Medicina
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Case Reports
Spontaneous Transvaginal Intestinal Evisceration Two Years after Vaginal Hysterectomy, a Case Report.
Vaginal evisceration is an exceedingly rare and poorly documented complication following vaginal hysterectomy. Prompt detection and surgical intervention are critical to prevent severe complications such as bowel ischemia, perforation, and secondary sepsis. We present the case of an 84-year-old woman with a history of vaginal hysterectomy two years prior, who presented with acute abdominal pain and a significant portion of her small bowel protruding through a defect in the vaginal vault. ⋯ The etiology of this condition is unclear and likely multifactorial. Various surgical approaches, including laparoscopic, abdominal, transvaginal, and combined techniques, have been described, all offering comparable outcomes. Therefore, the choice of surgical procedure should be tailored to the patient's clinical presentation.
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The diagnosis of basal cell carcinoma (BCC) in dark phototypes can be a challenging task due to the lack of relevant clues and its variable presentation. In this regard, there is growing evidence that dermoscopy may benefit the recognition of BCC even for skin of color (SoC). The objective of this review is to provide an up-to-date overview on clinical and dermoscopic patterns of BCC in SoC, also comparing such findings with those of the main clinical mimickers reported in the literature. ⋯ The most prevalent differentiating dermoscopic feature for BCC includes blue, black and gray dots, though arborizing vessels still remain the predominant BCC feature, even in dark phototypes. Diagnostic approach to BCC in dark-skinned patients varies due to the prevalence of dermoscopy findings associated with hyperpigmented structures. Clinicians should be aware of such points of differentiation for a proper management of this tumor in SoC.
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Randomized Controlled Trial
The Effect of Combined Balance Exercise on Knee Range of Motion, Balance, Gait, and Functional Outcomes in Acute Phase Following Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial.
Background and Objectives: Total knee arthroplasty (TKA) improves balance performance in patients with osteoarthritis; however, balance deficit and fall incidence after TKA have been reported. This study aimed to determine the effects of combined balance exercises on knee range of motion (ROM), balance, gait, and functional outcomes during the acute phase after TKA. Materials and Methods: A total of 42 participants were randomly assigned to either the combined balance group (n = 21) or the general physical therapy (control) group (n = 21). ⋯ Results: The combined balance exercise group demonstrated significant improvements post intervention (p < 0.05) for all outcomes. The time × group interaction effect for the WOMAC scores showed statistically significant interaction effects for pain, stiffness, and physical function; the static and dynamic balance values showed statistically significant interaction effects for CEA, PL, AV, and TUG; and gait ability showed a significant interaction effect for the 10 m walk test (p < 0.05). Conclusions: This study confirmed that combined balance training with general physical therapy has a positive effect on ROM, static and dynamic balance, gait, and functional outcomes in the acute phase post TKA and that combined balance exercise can be proposed as a rapid rehabilitation intervention with general physical therapy following TKA.
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Observational Study
Investigation of the Usefulness of HALP Score in Predicting Short-Term Mortality in Patients with Acute Decompensated Heart Failure in a Coronary Care Unit.
Background/Objectives: Acute decompensated heart failure (ADHF) presents a significant clinical challenge characterized by frequent hospitalizations, high mortality rates, and substantial healthcare costs. The united index of hemoglobin, albumin, lymphocytes and platelets (HALP) is a new indicator that reflects systemic inflammation and nutritional status. This study aimed to investigate the prognostic utility of the HALP score and hematological parameters in predicting short-term mortality among ADHF patients admitted to the coronary care unit (CCU). ⋯ ROC analysis demonstrated that hemoglobin, lymphocyte, albumin, and HALP score had significant discriminative power, with albumin showing the highest AUC (0.814). Conclusions: In conclusion, the HALP score and hematological parameters represent valuable prognostic feature for short-term mortality prediction in ADHF patients admitted to the CCU. These findings underscore the importance of early risk stratification and targeted interventions guided by comprehensive biomarker assessments in optimizing patient outcomes.
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Review Case Reports
Tryptase: The Silent Witness of Past and Ongoing Systemic Events.
Introduction: Tryptase is an important biomarker widely used in the laboratory confirmation of severe hypersensitivity reactions, especially anaphylaxis. It also plays a crucial role in the diagnosis, risk stratification, management and prognostic evaluation of many other mast cell-related conditions. Aim: This paper aims to highlight the role of serum tryptase, both in allergic disorders and other mast cell-related conditions. ⋯ According to the guidelines, measuring sAT 30 min to 2 h after the symptom onset and sBT 24 h after the resolution, using the 20 + 2 rule and an sAT/sBT ratio of 1.685, improves the diagnostic accuracy in anaphylaxis. Conclusions: Tryptase levels should be acquired in all cases with clinical suspicion of MC degranulation. Given the increasing clinical relevance, elevated baseline serum tryptase levels require a multidisciplinary approach and further investigation.