colonoscopy, revealing a 7 mm sessile polyp in the rectum (Figure 1a). The polyp was removed by a cold snare and was sent for histopathological evaluation. Histopathology of the hyperplastic polyp demonstrated osseous metaplasia with foreign body reaction (Figure 1b). Discussion: Osseous metaplasia of the gastrointestinal tract is an exceedingly rare phenomenon with a prevalence of less than 1%, with osseous metaplasia of the rectum accounting for 0.4% of cases. Although osseous metaplasia is a well-defined phenomenon, the pathogenesis is still unclear. Osseous metaplasia secondary to a malignant lesion has been hypothesized to be due to the presence of bone morphogenetic protein (BMP), which belongs to the TGFb family. The underlying mechanism seems to be the recruitment of undifferentiated stromal mesenchymal cells into osteoprogenitor cells or fibroblasts, a phenomenon termed epithelial-mesenchymal transformation. Kypson et al. demonstrated the overexpression of BMP-2 in tumor cells from cases of rectal adenocarcinoma with osseous metaplasia compared to those lacking bone formation. An alternative mechanism proposed is the increased expression of osteocalcin and upregulation of type-1 collagen and osteonectin, markers of bone matrix synthesis. Multiple theories exist regarding the development of metaplasia in malignant lesions. However, benign lesions have only been linked with chronic inflammation, as described in our case. Given the rarity of this condition, no large trials have been conducted to establish clear guidelines on surveillance of benign or malignant masses with osseous metaplasia. Therefore, the prognosis in metastatic lesions remains unclear.[2095] Figure 1. (a) 7 mm rectal polyp (yellow arrow) seen on colonoscopy and subsequently removed by cold snare technique. (b) Histology specimen (380 magnification) obtained from a rectal mucosa biopsy demonstrating osseous metaplasia (Arrowhead) with benign foreign body reaction. Figure also demonstrates the osseous metaplasia surrounded by normal colonic mucosa and crypts (Arrow).
gastrosplenic fistulas showed similar survival of 82% in all cases of gastrosplenic fistulas. However, in recent times safety and efficacy of PCD has been well established. PCD has been attempted in prior reports with gastrosplenic fistula but required surgery for definitive management. The choice of surgery is generally open splenectomy with partial gastric resection but laparoscopic techniques have been described. [2491] Figure 1. (a) Large splenic abscess with loss of fat planes with stomach (b) Resolution of abscess with double pigtail catheters (c) Gastrosplenic fistula opening seen in body of stomach on endoscopy (d) Healed gastric wall after 6 weeks of initial presentation.
Guillain-Barré Syndrome (GBS) is an acquired degenerative, demyelinating neurological disorder classically characterized by progressive, symmetrical ascending paralysis. Often associated to occur after a viral illness, most commonly an upper respiratory infection (URI), followed by gastrointestinal illnesses. Here we present a case of Miller Fisher syndrome (MFS) which is a rare variant of GBS. MFS presents with a triad of ataxia, areflexia, and opthalmoplegia. MFS is a clinical diagnosis but can be confirmed serologically with positive anti-ganglioside antibodies.
INTRODUCTION: Despite a heavy burden of disease, resource-limited settings remain underrepresented in pandemic research. Critical illness epidemiology for both COVID-19 and non-COVID-19 bystander patients may differ compared to well-resourced settings. METHODS:We performed a retrospective cohort study of patients admitted to intensive care units (ICU) at two public hospitals in the KwaZulu-Natal Department of Health in South Africa preceding and during the COVID-19 pandemic. We used multivariable logistic regression to analyze the association between three patient cohorts (pre-pandemic non-COVID-19, pandemic non-COVID-19, and pandemic COVID-19) and pandemic variant wave and the primary outcome of ICU mortality, adjusted for patient-level factors and ICU capacity strain.
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