Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Aug 2021
Case ReportsHemophagocytic Lymphohistiocytosis in a Pediatric Patient.
Hemophagocytic Lymphohistiocytosis (HLH) is an uncommon but a potentially fatal disease characterised by high grade fever, hepato-splenomegaly, deranged liver functions, cytopenias and multi-organ involvement. HLH has its own diagnostic criteria, which comprise of various clinical and laboratory features, which were revised in 2004 by HLH Society for prompt identification and recognition. Here, we present a case of 9-year developmentally normal female with all the complaints as mentioned above, who received treatment for almost eight months as a case of pyrexia of unknown origin (PUO) without a definitive diagnosis. ⋯ The diagnosis of HLH was made after fulfillment of its criteria which was addressed completely and found veracious. After addressing the active complaints of the patient, she was referred to a pediatric oncologist for chemotherapy and further management; and counselled for hematopoietic stem cell transplantation (HSCT). Key Words: Hemophagocytic lymphohistiocytosis, Pyrexia of unknown origin (PUO), Pediatric hematopoietic stem cell transplantation.
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To compare the results of sutureless aortic valve replacement (AVR) with the conventional method. ⋯ Ninety-one patients (45 women, 46 men) underwent AVR (49 sutureless, 42 conventional). The average age was 73.08 ± 7.54 years in the sutureless group and 66.26±8.63 years in the conventional group. The mean cross-clamp and cardiopulmonary bypass (CPB) times were 72.86 ± 34.09 and 91.88 ± 36.98 minutes, respectively, in the former; and 104.96 ± 41.64 and 119.81 ± 40.45 minutes, respectively, in the latter. In the sutureless group, 30 (61.2%) patients underwent additional procedures such as CABG, mitral interventions, tricuspid repair, ascending aortic surgery, and myxoma removal. Preoperative peak and mean pressure gradients decreased from 76 and 48 mmHg to 16 and 9 mmHg postoperatively in the sutureless group; and from 70.9 and 44 mmHg to 24 and 12 mmHg in the conventional group. Paravalvular leak and permanent pacemaker requirement due to AV-block rates were 6.1%. The mean ICU stay was 3.69±6.75 and 2.31±1.80 days, the mean hospital stay was 10.08±6.56 and 8.62±3.28 days, and the 30-day overall mortality rates were 8.2% and 4.8% in the sutureless and conventional groups, respectively. Conclusion: Sutureless AVR has advantages of shorter cross-clamp time, reduced CPB duration, and postoperative aortic gradients. However, there was no advantage in terms of mortality or hospital stay. Its benefits could be more prominent in complex cases or minimally invasive surgery. Key Words: Sutureless valves, Aortic valve stenosis, Valve replacement.
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J Coll Physicians Surg Pak · Aug 2021
Meta AnalysisVitrectomy alone or Vitrectomy Combined with Scleral Buckle in the Management of Giant Retinal Tears.
The aim of this study was to compare as to which treatment achieves better outcomes in the management of giant retinal tears (GRTs) - pars plana vitrectomy (PPV) alone or combined with scleral buckle (SB)? The Web of Science, PubMed, and Cochrane Library databases were searched from January 1, 1950 to October 1, 2020. Pooled odds ratios (ORs), 95% confidence intervals (CIs), heterogeneity, and publication bias were determined with Review Manager software. ⋯ According to the final anatomical success, final visual acuity, and risk factors of GRT ≥180°, there were no significant differences between PPV combined with SB and PPV alone for the management of GRT in the current study, except in decreasing the risk of RRD. Key Words: Giant retinal tear, Pars plana vitrectomy, Scleral buckling, Recurrent retinal detachment.
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J Coll Physicians Surg Pak · Aug 2021
Is the Duration of Temozolomide Predictive for Sequential Bevacizumab Treatment Responses in the Glioblastoma Multiforme Cancer Setting?
To evaluate the predictive significance of the duration of temozolomide (TMZ) in patients with glioblastoma multiforme (GBM) who were treated with bevacizumab (Beva) as second-line setting. ⋯ Duration of first-line TMZ treatment was not a predictor for OS of the GBM patients, who were treated with Beva as second-line setting. Key Words: Bevacizumab, Duration of treatment, Glioblastoma multiforme, Predictive score, Temozolomide.