Current glucose monitoring technology appears inadequate for the management of diabetic surgical and in critically ill patients requiring intensive insulin therapy. Subcutaneous sensors measure interstitial fluid glucose, and this technology has not yet been shown to provide the timely and accurate measurements necessary for intravenous insulin administration in surgical and critical care patients on intensive insulin therapy. Technologies under development that may be more suitable for surgical and intensive care unit patients are the automated intermittent type glucose monitors and central catheter glucose monitors. Improved accuracy, patient safety, incorporation of control algorithms, and alleviation of added nursing labor are important factors for consideration with future acute care glucose monitors. Hospital costs for these monitors are difficult to estimate but may be relatively low if their use can be related to better patient outcome, reduced labor costs, and increased job satisfaction for the nursing staff.
Background Morphological diagnosis of non-Hodgkin lymphoma (NHL) is usually based on lymph node biopsy. Bone marrow biopsy (BMB) is important for staging, and morphology alone can be challenging for subtyping. Immunohistochemistry (IHC) allows a more precise diagnosis and characterization of NHL using monoclonal antibodies. However, there is a need for a minimal panel that can provide maximum information at an affordable cost. Methods All newly diagnosed cases of B-cell NHL with bone marrow infiltration between 2017 and 2019 were included. BMB was the primary procedure for diagnosing B-cell NHL. Subtyping of lymphomas was performed by immunophenotyping using a panel of monoclonal antibodies on IHC. The primary diagnostic panel of antibodies for B-cell NHL included CD19, CD20, CD79, CD5, CD23, CD10, Kappa, and Lambda. The extended panel of antibodies for further subtyping included CD30, CD45, CD56, Cyclin D1, BCL2, and BCL6. Results All cases of B-cell NHL were classified into the chronic lymphocytic leukemia (CLL) and non-CLL groups based on morphology and primary IHC panel. In the CLL group, the most significant findings were CD5 expression, CD23 expression, dim CD79 expression, and weak surface immunoglobulin (Ig) positivity. In the non-CLL group, they were CD5 expression, positive or negative CD23 expression, strong CD79 expression, and strong surface Ig expression. An extended panel was used for further subtyping of non-CLL cases, which comprised CD10, Cyclin D1, BCL2, and BCL6. Conclusion We propose a two-tier approach for immunophenotypic analysis of newly diagnosed B-cell NHL cases with a minimum primary panel including CD5, CD23, CD79, Kappa, and Lambda for differentiation into CLL/non-CLL group and Kappa and Lambda for clonality assessment. An extended panel may be used wherever required for further subtyping of non-CLL.
First confirmed case of novel coronavirus was identified in December 2019 in Wuhan, China and designated as SARS coronavirus-2 (SARS-CoV-2). Afterwards, it spreads very rapidly all over the world. World Health Organization declared it as pandemic on 11 th march, 2020. The symptoms range from mild to severe acute respiratory distress syndrome leading to hospitalization and eventually, death of the patient. Lung is the predominant organ which is severely affected. Here, we present an autopsy finding in heart and lungs in a 22-year-old male who died with clinical diagnosis of pneumonia and ARDS in November 2020.
Penetrating trauma to the thorax involving the heart is usually fatal. Discovery and management of intrathoracic missiles especially in the close vicinity of the heart is a major challenge. Retained intracardiac missiles are exceptionally unusual, and there are 322 reported cases over 60 years, from 1940 to 2009.1 We present two patients who presented with penetrating gunshot wounds to the chest with retained intracardiac bullets. The management of hemodynamically stable patients with retained intrapericardial foreign body remains controversial. Management options of thoracic firearm injuries are based on patient stability, course and location of the missile. We report our experience of two patients with delayed presentation of a retained intrapericardial bullet from firearm injuries. In this paper, we discuss the management strategies of such injuries in light of the available literature and summarize our clinical experience.
Rheumatic heart disease contributes to significant cardiovascular morbidity and mortality and remains a predominant cause of cardiac morbidity in developing nations. Coronary angiography is indicated as a routine procedure in the preoperative assessment of patients with valvular heart disease, who are older than 40 years age. Though transthoracic echocardiography (TTE) is routinely done preoperative in every patient, transesophageal echocardiography (TEE) is an important imaging modality especially for the identification of thrombus. The diagnosis of associated left atrial thrombus changes the approach to the surgery, regardless of the symptoms. Rheumatic mitral valve disease contributes to significant cardiovascular morbidity and mortality worldwide. It is the predominant cause of cardiac morbidity in developing nations. This case demonstrates incidental finding of large left atrial thrombus, diagnosed incidentally through transesophageal echocardiography in a patient who was previously diagnosed as a case of severe mitral stenosis with coronary artery disease.
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