Acquired perforating dermatoses represent an uncommon group of chronic papulonodular dermatoses of unknown aetiology, characterized clinically by intense itching; and histopathologically by transepidermal elimination of dermal components. Definitive targeted pharmacological approaches are lacking, and the disease is usually refractory to therapy. We report here a case of rapid remission of acquired perforating dermatosis following simple thymectomy. If a role for the thymus in the pathogenesis of acquired perforating dermatoses was to be established, this could pave the way for a yet uncharted surgical therapy for these debilitating conditions.
Chronic pulmonary thromboembolism is one of the pathogenic mechanisms for the development of pulmonary arterial hypertension in thalassemic patients, but there are no current recommendations for the management of this complication. We report performing successful pulmonary thrombo-endarterectomy in a patient with chronic thromboembolic pulmonary hypertension linked to β-thalassemia, which was followed by substantial hemodynamic and functional improvements. This report supports the feasibility of pulmonary thromboendarterectomy in thalassemic patients, and highlights the need for a comprehensive evaluation for both the presence and cause of pulmonary arterial hypertension prior to determining the likelihood of surgical cure.
Objective: Calafiore and modified del Nido cardioplegic solutions are currently being used during coronary artery bypass surgery. This study aims to compare myocardial ischemic stress associated with both solutions by studying the changes in cardiac metabolites during cardioplegic ischemic arrest and early reperfusion. Methods: Biopsy specimens were taken from the left ventricles of 20 patients undergoing routine coronary artery bypass grafting using Calafiore or modified del Nido cardioplegic solutions. Biopsies were taken immediately after the beginning of extracorporeal circulation (basal biopsy), 30 min after application of the aortic cross‐clamp (ischemic biopsy), and 20 min following the removal of aortic cross‐clamp (reperfusion biopsy) and were analyzed for their amino acid and lactic acid contents using amino acid analyzer and appropriate kits. Peripheral blood samples were also collected for the determination of blood concentrations of cardiac proteins (CK‐MB and troponin I) using an immunofluorescence scanner. Results: Both CK‐MB and troponin I increased significantly 12 h postoperatively and were associated with an increase in myocardial lactic acid, but there were no significant differences in markers of myocardial injury between the two groups. Comparison of amino acid concentrations between the two groups according to sampling time showed that glutamic acid concentrations were significantly lower in the Calafiore cardioplegia group compared to the del Nido cardioplegia group, but there were no other significant differences in markers of metabolic stress (taurine and alanine/glutamate ratio) between the two groups. Moreover, there were no significant differences in changes in amino acid concentrations regardless of the type of cardioplegic solution used. Conclusions: Cardioplegic ischemic arrest and early reperfusion are associated with a rise in myocardial metabolic stress. Both Calafiore and modified del Nido cardioplegic solutions are effective in attenuating myocardial substrate derangements and confer equal myocardial protection during routine coronary artery bypass surgery. Trial Registration: ClinicalTrials.gov identifier: NCT06287372
Abstract Objective This study explored how the Syrian crisis, training conditions, and relocation influenced the National Medical Examination (NME) scores of final‐year medical students. Methods Results of the NME were used to denote the performance of final‐year medical students between 2014 and 2021. The NME is a mandatory standardised test that measures the knowledge and competence of students in various clinical subjects. We categorised the data into two periods: period‐I (2014–2018) and period‐II (2019–2021). Period‐I represents students who trained under hostile circumstances, which refer to the devastating effects of a decade‐long Syrian crisis. Period‐II represents post‐hostilities phase, which is marked by a deepening economic crisis. Results Collected data included test scores for a total of 18 312 final‐year medical students from nine medical schools (from six public and three private universities). NME scores improved significantly in period‐II compared with period‐I tests ( p < 0.0001). Campus location or relocation during the crisis affected the results significantly, with higher scores from students of medical schools located in lower‐risk regions compared with those from medical schools located in high‐risk regions ( p < 0.0001), both during and in the post‐hostilities phases. Also, students of medical schools re‐located to lesser‐risk regions scored significantly less than those of medical schools located in high‐risk regions ( p < 0.0001), but their scores remained inferior to that of students of medical schools that were originally located in lower‐risk regions ( p < 0.0001). Conclusion Academic performance of final year medical students can be adversely affected by crises and conflicts, with a clear tendency to recovery upon crises resolution. The study underscores the importance of maintaining and safeguarding the infrastructure of educational institutions, especially during times of crisis. Governments and educational authorities should prioritise resource allocation to ensure that medical schools have access to essential services, learning resources, and teaching personnel.
Abstract This report supports the feasibility of pulmonary thromboendarterectomy in thalassemic patients, and highlights the need for a comprehensive evaluation of the cause of pulmonary hypertension prior to determining the likelihood of surgical cure.
Background. Surgical mobilization of the internal mammary artery (IMA) can induce graft vasospasm, which is commonly managed by wrapping the IMA in a vasodilator-soaked swab before grafting. However, the choice of the most effective topical vasodilator remains the subject of continued investigation. We carried out a prospective randomized controlled trial to compare the effect of topically applied milrinone, nitroglycerin, and normal saline on IMA free flow. Methods. Forty-six consecutive patients undergoing elective primary coronary artery bypass grafting were enrolled. After the left IMA was harvested, free flow was measured under controlled hemodynamic conditions before any intervention (flow 1) and at a mean of 12.5 minutes after the topical application of one of three agents (milrinone, nitroglycerin, or normal saline) on the IMA (flow 2). Results. All agents induced a significant increase in IMA flow, and flow 2 was significantly higher in the nitroglycerin and milrinone groups compared to the normal saline group, even while controlling for flow 1 as a centered continuous variable. Nevertheless, there was no statistically significant difference in flow 2 between the nitroglycerin and milrinone groups. Conclusions. Topically applied milrinone and nitroglycerin can increase blood flow of the IMA significantly in the early period after surgical mobilization. IMA blood flow was greater after the topical application of milrinone compared to nitroglycerin, but this has failed to reach statistical significance in the present study setting. This trial is registered with NCT06301880.
A 51-year-old female underwent emergency mitral valve replacement for mitral stenosis with an undetermined mass which was attached to the anterior mitral leaflet. Histopathological testing of the excised specimen confirmed the diagnosis of rheumatic mitral disease in combination with a primary rhabdomyosarcoma. Postoperative adjuvant chemotherapy with pazopanib hydrochloride was given. At 10 months of follow-up, repeated computed tomographic screening has not shown any signs of local recurrence or secondary metastases. The potential for the existence of primary rhabdomyosarcomas should be borne in mind when faced with undetermined masses on mitral leaflets, even in the presence of rheumatic disease.
Surgical patch angioplasty is an alternative to classic coronary artery bypass grafting for patients with isolated coronary ostial stenosis and normal distal coronary arteries. We present a case where we successfully used an arterial patch from the right internal mammary artery to restore patency of an isolated ostial left main coronary artery stenosis. This technique is likely to offer more physiological antegrade myocardial perfusion, mimic normal vascular anatomy, and may be associated with an improved outcome.
Alpha thalassemia is a common recessively inherited blood disorder due to mutation or deletion of one or more alpha globin gene. Nowadays, the initial step for screening of alpha thalassemia is by determining the MCV and MCH values. Further investigation includes Hb analysis and confirmation test by molecular analysis. Among the popular molecular method commonly used today is the polymerase chain reaction (PCR). HTAR usually outsource its molecular tests for alpha thalassemia. However, only about 50% of the outsourced samples were positive for alpha thalassemia. Thus, to avoid performing molecular analysis unnecessarily, this study was proposed to find if there is any relationship between the RBC parameters, HBA₂ level and molecular findings for better screening of patients prior to request for molecular analysis. A total of 197 data which consisted of RBC parameters (TRBC, Hb, RDW, MCV, MCH, MCHC and Retic Count), HBA₂ level and molecular findings from HTAR patients diagnosed with alpha thalassemia in 2014. Independent t-test was conducted to evaluate whether the RBC parameters and , HBA₂ level differed significantly for groups of positive or negative molecular findings. Out of the eight parameters tested, RDW, MCHC and rectic were found to be significantly different between groups of positive and negative molecular analysis. Then, the RDW, MCHC and Retic were then anaylzed using ROC Curve to determine the cut-off values for positive molecular findings, respectively. The cut-off values for MCHC and Retic could be determined while cut-off values for RDW could not be determined as the area under the curve was less than 0.5. The cut-off values for MCHC was equal or greater than 34.15 g/dL while the cut-off value for Retic was equal or greater than 2.1%.
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