A case report

paythelady.612 shared this article with you from Inoreader Adult onset type 2 familial hemophagocytic lymphohistiocytosis with <em>PRF1</em> c.65delC/c.163C>T compound heterozygous mutations: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2289-2295. doi: 10.12998/wjcc.v9.i10.2289. ABSTRACT BACKGROUND: Familial hemophagocytic lymphohistiocytosis (FHL) is a primary immunodefici-ency disease caused by gene defects. The onset of FHL in adolescents and adults may lead clinicians to ignore or even misdiagnose the disease. To the best of our knowledge, this is the first report to detail the clinical features of type 2 FHL (FHL2) with compound heterozygous perforin (PRF1) defects involving the c.163C>T mutation, in addition to correlation analysis and a literature review. CASE SUMMARY: We report a case of a 27-year-old male patient with FHL2, who was admitted with a persistent fever and pancytopenia. Through next-generation sequencing technology of hemophagocytic lymphohistiocytosis (HLH)-related genes, we found compound heterozygous mutations of PRF1: c.65delC (p.Pro22Argfs*29) (frameshift mutation, paternal) and c.16 3C>T (p.Arg55Cys) (missense mutation, maternal). Although he did not receive hematopoietic stem cell transplantation, the patient achieved complete remission after receiving HLH-2004 treatment protocol. To date, the patient has stopped taking drugs for 15 mo, is in a stable condition, and is under follow-up observation. CONCLUSION: The delayed onset of FHL2 may be related to the PRF1 mutation type, pathogenic variation pattern, triggering factors, and the temperature sensitivity of some PRF1 mutations. For individual, the detailed reason for the delay in the onset of FHL warrants further investigation. PMID:33869605 | PMC:PMC8026822 | DOI:10.12998/wjcc.v9.i10.2289 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary intramedullary melanoma of lumbar spinal cord: A case report

paythelady.612 shared this article with you from Inoreader Primary intramedullary melanoma of lumbar spinal cord: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2352-2356. doi: 10.12998/wjcc.v9.i10.2352. ABSTRACT BACKGROUND: Primary intramedullary melanoma is a very rare tumor, most frequently occurring in the cervical and thoracic spinal cord. CASE SUMMARY: We present a rare case in which the primary intramedullary melanoma was located in the lumbar spine. A 56-year-old man complained of progressive intermittent pain in the lumbar area. Thoracic magnetic resonance imaging showed a spinal intramedullary tumor between the L3 and S1 levels. The tumor was resected entirely, and the diagnosis of malignant melanoma was confirmed by histopathology. CONCLUSION: Primary melanoma of the spinal cord, particularly intramedullary localization, has rarely been reported in the previous literature. We describe a primary malignant melanoma of the lumbar spinal cord and discuss the challenges associated with the diagnosis. PMID:33869613 | PMC:PMC8026835 | DOI:10.12998/wjcc.v9.i10.2352 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tertiary peritonitis: A disease that should not be ignored

paythelady.612 shared this article with you from Inoreader Tertiary peritonitis: A disease that should not be ignored Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2160-2169. doi: 10.12998/wjcc.v9.i10.2160. ABSTRACT Intra-abdominal infections can be classified into uncomplicated or complicated (peritonitis). Peritonitis is divided into primary, secondary, and tertiary. Tertiary peritonitis is the less common but the most severe among peritonitis stratifications, being defined as a recurrent intra-abdominal infection that occurs 48 h after a well-succeeded control of a secondary peritonitis. This disease has a complex pathogenesis that is closely related to the capacity of the peritoneal cavity to activate immunological processes. Patients who progress to persistent peritonitis are at an increased risk of developing several infectious complications such as sepsis and multiple organ failure syndrome. Moreover, tertiary peritonitis remains an important cause of hospital death mainly among patients with associated risk factors. The microbiological profile of organ isms causing tertiary peritonitis is often different from that observed in other types of peritonitis. In addition, there is a high prevalence of multidrug-resistant pathogens causing this condition, and an appropriate and successful clinical management depends on an early diagnosis, which can be made easier with the use of clinical scores presenting a good prediction value during the intensive care unit admission. Complementarily, immediate therapy should be performed to control the infectious focus and to prevent new recurrences. In this sense, the treatment is based on initial antimicrobial therapy and well-performed peritoneal drainage. PMID:33869592 | PMC:PMC8026831 | DOI:10.12998/wjcc.v9.i10.2160 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits in a young woman: A case report

paythelady.612 shared this article with you from Inoreader Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits in a young woman: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2357-2366. doi: 10.12998/wjcc.v9.i10.2357. ABSTRACT BACKGROUND: Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMID) is a newly recognized rare disease. The renal pathology is characterized by prominent manifestations of membranous hyperplasia, which are easy to misdiagnose. The clinical symptoms are severe. Massive proteinuria and hypoproteinemia are conspicuous, and most patients are accompanied by renal insufficiency and microscopic hematuria. CASE SUMMARY: A 27-year-old woman was admitted to a hospital for macroscopic hematuria and proteinuria 4 years prior, and renal biopsy in the hospital suggested moderate-to-severe mesangial proliferating glomerulonephritis (MsPGN). She had taken a glucocorticoid, cyclophosphamide, mycophenolate mofetil, and other treatments and achieved brief partial remission. Recently, the patient visited our hospital due to mass ive proteinuria. Repeated renal biopsy and re-evaluation of the first biopsy obtained 4 years previously revealed monoclonal immunoglobulin deposition in the glomeruli. A bone marrow examination was performed to exclude hematologic malignancy, and a diagnosis of PGNMID was established. The patient showed remission after four cycles of a bortezomib + cyclophosphamide + dexamethasone scheme. CONCLUSION: PGNMID is usually misdiagnosed as MsPGN or membranoproliferative glomerulonephritis. Although it often occurs in middle-aged and elderly individuals, it cannot be readily excluded in young people, even when serum immunofixation electrophoresis is negative. IgG subtype and light chain staining are necessary when this disease is highly suspected. An accurate diagnosis at the earliest stage may avoid the overuse of glucocorticoids and immunosuppressants. PMID:33869614 | PMC:PMC8026847 | DOI:10.12998/wjcc.v9.i10.2357 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.