Bilateral tubal pregnancy is the rarest form of ectopic pregnancy, and in most cases results from assisted reproductive techniques. The incidence of simultaneous bilateral tubal pregnancies has been reported to range from 1 per 725 to 1 per 1580 ectopic pregnancies or approximately corresponds to 1 per 200,000 pregnancies. To date, this is the only case reported in our institution. Bilateral tubal pregnancies are usually diagnosed intraoperatively, but with the advent of diagnostic tools and more readily available diagnostic modalities, an earlier diagnosis can be made to decrease maternal morbidity and mortality.
This is a case of a 24-year old female, who came in at the emergency room complaining of severe hypogastric pain. She was admitted as a case of ectopic pregnancy, probably ruptured. Subsequently, emergency exploratory laparotomy was done which revealed bilateral tubal masses, which on histopathological examination confirmed bilateral tubal pregnancy.

Human ; Female ; Adult ; Pregnancy ; Laparotomy ; Pregnancy, Tubal ; Pregnancy, Ectopic ; Emergency Service, Hospital ; Abdominal Pain ; Reproductive Techniques, Assisted

OBJECTIVE: The purpose of this study was to determine the efficacy of short segment fixation following postural reduction for the re-expansion and stabilization of unstable burst fractures in patients with osteoporosis. METHODS: Twenty patients underwent short segment fixation following postural reduction using a soft roll at the involved vertebra in cases of severely collapsed vertebrae of more than half their original height. All patients had unstable burst fracture with canal compromise, but their motor power was intact. The surgical procedure included postural reduction for 2 days and bone cement-augmented pedicle screw fixations at one level above, one level below and the fractured level itself. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period was 15 months. The mean pain score (visual analogue scale) prior to surgery was 8.1, which decreased to 2.8 at 7 days after surgery. The kyphotic angle improved significantly from 21.6+/-5.8degrees before surgery to 5.2+/-3.7degrees after surgery. The fraction of the height of the vertebra increased from 35% and 40% to 70% in the anterior and middle portion. There were no signs of hardware pull-out, cement leakage into the spinal canal or aggravation of kyphotic deformities. CONCLUSION: In the management of unstable burst fracture in patients with severe osteoporosis, short segment pedicle screw fixation with bone cement augmentation following postural reduction can be used to reduce the total levels of pedicle screw fixation and to correct kyphotic deformities.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Osteoporosis ; Spinal Canal ; Spine

BACKGROUNDNumerous studies have reported a relationship between hepatitis C virus (HCV) genotype and the response to interferon therapy. Despite high sensitivity and specificity, genotyping methods can be performed only on HCV RNA positive samples. Serotyping might be a rapid and cost effective method for determining HCV genotypes, especially in patients with previously undetectable HCV RNA. In this study, an enzyme linked immunosorbent assay (ELISA) method for HCV serotyping with the genotype specific, synthetic peptides derived from HCV nonstructural 5a (NS5A) region was developed.

METHODSBased on 45 sequences, representing HCV genotypes 1 - 6 from Genebank, we synthesised 305 overlapping 30-mer peptides within NS5A region at positions 2182 - 2343 of HCV. All peptides for antigenic reactivity were tested by enzyme immunoassay with 69 human sera with antiHCV positive representing genotype 1 - 6. Forty hepatitis C patient sera were serotyped using serotype specific, synthetic peptides and genotyped by sequencing analysis.

RESULTSThe correspondence of amino acids in HCV NS5A region with amino acids in positions 2182 - 2343 was very low among different genotype peptides. The highly conserved sequences were residues 2182 - 2211 (R1), 2272 - 2301 (R7) and 2302 - 2331 (R9): the highly variable 2212 - 2241 (R3) and 2257 - 2286 (R6). Using 305 peptides, antigenic regions were located in R3, R7 and R9. Eighteen peptides from highly conserved region representing genotypes 1 to 6 showed broad immunoreactivity with sera containing antibody to all HCV genotypes. Immunoreactivity of the peptides from highly variable region was stronger with similar genotype sera. Twelve unique peptides showed highly, genotype specific, reactivity with types 1 and 3 sera. Type 2 genotype specific peptides had cross reaction with type 3 serum. No type 4, 5 or 6 specific peptides were selected. The serotyping results showed high agreement with sequencing analysis.

CONCLUSIONSThe major antigenic regions in HCV NS5A region were at 2212 - 2241 (R3), 2272 - 2301 (R7) and 2302 - 2331 (R9). Eighteen peptides from highly conserved region show genotype independent, immunoreactivity, useful for antiHCV antibody test. Twelve peptides from highly variable region show genotype 1 and 3 dependent immunoreactivity, useful for determining HCV serotype, especially for patients with previously undetectable HCV RNA.

Amino Acid Sequence ; Genotype ; Hepacivirus ; classification ; genetics ; Humans ; Molecular Sequence Data ; Serotyping ; Viral Nonstructural Proteins ; chemistry ; immunology

Asia ; COVID-19 ; Humans ; Ophthalmologists ; Perception ; SARS-CoV-2

BACKGROUND: Cardiovascular disease is known as an important predictor of mortality, not only in patients undergoing dialysis treatment but also in those who are starting dialysis treatment. In addition, it is well known that cardiovascular morbidity is about twice higher in diabetic patients. In this study, MIBI and echocardiography were performed in patients starting dialysis treatment, and a comparison of these findings between diabetic (DM) and non-diabetic (Non-DM) patients was done. METHODS: Among the patients diagnosed as end- stage renal disease (ESRD) and started dialysis treatment at Severance Hospital, 77 patients underwent MIBI and echocardiography when they were clinically stable within 4 weeks after the initiation of dialysis. Clinical characteristics, laboratory findings, MIBI and echocardiographic findings of the 77 patients were analyzed. RESULTS: The mean age of the patients was 58.4+/-10.8 years with sex ratio of 1.1: 1. Of the 77 patients, 52 were DM and 25 were Non-DM. There were 30 patients (39.0%) with abnormal findings on MIBI scan, 26 with reVersible and 4 with fixed defects, and 69 patients (89.6%) with left ventricular hypertrophy (LVH) on echocardiography. DM group showed higher prevalence of myocardial perfusion defect than Non-DM group (48.1% vs. 20.0%, p< 0.05). There were no differences in the prevalence of LVH (92.3% vs. 84.0%) and in left ventricular ejection fraction (LVEF) (56.1+/-13.1% vs. 57.5+/-11.8%) between DM and Non-DM groups. LVEF was significantly lower in patients with abnormal findings on MIBI scan than those with normal MIBI finding. CONCLUSION: The majority of ESRD patients starting dialysis treatment accompanied LVH and myocardial perfusion defect was present in many cases especially in diabetic patients. Therefore, early evaluation and treatment of ischemic heart disease are mandatory in diabetic patients starting dialysis treatment for ESRD.
Cardiovascular Diseases ; Diabetes Mellitus ; Dialysis* ; Echocardiography* ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Mortality ; Myocardial Ischemia ; Perfusion ; Prevalence ; Sex Ratio ; Stroke Volume ; Technetium Tc 99m Sestamibi* ; Tomography, Emission-Computed, Single-Photon*