Background: The incidence of smuggling and illegal transport of substances by internal concealment, also known as body packing, is increasing. The clinical approach to body packers has changed significantly over the past two decades. In addition, the mortality of body packers is an important issue in patient management. The purpose of the current study is to determine the statistics and mortality related to body packing. Methods: In this cross-sectional study, all body packer patients who referred to Loghman Hakim hospital were evaluated from 2010 to 2017. Demographic characteristics, findings of clinical imaging, treatment, and outcome of the patients were recorded. The data were analyzed using SPSS version 21. Results: A total of 303 patients were enrolled in the study after the diagnosis of body packing by abdominal CT scanning without contrast. Conservative treatment including whole bowel irrigation (WBI) accompanied by close monitoring was done for 78% (n = 236) of patients; moreover, 26 patients (8.5%) underwent surgery after WBI, and 41 patients (13.5%) underwent surgery without bowel irrigation. Mortality was observed in eight patients (2.7%) five of whom (62.5%) died before surgery and had the clinical manifestation of crystal (methamphetamine) and cannabis toxicity. Furthermore, three patients (37.5%) died due to the complications of surgery such as gastrointestinal leakage of an abdominal abscess. Conclusion: Conservative treatment seems to be better for the management of body packers. In addition, it is necessary to monitor patients for possible signs and symptoms of intoxication and gastrointestinal obstruction.
Objective. To evaluate the midterm longitudinal changes in chorioretinal structures in patients with coronavirus disease 2019 (COVID-19). Methods. Thirty-four eyes of 17 COVID-19 patients were enrolled. The patients underwent retinal and choroidal imaging upon the recovery (baseline) after 1 and 3 months. Retinal measurements in fovea, parafovea, and perifovea were recorded. To calculate choroidal vascularity index (CVI), luminal and total choroidal areas were measured using Sonada's method. Choroidal thickness was measured at the subfovea 500 microns temporal and nasal to the fovea. Results. Mean CVI was 0.64 ± 0.04 at baseline that significantly increased to 0.67 ± 0.05 (P = 0.012) after 1 month and again significantly decreased to 0.63 ± 0.05 after 3 months (P < 0.001). While the stromal component showed a significant decrease between the baseline and first-month values (1.16 ± 0.29 to 1.01 ± 0.27, P = 0.03), the luminal area mostly changed between months 1 and 3 (2.03 ± 0.28 to 1.91 ± 0.23, P = 0.045). The average of subfoveal choroidal thickness and retinal thickness remained unchanged. Conclusion. CVI is increased in patients with COVID-19 1 month after recovery from COVID-19 and returns to baseline values after 3 months. Regarding the reversible nature of changes, there might be a prominent role in inflammation.
Introduction and importance Primary adrenal leiomyosarcoma (PAL) is an extremely rare neoplasm that usually arises from the smooth muscle cells of the adrenal or adjacent vascular structures. The tumor is asymptomatic until it grows up and develops a mass effect in the retroperitoneal region. Although there are about 50 reported valid cases, surgical intervention is mandatory in the majority of patients. Case presentation Herein, we report the case of a 32-year-old healthy woman with a chief complaint of vague abdominal pain. After initial clinical and radiological examinations, we found a large retroperitoneal mass located around the right adrenal gland. Due to the patient's pain, a laparotomy was performed, and a large mass was resected with free margins. Immunohistochemical examination was positive for vimentin, smooth muscle actin (SMA), and desmin. Therefore, the diagnosis of PAL was confirmed. Conclusion Although PAL is an uncommon malignancy, its diagnostic and therapeutic approaches are almost straightforward. A computed tomography scan can show the characteristics of the tumor and direct the management. Surgical resection is the mainstay of treatment, and the effects of adjuvant therapies have not been apparent yet.
Objectives: The present study seeks to provide insight into managing patients with chronic kidney disease (CKD) infected with COVID-19.Methods: Patients with COVID-19 with CKD were included in the study. The eligible patients were divided into four groups: 1) patients who were not on dialysis, 2) patients on maintenance dialysis, 3) patients who underwent dialysis following COVID-19, 4) patients with a history of a kidney transplant. After reviewing clinical charts, nursing records, laboratory findings, radiological reports, and other medical records of CKD patients with COVID-19 confirmed infection, clinical presentation, laboratory data, radiology findings, and results were extracted from documented medical records. The epidemiological, clinical, laboratory and outcome characteristics of the subgroups were evaluated and compared.Results: Seventy-eight patients were included into the study. Hypertension (50 cases, 72.5%), diabetes (44 cases, 63.8%), and Cardiovascular disease (26 cases, 38.2%) were the most common risk factors in the studied patients. Among all participants, 40 (52.6%) patients died. The most common symptom was dyspnea (56.6%), followed by dry cough (38.7%). Comparison of blood, inflammatory, biochemical, and clinical indices among the patients' groups show that LDH (P=0.022), AST (P=0.038), and ALT (P= 0.004) indices were significantly different between groups of patients. According to the results in Table 3, Unilateral ground-glass opacity (GGO) in the radiological findings of the Nondialysis CKD group was significantly (P=0.50) higher than the other groups. Conclusion:It can be concluded that CKD is one of the critical factors that can cause poor prognosis in COVID-19 patients.
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