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The assertion by the troubled teacher Patrick Doyle – “I just tell the bloody truth, as I see it” (p. 112) – in James Kelman’s novel A Disaffection goes to the heart of Kelman’s own aesthetic of showing things as they are. However, the qualifying clause – “as I see it” – also suggests that truth is not evidentially absolute and immediate but provisional or situated. Of course the very concept of truth would seem to require of itself a totalised fulfilment of its own promise. That is, truth sh...

Haemorrhage in patients with haemophilia is common after minor trauma but may occur spontaneously. Despite the diversity of bleeding sites, spontaneous haemothorax, on a non-traumatic basis, is an exceedingly rare event and only a few cases had been reported. We present a case of a 43-year-old man with a history of haemophilia A who had pleuritic chest pain for 1 day without significant history of trauma. Diagnostic thoracentesis showed bloody pleural fluid in which neither abnormal cell nor organism was found. He was treated by cryoprecipitate replacement and therapeutic thoracentesis for releasing haemothorax. After discharge, the patient returned for follow-up with complete radiological resolution. Regarding the consequences of retained haemothorax from conservative approach and the procedure-related bleeding of given therapeutic intervention in haemothorax making its management in patients with haemophilia to be more challenging. Our case illustrates a conservative treatment of spontaneous haemothorax in patient with haemophilia resulting in a good clinical outcome.

Behçet's disease (BD) is a multisystem inflammatory disease of unknown origin. It rarely but occasionally occurs together with myelodysplastic syndrome and primary myelofibrosis. Trisomy 8 is one of the most common cytogenetic abnormalities in myeloid neoplasms; however, the association of BD with polycythemia vera (PV) and trisomy 8 has not been reported. A 70-year-old woman, diagnosed with PV and treated with hydroxyurea, had bloody stool due to multiple ulcers in the ileocecal region. Considering the lack of a response to treatment and other features, we suspected complication with intestinal Behçet's-like disease. Our case suggests relationships among BD, trisomy 8, and PV.

The samples were collected between the period 12/2020–3/2021, and the number of patient samples was 75 blood samples, which were divided into 30 blood samples from patients before and after the hemodialysis process, and 15 blood samples from patients taking treatment they did not undergo hemodialysis, their ages ranged between 20 and 55 years. Twenty-five 25 blood samples were collected from apparently healthy people, ranging in age from 20 to 55 years, and specialized doctors diagnosed the disease cases. The results showed a significant increase in the activity of the enzyme Dipeptidyl Peptidase-4 (DPP-4) in the total patients 59.161 ± 4.070 UI/L with a probability level of P ≤ 0.01 compared with the healthy controls 35.380 ± 10.278UI/L, where the rate of the activity of enzyme Dipeptidyl Peptidase-4 in the serum of patients with renal failure before hemodialysis 86.053 ± 12.008 UI/L as well as increased in the blood of patients with renal failure who are receiving treatment was 57,855 ± 9.415 UI/L. While the concentration of enzyme decreased in the serum of patients with renal failure after hemodialysis 51.579 ± 8.788 UI/L compared to the group of patients before hemodialysis and during treatment, and fall at the probability level of P ≤ 0.01 in the class and concentration of selenium at the total level of patients as well as before and after the hemodialysis process. In contrast, its level increased among the patients taking the treatment and at the level of the probability P ≤ 0.01 compared to its level in all patients and before and after the dialysis process bloody. The effect of age on the status of the enzyme Dipeptidyl Peptidase-4 and selenium was also studied in according groups of patients, it found a significant impact of age on the level of the enzyme and the selenium element, as substantial differences were found that indicated the high level of the enzyme and the selenium element in elderly patients aged 36–55 years, while it decreased slightly in young patients whose ages ranged from 20 to 35 years old.

Background: The outcome in infants and young children of intestinal obstruction due to intussusception is well documented in high-income countries. Our aim was to investigate the current pattern of presentation, management and outcome of childhood intussusception in a middle-income country using a multicentre approach. Methods: Records of children managed for intussusception in three centres in South West Nigeria were retrospectively reviewed and analysed. Results: One hundred and ninety children managed for intussusception were analysed. The male-to-female ratio was 1.8:1. The median age was 7 months with a peak age incidence of 3–6 months. Peak incidence was recorded during the dry season. Passage of bloody stool, vomiting, abdominal pain and fever were the most common presenting features. Seventy-three (38.4%) of the patients presented with the classic triad. The median duration of symptoms was three days and only 19 (10.1%) patients presented in less than 24 hours. Ileocolic intussusception was the most common anatomic type, occurring in 166 (87.4%) patients, and was significantly associated with age. Twenty-two (56.4%) had successful hydrostatic reduction, while 165 (88.2%) required surgery. Forty (21.1%) patients suffered postoperative complications. Eleven (5.8%) of the patients died. The median duration of hospital stay was six days, and this correlated with the duration of symptoms and the length of hospital stay. Conclusion: Delayed presentation is a persisting challenge in the management of childhood intussusception in Nigeria. Prompt referral to a paediatric surgeon may reduce the surgery rate, associated morbidity and the length of hospital stay.&nbsp

Rusty pipe syndrome is a benign clinical condition that causes a bloody nipple discharge that usually resolves spontaneously within a week. The first-line methods of treatment for rusty pipe syndrome are avoiding unnecessary research techniques and reducing the mother’s anxiety. However, in prolonged cases of rusty pipe syndrome, additional examinations should be performed to assess whether there is an underlying pathological disease, such as breast cancer or ductal papilloma. This case report presents a woman with rusty pipe syndrome and includes a literature review of databases for the period January 2001 through January 2021. A 27-year-old multiparous (gravida:3, para:3) mother gave birth at 37 weeks of gestation to a male infant. At the first breastfeeding, brownish, bloody milk was observed from both breasts. The mother had no history of surgery or trauma and had similar complaints after her previous two births. Pathological examination of a nipple blood sample and breast ultrasonography found no pathology. The bloody nipple discharge stopped spontaneously within 5 days. The mother was discharged on the seventh day after admission without complications.

Introduction: The triple burden of COVID-19, human immune virus (HIV), and TB co infection is one of the contemporary challenges to this globe. People living with chronic medical diseases such as HIV and TB are more likely to experience poor outcomes from COVID-19. This study aimed to report survival from triple co-infection with PTB, HIV, and COVID-19 in Wollega University referral hospital (WURH), western Ethiopia. Case Presentation: A 55-year-old male known HIV patient on HAART for the last 3 years presented to WURH on May 26, 2021, with chief complaints of shortness of breath of 5 days' duration associated with productive cough, history of high-grade fever, and severe headache. He had produced a lot of bloody sputum one month prior to the current complaints. On 1st day of his presentation, a Gene Expert test was done from sputum, and he was positive for pulmonary TB. On the same day, a nasopharyngeal sample for COVID-19 using polymerase chain reaction (PCR) was positive. On his 2nd day of admission, he was transferred to the COVID-19 treatment center with the diagnosis of severe COVID-19, PTB, and WHO stage-3 RVI. During his stay in the hospital, he was provided with oxygen via a nasal cannula. Intensive phase anti-TB treatment was initiated on the 3rd day of admission. HAART was continued with the same regimen he was taking prior to his presentation. On June 6, 2021, the patient was recovered and discharged from the hospital after 10 days of hospital stay. Conclusion: This case report suggests, after 10 days of admission with triple infections, there is a good clinical prognosis and survival from COVID-19. On admission, further diagnosis and investigations of TB co-infection should be performed for all patients admitted with COVID-19 due to their similar and non-specific clinical manifestations.

Background Isolated sphenoid sinus disease (ISSD) is a rare clinical entity with potentially serious complications. The etiological distribution of ISSD varies among different areas and ethnicities. We aimed to investigate the clinical features of patients with endoscopic treated ISSD. Methods We retrospectively reviewed all patients with ISSD who had undergone endoscopic surgery between April 2013 and May 2019. The patient records were reviewed for demographic data, clinical presentations, endoscopic and imaging study findings, surgical outcomes and complications. Results A total of 37 patients with ISSD who underwent surgery were recruited. We divided patients into three groups according to etiology, including inflammatory diseases (78.4%), neoplasms (13.5%) and spontaneous cerebrospinal fluid (CSF) leaks (8.1%); fungal ball (62.2%) constituted the major cause of ISSD. Overall, the most common presenting symptom was headache or facial pain (65.5%). The endoscopic findings of bloody discharge and tumor lesions were mainly from the neoplasm group. Bony defects were more obvious on computed tomography in the neoplasm and CSF leak groups. Magnetic resonance imaging revealed a higher rate of involvement of the cavernous sinus (40.0%) and intracranial extensions (40.0%) in the neoplasm group. To summarize the surgical outcomes, the success rate was 97.1%, and the major complication rate was 5.4%. Conclusion ISSD represents a variety of etiologies, mostly comprising fungal ball in our area, while there is still a considerable proportion of ISSDs attributed to neoplasm and CSF leak. Untreated ISSD can result in serious complications. We recommend early surgical intervention for all patients with ISSD.

Haemolacria, also known as bloody tears, is a physical condition in which a person produces tears partially composed of blood. Multiple disorders can cause haemolacria, including trauma, inflammation, vascular lesions, vicarious menstruation, blood disorders, epistaxis, tumours and psychiatric and systemic disorders. Often, no aetiology is identified. It is usually benign, self-limiting, and the treatment depends on the cause. A 14-year-old girl presented to the paediatric emergency department with sudden onset of bloody tears from both eyes and epistaxis for the first time. A detailed history focusing on aetiological factors was unremarkable. Systemic, ocular, nasal and paranasal examination was also unremarkable. Radiological and laboratory investigations were normal, and the patient was diagnosed with idiopathic haemolacria. High-dose oral vitamin C, prophylactic iron therapy and psychological support were provided as conservative treatment. During regular follow-up, there was a spontaneous reduction in the frequency of symptoms.

The authors report a case of a 32-year-old Thai woman with a COVID-19 infection that presented with urticaria and angioedema with a pityriasis rosea (PR)-like rash at a private hospital in Thailand. She presented at the hospital with bloody nasal discharge and diarrhea but without fever, myalgia, or any respiratory symptoms. She complained of angioedema and PR-like lesions on the third day of the treatment. Urticarial rash appeared intermittently for four weeks after all medications were discontinued, during which the patient had no fever, no respiratory symptoms, or any other symptoms. However, the RT-PCR results for COVID-19 RNA were positive during the time that the urticarial symptoms persisted. The COVID-19 RNA became negative on the fourth day after the last urticarial episode. Urticarial rash may be a clue that the inflammatory process is activated by COVID-19 virus after the treatment is completed. Keywords: Cutaneous; Pityriasis rosea; Angioedema; Urticaria; COVID-19 DOI: doi.org/10.35755/jmedassocthai.2021.07.12420 Received 9 March 2021 | Revised 10 June 2021 | Accepted 15 June 2021

Background: According to World Health Organization statistics, the annual suicidal death rate is about one million people worldwide (mean mortality rate: 16/100.000). In some countries, suicide is the second leading cause of death in the 10-24-year age group. Wrist cutting is sometimes practiced with the goal of self-harm rather than being a suicidal attempt. However, if the bleeding is copious or allowed to continue unchecked, cardiac arrhythmia which is followed by severe hypovolemia, shock, circulatory collapse or cardiac arrest, and death may ensue. Another aim from self- cutting could be wound fabrication to mimic physical assault. In the current study, the updated knowledge concerning self-inflicted injuries including medicolegal, theoretical, and methodological approaches to assess such incidents, is discussed. Moreover, a rare case of unusual, ambiguous cut – wrist will be presented. It is a case of an Asian, female, domestic worker who was claimed to commit suicide at her sponsor’s house by deliberately cutting her left wrist. In a bloody scene, the deceased was found with a completely severed left wrist leading to a complete left- hand amputation. The right hand with a small bloody sharp knife was found behind the body. After a detailed examination of the death scene and full autopsy, the debate appeared. Both homicidal and suicidal scenarios were possible. However, no evidence was found to confirm the homicidal accusation.Consequently, the case was reported as a possible suicide with no previously reported similar cases in the literature.

Background. Endometriosis is defined as presence of endometrial glands outside the uterine cavity and it most commonly involves the structures within the pelvic cavity. Thoracic endometriosis syndrome usually presents as pneumothorax, hemoptysis, hemothorax or pulmonary nodules. Endometriosis presenting as hemorrhagic pleural effusion is rarely reported. Objectives. The aim of the study was to describe pleural endometriosis presenting as hemorrhagic pleural effusion and to insist on the role of medical thoracoscopy in making the diagnosis with the help of a case report. Methods. A case report of pleural endometriosis as a non-resolving hemorrhagic pleural effusion is presented. Results. A 28-years old female on treatment for her primary infertility presented with non-resolving bloody pleural effusion and she was on empirical anti-tubercular drugs for the last four months. Medical thoracoscopy revealed flat brownish grey plaques over the diaphragmatic pleura and the histology of pleural tissue revealed pleural endometriosis. She was initiated on gonadotropin releasing hormone-leuprolide and there was some clinico-radiological improvement. Conclusions. Thoracic endometriosis should be considered as one of the differentials for pleural effusion in female patient especially on treatment for infertility. Medical thoracoscopy should be the investigation of choice for evaluating pleural effusions before initiating empirical treatments.

Dysgerminoma is a rare malignant neoplasm, associated with hormonal dysfunctions, which occurs in canine and feline females from middle age to elderly, without racial predisposition. In the present report, we described a case of ovarian dysgerminoma in a dog, only abdominal distension, persistent vulvar bloody discharge and apathy. The animal in question underwent exploratory laparotomy, where general neoformations were detected in the ovaries, and a lymph node with abnormal characteristics was also found. Therefore, surgery for ovariosalpingoisterectomy and puncture of a fragment of the lymph node altered for incisional biopsy was performed. The diagnosis was made through histopathological examination of the ovaries of the fragment derived from the lymph node, the result of which indicated the presence of dysgerminoma in both ovaries and in the lymph node, characterizing a metastasis. In view of this result, the chemotherapy protocol with the association of carboplatin and vinblastine was instituted, which proved to be effective and not very toxic to the animal, with no clinical sign of metastasis being identified after its use.

Bloody Mahjong is a kind of mahjong. It is very popular in China in recent years. It not only has the characteristics of mahjong's conventional state space, huge hidden information, complicated rules, and large randomness of hand cards but also has special rules such as Change three, Hu must lack at least one suit, and Continue playing after Hu. These rules increase the difficulty of research. These special rules are used as the input of the deep learning DenseNet model. DenseNet is used to extract the Mahjong situation features. The learned features are used as the input of the classification algorithm XGBoost, and then the XGBoost algorithm is used to derive the card strategy. Experiments show that the fusion model of deep learning and XGBoost proposed in this paper has higher accuracy than the single model using only one of them in the case of high‐dimensional sparse features. In the case of fewer training rounds, accuracy of the model can still reach 83%. In the games against real people, it plays like human.

We present a very rare case of rectal cancer in a patient with situs inversus totalis (SIT), which is a complete transposition of the thoracic and abdominal viscera. A woman in her 60s visited a local hospital reporting bloody stool and was diagnosed with upper rectal cancer and SIT. We made careful preoperative preparations for the congenital anomaly, and robotic-assisted high anterior resection with D3 lymph node dissection was performed. Although we adopted an unusual six-port placement, the operation was performed safely and efficiently without any adverse events. The patient recovered uneventfully. The pathological specimen was classified as pT3N2bM0 with negative resection margins. Robotic-assisted surgery is advantageous for rectal cancer treatment even when anatomical abnormalities make the surgical procedure more difficult.

This article explores the legacy of the bleeding woman healed by Jesus. It considers how her story speaks to modern women, and the norms and taboos of each context. As a bleeding woman, and an orda...

ObjectivesCentral nervous system involvement is present in 70% of patients with hemophagocytic lymphohistiocytosis (CNS-HLH). CNS-HLH is defined by neurologic deficits, neuroimaging abnormalities, or positive cerebrospinal fluid (CSF) findings. The CSF cytomorphologic spectrum of CNS-HLH, however, has not been well investigated.MethodsA retrospective review was performed on 64 CSF specimens from pediatric and adult patients with HLH. Ten patients had clinicoradiologic evidence of CNS involvement.ResultsWe identified five CSF cytomorphologic patterns: (1) hemophagocytosis, (2) vacuolated macrophages without evidence of hemophagocytosis, (3) monocytes and/or nonvacuolated macrophages, (4) acellular specimens, and (5) bloody specimens. Patterns 1 and 2 were common in CNS-HLH and rare in patients without CNS involvement. The CSF cytomorphologic patterns did not correlate well with WBC counts or protein concentration.ConclusionsOur study offers a comprehensive view of the cytomorphologic features seen in CSF specimens from patients with HLH.

This article explores the political, strategic and emotional issue of victim groups deciding to continue or discontinue central components of a justice campaign in the aftermath of receiving ‘truth’. Drawing on in-depth interviews, the article focuses on relatives and other stakeholders’ varying positions on (dis)continuing the annual Bloody Sunday commemoration march after the publication of the Report of the Bloody Sunday Inquiry and the UK Prime Minister’s apology for the massacre. I demonstrate that there has emerged an, at times, acrimonious schism between those who feel the apology and report were sufficient to stop the march and those who believe them to be insufficient. Thus, while much of the literature on political apology evaluates its effects on the dyadic relationship between victim and perpetrator, this article develops Sara Ahmed’s concept of ‘overing’ to demonstrate that the ostensible moment of truth can create unanticipated and deleterious intra-victim tensions. The article concludes by suggesting practical measures emerging from the findings that other justice campaigns may consider.

The aim of this study is to determine the factors that influence success of sonographically guided hydrostatic reduction of ileocolic intussusception in children. A retrospective study of patients with ileocolic intussusception who presented to our local university hospital between 2015 and 2020 was carried out. The demographic, clinical, radiological, and laboratory data of patients were reviewed. Data were collected from 106 patients, 7 of whom were excluded because they had contraindications for hydrostatic reduction of their intussusception. These 7 patients had primary surgery done for them. The success rate of Hydrostatic reduction was 60.6%. Univariate analysis was used to determine the effect of 14 variables on the success of the hydrostatic reduction of ileocolic intussusception. It was found that weight, age, duration of symptoms, and length of the intussusceptum were significantly greater in the group that failed hydrostatic reduction. An important correlation was found between failure of reduction of the intussusception and the position of the head of the intussusception, presence of free fluid within the peritoneum, presence of air-fluid levels, bloody defecation, vomiting, and abdominal distension. While no significant relationship was observed for sex, laboratory criteria, or mesenteric lymph node enlargement with the outcome of the reduction. Using multivariate analysis, 4 independent risk factors were identified for reduction failure: bloody defecation, duration of symptoms ≥ 24 h, length of the intussusceptum, and the presence of free fluid within the peritoneal cavity. These criteria could be used as predictive value to determine the patients with high risk of failure in regard of hydrostatic reduction of intussusceptions in children. It could be used as well in a later study to design a predictive mathematical model to predict the failure of a hydrostatic reduction of ileocolic intussusception.

Food protein-induced allergic proctocolitis (FPIAP) is a non-immunoglobulin E (IgE)-mediated food allergy, which presents with bloody mucoid stool in infants. Although IgE-mediated allergy and sensitizations to offending foods have been described in other non-IgE-mediated food allergies, it has not been investigated in FPIAP.To investigate IgE-mediated allergy and sensitization to offending foods in FPIAP.Patients (n = 204) were retrospectively recruited and grouped as FPIAP (n = 180; FPIAP with or without the symptoms of IgE-mediated food hypersensitivity to offending and nonoffending foods at initial consultation), FPIAP-IgE sensitization to offending foods (n = 17), and FPIAP-transition to IgE-mediated allergy to offending foods (n = 7). The study was performed in accordance with the protocol approved by the local ethical committee of the Hacettepe University.The median age of onset of symptoms and the development of tolerance was 2 months (interquartile range [IQR], 1.0-3.0) and 12 months (IQR, 10.0-14.0), respectively, and of the patients with skin prick test or serum specific IgE tests (n = 196), 38 (19.4%) had evidence of IgE sensitization to offending foods at the initial consultation or during follow-up; 17 (8.6%) had IgE sensitization, 7 (3.6%) indicated a transition to IgE-mediated allergy to FPIAP-induced foods. The median age of tolerance development of the FPIAP-transition group (19 months, IQR, 18.0-29.0) was significantly later than that of the FPIAP group (11 months, IQR, 10.0-14.0; P.001) and the FPIAP-IgE sensitization group (11.0 months, IQR, 9.5-12.0; P .001). Tolerance was observed within the study period in almost all the patients.Children with FPIAP may have sensitization or develop IgE-mediated allergy over time to offending foods. In addition, IgE sensitization in FPIAP does not have an unfavorable effect on tolerance development; however, the transition to an IgE-mediated phenotype may delay tolerance for a brief time.

A 32-year-old multiparous rural woman having 26 weeks of pregnancy with giant uterine fibroid extending up to the cervix had stillbirth 2 weeks back and left hospital against medical advice. She was readmitted in emergency with necrotic prolapsed uterine fibroid with offensive vaginal bleeding. On examination, the patient had necrotic prolapsed fibroid with very offensive bloody discharge and a large number of larvae of Dermatobia hominis (human botfly) were crawling in necrotic tissue. The location of this infestation at genital region is an extremely rare occurrence in postdelivery patients.

A 24-year-old man with a history of bloody sputum for 6 months was referred to our hospital with suspected alveolar hemorrhaging due to vasculitis. Chest computed tomography showed ground-glass opacities in both lungs, and an examination of his bronchoalveolar lavage fluid showed alveolar hemorrhaging. However, no evidence of vasculitis was found, and subsequent polysomnographic testing confirmed that he had severe obstructive sleep apnea (OSA). Since the alveolar hemorrhaging improved after the initiation of continuous positive airway pressure treatment, the diagnosis was negative-pressure alveolar hemorrhaging due to severe OSA.

Background A wide variation of causes can lead to gastrointestinal symptoms in children- an infection with parasites is one of them. The expansion of international travel might lead to an increase in testing children for a correspondent infection. Currently there are no guidelines available, which patients should be tested for a possible parasitical infection. The aim of the study was to characterize Swiss children suffering from intestinal parasites, in order to provide more knowledge for the clinician who should be tested. Methods This is a retrospective study of Swiss pediatric patients, whose stools have been tested for parasites and helminths. Results A total of 1855 stool samples, belonging to 572 different children with an average age of 7.9 years, were tested within a 10-year period. The prevalence of a positive result was 4.2%, of which all were positive for Blastocystis, and 12.5% had a co-infection with Endolimax nana. Conclusion Immigrants, immune compromised children with diarrhea and pediatric patients with bloody or protracted diarrhea should have 2 different stool specimens examined for a possible parasitical infection.

Main goal of Serbian ideology, policy, practice, starting from the late XVIII until the beginning of XIX century is creation of a clean, pure and ethnic Serbian country so called Great Serbia. In such country idealists also included the territory of Bosnia and Herzegovina. Meanwhile that is achievable only by committing heinous crimes including the Bosnian Genocide. Because of the Visegrads Geostrategic position the city is crucial for Serbian plans, aggressors and criminals tried by any means to form ethnically clean territory, not choosing the means or tools in the attempt of achieving that goal. Highest point of those crimes happened during the second world war 1941-1945, also in the time of aggression on Republic Bosnia and Herzegovina 1992-1995. Numerous mass and individual killings, extermination, enslavement, deportations and / or forcible transfer of the Bosniak population, imprisonment and other forms of deprivation of liberty committed in violation of basic rules of international law constitute a long and sad list of criminal and genocidal acts committed against Bosniaks in the Drina Valley, and in the name of the so-called project Great Serbia. In this cycle and history of chetnik misery and inhumanity, the culmination of human malice, evil blood and moral dishonor was against the Bosniaks of Eastern Bosnia. Thanks to the hard work of the community and people of the country this evil plan and evil intentions of Serbs ideologists did not come through. Yet they do not give up, furthermore they use new means and methods. In that contest targeting wider area of Visegrad, as a starting point for commencing Great Serbian goals and ideas. That gave birth to the idea that Visegrad is continuously in focus to the leaders and actors of the ideology of Great Serbia, therefore creation of ethnically clean Serbian areas. All this, for a consequence, had a permanent acts of numerous crimes against humanity and international human rights among Bosnians in wider area of Visegrad, from the period of World war 2 and in the time of aggression on Republic of Bosnia and Herzegovina. In this area number of heinous crimes were committed. One of the consequences of the horrific crimes committed against Bosniaks is a radical change in the ethnic structure of the population in the Visegrad area during the 1992-1995 aggression. In relation to the 1991 Census, when there were 13,471 Bosniaks, according to the 2013 census, 1,043 Bosniaks have registered residence in Visegrad. Still, the area wasn’t ethnically cleansed as in accordance to Serbian ideologists, so this shameful project that’s grounded on crime, continued by new means and methods. Analysis confirmed key marks of aggressive attempts of ideology and policy in creating ethnic clean Serbian territory within area of Visegrad. Research is focused and timely determined on three periods: First during the Second world war 1941-1945, Second, Aggression on Republic of Bosnia and Herzegovina, third period after signing of Dayton’s 1995. still this day. For the purpose of proving the general hypothesis of the research, the methods of analysis and synthesis, the hypothetical-deductive method and the comparative method will be used, and for the purposes of obtaining data, the method of analysis (content) of documents and the case study method. Serbian ideologist still tries to remove all Bosnians from the wider area of Visegrad and by doing so make that town the starting point for the next phases of ethical cleansing of non-Serbian population from walleyes of Drina Conclusion would be under any price secure at first economic conditions for survival of Bosnians on those areas, take a set of measures on economically strengthening Gorazde, as a center of gathering non-Serb population in the walleye of Drina.

Inflammatory bowel disease is rare in infants, and the early diagnosis is very important. We herein report an infant who received an early diagnosis of infantile Crohn’s disease (CD). A two-month-old boy presented with bloody stool. He developed a poor sucking tendency and a painful perianal lesion at three months of age. He was suspected of having infantile CD because of his atypical perianal lesion. Colonoscopy revealed that his perianal lesion had induced rectal longitudinal ulcers. Histology showed no granulomas but patchy inflammation reaching the submucosal layer. He was diagnosed with infantile CD based on the Japanese criteria. CD should be suspected in infants with atypical perianal lesions, irrespective of their age. Early colonoscopy with histology should be considered in these cases in order to prevent adverse outcomes in children.

An unneutered female cat of unknown age presented bloody lesions on the edematous face, and respiratory signs. Cytology and culture from the skin sample collected with fine-needle aspiration showed yeasts inside activated macrophages, and fungal growth characteristic of Histoplasma spp., which was molecularly confirmed that was Histoplasma capsulatum var. capsulatum. The cat was successfully treated with oral itraconazole (10 mg/kg/daily) for 120 days. This is the first case report of feline histoplasmosis confirmed molecularly in Brazil.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, and it is still a major health problem in Nigeria especially among people with poor socio-economic status. This study was conducted with the aim of determining the prevalence of tuberculosis among two study subjects living in Hayin Dogo community of Samaru, Zaria, Kaduna state: “Al majirai” (Qur’anic school children) and children showing respiratory symptoms The major focus of this study is the al majirai, due to their unhygienic, overcrowded living environments and poor nutritional status. Two hundred sputum samples were collected from the al-majirai, and one hundred from the other children; convenience sampling method was employed. The samples were stained using the Ziehl Neelsen technique and observed microscopically for the presence of acid fast bacilli. The prevalence of acid fast bacilli (AFB) among the Al majirai was 0%, and 12% among the children attending the medical center. Symptoms such as night sweat and bloody sputum, as well as risk factors such as malnutrition and poor housing hygiene were found to be significantly associated with the infection in the children showing respiratory symptoms and attending the Ahmadu Bello University medical center (P

Background Pancreaticopleural fistula (PPF) is a rare disease, especially in children. Conservative treatment and surgery are traditional therapies, but surgery is invasive. The emergence of endoscopic retrograde cholangiopancreatography (ERCP) has provided a new noninvasive treatment for PPF and may become the first choice for children with PPF. Aim To explore the treatment response to ERCP for PPF in children. Methods Seven children with PPF were hospitalized in the Gastroenterology Department of Beijing Children's Hospital from December 2007 to May 2019. Data on these seven patients' clinical characteristics, diagnosis, treatments, and outcomes were analyzed, and their treatment responses following surgery and ERCP were compared. The correlation between the length of hospital stay and conservative treatment was analyzed. Peer-reviewed articles written in English and Chinese published from January 2009 to December 2019 were obtained from various open data sources and reviewed. Results The seven patients comprised three boys and four girls with a mean age of 6.57 ± 3.26 years. The main symptoms were chest tightness and pain (n = 4), intermittent fever (n = 3), dyspnea (n = 3), and abdominal pain (n = 1), and all patients had bloody pleural effusion. All seven patients were diagnosed with PPF by magnetic resonance cholangiopancreatography, and all were initially treated conservatively for a mean of 34.67 ± 22.03 d with a poor response. Among five patients who underwent ERCP, one required surgery because of intubation failure; thus, the success rate of ERCP was 80%. Two patients were successfully treated with surgery (100%). The postoperative hospital stay of the two patients treated by surgery was 20 and 30 d, respectively (mean of 25 d), and that of the four patients treated by ERCP ranged from 12 to 30 d (mean of 19.25 ± 8.85 d). The recovery time after ERCP was short [time to oral feeding, 4-6 d (mean, 5.33 ± 1.15 d); duration of closed thoracic drainage, 2-22 d (mean, 13.3 d)]. Analysis of previous cases of PPF published worldwide during the past decade showed that the treatment success rate of ERCP is not lower than that of surgery. There was no significant difference in the postoperative hospital stay between surgery (16 ± 10.95 d) and ERCP (18.7 ± 6.88 d, P > 0.05). A positive linear correlation was found between the overall hospital stay and ERCP intervention time (R 2 = 0.9992). Conclusion ERCP is recommended as the first-choice treatment for PPF in children. ERCP should be performed as early as possible if conditions permit.

A 41-year-old female patient was admitted to hospital with bloody stool and diarrhoea for 2 months, accompanied with fever, left earache, obvious saddle-nose deformity and red eyes for 2 weeks. She had history of repeated multiple sore joints for 6 months and hearing impairment in the left ear for 4 months. Laboratory tests showed elevated white cell count (WBC) of 15.57×10ˆ9/L, neutrophil of 76.8% and C reactive protein (CRP) of 95.4 mg/L. Haemoglobin was decreased at 94 g/L. Antineutrophil cytoplasmic antibody was negative. Colonoscopy showed diffuse inflammation and ulcers in the left-sided colon (figure 1). Histological findings from sigmoid colon showed chronic inflammation without vasculitis appearance. CT enterography revealed left-sided colon inflammation (figure 2). MRI of …

Highlights • In contrast with the usual idiopathic intussusception appearing in infants, neonatal intussusception in full-term newborns is a very rare entity. • It’s a challenging diagnosis since it has a misleading and variable presentation. • Early diagnosis may be enhanced with abdominal ultrasonography that showed the classic target and pseudo kidney signs. • An emergency laparotomy must be performed to confirm the ultrasound findings and to reduce the intussusception: Only way to save the patient. • The overall prognosis for neonates with intussusceptions depends on early diagnosis, because once a critical condition develops, as in this case, the mortality rate is likely to rise., Introduction In contrast with the usual idiopathic intussusception appearing in infants, neonatal intussusception in full-term newborns is a rare entity and usually due to an organic lead point lesion. It has a misleading and variable presentation. This manuscript reports a very rare case of neonatal idiopathic intussusception in a full-term male newborn in order to highlight the difficulties in establishing an early diagnosis. Presentation of case We present a full-term male newborn who was referred to our department at day 7 of life with fecaloid vomiting, distended abdomen and absence of intestinal transit. No bloody stool was identified. The newborn was in poor condition, dehydrated and hypothermic. He was promptly resuscitated and an abdominal ultrasound was quickly performed, it showed an ileocecal intussusception located in the right hypochondriac region. An emergency laparotomy was performed confirming the ultrasound findings. The pathological exam of the resected bowel confirmed the presence of an intussusception with areas of hemorrhagic rearrangements but no lead point was detected. The patient died from septicemia. Conclusion Intussusception occurring in the neonate is still difficult to assess, because of its rarity and its uncommon mode of presentation. This case report underlines the importance to make early diagnosis, because once a critical condition develops, the mortality rate is likely to rise.

Background Adult intussusception is less common than paediatric intussusception. The aim of this study was to explore the clinical presentation, aetiology, diagnosis and treatment of adult intussusception. Methods Adults (>18 years) with intussusception treated by surgical or conservative measures were included from January 2005 to January 2018, and the manifestation, types, diagnosis and treatment of adult intussusception in our centre were reviewed. Results A total of 150 patients with adult intussusception were included in this study. The clinical manifestations included 111 cases (74%) of abdominal pain, 38 cases (25.3%) of bloody stool, 37 cases (24.7%) of bowel obstructions, 33 cases (22%) of abdominal distension, 29 cases (19.3%) of nausea and vomiting, 19 cases (12.7%) of an abdominal mass, and 12 cases (8.0%) of diarrhoea. The types of intussusception were classified into 36 cases (24%) of enteric intussusception, 87 cases (58%) of intestine-colon intussusception and 27 cases (18%) of colonic intussusception. Surgical intervention was applied in 139 cases (92.7%), including 115 patients who underwent open surgery, and laparoscopy-assisted surgery was performed in 24 patients. The main pathogenesis of intussusception was malignant tumors in 51 cases (36.7%) and benign tumors and polyps in 49 cases (35.3%). Conclusion Malignant and benign tumors are the main causes of adult intussusception. Abdominal CT is the preferred evaluation method for the preoperative diagnosis of this condition. The choice of surgical procedure depends on the location and type of intussusception.

This study aimed to clarify the usefulness of the Ikari-curve left (IL) guiding catheter for balloon pulmonary angioplasty (BPA).The current BPA strategy for chronic thromboembolic pulmonary hypertension is dilation of as many branches as possible to normalize hemodynamics and oxygenation. The shape of the guiding catheter is a major factor in achieving this. However, conventional guiding catheters are difficult to introduce into particular branches. The IL guiding catheter may be suitable; however, its utility remains unclear.We retrospectively analyzed 202 consecutive BPA sessions of 40 patients from November 2016 to October 2019 and divided these sessions into two groups: the IL group where the IL guiding catheter was used and the non-IL group where other catheters were utilized. The occurrence of lung injury was determined by the presence of bloody sputum. We compared the rates of successful introduction into target vessels and assessed for the occurrence of lung injury.The average age of enrolled patients was 60.3 ± 14.4 years, with females comprising 65%. There were 99 sessions in the IL group. The median treated branches per session differed between the 2 groups (IL group: 15 versus non-IL group: 10, P < 0.05). The occurrence of lung injury was lower in the IL group (4.0% versus 11.7%, P = 0.07). The IL group had more successful vessel insertions than the non-IL group (78.8% versus 42.7%, P < 0.01).The IL guiding catheter may be introduced into branches that cannot be accessed by conventional guiding catheters.

Background Despite the fact that the majority of the acute diarrheal diseases are viral in origin and self-limited, routine and injudicious antibiotic treatment is a common practice globally and more prevalent in Africa. Indeed, the irrational use of antibiotics has a detrimental effect on the issue of antibiotics resistance and associated healthcare costs. Accordingly, a health center-based cross-sectional study is mandatory and was conducted due to the common malpractice of antibiotics use. Objective The aim of this study was to evaluate the antibiotic use pattern in the treatment of acute diarrheal disease in Chefa-robit health center, Kemissie, Northeastern Ethiopia. Methods and materials A retrospective cross-sectional study was conducted to evaluate the antibiotic utilization pattern for the treatment of acute diarrheal disease. Data was collected from 230 patients' record cards treated for acute diarrheal disease from January 2018 to December 2018 using structured questionnaires. The finding is presented using frequency distribution and percentages in tables as well as figures. Results Among the 230 patients, 49.60% were males and the rest were females. From the total, 172 of them were with watery type of diarrhea and 132 of them were prescribed antibiotics inappropriately out of which 77 were under 5 years. In addition, 27 patients were diagnosed with mucoid diarrhea and only eight of them were treated with antibiotics whereas 31 patients were with bloody type of diarrhea and 10 of them were not treated with antibiotics. Of the 230 cases, 161 (70%) patients received different types of antibiotics, and co-trimoxazole, amoxicillin and ciprofloxacin were the most prescribed antibiotics. Conclusion The study revealed that there is a high level of inappropriate antibiotics use which may fuel the increased antimicrobial resistance and associated costs nationally as well as globally.

Invasive breast cancer deriving from the milk duct and lobule that develops in the nipple is extremely rare, except in Paget’s disease and skin cancer. This is the second reported case of the development of invasive cancer confined to the nipple after breast-conserving surgery. A 69-year-old woman visited our department due to redness, swelling, and bloody discharge of the right nipple in the last month. A needle biopsy was suggestive of invasive ductal carcinoma; we performed a removal surgery of the right residual breast tissue and a second sentinel lymph node biopsy. She underwent these procedures 10 years previously as well. Thus, we diagnosed the present lesion as a local recurrence, but it was unknown whether the lesion was a true recurrence or second cancer, namely, metachronal ipsilateral breast cancer. The present case helps promote awareness that invasive cancer rarely develops in the nipple after conserving surgery. Patients should be encouraged to visit a medical facility if experiencing skin changes and swelling of the nipple. Additionally, breast cancer patients must be carefully selected for breast-conserving surgery; failure to do so may later result in nipple-specific local recurrence.

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BACKGROUND Spinal anesthesia using a surface landmark-guided technique can be challenging in patients with anatomical alterations of the lumbar spine; however, it is unclear whether using ultrasonography can decrease the technical difficulties in these populations. We assessed whether an ultrasound-assisted technique could reduce the number of needle passes required for block success compared with the landmark-guided technique in patients with abnormal spinal anatomy. METHODS Forty-four patients with abnormal spinal anatomy including documented lumbar scoliosis and previous spinal surgery were randomized to receive either surface landmark-guided or preprocedural ultrasound-assisted spinal anesthesia. All spinal procedures were performed by 1 of 3 experienced anesthesiologists. The primary outcome was the number of needle passes required for successful dural puncture. Secondary outcomes included the success rate on the first pass, total procedure time, periprocedural pain scores, and the incidences of radicular pain, paresthesia, and bloody tap during the neuraxial procedure. Intergroup difference in the primary outcome was assessed for significance using Mann-Whitney U test. RESULTS The median (interquartile range [IQR; range]) number of needle passes was significantly lower in the ultrasound group than in the landmark group (ultrasound 1.5 [1-3 {1-5}]; landmark 6 [2-9.3 {1-15}]; P < .001). First-pass success was achieved in 11 (50.0%) and 2 (9.1%) patients in the ultrasound and landmark groups, respectively (P = .007). The total procedure time, defined as the sum of the time for identifying landmarks and performing spinal anesthesia, did not differ significantly between the 2 groups (ultrasound 141 seconds [115-181 seconds {101-336 seconds}]; landmark 146 seconds [90-295 seconds {53-404 seconds}]; P = .888). The ultrasound group showed lower periprocedural pain scores compared with the landmark group (ultrasound 3.5 [1-5 {0-7}]; landmark 5.5 [3-8 {0-9}]; P = .012). The incidences of complications during the procedure showed no significant differences between the 2 groups. CONCLUSIONS For anesthesiologists with experience in neuraxial ultrasonography, the use of ultrasound significantly reduces the technical difficulties of spinal anesthesia in patients with abnormal spinal anatomy compared with the landmark-guided technique. Our results can lead to practical suggestions that encourage the use of neuraxial ultrasonography for spinal anesthesia in such patients.