A Case of Distal Vaginal Agenesis Presenting with Recurrent Urinary Tract Infection and Pyuria in a Prepubertal Girl

Background

Isolated distal vaginal agenesis is a rare anomaly and mostly becomes symptomatic after menarche. We describe an unusual presentation of this anomaly in a prepubertal girl.

Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys

BackgroundIn response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports.ObjectiveWe aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support.MethodsWe collected 13,678 participants through online representative sampling across six countries—Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom—during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports.ResultsImmunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43%) and the United Kingdom (759/1484, 51.15%); followed by Taiwan (2841/5989, 47.44%), Australia (963/2086, 46.16%), and Spain (693/1491, 46.48%); and was the lowest in Japan (241/1081, 22.94%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95% CI 1.13-1.22), personal concern (OR 1.07, 95% CI 1.00-1.16), perceived virus severity (OR 1.07, 95% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95% CI 2.36-2.66), liking immunity passports (OR 2.77, 95% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95% CI 0.82-0.98), immunity passport concern (OR 0.61, 95% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data.ConclusionsOur research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world.     

Alteration of Auto-CPAP requirements in obstructive sleep apnea patients with COVID-19 history

BackgroundCoronavirus disease 2019 (COVID-19) is an infectious disease that leads to critical respiratory problems.Obstructive sleep apnea (OSA) is the most common sleep-associated breathing disease and is represented by repetitive experiences of constraint of the respiratory tract prompting to reduced or deficient breathing during sleep.Auto-Continuous positive airway pressure (Auto-CPAP) is a modality of respiratory ventilation used as gold standart in the treatment of OSA.ObjectiveThis study was performed to conclude the alteration of Auto-CPAP levels in OSA patients who had COVID-19 history.MethodsNineteen OSA patients who had cured COVID-19 and used Auto-CPAP were included in this study. Nightly Auto-CPAP 95th percentile pressure (95thpp), median CPAP pressure and AHI before COVID-19 disease and one month after COVID therapy were recorded from electronic cards of Auto-CPAP devices.ResultsBefore COVID infection, average Auto-CPAP 95thpp was 8.56 ± 0.17 cm H₂O. One month after COVID-19, average Auto-CPAP 95thpp was 9.78 ± 0.21 cm H₂O (P < 0.01). While Median CPAP pressure was 7.49 ± 0.16 cm H₂O before COVID, it was found to be 8.15 ± 0.19 cm H₂O after the disease (P < 0.01).ConclusionsThe increase in need of average Auto-CPAP 95thpp and median CPAP pressure in OSA patients who have had COVID-19 disease and use Auto-CPAP shows that this disease causes problems in both the lower and upper airways.     

Psychometric Evaluation of the Wijma Delivery Expectancy/Experience Questionnaire Version B

Examining the fear of delivery after childbirth is important. The authors’ aim is to examine the overall psychometric quality of the Wijma Delivery Expectancy/Experience Questionnaire version B. Reliability and validity of the instrument were evaluated via reliability analysis, exploratory and confirmatory factor analyses, and multidimensional subscore estimation. A six-factor model was proposed to explain instrument results. Factors included concerns about labor pain, lack of positive behaviors, loneliness, lack of positive feelings, concerns about childbirth, and concerns about the baby. Researchers provide psychometric evidence about the quality of the questionnaire to measure fear of delivery after childbirth.     

Arch-first technique via clamshell incision: successful surgical reoperation for aortic arch dissection

We report a case of successful reoperation for aortic arch dissection with use of the "arch-first" technique in a patient who had Marfan syndrome. Extracorporeal circulation was initiated via right subclavian artery cannulation, and the chest was entered through a clamshell incision for the best exposure. When the patient was cooled to 18 degrees C, the perfusion was stopped. After the 1st aortic arch anastomosis to a 30-mm Dacron graft, cerebral perfusion was reestablished via the right subclavian artery. The aortic repair was then completed. The cerebral ischemic time was 18 minutes, the aortic cross-clamp time was 69 minutes, and the total extracorporeal circulation time was 334 minutes. The patient was discharged from the hospital on postoperative day 10 with no neurologic impairment. The arch-first technique shortens the duration of brain ischemia. When combined with a clamshell incision, the technique is particularly helpful for reoperation of the aortic arch and thoracic aorta.     

The rare coexistence of high titer inhibitor development and gastrointestinal stromal tumor in a patient with severe hemophilia: A case report

Hemophilia is a hereditary disease with impaired blood coagulation due to a genetic deficiency of blood coagulation factors. The development of inhibitors further complicates the course of the disease and management. The case is here reported of a haemophilia patient who presented with coexisting development of high titer inhibitor with Gastrointestinal Stromal Tumor (GIST) diagnosis and was admitted with upper gastrointestinal system bleeding. The patient had no prior history of inhibitor presence. During all procedures including surgery, excellent hemostasis was achieved with rFVIIa treatment and no hemorrhagic complication was observed. To the best of our knowledge, this constitutes the first reported case of GIST associated with inhibitor development in a hemophilia A patient.     

Predictive value of SYNTAX score II for clinical outcomes in cardiogenic shock underwent primary percutaneous coronary intervention; a pilot study

SYNTAX Score II (SSII) connects clinical variables with coronary anatomy. We investigated the prognostic value of SSII in patients with ST segment elevated myocardial infarction (STEMI) complicated with cardiogenic shock treated with primary percutaneous coronary intervention (PPCI). In this retrospective analysis, we evaluated the in-hospital prognostic impact of SSII on 492 patients with STEMI complicated with cardiogenic shock treated with PPCI. Patients were stratified by tertiles of SSII, in-hospital clinical outcomes were compared between those groups. In-hospital univariate analysis revealed higher rates of in-hospital death for patients with SSII in tertile 3, as compared to patients with SSII in tertile 1 (OR 17.4, 95% CI 10.0–30.2, p?<?0.001). After adjustment for confounding baseline variables, SSII in tertile 3 was associated with 6.2-fold hazard of in-hospital death (OR 6.2, 95% CI 2.6–14.1, p?<?0.001). SSII in patients with STEMI complicated with cardiogenic shock treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggests SSII to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with STEMI complicated with cardiogenic shock treated with PPCI.     

The pleuro-esophageal muscle: a disregarded anatomical structure

A transverse muscular band extending from the left pleura to the esophagus was detected during routine dissection of posterior mediastinum in Anatomy Department of Ege University Medical Faculty. As a result of a detailed review of the literature, we found that this structure is named as the pleuro-esophageal muscle. This muscle was made of smooth fibers, acting as an anchoring structure to the lower part of the esophagus. While the entire esophageal muscle is smooth in the early stage of fetal development, this muscle probably derives as an early separation from the esophagus.     

Treatment Outcomes of Long-Pulsed Nd: YAG Laser for Two Different Subtypes of Rosacea

Background: A variety of lasers have been used for the treatment of rosacea. However, treatment of this condition with long-pulsed neodymium-doped yttrium aluminium garnet laser has not been reported yet. Objective: To assess the efficacy and safety of long-pulsed neodymium-doped yttrium aluminium garnet laser in two different subtypes (erythematotelangiectatic and papulopustular) of rosacea. Methods: A total of 66 patients were enrolled in the study. All of the patients were treated with long-pulsed neodymium-doped yttrium aluminium garnet laser with 3- to 4-week intervals. Rosacea severity score was assessed by using photographs. Improvement in severity was defined as the percentage reduction in severity scores from baseline to the end of treatment. Patients were also asked about their own opinions of improvement at the end of the treatment. Side effects were also documented. Results: Good to excellent improvement was achieved in up to 50 percent of the patients in the erythematotelangiectatic and papulopustular groups. Percent improvement of global severity was significantly greater in the erythematotelangiectatic patients than in the papulopustular patients. The majority of patients from both groups noted a significant improvement of the lesions. Hypopigmented atrophic scars were seen in two patients. Conclusion: The long-pulsed neodymium-doped yttrium aluminium garnet laser is a safe and effective treatment for vascular and inflammatory lesions of rosacea.Rosacea is a chronic inflammatory cutaneous disorder with periods of exacerbations and remissions. Clinical findings are characterized by flushing, erythema, telangiectasia, papules, and pustules. There are four recognized subtypes—erythematotelangiectatic (ETR), papulopustular (PPR), phymatous, and ocular.1 Although angiogenic and sebaceous factors have been implicated in the etiopathology of the disease, it remains unclear. Vascular abnormalities, dermal matrix degeneration, environmental factors, and microorganisms may have a potential role in the development of rosacea.2Rosacea may significantly affect patients’ lives, leading to considerable psychological and social distress over appearance. Therefore, management of this condition is very important. There is no definite cure. Electrosurgery and lasers can be used to decrease vascular lesions.3 Topical and/or oral antibiotics can be used to suppress the inflammatory lesions. Although these methods are moderately successful in controlling symptoms, relapse usually occurs shortly after the cessation of therapy.4,5Many types of lasers and light devices have been increasingly used in the treatment of rosacea. However, the role of long-pulsed neodymium-doped yttrium aluminium garnet (Nd:YAG) laser in this condition has not been well-studied. In this study, the authors assessed the efficacy of long-pulsed Nd:YAG laser in treating patients with two different subtypes (ETR and PPR patients) of rosacea.