Objective: To assess psychosexual distress among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot, shortly after women received their results and 6 and 12-months later. Design: Longitudinal, between-groups study. Setting: Five sites in England where primary HPV testing was piloted. Population: Women aged 24-65 years (n=1133) who had taken part in the NHS Cervical Screening Programme. Methods: Women were sent a postal questionnaire soon after receiving their screening results and 6 and 12-months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible screening results. Main Outcome Measures: Psychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q). Results: At all three time-points, there was an association between screening result and overall psychosexual distress (all p<0.001). At baseline, psychosexual distress was significantly higher among women with HPV and normal cytology (B=1.15, 95% CI:0.961-1.337), HPV and abnormal cytology (B=1.02, 95% CI:0.783-1.266) and persistent HPV (B=0.90, 95% CI:0.703-1.102) compared with the control group (all p<0.001). At 6 and 12-month follow-up the pattern of results was similar, but coefficients were smaller. Conclusions: Our findings suggest that while simply participating in HPV testing does not appear to cause psychosexual distress, receiving an HPV-positive result does, particularly in the short-term. Developing interventions to minimise the psychosexual burden of testing HPV-positive will be essential to avoiding unnecessary harm to the millions of women taking part in cervical screening.

Objective We explored the association of smoking and GBS colonization among women delivering neonates 35 weeks+. Design Retrospective chart review Setting A large tertiary care inner-city hospital in the southern United States Population/Sample 803 women pregnant women of term or near term neonates Methods The electronic health records of a convenience sample. Main Outcome Measures The outcome variable of interest was maternal GBS colonization. The primary independent variable of interest was tobacco smoking during pregnancy. Results The prevalence of maternal GBS colonization was 32% among the study population. In the univariate analyses, factors associated with maternal GBS colonization were tobacco smoking during pregnancy (P of trend <0.001), Race (African Americans with the highest colonization rates and East Asians the lowest; P<0.001), maternal age <20 years (P=0.006), low birthweight <2500 gm (P=0.02), maternal drug use (P=004), and gestational age <37 (P=0.041). Gestational diabetes, parity, and gender were not predictive of GBS colonization. In the multiple logistic regression analysis, Women who smoked during pregnancy were more than twice more likely to be colonized than their non-smoking counterparts (OR=2.6; 95% CI=1.5- 4.6; p<0.001). Maternal age was the only other significant predictor with young mothers < 20 years more than one and a half time more likely to be colonized than their older counterparts (OR= 1.65; 95% CI=1.02-2.68; P=0.04). Conclusion Smoking during pregnancy was identified as an independent risk factor for GBS colonization. This is another reason that women should refrain from smoking during pregnancy to avoid risking their babies developing GBS disease.

We report the case of a 73-year-old man who was presumed to have iron deficiency anemia and was treated with iron supplements since adolescence. His workup revealed β-thalassemia minor and H63D homozygous hereditary hemochromatosis complicated with liver cirrhosis and hepatocellular carcinoma.

An 88-year-old lady presented with idiopathic sepsis and ischaemic gangrene of the right breast. Group-A bacteraemia was identified on blood culture. Breast biopsies taken were negative for malignancy. The patient was treated with intravenous antibiotics and fluid resuscitation. Subsequent wound care and continuation of oral antibiotics led to complete recovery.

Cutaneous Leishmaniasis (CL) is often a localized and self-limited disease, but its behavior changes in the state of immunosuppression. Here, we report a rare clinical presentation of disseminated CL after reactivation of leishmania infection in a 42 year old male with corticosteroid induced immune suppression.

Typical form of Hemolytic Uremic Syndrome is caused most commonly enterohemorrhagic E. coli strain O157:H71. Here we report a unique case of HUS secondary to enteropathogenic E. coli infection, with a discussion on the diagnosis of HUS and how it is distinguished from other thrombotic microangiopathies (TMAs).

Colon cancer is a highly prevalent disease worldwide, and approximately 15% of patients present with locally advanced tumors (T4 stage). En bloc resection of the tumor is of pivotal importance and is associated with a highly significant improvement in 5-year survival.

The trochanteric fractures usually occur in elderly people who are often associated with osteoporosis; the impacting forces are commonly low energy. The displacement of fragments can be much or little, but it can cause pain a lot.

The decision to implement screening for infections during pregnancy depends upon epidemiological, economic, therapeutic and test performance criteria. It therefore varies with public health priorities from country to country. When screening is implemented, first trimester has become the best time slot to build individual care pathways also in this field. This is most relevant for evaluating the risk of embryonic consequences, plan diagnostic testing, initiate primary or secondary prevention and increase the accuracy of ultrasound follow-up. This is a critical appraisal of epidemiological data and current international screening recommendations for infections in pregnancy.

Hemangiomas are defined as soft tissue lesions in the maxillofacial or oral region. Hemangiomas of salivary glands constitute 30% of the non-epithelial tumors in major salivary glands. Benign tumors in salivary glands are located 85% in parotid gland and 13% in submandibular gland. We present a case of submandibular hemangioma in an infant patient that had some complications and a challenging diagnosis. A 3- month-old female patient presented a giant hemangioma located in the submandibular, preauricular and right malar region with purplish color that during hospitalization had a cardiorespiratory arrest as a severe complication of the disease.

Background: Patients with end stage renal disease (ESRD) have a cardiovascular mortality about 15-30 times the general population and this is reduced by about 70% with renal transplant. Dobutamine stress echocardiography (DSE) is commonly performed for preoperative cardiac evaluation before renal transplantation. Hypertensive response during DSE occurs in about 1-5% of DSE studies. However, it seems to be more frequent in patients with ESRD. But its frequency and clinical implications are not known. Methods and Results: Of the 249-consecutive adult ESRD patients undergoing DSE for pre-kidney transplant cardiac risk assessment at our dedicated clinic, 53 (21%) had a hypertensive response. Half of the patients with a hypertensive response, had stress induced segmental wall motion abnormalities, of whom only half had angiographically significant coronary artery disease by quantitative coronary angiography. The hypertensive response was not a predictor of survival. Stress induced segmental wall motion abnormalities predicted poor survival in those with a normotensive response, but not in those with a hypertensive response. The main and independent predictor of a hypertensive response was higher baseline systolic blood pressure (p< 0.0001). Conclusions: Hypertensive response to dobutamine stress is common in ESRD patients and is not a predictor of survival. Stress induced segmental wall motion abnormalities occur nearly thrice as frequently with a hypertensive response, but this is a poor predictor of angiographically significant coronary artery disease and does not predict survival.

Background: On June 05, 2017, the U.S. Food and Drug Administration approved the Edwards Lifesciences SAPIEN S3 Valve for transcatheter mitral valve replacement of degenerated bioprosthetic mitral valves. We present a case of the youngest patient (13 years old) to undergo this procedure. Case presentation: At 10 years old, this female patient underwent bioprosthetic mitral valve replacement. Three years later, she began experiencing shortness of breath NYHA class III. A transthoracic echocardiography showed a degenerated bioprosthetic mitral valve and severe mitral stenosis with a mean pressure gradient of 18 mm Hg. After deeming the patient, a high risk for surgery, the heart team opted to perform a transcatheter mitral valve-in-valve replacement. After the valve delivery system crossed the degenerated valve, a SAPIEN valve balloon was slowly inflated without rapid pacing to allow for fine positioning. Transoesophageal echocardiography evaluation revealed a mean gradient of 5 mm Hg. The patient discharged after 2 days. At her 30-month follow-up, she reported regular daily activity with no shortness of breath, and a follow-up transthoracic echocardiography showed normal function of the right ventricle, which also had reduced in size. Her systolic pulmonary artery pressure decreased to 33 mm Hg, the mean pressure gradient of the left ventricular outflow tract was 10 mm Hg, and the mitral valve mean pressure gradient was 6 mm Hg. Case discussion: Transcatheter mitral valve replacement is feasible in young female patients with a small body surface area. Safety and long-term outcomes need more research in this age group.

Timely use of Sacubitril/Valsartan has the potential to significantly improve cardiac function and dramatically reduce secondary mitral regurgitation (MR) severity even in patients presenting with acute decompensated heart failure (HF), not only in compensated chronic HF patients. The outstanding impact of echocardiography is obvious in monitoring improvement of cardiac function and MR severity in patients with heart failure with reduced ejection fraction (HFrEF). We report a relevant case of an elderly patient who presented with acute decompensated HF with severe bi-ventricular dysfunction and severe MR. He was previously on optimal medical therapy (OMT), however still symptomatic. Coronary angiogram (CAG) depicted three vessel coronary artery disease (CAD). Patient advised to undergo coronary artery bypass graft surgery (CABG) with mitral valve repair, then followed by implantation of a cardiac resynchronization therapy defibrillator device (CRT-D) if no LV function improvement observed after revascularization. Patient’s ECG showed a QRSd ≥ 125 ms, hence a good candidate for CRT. Two weeks after starting Sacubitril/Valsartan the LV EF improved from 15% to 40%. Severe MR reduced to grade II and there was dramatic improvement of patient’s symptoms from NYHA class IV to NYHA class I. NT-proBNP reduced from 9,000 pg/ml to 800 pg/ml. Following an elective percutaneous coronary intervention (PCI), LV EF further improved to 50%. The patient was symptoms-free with preserved LV EF on follow up for 18 months later. This case report documents the swift echocardiographic and symptom improvement in an elderly patient with decompensated end-stage HF when Sacubitril/Valsartan started during the acute setting

Abstract: Trisomy 3 has been previously reported in association with T-cell lymphomas and less commonly in different types of non-Hodgkin B-cell lymphomas. Trisomy 3 has also been reported in two cases of pediatric post-transplant lymphoproliferative disorder (PTLD). We present comprehensive clinicopathologic review of two pediatric patients with cardiac and liver/intestinal allografts that developed polymorphous PTLD characterized by trisomy 3. Both patients had EBV viremia and EBV was positive in tissue by EBER in situ hybridization. Using karyotype analysis and fluorescence in situ hybridization, we identified trisomy 3 in both patients. Both patients responded to treatment and are now free of the PTLD. Trisomy 3, an uncommon cytogenetic finding in PTLD, may be a recurrent cytogenetic if confirmed in a larger study of pediatric PTLD’s. Further clinical follow up might help stratify significance of trisomy 3 as a prognostic factor.

Background Adverse drug reactions (ADRs) constitute major clinical burden of public health concern. Intensive adverse drug reactions monitoring in hospitals, though advocated are rare. Aims Intensive monitoring of medical patients for ADRs to assess incidence, risk factors and fatality of ADRs leading to hospital admission or occurring in the hospital. Research design and methods Prospective cohort study on 1280 adult patients admitted to the six medical wards of a tertiary institution over a 12-month period. Patients were assessed for ADRs during and throughout admission. Causality assessment and preventability of ADRs were assessed. Results Sixty-seven (5.2%) patients had ADRs, which was the cause of admission in 46 (3.6%), and majority 61(91%) of the ADRs were preventable. NSAIDs, 14 (20.3%), antidiabetics, 12 (17.4%) and antibacterial, 11 (15.8%) were the most suspected drugs. Gastrointestinal tract (37%), CNS (30.2%), and skin (24.7%) were the most affected organ/systems, while upper GI bleeding and hypoglycaemia were the most observed ADRs. ADRs led to deaths in 7(10.4%) patients, with overall case fatality rate of 0.5%. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 3/7(42.9%) had the highest fatality rate. Risk factors, relative risk, 95% confidence interval for ADRs were alcohol intake, 1.7 (1.04, 2.80) and duration of hospital stay, 2.0 (1.16, 3.26). Conclusions Preventable ADRs are common and important cause of hospitalization and inpatients’ morbidity and mortality among medical patients in Nigeria. Upper GI bleeding and hypoglycaemia, resulting from NSAIDs and antidiabetic drugs were the most observed ADRs. Strategic planning for intensive follow up of ADRs in Nigeria is advocated.

The novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a serious threat to global public health. Respiratory failure followed by cardiovascular complications with wide-spread endothelial dysfunction and inflammation is rapidly emerging as a key threat in COVID-19. ACE-2 receptors are the cell-entry gate for SARS-CoV-2. Valproic Acid (VPA) is a proposed potential drug to treat COVID-19 but its mechanism of action is not well understood. We demonstrate that VPA-treatment significantly reduced ACE-2 expression in endothelial cells. VPA-treatment significantly reduced the expression of inflammatory cytokines IL-6 along with the endothelial activation marker ICAM-1. We provide evidence and discuss the plausible mechanism in detail for VPA use to prevent and treat COVID-19 in a personalized manner. Our study is expected to entice the scientific and clinical society to investigate VPA as a potential therapeutic option against COVID-19.

A document by Xiaomei Peng. Click on the document to view its contents.

Aim: To evaluate the pathogenesis, risk factors, diagnosis and management strategies in pregnant women suspected or confirmed with COVID-19 infection. Methods: A literature review of published articles was carried out using keywords of corona virus (and its root derivatives), pregnancy, vertical transmission and childbirth in Medline, Cochrane, CINAHL, Clinicaltrials.gov and Web of Sciences. Clinical articles including case-control, case reports, case series and reviews published between 2019 and 2020, in English language were included. Editorials and Letter to Editors were not included. Two independent authors reviewed title and abstract of the articles and another set of two independent authors screened full text. A total of 22 articles were shortlisted for addition into the final manuscript Results: A total of 403 pregnancies were considered in the study with most of the patients in the third trimester of pregnancy. There was no maternal mortality reported in the literature, however 1.49% fetal mortality has been reported. Conclusion: The ideal management revolves around, rapid detection, prompt diagnosis and effective isolation.

A 2-year-old girl with TCF3-ZNF384 re-arranged standard-risk B-cell precursor acute lymphoblastic leukaemia (BCP-ALL) showed an apparent lineage-switch to predominantly myeloid blasts following 7-days of corticosteroid therapy. ZNF384-re-arranged leukemias are increasingly recognized to present either as mixed-phenotype acute leukemia or as BCP-ALL with pro-B immunophenotype. Lineage switch is a rare phenomenon described at relapse or following CAR-T-cell therapy previously mostly in KMT2A re-arranged leukemias; and now, also in ZNF384-rearranged patients. It is previously unreported in any patient after pre-phase corticosteroid therapy. Hematologists should be aware of this distinct emerging entity among leukemias with multi-lineage differentiation potential.

Iatrogenic acute aortic dissection during percutaneous coronary intervention is an extremely rare but potentially life-threatening complication occurring in less than < 0,02% of the procedures. We report the cases of 3 patients with aortic dissection during percutaneous coronary intervention successfully treated with an emergent ascending aorta replacement. The main goal is the closing of the intimal tear as fast as possible damage either with a percutaneous system (i.e. a proximal stent) or with an open heart open surgery to prevent the extension of the dissection and neurological. A conservative strategy should be pursuit only in small localized sinus dissections.

Commentary: Animal free applications in the development of cell-based therapies

Catheter ablation is a widely accepted therapy for atrial fibrillation (AF), of which stroke is a major complication. A stroke after catheter ablation has been reported in numerous studies not only in the acute phase but also in the chronic phase. A 66-year-old man with drug refractory paroxysmal AF underwent catheter ablation. Fourteen months later, the patient was diagnosed with cerebral infarction. Transesophageal echocardiography detected an ovoid mass on the anterior aspect of the right superior pulmonary vein atrium, where the previous ablation was performed. We report a very rare case of left atrial thrombus formation required surgical treatment 14 months after cryoballoon ablation.Careful follow up with multimodalities is necessary for the detection and diagnosis of chronic phrase thrombus formation.

Alternatives to traditional aortic valve replacement now form part of the valve surgeon's armamentarium. Sutureless valves offer decreased bypass and crossclamp times, excellent maneuverability, and promising outcomes. We present a case of a sutureless aortic valve replacement for a late failed David procedure, complicated by post-operative development of severe paravalvular regurgitation. We attempted off-label balloon post-dilation to improve expansion of the valve, however paravalvular regurgitation persisted. The patient underwent subsequent aortic valve replacement using a mechanical valve and experienced no further paravalvular leak.

Background and Purpose: COPD is one of the most common respiratory diseases worldwide with high comorbidities as major depressive disorder(MDD). Cigarette smoking(CS) is the most major risk factor and smokers tend to be more easy to get COPD and MDD, the mechanisms still remained poorly defined. Experimental Approach: The gene expression microarray analyzed between COPD lung tissues and MDD brain tissues were conducted and enriching GO and KEGG pathways analysis in R. CS exposure induced COPD animal model in mice was established and followed the expression of hub-bottleneck genes. Key Results: Based on microarray analysis, found some DEGs plays a prominent role in COPD and MDD, such as Casitas B-lineage Lymphoma Proto-OncogeneB (CBLB) is involved in the regulation of immune response. Myocyte enhancer factor 2C (MEF2C) have been associated with severe cognitive disability, stereotypic movements and cerebral malformation. Mitogen-activated protein kinase 7 (MAPK7) was involved in various cellular processes. Furthermore, animal studies showed that mice exposure to CS whose airway inflammation increased and inflammatory cells rise in bronchoalveolar lavage fluid accompanied with markedly declined lung function. In addition, CBLB and MAPK7 with abnormal expression in the brain tissue. Even more important, mice exposure to CS whose brain was seriously injured and the nerve cells morphological have changed, CBLB deficiency increased the GM-CSF signal pathway related inflammatory reactions in brain tissue. Conclusion and Implications: In conclusion, CS causes COPD accompanied with early acute brain injury, GM-CSF and MAPK7 signal pathway may be involved in it. To some extent, the study revealing that inflammatory response accompany with the earliest acute brain injury is the pathological basis of COPD complicating MDD