#Primary volvulus

[sarajcsmicasereports]

Retroperitoneal cystic Lymphangioma in adulthood – A case report by Urânia Fernandes in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Cystic lymphangioma is a benign lymphatic system malformation, rarely diagnosed in adulthood. Head and neck are commonly affected and abdominal location is rare. Its presentation ranges from asymptomatic to severe symptoms (bleeding, rupture, infection, volvulus). The diagnosis is often made after surgery and confirmed by histopathological examination.

Methods: A case report of a 57-year healthy female patient presented with abdominal pain, postprandial fullness, sporadic vomit and imaging revealing a 9-centimeter retroperitoneal cyst is described.

Results: She was submitted to surgery and histology confirmed the diagnosis of cystic lymphangioma.

Conclusion: Retroperitoneal cystic lymphangioma is a very rare disease. Preoperative diagnosis is challenging and definitive treatment is surgical resection in symptomatic patients.

Keywords: Abdominal neoplasms; cystic lymphangioma; case reports

Background

Cystic lymphangioma is a benign malformation of the lymphatic system. Congenital lesions occur when primary lymphatic cysts fail to converge with the main lymphatic system.[1, 2] Acquired lesions are caused by obstruction between lymphatic and venous systems due to inflammation, trauma or degeneration.[3] Head and neck are more commonly affected (75%), followed by axillae (20%) and abdomen (5%).[4] Amongst  abdominal cases, mesentery is the main location but the gastrointestinal tract, spleen, liver, kidneys and adrenals may also be affected.[3] Retroperitoneal location is even rarer (1%).[4] Most of cystic lymphangiomas (60%) are diagnosed in children less than 5 years of age.[3] To the best of our knowledge, only about 200 cases have been described in adults so far, but the real prevalence may be underestimated due to nonspecific clinical presentation and difficult recognition of the disease.[2, 4] Patients with slowly growing lesions, mainly in retroperitoneal location, may present an asymptomatic palpable mass in the abdomen.

Abdominal pain is the commonest symptom in bigger tumors, but abdominal distension and constipation can also occur. Uncommon complications that may cause acute abdomen situations are intracystic or gastrointestinal bleeding, infection, cystic rupture and volvulus.[3] This report aimed to present the case of a retroperitoneal cystic lymphangioma in adulthood and a brief review of the literature.

Case report

A 57-year healthy female patient presented to the clinic with a nonradiated, moderate and constant epigastric abdominal pain. She referred also postprandial fullness and sporadic vomit, but denied weight loss and gastrointestinal bleeding. Physical examination was innocent. Laboratory work-up (including blood count, liver and pancreatic enzymes and carcinoembryonic antigen) was unremarkable, as well as esophagogastroduodenoscopy. Abdominal ultrasonography revealed a 9-centimeter cystic lesion, located inferiorly to the left kidney and dislocating the aorta. Computed tomography (CT) excluded renal and aortic invasion and suggested a possible relation with distal duodenum (Figure 1). Patient was submitted to an uneventful open, anterior and total resection of the cystic lesion, which did not invade adjacent structures (Figure 2 and 3). Patient did well in the postoperative period and was discharged in day 4. Histology revealed a cystic lesion with thin and translucent wall with 9.5-centimeter of maximum diameter. Immunohistochemical study was compatible with cystic lymphangioma with endothelium staining for podoplanin (D2-40) but not for calretinin (Figure 4 and 5). Patient remains asymptomatic and with no evidence of recurrence during 42 months of follow-up.

Discussion

Preoperative diagnosis of retroperitoneal lymphangioma is difficult and it is frequently an incidental radiological finding. Ultrasound often shows a well limited, simple or multilocular cyst with thin septation and clear fluid or hyperechogenic content if bleeding or calcifications exist. CT allows a better assessment of the relation with adjacent organs. Cystic content is better characterized by Magnetic Resonance Imaging as well as perivascular extension of the lesion.[2, 3] This patient declined Magnetic Resonance because of “claustrophobia sensation” and diagnosis was not possible preoperatively, despite ultrasound and CT.

Differential diagnosis of abdominal cystic lymphangioma include lymphoma, cystic mesothelioma, teratoma, sarcoma, lymphangioma, adenoma, hematoma, abscess, duplication cyst, ovarian cyst, postoperative lymphocele, lymphadenopathy, ovarian or gastric cystic metastases. In spite of excellent imaging tools, diagnosis of cystic retroperitoneal lymphangioma is often made after surgery only and after confirmation by histopathological examination. Diagnostic criteria are dilated lymphatics lined with flat endothelium rich in lymphoid tissue with no atypical cells.[3, 4] Immunohistochemically, cystic lymphangioma endothelial cells express factor VIII-related antigen, CD31 and CD34, but negative staining with cytokeratin [1, 5], as observed in this patient.

Asymptomatic patients can be proposed to conservative treatment reserving surgery for symptomatic patients, considering the absence of final diagnosis. Percutaneous drainage or aspiration with or without injection of sclerosant agents present a high rate of recurrence and must be reserved for patients not fit for surgery.[2, 3] Surgery (open/laparoscopic, retroperitoneal/anterior) is the definitive treatment and it may be limited by tumor location and relation with adjacent structures. Lymphostasis must be meticulous to avoid complications as lymphocele or chylous ascites. Recurrence can achieve 17-40% depending on total or partial resection.[2, 3] In the present case, the presence of symptoms, probably due to extrinsic compression of duodenum, the lack of diagnosis, and the size of the lesion, a laparotomy was proposed, which allowed the complete resection of the lesion through an anterior approach.

Conclusion

Retroperitoneal cystic lymphangioma is a benign disease, very rare in adults, that must be considered as a differential diagnosis of intra-abdominal cystic lesions. Preoperative diagnosis is challenging and in symptomatic patients definitive treatment is surgical resection.

Main novel aspects

We present a rare disease, even rarer in an adult, and in an uncommon location

[critterwags]

Understanding the Benefits of Slow Feeder Bowls for Dogs

Mealtime is a highlight of the day for most dogs, but for some, eating too quickly can lead to health issues and discomfort. Dogs that wolf down their food in a matter of seconds may experience problems like bloating, choking, or indigestion. Slow feeder bowls, designed with ridges, mazes, or other obstacles, can help pace your dog’s eating. But these bowls do more than just slow down eating—they offer a range of benefits that contribute to your dog’s overall well-being. In this blog, we'll explore the advantages of slow feeder bowls and why they might be the perfect addition to your dog’s mealtime routine.

1. Promotes Better Digestion

One of the primary benefits of using a slow feeder bowl is improved digestion. When dogs eat too quickly, they tend to swallow large amounts of food without properly chewing. This can lead to digestive issues like bloating, gas, or even a condition known as gastric dilatation-volvulus (GDV), commonly referred to as bloat. GDV is a serious and potentially life-threatening condition where the stomach fills with gas and twists, cutting off blood flow.

Slow feeder bowls are designed to make it more challenging for your dog to reach their food, forcing them to eat more slowly. By encouraging your dog to take smaller bites and chew thoroughly, these bowls help reduce the risk of digestive problems and promote a healthier, more comfortable mealtime experience.

2. Prevents Choking and Gagging

Dogs that eat too quickly are at a higher risk of choking or gagging on their food. This is especially true for dogs that are particularly enthusiastic about mealtime, often gulping down large amounts of food in one go. Slow feeder bowls help mitigate this risk by breaking up the food into smaller, more manageable portions that your dog must navigate to access.

The ridges and barriers in a slow feeder bowl slow down your dog’s eating pace, making it less likely for them to choke on large chunks of food. This not only makes mealtime safer but also more enjoyable for your dog.

3. Encourages Mental Stimulation

In addition to the physical benefits, slow feeder bowls also provide mental stimulation for your dog. The process of figuring out how to access their food through the maze or obstacles in the bowl engages your dog’s problem-solving skills. This added challenge can make mealtime more interesting and mentally enriching for your dog, especially for those that get bored easily.

Mental stimulation is just as important as physical exercise for a dog’s overall well-being. By turning mealtime into a fun and engaging activity, slow feeder bowls help keep your dog’s mind sharp and reduce the likelihood of boredom-related behaviors.

4. Helps with Weight Management

Dogs that eat quickly are often less aware of their fullness, leading them to consume more food than they need. Over time, this can contribute to weight gain and obesity, which can lead to various health issues, including diabetes, joint problems, and heart disease.

Slow feeder bowls help control portion sizes and give your dog’s body more time to signal that they’re full. By pacing their eating, your dog is less likely to overeat, making it easier to maintain a healthy weight. This is particularly beneficial for dogs that are prone to weight gain or those that are on a diet.

5. Reduces Food Aggression

Some dogs develop food aggression or resource guarding behaviors when they feel the need to protect their food. This is often exacerbated by the stress of eating quickly, especially in multi-dog households where competition for food may be more intense. Slow feeder bowls can help alleviate some of this anxiety by slowing down the eating process, giving your dog more time to eat calmly and reducing the urgency to finish quickly.

By making mealtime a more relaxed experience, slow feeder bowls can help decrease food aggression and create a more peaceful environment for both your dog and others around them.

6. Works for All Dog Breeds and Sizes

Slow feeder bowls come in various shapes, sizes, and designs, making them suitable for dogs of all breeds and sizes. Whether you have a small breed dog that nibbles at their food or a large breed that tends to gulp it down, there’s a slow feeder bowl designed to meet their specific needs. Some bowls are even adjustable, allowing you to customize the difficulty level based on your dog’s eating habits.

Conclusion

Slow feeder bowls are more than just a trendy pet accessory—they offer significant health and behavioral benefits that can improve your dog’s quality of life. From promoting better digestion and preventing choking to providing mental stimulation and aiding in weight management, these bowls are a simple yet effective way to enhance your dog’s mealtime experience.

If you’re concerned about your dog’s fast eating habits, it’s worth considering a slow feeder bowl. When shopping for a Dog Food Bowl online, be sure to explore options like slow feeders that can help make mealtime safer, healthier, and more enjoyable for your furry friend. So, don’t hesitate to buy a Food Bowl that meets your dog’s unique needs and watch as they benefit from a more paced and enriching mealtime.

[helthcareheven]

Thriving with Short Bowel Syndrome: Empowering Stories of Resilience

What is Short Bowel Syndrome? Short bowel syndrome (SBS) occurs when a significant portion of the small intestine is surgically removed or not developed properly. The small intestine plays a key role in absorbing nutrients and fluids from foods. When a large part of the small intestine is removed or does not function well, the body is unable to absorb enough nutrients and fluids from what is consumed. This can lead to malnutrition, dehydration, and weight loss.

Causes of Short Bowel Syndrome The most common causes of SBS include: - Crohn's disease: Inflammation from Crohn's disease can damage the intestines over time and require surgical removal of portions. - Irritable bowel disease: Conditions like ulcerative colitis that cause severe inflammation can lead to the need for intestines to be surgically removed. - Untreated birth defects: Babies born with congenital defects like volvulus where the intestines twist may require surgery to remove damaged portions. - Trauma: Blunt force trauma to the abdomen from accidents can tear the intestines and require surgical resection. - Cancer: Cancers of the small intestine or colon sometimes require surgical removal of large portions of the intestines. - Other conditions: Rare conditions like mesenteric ischemia which reduces blood flow to the intestines can also lead to needing intestinal resection.

Symptoms of Short Bowel Syndrome The primary symptoms of SBS are related to malabsorption and include: - Diarrhea: Frequent, loose stools are common as the intestines cannot absorb enough water and nutrients from food. - Dehydration: Fluid loss leads to dehydration which causes dizziness, fatigue, and fainting. - Weight loss: Inability to absorb enough calories and nutrients leads to weight loss over time. - Vitamin/Mineral deficiencies: Specific deficiencies can occur depending on which segments are resected including iron, calcium, vitamin B12, and fat soluble vitamins. - Bone loss: Prolonged vitamin D and calcium malabsorption leads to osteomalacia or osteoporosis in adults. - Bloating/cramping: Undigested carbohydrates fermenting in the intestines cause abdominal discomfort.

Diagnosis and Treatment of Short Bowel Syndrome Diagnosis is based on medical history, physical exam, stool studies, and imaging tests. Treatment depends on how much intestine remains but generally involves:

- Diet modifications: Eating smaller, more frequent meals high in calories, protein, and fat while limiting roughage. Vitamin/mineral supplements are also important. - Medications: Antidiarrheals,proton pump inhibitors, somatostatinanalogues, and other drugs can help absorption. - IV nutrition: Total parenteral nutrition (TPN) through a central line provides complete nutrition for those unable to meet needs enteral. - Growth hormones: May stimulate intestinal absorption through proliferation of mucosal cells. - Intestinal rehabilitation programs: Coordinate nutritional support, medications, and lifestyle adjustments. - Intestinal transplant: Considered for those reliant on TPN when complications arise, but it carries substantial morbidity and mortality risks.

Outcomes and Prognosis The long-term outlook depends on the underlying cause and extent of intestinal resection. With appropriate treatment, many can achieve enteral autonomy. However, some may continue to rely on parenteral or enteral support long-term. Children are more likely to adapt than adults as the intestine can expand its absorptive capacities. Risks include lifelong micronutrient deficiencies, osteoporosis with bone fractures, hepatobiliary complications from TPN, central line infections, and even mortality in severe cases not responsive to interventions. Overall five-year survival has improved to 60-80% with advances in medical and surgical therapies.

Living with Short Bowel Syndrome For individuals and families managing SBS long-term, the following tips can help optimize quality of life:

- Meal planning is crucial. Having high calorie liquid meal replacements provides flexibility. - Hydration with oral rehydration solutions prevents dehydration between outputs. - Loperamide or codeine as needed for diarrhea between dietary adjustments. - Monitoring micronutrient levels with supplements adjusts prevents deficiencies. - Participating in support groups shares challenges and solutions. - Taking precautions like remaining near bathrooms aids daily activities. - Maintaining central access sites clean reduces line infections. - Keeping hydrated and active as tolerated prevents complications.

In summary, short bowel syndrome is a serious condition requiring multifaceted lifelong management. With a coordinated care team and adherence to treatment plans, many can live full and active lives despite resection of parts of their small intestine. Advancements continue toward improving management strategies and clinical outcomes for individuals affected by SBS.

[drpinakdasgupta]

Best Coloncancer Treatment in Chennai

What Is Colorectal Surgery?

Colorectal surgery treats issues of the intestines. Your intestines enable your body absorb nutrients from food and process waste. When you have a colorectal condition, it can affect your ability to use the bathroom. Your symptoms may make it difficult or uncomfortable to complete routine tasks and activities. Surgery can help you feel better.

Types of Colorectal Surgery:

Depending on the specific area and extent of colorectal cancer, surgical options include:

Colonoscopy to remove early-stage cancers/polyps. During procedures used to examine the colon, precancerous polyps (abnormal tissue growths) and small cancers are removed.

Laparoscopy (minimally invasive). Surgery uses smaller cuts through which a tiny camera and instruments are used to remove the tumor.

Robotic surgery (minimally invasive). Surgical systems with 3D capability allow more precision than hands-on procedures.

Laparotomy (open surgery). Surgery is done through an incision in the abdominal area, often to remove larger tumors and surrounding tissue.

Who Might Need Colorectal Surgery?

Colorectal surgery is used for patients with certain noncancerous conditions too. Reasons include:

Colorectal cancer. Surgery is the primary treatment for curable colorectal cancer.

Large polyps. A polyp is a growth in the colon or rectum.

Diverticular disease. Diverticulosis, or diverticulitis, involves small sacs or bulges called diverticula that form in the colon. Complications from diverticulosis, such as infections or bleeding, may require surgery.

Inflammatory bowel disease. Complications from IBD, such as ulcerative colitis or Crohn’s disease may require surgery.

Volvulus. Abnormal twisting of the intestines can dangerously restrict blood supply to the colon. 

Ostomy reversal. Surgery is used to reattach the colon to the rectum or anus and close off the temporary ostomy.

Dr. Pinak Dasgupta conduct minimally invasive and complex revisional surgeries of the lowest part of the digestive tract. Our team treats both cancerous and noncancerous conditions of the:

Bowel, the small tubing that joins the stomach to the colon and absorbs nutrients 

Colon, the large tube between the bowel and rectum that stores, processes and removes waste from the body

Rectum, the pocket at the end of the colon that temporarily holds waste until it’s time to empty

Anus, the sphincter at the end of the rectum that allows waste to pass out of the body

Life After Colorectal Surgery:

You’ll spend a few days recovering in the hospital before you’re discharged. It might be two days or up to a week, depending on what kind of operation you had and how you are doing. During this time, you’ll be:

Monitored for any signs of complications from the procedure.

Gradually weaned from your pain medication.

Fed with a liquid diet or soft diet.

Waiting for your bowels to begin functioning again.

You’ll also receive counseling on how to take care of yourself when you get home. This may include:

Wound care

Ostomy care

Dietary advice

Talk To Dr. Pinak Dasgupta:

Dr. Pinak Dasgupta and their team has a dedicated and caring approach and will seek to find you the earliest appointment possible with one of lthe best colorectal surgeon in Chennai – Dr. Pinak Dasgupta for your needs. For more information about our comprehensive treatment options, or to request an appointment with the best gastro care clinic in Chennai. Call us on 8811091676.

[certifydelhi]

Buy Ivermectin Medicine Online in USA 

About Ivermectin medicine

Ivermectin 12mg tablets are a type of medication that is commonly used to treat parasitic infections in humans. These tablets contain the active ingredient Ivermectin, which is a type of anthelmintic medication that works by paralyzing and killing parasites. Ivermectin 12mg tablets are a highly effective treatment option for parasitic infections, including strongyloidiasis and onchocerciasis. If you believe you may have a parasitic infection or have been diagnosed with one you should speak to your healthcare provider to determine if Ivermectin 12mg tablets may be an appropriate treatment option for you.

Ivermectin (Ivermectol) Medicine Uses

One of the primary uses of Ivermectin 12mg tablets is in the treatment of strongyloidiasis, a type of parasitic infection that is caused by the roundworm Strongyloidesstercoralis. This infection is commonly found in tropical and subtropical regions and can cause a range of symptoms, including itching, abdominal pain, and diarrhea.

Another common use of Ivermectin 12mg tablets is in the treatment of onchocerciasis, also known as river blindness. This is a parasitic infection that is caused by the worm Onchocerca volvulus, which is transmitted to humans through the bites of blackflies. Symptoms of onchocerciasis can include itching, skin rashes, and vision problems, including blindness in severe cases.In addition to these uses Ivermectin 12mg tablets are also sometimes used to treat other types of parasitic infections including scabies, head lice, and certain types of mange in animals.

Generally, the following types of parasitic infections are treated usingIvermectin medicine:

Onchocerciasis: Also known as river blindness, this is a parasitic infection caused by a worm that's transmitted by black flies. Ivermectin is effective at killing the worms that cause this disease.

Strongyloidiasis: This is an infection caused by a type of roundworm that lives in the soil. Ivermectin is used to kill the worms in the body.

Scabies: This is a skin infection caused by mites. Ivermectin is used to kill the mites and relieve symptoms such as itching.

Head lice: Ivermectin is sometimes used as a treatment for head lice, although other medications are more commonly used.

How to use Ivermectin (Ivermectin 12mg)

It is important to note that Ivermectin 12mg tablets should only be taken under the supervision of a healthcare provider. 

The medicine should not be used by individuals who are allergic to Ivermectin or any other ingredients in the medication. 

Additionally, certain medications and medical conditions may interact with Ivermectin 12mg tablets and therefore it is important to discuss any medical concerns or conditions with your healthcare provider before taking this medicine

If you have any concerns or questions about Ivermectin 12mg tablets or their use, speak to your physician to learn more.

Precautions Before Taking Ivermectin:

Before taking ivermectin, there are a few precautions you should take to ensure your safety:

Inform your doctor if you are allergic to ivermectin or any other medications.

Inform your doctor if you are pregnant or breastfeeding, as ivermectin can be harmful to unborn babies and infants.

Inform your doctor if you have liver disease, as this may affect how your body processes the medication.

Inform your doctor if you are taking any other medications, as these may interact with ivermectin and cause unwanted side effects.

Do not take ivermectin if you have a history of alcoholism, as this may increase your risk of liver damage.

Side Effects of Ivermectin:

While ivermectin is generally safe and well-tolerated, it can cause side effects in some people. The most common side effects of ivermectin include:

Loss of appetite

Stomach pain or bloating

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[ijcmcrjournal]

Non-Operatively Managed Primary Small Bowel Volvulus: A Case Report by Ewnte B*

Abstract

Background: Primary small intestinal volvulus is one of the common causes of intestinal obstruction in various localities of the developing world. Although operative intervention has been the usual mode of treatment; this case report depicts meticulous follow-up & care, there is a possibility for relief of obstruction with non-operative management.

Case presentation: this is a case report of a 20-year-old male patient presented with crampy abdominal pain and frequent bilious vomiting. Plain abdominal film showed multiple distended small bowel loops with air fluid level, consistent with small bowel obstruction. Ruling out other etiologies primary small bowel volvulus was entertained and naso-gastric tube inserted, patient catheterized and kept nil per oral. After 48 hours of admission all symptoms resolved the patient resumed feeding and was discharged home.

Conclusions: The reported case shows evidence in which the patient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

Key words: Small bowel volvulus; Primary volvulus; Non-operative management

Abbreviations: BPM: Beats Per Minute; WBC: White Blood Cells; RBC: Red Blood Cells; HGB: Hemoglobin; HCT: Hematocrit; MCV: Mean Corpuscular Volume; BUN: Blood Urea Nitrogen; ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; ALP: Alkaline Phosphatase

Introduction

Small bowel volvulus is a condition in which there is a torsion of all or a segment of the small bowel and its mesentery: this can lead to bowel obstruction, ischemia, infarction, or perforation. The typical patient with the primary volvulus of the small intestine was found to be a young adult, male, muscular, farmer, from a rural area whose diet was bulky and mainly made of cereals [1,2].

Case Presentation

A 20-year-old male patient presented to Nefas Mewcha primary hospital Emergency department in January 2020 with the main complaint of crampy abdominal pain and distention of 14 hours duration. Associated with this, he also had nausea and frequent bilious vomiting eight times. He had passed feces 24 hours ago. He had no fever, cough, chest pain or night sweating. He had no history of similar illness before, no history of previous abdominal surgery.

He is not married and claims to be not sexually active. Lives with his parents and has three sisters and two brothers. He makes a living as a farmer. There are no medical illnesses that run in the family. There was no history of tobacco smoking or substance abuse. He consumes a local alcohol made of sorghum occasionally.

At presentation, his blood pressure was 105/60 mm Hg, pulse rate was 68 Beats Per Minute (BPM), respiratory rate was 18 per minute and temperature was 36.2 oC axillary. Physical examination of the patient at presentation, the patient was acutely sick looking in pain; not in cardio respiratory distress. He had a dry tongue and buccal mucosa. No palpable lymph adenopathy in all accessible areas. Chest was clear and resonant. S1 and S2 cardiac sounds were well heard and there were no added cardiac sounds. Abdomen was slightly distended, moves with respiration, flanks were full, there were no scars, no distended veins and hernia sites were free. Palpation revealed a tense abdomen with no area of tenderness, no shifting dullness, hyperactive tympanic percussion note, bowel sounds were 35 per minute. There is scanty stool on the examining finger, with no blood on it from digital rectal examination, no palpable mass was detected. The patient was conscious and neurological examination was intact.

A complete blood count of our patient showed: White Blood Cells (WBC) 12500 mcL, Red Blood Cells (RBC) 4.6 mcL, Hemoglobin (HGB) 16 gm/dL, Hematocrit (HCT) 48%, Mean Corpuscular Volume (MCV) 89.1fL, platelets 470×103, creatinine 0.6, Blood Urea Nitrogen (BUN) 30, Alanine Aminotransferase (ALT) 28, Aspartate Aminotransferase (AST) 24, Alkaline Phosphatase (ALP) 48, albumin 4.3, total bilirubin 1.1 and direct bilirubin 0.4.

Plain abdominal X-Ray showed centrally distributed, distended small bowel loops and rectal gas shadow (Figure 1). CT scan is not available at this setup so it was not possible to do one.

Management and Outcomes

The diagnosis of acute abdomen secondary to small bowel obstruction secondary to primary small bowel volvulus plus stage I shock was entertained, Double intravenous line was inserted and Trans-urethral catheter inserted, Naso-gastric tube was inserted. Three Liters of normal saline was given over a course of 2 hours, at emergency department. The patient was admitted to the ward and was advised on the possible options of management, consented on conservative management, associated risks and the possibility of surgical intervention at any time in the course of the management. The patient was kept Nil per oral, put on maintenance fluid and replacement of ongoing losses. Nasogastric tubes produced 600 ml of bilious content during the first 6 hours; which was replaced with an equal amount of ringer lactate. The abdominal cramp subsided after 4 hours of inpatient admission. After 12 hours of admission, the Blood pressure was 100/70 mmHg, pulse rate 68 per minute and the abdominal distension decreased significantly and the bowel sounds were 26 per minute, there was no area of tenderness and the patient passed flatus.

Following 24 hours of admission, the patient passed feces and vital signs were within normal range. Naso-gastric was removed and the patient was initiated with sips. The patient tolerated sips very well and was observed for 24 more hours and discharged on the next day. He was appointed to the surgical referral clinic after a week.

In subsequent weeks, the patient was seen at a referral clinic; he had no change in bowel habit or any other complaint. His vital signs were stable and physical examination was detected with no abnormality. He has been followed every month for 3 consecutive months and has reported no recurrence of symptoms.

Discussion

Volvulus is the Latin word for rolled up or twisted and is derived from the verb ‘volvere’, meaning to roll or turnabout. By definition, volvulus is an abnormal twisting of the intestine, which can impair the blood flow to the intestine. Volvulus can lead to gangrene and death of that segment of the gastrointestinal tract, intestinal obstruction, perforation of the intestine and peritonitis [3]. Small intestinal volvulus in adults can be classified as primary or secondary. In the former there is no obvious anatomical cause involving the mesentery or the small bowel, whereas in the latter there is an abnormal fixation due to adhesions or bands leading to the twisting of the mesentery. The primary type is often seen in Africa and Asia [4]. It is a significant cause of primary bowel obstruction in sub-Saharan Africa [5]. It is the leading cause of small bowel obstruction in Ethiopia [6].It is a rare entity in Western adults [7].

Clinical signs & symptoms were unspecific & resembled intestinal obstruction [8]. The most frequent symptom was observed to be sudden abdominal pain [9]. Vomiting was also observed in most of the patients while abdominal distention and constipation were reported less frequently [10]. Clinical examination reveals abdominal distension and/or diffuse tenderness with or without signs of peritonitis [8]. Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction [11].

One of the challenges in managing primary small bowel volvulus operatively has been the risk of subsequent adhesion obstructions. The risk of occurrence of adhesion obstructions among patients that underwent laparotomy in general was reported to be 4.6% [12]. This gives rise to the endless circle of obstruction and subsequent operation, which further increase the risk more.

This case report presents a case of primary small bowel volvulus causing small bowel obstruction; which was managed non-operatively. Treatment of primary volvulus has mostly been via surgical intervention. This report depicts with close follow-up and Naso-gastric tube decompression, primary small bowel volvulus can also be treated without surgical intervention.

In the course of managing patients with primary small bowel volvulus, spontaneous resolutions has been observed [3]. This is because of natural de-rotation of the volvulus segment and relief of the obstruction. The case reported presented with symptoms and signs of small bowel obstruction. The patient has frequent vomiting with severe abdominal cramp associated with mild abdominal distension. The vital signs were within normal range supporting the diagnosis of non-ischemic obstruction. Abdominal x-ray showed multiple air fluid levels, which confirmed the diagnosis of small bowel obstruction. Ruling out other causes and considering the epidemiological prevalence, primary small bowel volvulus was entertained as a cause of obstruction.

As per the request of the patient to be followed conservatively, the patient was managed non-operatively with insertion of naso gastric tube and keeping nil per oral. The patient responded well for the management and were discharged subsequently. Showed no recurrence during the follow-up period.

Conclusion

Primary Small bowel volvulus is a rare cause of small bowel obstruction. The reported case shows evidence in which the patient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

For more information about Article : https://ijclinmedcasereports.com/

https://ijclinmedcasereports.com/ijcmcr-cr-id-00134/ https://ijclinmedcasereports.com/pdf/IJCMCR-CR-00134.pdf

[superrobotmonkeyteamramblingsgo]

I still have a couple of spots for the Robot Monkey OC drawing meme. So hit me up for free fanart of your OC!

I just don’t think that I will be able to get them done as soon as I hoped. Our family dog had to go to the ER with gastric dilation volvulus aka bloat. Thank God I’m a CVT, obviously my work was very understanding when I was late due to this. It also helps that the vet I work with is Lily’s primary caregiver and could call the ER for updates and help sooth my mom’s worries. And Lily dog is home now, recovering from surgery :)

Rambling aside, things have just been chaotic, so sorry for the wait!

[juniperpublisherscasestudies]

Juniper Publishers- Open Access Journal of Case Studies

Mammography Appearance of Filariasis - A Case Study

Authored by Biren A Shah

Abstract

Filariasis of the breast, most commonly caused by a roundworm in the Filarioidea family, Wuchereria bancrofti, can have pathognomonic findings of breast calcifications on mammography that may be confused with other calcifications associated with malignancy. The purpose of this report is to describe a classic presentation of breast filariasis on mammography and distinguish it from other malignant calcifications of the breast.

Keywords: Filariasis; Parasite; Mammography

Introduction

Lymphatic filariasis is typically a benign infection caused by Wuchereria bancrofti, native to tropical countries like Nigeria, India and Indonesia [1]. This parasite is transmitted by mosquitoes and black flies that carry larvae from one human host to the next. The larvae enter the bloodstream, infiltrate and obstruct the lymphatic vessels, and cause potential vascular extravasation of the parasite into mammary tissue and later become calcified [1].

Patients may present with palpable, tender, mobile, firm, and benign lumps on the breast and “serpiginous calcifications” on mammography [2]. Though the presentation of this infection in the breast is uncommon, it is increasing in developed countries as people immigrate from areas where filariasis is endemic [2]. Active filariasis is conventionally diagnosed by peripheral blood smear and, sometimes by fine needle aspiration, these calcifications can indicate the presence of a past or current infection [3].

Case Presentation

62-year-old Nigerian female for a bilateral screening mammogram (Figures 1-4).

Discussion

Filariasis is caused by a nematode infection, most commonly by Wuchereria bancrofti, transmitted by blood feeding arthropods, mainly black flies and mosquitoes. The existence of lymphatic filariasis and the classic presentation of elephantiasis dates back as early as 1500 B.C. documented by the ancient Egyptians, Hindus, and Persians [4]. Filariasis affects the lymphatic system and, in chronic cases, can cause severe lymphedema, elephantiasis, pain, and disability [5]. “In 2000, over 120 million people were infected in 52 countries worldwide, with about 40 million people disfigured and incapacitated by the disease” [5].

Although this infection can have an asymptomatic, acute and chronic presentation, breast involvement is most commonly a sequelae of chronic infection [5]. Though uncommon, filariasis of the breast can present as a tender, palpable breast mass with possible filarial granuloma and worm-like calcifications [6]. The filarial calcifications in particular can be present in any location in the breast, as depicted in the findings of our patient [6]. In addition to the classic tortuous, ring-like calcifications, the location of the calcification can further differentiate the different nematode infections of the breast. For example, Wuchereria bancrofti is found in the breast parenchyma while other infections like onchocerca volvulus are found just beneath the skin and in lymphatic vessels and nodes [6].

In this case, the patient presented with several fine-beaded, whorl-like, serpentine, and vermiform lesions caused by the calcification of the dead parasite in the breast parenchyma. In active forms of the disease, these calcifications can be accompanied by inflammatory changes that include a “peau d’ orange” edema of the skin and enlarged lymph nodes that can sometimes mimic inflammatory carcinoma [6]. This patient’s condition was only remarkable for her breast calcifications without inflammatory changes and was asymptomatic indicating an inactive form of the disease process.

Breast calcifications are common findings detected on routine mammography that can be associated with several benign and malignant pathologies [7]. In the case of filariasis, the worm-like, serpiginous calcifications can occur many years after exposure to the parasite and are benign findings on mammography [7]. Understanding this kind of filarial breast calcification and its appearance on radiographic imaging, can discriminate suspicious calcifications requiring biopsy from those that are benign [7]. Our patient’s serpiginous calcifications were detected on routine mammography screening and the patient was asymptomatic. Once these findings were determined to be filarial calcifications of the breast, no further work up was conducted.

In the event that a patient presents with these mammographic findings and symptoms of acute infection including lymphedema and several inflammatory changes, the conventional mode of diagnosis is a peripheral smear [8]. Blood collection should be done at night as lymphatic filariasis circulate in the blood with nocturnal periodicity [8]. Serologic techniques measuring anti-filarial IgG4 in the blood can diagnose patients with active infection [8].

In countries where filariasis is endemic, the primary goal of treatment is to eliminate microfilariae infected individuals to prevent the transmission of the disease [5]. According to the WHO, a single dose administration of diethylcarbamazine citrate (DEC) and albendazole is 99% effective in removing microfilariae from the blood for one year after treatment [5]. Understanding the radiographic findings, diagnosis, treatment and prevention of this diseases, particularly the rare manifestations like the breast calcification, can prove to be very beneficial in a clinical setting. With the increasing immigrant population from India and Africa here in the United States, recognizing the benign nature of this radiographic imaging will eliminate unnecessary testing for diagnosis.

For more articles in Open Access Journal of Case Studies please click on: https://juniperpublishers.com/jojcs/index.php

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Robotic Surgeon in Chennai | Robotic Colorectal and Hernia Surgeon | Dr. Pinak Dasgupta

What Is Colorectal Surgery?

Colorectal surgery treats issues of the intestines. Your intestines enable your body absorb nutrients from food and process waste. When you have a colorectal condition, it can affect your ability to use the bathroom. Your symptoms may make it difficult or uncomfortable to complete routine tasks and activities. Surgery can help you feel better.

Types of Colorectal Surgery:

Depending on the specific area and extent of colorectal cancer, surgical options include:

Colonoscopy to remove early-stage cancers/polyps. During procedures used to examine the colon, precancerous polyps (abnormal tissue growths) and small cancers are removed.

Laparoscopy (minimally invasive). Surgery uses smaller cuts through which a tiny camera and instruments are used to remove the tumor.

Robotic surgery (minimally invasive). Surgical systems with 3D capability allow more precision than hands-on procedures.

Laparotomy (open surgery). Surgery is done through an incision in the abdominal area, often to remove larger tumors and surrounding tissue.

Who Might Need Colorectal Surgery?

Colorectal surgery is used for patients with certain noncancerous conditions too. Reasons include:

Colorectal cancer. Surgery is the primary treatment for curable colorectal cancer.

Large polyps. A polyp is a growth in the colon or rectum.

Diverticular disease. Diverticulosis, or diverticulitis, involves small sacs or bulges called diverticula that form in the colon. Complications from diverticulosis, such as infections or bleeding, may require surgery.

Inflammatory bowel disease. Complications from IBD, such as ulcerative colitis or Crohn’s disease may require surgery.

Volvulus. Abnormal twisting of the intestines can dangerously restrict blood supply to the colon. 

Ostomy reversal. Surgery is used to reattach the colon to the rectum or anus and close off the temporary ostomy.

Dr. Pinak Dasgupta conduct minimally invasive and complex revisional surgeries of the lowest part of the digestive tract. Our team treats both cancerous and noncancerous conditions of the:

Bowel, the small tubing that joins the stomach to the colon and absorbs nutrients 

Colon, the large tube between the bowel and rectum that stores, processes and removes waste from the body

Rectum, the pocket at the end of the colon that temporarily holds waste until it’s time to empty

Anus, the sphincter at the end of the rectum that allows waste to pass out of the body

Life After Colorectal Surgery:

You’ll spend a few days recovering in the hospital before you’re discharged. It might be two days or up to a week, depending on what kind of operation you had and how you are doing. During this time, you’ll be:

Monitored for any signs of complications from the procedure.

Gradually weaned from your pain medication.

Fed with a liquid diet or soft diet.

Waiting for your bowels to begin functioning again.

You’ll also receive counseling on how to take care of yourself when you get home. This may include:

Wound care

Ostomy care

Dietary advice

Talk To Dr. Pinak Dasgupta:

Dr. Pinak Dasgupta and their team has a dedicated and caring approach and will seek to find you the earliest appointment possible with one of lthe best colorectal surgeon in Chennai – Dr. Pinak Dasgupta for your needs. For more information about our comprehensive treatment options, or to request an appointment with the best gastro care clinic in Chennai. Call us on 8811091676.

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About Ivermectin medicine

Ivermectin 12mg tablets are a type of medication that is commonly used to treat parasitic infections in humans. These tablets contain the active ingredient Ivermectin, which is a type of anthelmintic medication that works by paralyzing and killing parasites. Ivermectin 12mg tablets are a highly effective treatment option for parasitic infections, including strongyloidiasis and onchocerciasis. If you believe you may have a parasitic infection or have been diagnosed with one you should speak to your healthcare provider to determine if Ivermectin 12mg tablets may be an appropriate treatment option for you.

Ivermectin (Ivermectol) Medicine Uses

One of the primary uses of Ivermectin 12mg tablets is in the treatment of strongyloidiasis, a type of parasitic infection that is caused by the roundworm Strongyloidesstercoralis. This infection is commonly found in tropical and subtropical regions and can cause a range of symptoms, including itching, abdominal pain, and diarrhea.

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Generally, the following types of parasitic infections are treated usingIvermectin medicine:

Onchocerciasis: Also known as river blindness, this is a parasitic infection caused by a worm that's transmitted by black flies. Ivermectin is effective at killing the worms that cause this disease.

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How to use Ivermectin (Ivermectin 12mg)

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[ijcmcrjournal]

Non-Operatively Managed Primary Small Bowel Volvulus: A Case Report by Ewnte B*

Abstract

Background: Primary small intestinal volvulus is one of the common causes of intestinal obstruction in various localities of the developing world. Although operative intervention has been the usual mode of treatment; this case report depicts meticulous follow-up & care, there is a possibility for relief of obstruction with non-operative management.

Case presentation: this is a case report of a 20-year-old male patient presented with crampy abdominal pain and frequent bilious vomiting. Plain abdominal film showed multiple distended small bowel loops with air fluid level, consistent with small bowel obstruction. Ruling out other etiologies primary small bowel volvulus was entertained and naso-gastric tube inserted, patient catheterized and kept nil per oral. After 48 hours of admission all symptoms resolved the patient resumed feeding and was discharged home.

Conclusions: The reported case shows evidence in which the patient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

Key words: Small bowel volvulus; Primary volvulus; Non-operative management

Abbreviations: BPM: Beats Per Minute; WBC: White Blood Cells; RBC: Red Blood Cells; HGB: Hemoglobin; HCT: Hematocrit; MCV: Mean Corpuscular Volume; BUN: Blood Urea Nitrogen; ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; ALP: Alkaline Phosphatase

Introduction

Small bowel volvulus is a condition in which there is a torsion of all or a segment of the small bowel and its mesentery: this can lead to bowel obstruction, ischemia, infarction, or perforation. The typical patient with the primary volvulus of the small intestine was found to be a young adult, male, muscular, farmer, from a rural area whose diet was bulky and mainly made of cereals [1,2].

Case Presentation

A 20-year-old male patient presented to Nefas Mewcha primary hospital Emergency department in January 2020 with the main complaint of crampy abdominal pain and distention of 14 hours duration. Associated with this, he also had nausea and frequent bilious vomiting eight times. He had passed feces 24 hours ago. He had no fever, cough, chest pain or night sweating. He had no history of similar illness before, no history of previous abdominal surgery.

He is not married and claims to be not sexually active. Lives with his parents and has three sisters and two brothers. He makes a living as a farmer. There are no medical illnesses that run in the family. There was no history of tobacco smoking or substance abuse. He consumes a local alcohol made of sorghum occasionally.

At presentation, his blood pressure was 105/60 mm Hg, pulse rate was 68 Beats Per Minute (BPM), respiratory rate was 18 per minute and temperature was 36.2 oC axillary. Physical examination of the patient at presentation, the patient was acutely sick looking in pain; not in cardio respiratory distress. He had a dry tongue and buccal mucosa. No palpable lymph adenopathy in all accessible areas. Chest was clear and resonant. S1 and S2 cardiac sounds were well heard and there were no added cardiac sounds. Abdomen was slightly distended, moves with respiration, flanks were full, there were no scars, no distended veins and hernia sites were free. Palpation revealed a tense abdomen with no area of tenderness, no shifting dullness, hyperactive tympanic percussion note, bowel sounds were 35 per minute. There is scanty stool on the examining finger, with no blood on it from digital rectal examination, no palpable mass was detected. The patient was conscious and neurological examination was intact.

A complete blood count of our patient showed: White Blood Cells (WBC) 12500 mcL, Red Blood Cells (RBC) 4.6 mcL, Hemoglobin (HGB) 16 gm/dL, Hematocrit (HCT) 48%, Mean Corpuscular Volume (MCV) 89.1fL, platelets 470×103, creatinine 0.6, Blood Urea Nitrogen (BUN) 30, Alanine Aminotransferase (ALT) 28, Aspartate Aminotransferase (AST) 24, Alkaline Phosphatase (ALP) 48, albumin 4.3, total bilirubin 1.1 and direct bilirubin 0.4.

Plain abdominal X-Ray showed centrally distributed, distended small bowel loops and rectal gas shadow (Figure 1). CT scan is not available at this setup so it was not possible to do one.

Management and Outcomes

The diagnosis of acute abdomen secondary to small bowel obstruction secondary to primary small bowel volvulus plus stage I shock was entertained, Double intravenous line was inserted and Trans-urethral catheter inserted, Naso-gastric tube was inserted. Three Liters of normal saline was given over a course of 2 hours, at emergency department. The patient was admitted to the ward and was advised on the possible options of management, consented on conservative management, associated risks and the possibility of surgical intervention at any time in the course of the management. The patient was kept Nil per oral, put on maintenance fluid and replacement of ongoing losses. Nasogastric tubes produced 600 ml of bilious content during the first 6 hours; which was replaced with an equal amount of ringer lactate. The abdominal cramp subsided after 4 hours of inpatient admission. After 12 hours of admission, the Blood pressure was 100/70 mmHg, pulse rate 68 per minute and the abdominal distension decreased significantly and the bowel sounds were 26 per minute, there was no area of tenderness and the patient passed flatus.

Following 24 hours of admission, the patient passed feces and vital signs were within normal range. Naso-gastric was removed and the patient was initiated with sips. The patient tolerated sips very well and was observed for 24 more hours and discharged on the next day. He was appointed to the surgical referral clinic after a week.

In subsequent weeks, the patient was seen at a referral clinic; he had no change in bowel habit or any other complaint. His vital signs were stable and physical examination was detected with no abnormality. He has been followed every month for 3 consecutive months and has reported no recurrence of symptoms.

Discussion

Volvulus is the Latin word for rolled up or twisted and is derived from the verb ‘volvere’, meaning to roll or turnabout. By definition, volvulus is an abnormal twisting of the intestine, which can impair the blood flow to the intestine. Volvulus can lead to gangrene and death of that segment of the gastrointestinal tract, intestinal obstruction, perforation of the intestine and peritonitis [3]. Small intestinal volvulus in adults can be classified as primary or secondary. In the former there is no obvious anatomical cause involving the mesentery or the small bowel, whereas in the latter there is an abnormal fixation due to adhesions or bands leading to the twisting of the mesentery. The primary type is often seen in Africa and Asia [4]. It is a significant cause of primary bowel obstruction in sub-Saharan Africa [5]. It is the leading cause of small bowel obstruction in Ethiopia [6].It is a rare entity in Western adults [7].

Clinical signs & symptoms were unspecific & resembled intestinal obstruction [8]. The most frequent symptom was observed to be sudden abdominal pain [9]. Vomiting was also observed in most of the patients while abdominal distention and constipation were reported less frequently [10]. Clinical examination reveals abdominal distension and/or diffuse tenderness with or without signs of peritonitis [8]. Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction [11].

One of the challenges in managing primary small bowel volvulus operatively has been the risk of subsequent adhesion obstructions. The risk of occurrence of adhesion obstructions among patients that underwent laparotomy in general was reported to be 4.6% [12]. This gives rise to the endless circle of obstruction and subsequent operation, which further increase the risk more.

This case report presents a case of primary small bowel volvulus causing small bowel obstruction; which was managed non-operatively. Treatment of primary volvulus has mostly been via surgical intervention. This report depicts with close follow-up and Naso-gastric tube decompression, primary small bowel volvulus can also be treated without surgical intervention.

In the course of managing patients with primary small bowel volvulus, spontaneous resolutions has been observed [3]. This is because of natural de-rotation of the volvulus segment and relief of the obstruction. The case reported presented with symptoms and signs of small bowel obstruction. The patient has frequent vomiting with severe abdominal cramp associated with mild abdominal distension. The vital signs were within normal range supporting the diagnosis of non-ischemic obstruction. Abdominal x-ray showed multiple air fluid levels, which confirmed the diagnosis of small bowel obstruction. Ruling out other causes and considering the epidemiological prevalence, primary small bowel volvulus was entertained as a cause of obstruction.

As per the request of the patient to be followed conservatively, the patient was managed non-operatively with insertion of naso gastric tube and keeping nil per oral. The patient responded well for the management and were discharged subsequently. Showed no recurrence during the follow-up period.

Conclusion

Primary Small bowel volvulus is a rare cause of small bowel obstruction. The reported case shows evidence in which the patient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

For more information about Article : https://ijclinmedcasereports.com/

https://ijclinmedcasereports.com/ijcmcr-cr-id-00131/ https://ijclinmedcasereports.com/pdf/IJCMCR-CR-00131.pdf

[coolluminaryland-blog1]

Onchocerciasis Treatment Market : Key Drivers & On-going Trends 2017 - 2025

Global Onchocerciasis Treatment Market: Snapshot

Commonly known as river blindness, onchocerciasis is caused by infection due to a parasitic worm that can lead to serious complications. The parasitic worm, Onchocerca volvulus, is generally imparted within the human skin though bites received from a particular black fly from the Simulium family. Several bites are usually required for the infection to initiate inside the human body, but can cause problems once it does. The worms, once they enter the body, start producing larvae that can travel back towards the skin and infect another black fly that bites the infected human.

Read Report Overview: https://www.transparencymarketresearch.com/onchocerciasis-treatment-market.html

The core diagnostics for onchocerciasis include the use of a biopsy on the skin with regular saline. The medical personnel then wait for the larva to come out. Another procedure involves searching for the larvae in the eye as well as sensing bumps under the skin which is a sign of adult worms. There is currently no vaccine against river blindness and most of the efforts against the disease are directed towards the regular treatment of the likely patient base every year. Ivermectin is the drug used to treat patients every six months to one year, while doxycycline reduces the worms’ strength to antibiotics.

Onchocerciasis is likewise alluded to as waterway visual impairment and contaminates more than 37 million people who are living close quick moving streams and additionally waterways of sub-Saharan range of Africa. Few cases likewise have been accounted for out of Yemen and the Americas. Onchocerciasis is accepted to be the fourth driving reason for preventable visual impairment. Roughly 500,000 of people tainted with onchocerciasis are outwardly genuinely debilitated and another around 270,000 have turned out to be visually impaired for all time from this sickness. An extensive variety of causes lie behind these infections, yet for large portions of them the cause is obscure. There is no present specific treatment, and specialists must attempt to diminish the infection purely. Oral drugs has been as of late appeared to moderate the movement of sickness in a few patients. It is the world’s second driving irresistible reason for visual impairment. WHO prescribes treating onchocerciasis with ivermectin at any rate once yearly for around 10-15 years.

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The solution incapacitates and executes microfilariae, diminishing exceptional itching skin and ending the movement towards visual impairment. It additionally keeps grown-up worms from delivering more microfilariae for a couple of months taking after treatment, in this way lessening transmission. The commonness of disease can fluctuate amongst towns and was verifiably as high as 80 to 100 percent by the age of 20 years in a few territories, with visual impairment topping at 40 to 50 years old. Preceding control exercises, hyper endemic areas were as often as possible terminated in view of high rates of visual impairment.

Onchocerciasis Treatment Market: Drivers and Restraints

Onchocerciasis treatment market has influenced the demand in recent years, soaring market capitalization of smaller players, rising number of strategic partnerships to scoop out the best of emerging medications or drugs, increased R&D spending by big pharma and emerging players, expanded indications for approved drugs and rising competition between companies producing drugs for same indications are majorly driving the overall onchocerciasis market. A current review in Mali and Senegal has given the primary confirmation of disposal following 15-17 years of treatment. Taking after this finding, the African Program for Onchocerciasis Control (APOC) has begun a precise assessment of the long haul effect of ivermectin treatment ventures and the attainability of end in APOC upheld nations.

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The World Health Organization has focused on Onchocerciasis for worldwide disposal in select nations in Africa by 2020. Control and disposal programs for this irresistible sicknesses by utilizing the medication ivermectin to stop transmission. Together with evidence of-idea for onchocerciasis disposal with yearly CDTI (community directed treatment with ivermectin) from foci in Senegal and Mali, this has brought about focusing on onchocerciasis end in chose African nations by 2020 and in 80% of African nations by 2025. The difficulties for meeting these objectives incorporate the quantity of endemic nations where struggle has deferred or intruded on control programs, cross-fringe foci, and possible growth of organism strains with low helplessness to ivermectin and co-endemicity of loiasis, another parasitic vector borne malady, which backs off or denies CDTI execution. Some of these difficulties could be tended to with new medications or medication mixes with a higher impact on Onchocerca Volvulus than ivermectin. Troublesome manufacturing procedures of this medication is in charge of its high value, which confines its utilization. There are risks of severe side effects. Uncertainty by the government regulations, also low guidance from doctors in selecting proper drug, reimbursement coverage may be weak sometimes and accuracy or medical technology infancy is concern to a certain extent during the forecast period. While the orphan Onchocerciasis treatment market is for the most part limited to the U.S. what’s more, Africa now, pharmaceutical organizations are probably going to begin taking advantage of the African market — which has a high populace of untreated uncommon sicknesses in 2017–2018. In addition, the emergence of effective generic drugs for the treatment of onchocerciasis is expected to encourage the growth of the market during the forecast period. The growing focus of governments in emerging countries on the development of healthcare infrastructure and creating an awareness regarding the condition are additional positive factors assessed to quicken the development of the onchocerciasis treatment market.

Segmentation by Drugs

Segmentation By End User

Storomectol (oral)

Ivermectin (oral)

Hospitals

Specialty Clinics

Others

It is to be expected that the global market of orphan onchocerciasis treatment will show steady growth. Pharmaceutical and medical industries have gained popularity by generating new drugs for treatment of Onchocerciasis. Advancement in this field has been moved by different motivating forces, for example, quick track survey conventions, more medical campaigns, government funding and R&D expenses provided by authorized specialists in selective countries, majorly in Africa. Some of the major key players for orphan Onchocerciasis treatment market are Merck & Co., Inc., Mayne Pharma Group, Par Pharmaceutical Companies, Inc., Delta Pharma Ltd., Life Pharmaceutical Company and Taj Pharmaceuticals Limited.

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[abdallahalhakim]

How mindfulness helped this physician’s primary care journey

“Paying attention in a particular way: on purpose, in the present moment and nonjudgmentally.” That’s how Jon Kabat-Zinn, PhD, describes mindfulness. In the book Zen Mind, Beginner’s Mind, another thought leader in mindfulness, Shunryu Suzuki, says that, “In the beginner’s mind there are many possibilities, but in the expert’s there are few.” In my experience, I’ve found that cultivating a beginner’s mind opens doors and improves clinical diagnosis.

Medical training has phases, and clinicians in different phases think differently. In medical school, students learn all the zebras. To a student, every vomiting infant is thought to have volvulus or a metabolic disorder. Every abnormal CBC is leukemia. Then, in practice, most vomiting infants are found to have gastroenteritis and most abnormal CBCs have a more-benign explanation, such as a routine infection. Skilled physicians try to keep an open mind about having a broad differential diagnosis, but the parade of the routine can dull the mind.

I’ve had my own experience with a “zebra” condition and its evaluation by a perhaps weary clinician. After an ER trip for severe pain, a follow-up CT scan and numerous examinations, I was discharged with no diagnosis and no treatment plan. End of inquiry. Later providers did more to take a full history and let curiosity sink in. After many painful weeks, I had my diagnosis: zoster sine herpete. Shingles without a rash.

Continue reading ...

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

[Read More ...] https://www.kevinmd.com/blog/2018/05/how-mindfulness-helped-this-physicians-primary-care-journey.html

[mrmarknewman]

How mindfulness helped this physician’s primary care journey

“Paying attention in a particular way: on purpose, in the present moment and nonjudgmentally.” That’s how Jon Kabat-Zinn, PhD, describes mindfulness. In the book Zen Mind, Beginner’s Mind, another thought leader in mindfulness, Shunryu Suzuki, says that, “In the beginner’s mind there are many possibilities, but in the expert’s there are few.” In my experience, I’ve found that cultivating a beginner’s mind opens doors and improves clinical diagnosis.

Medical training has phases, and clinicians in different phases think differently. In medical school, students learn all the zebras. To a student, every vomiting infant is thought to have volvulus or a metabolic disorder. Every abnormal CBC is leukemia. Then, in practice, most vomiting infants are found to have gastroenteritis and most abnormal CBCs have a more-benign explanation, such as a routine infection. Skilled physicians try to keep an open mind about having a broad differential diagnosis, but the parade of the routine can dull the mind.

I’ve had my own experience with a “zebra” condition and its evaluation by a perhaps weary clinician. After an ER trip for severe pain, a follow-up CT scan and numerous examinations, I was discharged with no diagnosis and no treatment plan. End of inquiry. Later providers did more to take a full history and let curiosity sink in. After many painful weeks, I had my diagnosis: zoster sine herpete. Shingles without a rash.

Continue reading ...

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

from KevinMD.com https://ift.tt/2IzZ7cz

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Onchocerciasis Treatment Market Growth, Share, Demand and Analysis of Key Players to 2025

Commonly known as river blindness, onchocerciasis is caused by infection due to a parasitic worm that can lead to serious complications. The parasitic worm, Onchocerca volvulus, is generally imparted within the human skin though bites received from a particular black fly from the Simulium family. Several bites are usually required for the infection to initiate inside the human body, but can cause problems once it does. The worms, once they enter the body, start producing larvae that can travel back towards the skin and infect another black fly that bites the infected human. 

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The core diagnostics for onchocerciasis include the use of a biopsy on the skin with regular saline. The medical personnel then wait for the larva to come out. Another procedure involves searching for the larvae in the eye as well as sensing bumps under the skin which is a sign of adult worms. There is currently no vaccine against river blindness and most of the efforts against the disease are directed towards the regular treatment of the likely patient base every year. Ivermectin is the drug used to treat patients every six months to one year, while doxycycline reduces the worms’ strength to antibiotics.

Onchocerciasis is likewise alluded to as waterway visual impairment and contaminates more than 37 million people who are living close quick moving streams and additionally waterways of sub-Saharan range of Africa. Few cases likewise have been accounted for out of Yemen and the Americas. Onchocerciasis is accepted to be the fourth driving reason for preventable visual impairment. Roughly 500,000 of people tainted with onchocerciasis are outwardly genuinely debilitated and another around 270,000 have turned out to be visually impaired for all time from this sickness. An extensive variety of causes lie behind these infections, yet for large portions of them the cause is obscure. There is no present specific treatment, and specialists must attempt to diminish the infection purely. Oral drugs has been as of late appeared to moderate the movement of sickness in a few patients. It is the world’s second driving irresistible reason for visual impairment. WHO prescribes treating onchocerciasis with ivermectin at any rate once yearly for around 10-15 years. The solution incapacitates and executes microfilariae, diminishing exceptional itching skin and ending the movement towards visual impairment. It additionally keeps grown-up worms from delivering more microfilariae for a couple of months taking after treatment, in this way lessening transmission. The commonness of disease can fluctuate amongst towns and was verifiably as high as 80 to 100 percent by the age of 20 years in a few territories, with visual impairment topping at 40 to 50 years old. Preceding control exercises, hyper endemic areas were as often as possible terminated in view of high rates of visual impairment.

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Onchocerciasis Treatment Market: Drivers and Restraints

Onchocerciasis treatment market has influenced the demand in recent years, soaring market capitalization of smaller players, rising number of strategic partnerships to scoop out the best of emerging medications or drugs, increased R&D spending by big pharma and emerging players, expanded indications for approved drugs and rising competition between companies producing drugs for same indications are majorly driving the overall onchocerciasis market. A current review in Mali and Senegal has given the primary confirmation of disposal following 15-17 years of treatment. Taking after this finding, the African Program for Onchocerciasis Control (APOC) has begun a precise assessment of the long haul effect of ivermectin treatment ventures and the attainability of end in APOC upheld nations.

The World Health Organization has focused on Onchocerciasis for worldwide disposal in select nations in Africa by 2020. Control and disposal programs for this irresistible sicknesses by utilizing the medication ivermectin to stop transmission. Together with evidence of-idea for onchocerciasis disposal with yearly CDTI (community directed treatment with ivermectin) from foci in Senegal and Mali, this has brought about focusing on onchocerciasis end in chose African nations by 2020 and in 80% of African nations by 2025. The difficulties for meeting these objectives incorporate the quantity of endemic nations where struggle has deferred or intruded on control programs, cross-fringe foci, and possible growth of organism strains with low helplessness to ivermectin and co-endemicity of loiasis, another parasitic vector borne malady, which backs off or denies CDTI execution. Some of these difficulties could be tended to with new medications or medication mixes with a higher impact on Onchocerca Volvulus than ivermectin. Troublesome manufacturing procedures of this medication is in charge of its high value, which confines its utilization. There are risks of severe side effects. Uncertainty by the government regulations, also low guidance from doctors in selecting proper drug, reimbursement coverage may be weak sometimes and accuracy or medical technology infancy is concern to a certain extent during the forecast period. While the orphan Onchocerciasis treatment market is for the most part limited to the U.S. what’s more, Africa now, pharmaceutical organizations are probably going to begin taking advantage of the African market — which has a high populace of untreated uncommon sicknesses in 2017–2018. In addition, the emergence of effective generic drugs for the treatment of onchocerciasis is expected to encourage the growth of the market during the forecast period. The growing focus of governments in emerging countries on the development of healthcare infrastructure and creating an awareness regarding the condition are additional positive factors assessed to quicken the development of the onchocerciasis treatment market.

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When to Refer a Colic Case

New Post has been published on http://lovehorses.net/when-to-refer-a-colic-case/

When to Refer a Colic Case

Generally, horses with mild to moderate pain and that are medically manageable can be treated in the field. There are, however, some scenarios in which the veterinarian should refer the horse immediately.

Photo: Anne M. Eberhardt/The Horse

If your horse colicked today, what would you do? In many colic scenarios, the time spent deciding whether to transport the horse to an equine hospital for specialized care can mean the difference between life and death. For this reason, it’s important for veterinarians and owners to be able to make a quick decision about when to refer a colicking horse.

At the American Association of Equine Practitioners’ Focus on Colic, held July 16-18, 2017, in Lexington, Kentucky, Jarred Williams, MS, DVM, PhD, Dipl. ACVS-LA, ACVECC, clinical assistant professor of Large Animal Emergency Medicine at the University of Georgia’s College of Veterinary Medicine, shared protocol for referring colic cases.

The two decision-makers for referral, he said, are the type of abdominal lesion and the owner’s opinion.

“The vet’s job is to identify the lesion as quickly as we can and educate the owner,” he said.

Situations in which referral is simply not an option include a lack of finances, no trailer access or a horse that refuses to load, and personal opinion about surgery or referral off the farm.

Otherwise, Williams said, the veterinarian should proceed immediately with a colic workup to determine what section of the gastrointestinal tract is involved—the small intestine, large intestine, or other—and the type of disease—strangulating obstruction (SO), nonstrangulating obstruction (NSO), or inflammatory.

He reviewed with attendees the different types of lesions they might find and whether they typically warrant referral.

Small Intestinal Disease

Strangulating obstruction of the small intestine These are always surgical cases. “It’s not going to fix itself medically on the farm,” Williams said. “The lesion has dictated what the horse needs.”

Inflammatory disease (e.g., enteritis) While these aren’t usually surgical, they do require a lot of time and effort spent refluxing (emptying stomach contents via stomach tube) and getting fluids into the horse. Thus, Williams recommends referral, if practical.

Nonstrangulating obstruction of the small intestine Veterinarians can manage horses with NSOs on the farm with sedation, gastric decompression, and intravenous (IV) fluids. Less commonly do these cases require surgery. Williams said veterinarians might still elect to refer, however, if it looks like there will be frequent farm visits.

Large Intestinal Disease

Strangulating obstruction of the large intestine Again, SOs such as volvulus aren’t going to fix themselves. Refer, said Williams.

Inflammatory disease (e.g., hypovolemic shock) These cases almost always require referral due to the need for isolation of the horse to prevent spread of pathogens such as Salmonella. These horses also require continuous support including IV fluids and cryotherapy or icing to prevent secondary laminitis.

Nonstrangulating obstruction of the large intestine “These are the vast majority of colics we see,” said Williams, and they include impactions, left and right dorsal displacement, and gas/spasmodic colic. He said veterinarians can manage them in the field with sedation, supportive fluids, and hand-walking. If horses don’t respond to treatment, however, they might still be referred to a tertiary facility.

Special Considerations

Generally, horses with mild to moderate pain and that are medically manageable can be treated in the field, said Williams. There are, however, some scenarios in which the veterinarian should refer the horse immediately. These include:

Distended loops of small intestine, evident via rectal or ultrasonographic examination;

Postpartum broodmares;

Diarrhea, for biosecurity reasons;

Cardiovascular instability;

A very, very painful horse; and

Uncertainty about the lesion site or type. “It’s never wrong to get the horse some place where surgery can be done,” said Williams.

Once the horse arrives at the hospital, the referral vet will repeat the colic workup, possibly take bloodwork, analyze abdominal fluids, and make a recommendation about whether to go to surgery.

Take-Home Message

Williams wrapped up his presentation with practical tips for making that all-important decision about how to manage a colicking horse:

Be sure of the lesion site and type.

Make sure the owner knows the costs involved.

Estimate how much multiple farm visits or treatment at the primary clinic will cost. Sometimes it’s more cost-effective and efficient to refer.

Make sure the owner knows that delaying surgery after it’s been recommended might increase the risk of postoperative complications.

“Eighty to 90 percent of presenting colics (at the University of Georgia’s Veterinary Medical Center) don’t go to surgery,” said Williams. “For many cases, referral is more about the ability to manage efficiently.

“If you’re not sure what’s going on,” he concluded, “don’t sit on it.”

About the Author

Alexandra Beckstett, The Horse Managing Editor

Alexandra Beckstett, Managing Editor of The Horse and a native of Houston, Texas, is a lifelong horse owner who has shown successfully on the national hunter/jumper circuit and dabbled in hunter breeding. After graduating from Duke University, she joined Blood-Horse Publications as Assistant Editor of its book division, Eclipse Press, before joining The Horse.