Successful pregnancy after mucinous cystic neoplasm with invasive carcinoma of the pancreas in a patient with polycystic ovarian syndrome: a case report

The incidence of invasive cancer within a mucinous cystic neoplasm of the pancreas varies between 6 and 36%. Polycystic ovarian syndrome is a disorder characterized by hyperandrogenism and anovulatory infertil...

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Prophylaxis of postoperative complications after craniotomy.

Purpose of review: This review reports an update of the evidence on practices applied for the prevention and management of the most common complications after craniotomy surgery. Recent findings: Latest guidelines support the combined thromboprophylaxis with the use of both mechanical and chemical modalities, preferably applied within 24 h after craniotomy. Nevertheless, a heightened risk of minor hemorrhagic events remains an issue of concern. Postoperative nausea and vomiting (PONV) and pain constitute the complications most commonly encountered during the first 24 h postcraniotomy. Recently, neurokinin type-1 receptor antagonists have been tested as adjuncts for PONV prophylaxis with encouraging results, whereas dexmedetomidine and gabapentinoids emerge as promising alternatives for postcraniotomy pain management. The available data for seizure prophylaxis following craniotomy lacks scientific quality; thus, this remains still a debatable issue. Significantly, a growing body of evidence supports the superiority of levetiracetam over the older antiepileptic drugs (AEDs), in terms of efficacy and safety. Summary: Optimum management of postoperative complications is incorporated as an integral part of the augmented quality of care in patients undergoing craniotomy surgery, aiming to improve outcomes. This review may serve as a benchmark for neuroanesthetists for heightened clinical awareness and prompt institution of well-documented practices. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Lipid emulsion in local anesthetic toxicity.

Purpose of review: Enthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local anesthetic systemic toxicity (LAST) remains. Intravenous lipid emulsion (ILE) for the treatment of LAST has been endorsed by anesthetic regulatory societies on the basis of animal study and human case report data. The accumulated mass of reporting now permits objective interrogation of published literature. Recent findings: Although incompletely elucidated the mechanism of action for ILE in LAST seemingly involves beneficial effects on initial drug distribution (i.e., pharmacokinetic effects) and positive cardiotonic and vasoactive effects (i.e., pharmacokinetic effects) acting in concert. Recent systematic review by collaborating international toxicologic societies have provided reserved endorsement for ILE in bupivacaine-induced toxicity, weak support for ILE use in toxicity from other local anesthetics, and largely neutral recommendation for all other drug poisonings. Work since publication of these recommendations has concluded that there is a positive effect on survival for ILE when animal models of LAST are meta-analyzed and evidence of a positive pharmacokinetic effect for lipid in human models of LAST. Summary: Lipid emulsion remains first-line therapy (in conjunction with standard resuscitative measures) in LAST. Increasing conjecture as to the clinical efficacy of ILE in LAST, however, calls for high-quality human data to refine clinical recommendations. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Taking Care of Vulnerable Populations as Global Health – Case Reports on Refugees and Migrants

By Nathan Douthit

According to the United Nations High Commissioner for Refugees, a refugee is someone who," owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country ." ¹ Globally, the World Health Organization estimates there are 65 million forcibly displaced persons, 86% of whom are in developing countries .²  Implicit in the care of refugees are complex healthcare challenges including language barriers, unfamiliarity with the theory and practice of primary health care, common exposure to violence, torture and warfare, the high prevalence of PTSD, anxiety and depression and anti-immigrant sentiment in their new host country. Access to primary care is an essential facet of refugee care. Low socio-economic status and social isolation complicates the management of chronic non-communicable disease.

 

In the case report  "A Rohingya refugee's journey in Australia and the barriers to accessing healthcare," Jiwrajka et al discuss some of these issues.³ The case describes the peculiar challenge of the Rohingya people

 

"[o]ver 200000 Rohingya refugees are currently resettled in Bangladesh, a country with already limited health-care for its own citizens as well as a non-signatory country to any of the United Nations Refugee or Stateless Conventions. As a result, refugees are not guaranteed access to basic human rights, including healthcare."

 

Even with a robust translation service freely available in Australia, this patient states the interpreter spoke an "unfamiliar dialect." She did not understand her prescriptions as a result.  The patient did not feel that her doctors cared about her concerns of infertility, instead she states that "the doctors were more interested in her diabetes." The low socio-economic status of this patient is linked to her health – the authors write:

 

"[T]here is a disproportionate burden of diabetes among minority groups, migrants and the socioeconomically vulnerable. [Socioeconomic status] and social stratification are intrinsically linked to health, in turn creating a social gradient of health. As a result, adverse health outcomes within vulnerable populations, including refugees, transgress beyond the individual to affect whole communities."

 

Due to a variety of factors, most notably the conflict in Syria, the world is in the midst of the largest migration of people since World War II. BMJ Case Reports invites authors to publish cases regarding the health of these vulnerable patients as well as the dilemmas created by migration on national health systems. Global health case reports can emphasize:

-Barriers to access of care due to linguistic, social and cultural differences

-Problems created by lack of cultural competence in healthcare systems

-Discrimination and effects on healthcare for refugees and migrants

-Uncontrolled chronic conditions due to migration or delays in access to healthcare

-Other factors that exacerbate the vulnerability of migrant populations

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about refugee health at BMJCR:

–Paired suicide in a young refugee couple on the Thai-Myanmar border

–A Syrian man with abdominal pain

–Ethiopian-Israeli community

References:

1. UNHCR. Global Strategy for Public Health: A UNHCR Strategy 2014-2018. United Nations High Commission for Refugees, Geneva. 2014.
2. WHO. Refugee and migrant health [internet]. World Health Organization 2017 [cited July 6 2017] Available at: http://ift.tt/2uIs27X
3. A Rohingya refugee's journey in Australia and the barriers to accessing healthcare. Manasi Jiwrajka, Ahmad Mahmoud, Maneeta Uppal. BMJ Case Reports 2017: published online 9 May 2017, doi:10.1136/bcr-2017-219674.

Selected References on Refugee and Migrant Health from other sources:

-Hunter P. The refugee crisis challenges national health care systems. EMBO reports. 2016 Apr 1;17(4):492-5.

-Onnell C. Healthcare for Syrian refugees. BMJ. 2015 Aug 8:13.

-Jackson JC, Haider M, Owens CW et al. Healthcare Recommendations For Recently Arrived Refugees: Observations from EthnoMed. Harvard Public Health Review. 2016 April;7

 

 

 

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First Report on Fetal Cerebral Polyglucosan Bodies in Mucopolysaccharidosis Type VII

We report on the detection of discordant inclusions in the brain of a 25-week female fetus with a very rare lysosomal storage disease, namely, Sly disease (mucopolysaccharidosis (MPS) type VII), presenting with nonimmune hydrops fetalis. Besides vacuolated neurons, we found abundant deposition of polyglucosan bodies (PGBs) in the developing brain of this fetus in whom MPS-VII was corroborated by lysosomal beta-glucuronidase-deficiency detected in fetal blood and fetal skin-fibroblasts and by the presence of a heterozygous pathogenic variant in the GUSB gene in the mother. Fetal/neonatal metabolic disorders with PGB-deposition are extremely rare (particularly in relation to CNS involvement) and include almost exclusively subtypes of glycogenosis (types IV and VII). The accumulation of PGBs (particularly in the fetal brain) has so far not been depicted in Sly disease. This is the first report on such "aberrant" association. Besides, the detection of these CNS inclusions at such an early developmental stage is remarkably unique.

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