Background: Ewing sarcoma (ES), the second most common malignant bone tumor after osteosarcoma in the second decade, occurs in 0.9% of cases as the primary non-sacral form.Case: A 20-years-old male presented with acute paraparesis of bilateral lower limb and numbness following initial back pain for the last 6 months. Magnetic resonance imaging (MRI) of the lumbar spine revealed a 4 cm enhancing soft tissue mass at the L4/L5 vertebra extending into the spinal canal with compression of the thecal sac.The computed tomography (CT) of the chest, abdomen, and pelvis revealed aggressive lytic lesions in the L4 spinous process with soft tissue extension into the spinal canal with no other site of distant metastasis. He was treated with IV steroids (Injection dexamethasone 10 mg IV followed by 4 mg tablet dexamethasone q6h; subsequently tapered off). A core needle biopsy showed a small, round blue cell neoplasm, (suggestive of a primitive neuroectodermal) stained positive for CD99 and vimentin stain. The diagnosis of ES lumbar spine was made which was treated with surgical resection with an appropriate margin measuring 8 Â 4.5 Â 2.5 cm with decompression and L4/5 laminectomies, which had a negative margin in the surgical pathology report. Concomitant local radiotherapy and chemotherapy [cycles of vincristine 2 mg/m 2 , adriamycin/doxorubicin 75 mg/m 2 , cyclophosphamide 1200 mg/m 2 (VDC) with mesna rescue alternating with cycles of ifosfamide 1800 mg/m 2 and etoposide 100 mg/m 2 (IE)] was started. The motor strength was regained gradually with preserved spine biomechanics and oncological control with no recurrence in 2-year follow-ups. Conclusions:The presentation of lumbar ES can vary from local pain and swelling to acute paraparesis. Timely diagnosis and treatment with multimodal therapy, namely, steroids for acute spinal cord compression and surgery with chemoradiotherapy for ES can improve spinal biomechanics and oncological control.
Emamectin Benzoate (EB, also known as MK-0244) is the 4′-deoxy-4′-epi-methyl-amino benzoate salt of avermectin B1 (avermectin family of 16-membered macrocyclic lactones), which is similar structurally to natural fermentation products of Streptomyces avermitilis. 1,2 Streptomyces avermitilis is a naturally occurring soil actinomycete. 3 This EB stimulates high-affinity GABA (Gamma Amino Butyric Acid) receptors and increases membrane chlorideion permeability. 1,2 Used as insecticides and pesticides, it is efficacious against many organisms like armyworm species, diamondback moth (Plutellaxylostella), cabbage looper (Trichoplusiani [Hubner]), beet armyworm (Spodopteraexigua (Hubner), etc.. 2 To the best our knowledge, there has been few available literatures regarding EB poisoning in human, and that too lacks specific recommendations to tackle cases of EB poisoning.Here, we report a case of EB poisoning in child resulting in gastrointestinal distress and confusion, which was managed with vigorous lavage, fluids, and supportive treatments. | CASE PRESENTATIONA six-year-old girl was brought to the Emergency Department (ED) of Kalaiya District Hospital, Bara, Nepal, with complaints of nausea, vomiting, and abdominal pain at 3:30 pm. It was accompanied by her parents who had noted her of being alert and playful after returning from school on the same day. The mother while doing
Introduction: Patients with neutropenia are at increased risk for bacteremia and sepsis after endoscopy. According to the American Society for Gastrointestinal Endoscopy (ASGE), there is insufficient evidence to recommend for or against administration of prophylactic antibiotics prior to routine endoscopic procedures in patients with neutropenia. This study was conducted to assess the safety of gastrointestinal endoscopic procedures in patients with neutropenia and to compare outcomes between patient who received periprocedural prophylactic antibiotics to those who did not. Methods: We studied neutropenic patients who underwent endoscopic procedures from 2012 through 2022. Neutropenia was defined as an absolute neutrophil count (ANC) , 1500 cells/mL which was further sub-classified into mild (ANC , 1500), moderate (ANC , 1000) and severe (ANC , 500) neutropenia. Multilevel logistic regression models were used to assess factors associated with clinically relevant bacteremia. Results: We identified 102 neutropenic patients who underwent gastrointestinal endoscopies; 45% (N546) of patients received periprocedural prophylactic antibiotics. 16% (N59) of patients who did not received prophylactic antibiotics were started on antibiotics within 3 days following the procedure due to sepsis. A similar proportion of patient 15% (N57) who received periprocedural antibiotics developed sepsis within 3 days of endoscopy and required either resumption or broadening of antibiotic regimen. Subsequently, blood cultures that were drawn on these septic patients did not grow any organisms. Poor performance status was associated with increased risk of infectious adverse events. No association was observed between low ANC or use of steroid with infectious adverse events (p . 0.6) (Table ).
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