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Chronic cavitary pulmonary aspergillosis (CCPA) is a slow destructive type of chronic pulmonary aspergillosis, characterised by multiple pulmonary cavities that develop and expand over several months or years. Pleural involvement in the form of pneumothorax has been rarely reported in CCPA. We report such an unusual case of an immunocompromised male, with a history of chronic cough and fever, presenting with acute onset of shortness of breath. Chest imaging showed bilateral multiple cavitating nodules, ground glass opacities and dense right middle lobe consolidations and right-sided pneumothorax. Bronchoalveolar lavage (BAL) showed septate hyaline hyphae on KOH (potassium hydroxide) staining and fungal culture grew Aspergillus fumigatus. BAL and serum galactomanan were positive and serum IgG for A. fumigatus was 58 MgA/L (0–40MgA/L) confirming the cause of spontaneous secondary pneumothorax in our patient as CCPA.

Neoscytalidium is a phytopathogen that is often found in plants and soil. It mostly leads to skin and nail infections, and invasive diseases of the sinuses, lung, and brain have been described mostly in immunocompromised patients. We report a case of a post-renal transplant patient who received anti-thymocyte globulin for induction immunosuppression. A month after her transplant, she presented with fever and new-onset seizures, and computed tomography revealed a brain abscess with mass effects and herniation. The patient underwent abscess drainage and craniectomy. The pathological findings showed filamentous septate hyphae. The surgical culture rapidly grew wool-like colonies with a black reverse on Sabouraud agar. Lactophenol cotton blue staining showing septate branched hyphae with one to two arthroconidia cells with flattened ends. The patient was given a combination of amphotericin B and voriconazole but unfortunately died ten days after the diagnosis. This case highlights Neoscytalidium as a cause of invasive fungal disease in immunocompromised patients that is difficult to treat and is often fatal, even when combined surgical and medical therapies are used as treatment modalities., Highlights • Neoscytalidium spp. is a rare human pathogenic fungal disease that most likely leads to superficial infection. • Immunocompromised host is at particularly higher risk of invasive disease. • This is the fifth case in the literature describing cerebral invasive disease caused by Neoscytalidium spp. • The present case further confirms the aggressiveness of the disease and refractoriness to antifungal therapy. • The diagnoses need to be entertained, especially in an immunocompromised patient and who have history of exposure to agricultural areas.

OBJECTIVE To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). DATA SOURCES MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. METHODS OF STUDY SELECTION Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. TABULATION, INTEGRATION, AND RESULTS Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. CONCLUSION Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021244487.

Plants maintain beneficial mutualistic relationships with the mycobiont communities found in their rhizosphere, leading to an increase in plant productivity and health. In nutrient-depleted substrates like mine tailings, mycobiont inoculation is often recommended to help restore a successful plant cover. Our 15-week greenhouse experiment aimed to assess the individual effects of a dark septate endophyte (Phialocephala fortinii C.J.K. Wang & H.E. Wilcox #4 (KX611529)) and two Helotiales strains (Rhizoscyphus ericae (D.J. Read) W.Y. Zhuang & Korf #22 (EU221877) and Meliniomyces sp. #1 (KT275679)) on the growth of plane-leaved willow (Salix planifolia Pursh) cuttings on sterilized and unsterilized waste rock. Rhizoscyphus ericae increased shoot biomass of cuttings on sterilized waste rock, whereas Meliniomyces sp. had a positive effect on cuttings grown on unsterilized waste rock. However, P. fortinii strain had no effect on the survival rate, shoot production, and biomass production of S. planifolia cuttings. This study demonstrates that controlled inoculation with ecologically well-adapted mycobionts could promote plant establishment and productivity on abandoned waste rock and could be an efficient and integrated biotechnological approach for ecological restoration of Canadian mining boreal ecosystems.

RESUMEN Objetivo. Evaluar la asociación del higroma quístico retronucal (HQR) y anomalías cromosómicas fetales. Métodos. Estudio observacional retrospectivo de 323 fetos del primer trimestre con riesgo para anomalías cromosómicas diagnosticados por ecografía entre las 11 y 13,6 semanas. Resultados. De 323 fetos con riesgo para anomalías cromosómicas, se encontró 132 casos de anomalías cromosómicas (40,9%). Se identificaron 145 casos de HQR; en 64 (56,6%) se realizó biopsia de vellosidades coriales y en 81 (43,5%) amniocentesis, hallándose cariotipo anómalo en 82 (56,6%). De 88 fetos con HQR aislado, 33 casos (37,5%) tuvieron alguna anomalía cromosómica; en 58 fetos con HQR asociado a otros hallazgos anormales, se encontró que en 43 fetos (74,1%) hubo anomalías cromosómicas, y de ellos 24 (41,4%) tenían onda de flujo (OVF) anormal del ductus venoso, 17 (29,3%) tenían edema generalizado, 8 casos (13,8%) con cardiopatía, 7 (12,1%) ausencia del hueso nasal. Los valores predictivos del HQR fueron: sensibilidad (S) 62,1%, especificidad (E) 67%, valor predictivo positivo (VPP) 56,6%, valor predictivo negativo (VPN) 71,9%, p

Pepper production has decreased recently, especially due to yellow diseases of Fusarium sp. Thus, this research aimed to isolate and characterize Fusarium sp. from soil and root of healthy and diseased pepper plants. The sampling technique used was purposive sampling. Soil and root pepper samples were taken from lands in Payung and Ranggung Village, Payung District, South Bangka Regency. There were 3 varieties of pepper plant used, including Petaling 1, Nyelungkup, and Merapin Daun Kecil. The characterization of Fusarium sp. isolate included macroscopic and microscopic observation. Macroscopic observation included colony color, colony base color, and growth rate/colony diameter size (cm), while microscopic observation included hyphae structure, and the shape and size of microconidia, macroconidia, chlamydospore, and conidiophore. The research found 66 isolates of Fusarium genus based on the colony color. Most of the isolates were white or purple and red. Colony color of Fusarium sp. showed white color, which then turned to orange color. All isolates showed septate hyphae. Isolates with macroconidia 3-4 septate and micronidia 0-1 septate showed the character of Fusarium oxysporum, while isolates with macroconidia 3-5 septate and microconidia 0-2 septate showed the character of Fusarium solani.

OBJECTIVE. The purpose of our study was to identify the imaging features that differentiate a hepatic mucinous cystic neoplasm (MCN) from a simple biliary cyst. MATERIALS AND METHODS. Surgically resected hepatic MCNs and simple biliary cysts over a 20-year period (October 29, 1997-January 23, 2018) with preoperative CT, MRI, or both were retrospectively identified. Included cases underwent histopathologic confirmation of diagnosis based on the 2010 World Health Organization criteria and blinded imaging review. Various imaging features, including cyst shape and septal enhancement, were assessed for performance. For septate cysts, the relationship of the septation to the cyst wall-that is, arising from the wall without an indentation versus arising from an external macrolobulation-was recorded. Statistical analysis was performed for the imaging features with the chi-square test. RESULTS. The study group comprised 22 hepatic MCNs and 56 simple biliary cysts. A unilocular hepatic cystic lesion was highly predictive of a simple biliary cyst (positive predictive value = 95.2%). The imaging feature of septations arising only from macro-lobulations was 100% specific for a simple biliary cyst on CT (p = 0.001). The presence of septations arising from the cyst wall without indentation was 100% sensitive for hepatic MCN but was only 56.3% specific on CT. Septal enhancement reached 100% sensitivity for hepatic MCN on MRI (p = 0.018). CONCLUSION. The presence of septations, relationship of the septations to the cyst wall, and septal enhancement were sensitive imaging features in the detection of hepatic MCN. The imaging feature of septations arising only from macrolobulations in the cyst wall was specific for simple biliary cysts on CT and helped differentiate simple biliary cysts from hepatic MCNs.

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors that originate in the gastrointestinal tract. We present the case of a 30-year-old man who presented with progressive abdominal distension of one-years’ duration. A physical examination revealed a distended, tense, non-tender abdomen, and initial imaging investigations revealed a huge cystic, septate abdominal mass. A provisional diagnosis was made of a huge retroperitoneal, malignant, cystic mass. However, aspiration cytology showed signs suggestive of a benign cyst. Cystic tumor excision performed with control of drain site to prevent leakeage throughout the procedure. The tumor extending into the pelvis, measuring approximately 17 x 31 x 42 cm in diameter and weighing 3.78 kg. The tumor was resected, and a histopathological examination showed findings consistent with a GIST of mixed spindle and epithelioid type. Further evaluations revealed that the tumor was positive for CD 117 and CD 34, prompting the oncology team to start the patient on oral imatinib 400 mg once daily. No evidence of local recurrence or distant metastasis was noted on an abdominal computed tomography scan performed during the follow-up visit up to October 2020 last follow-up. The clinical presentation of GISTs is often complex, making its diagnosis challenging, especially in patients who present with non-specific gastrointestinal symptoms. The successful management of these tumors requires a multidisciplinary approach, and regular follow-ups.

Bicornuate, septate, or arcuate uterus are common mullerian anomalies which account for 85% of such anomalies. A rare mullerian anomaly is an asymmetric septate uterus with hematometra, reported first by Robert H. A complete septum divides the uterine cavity into one non-communicating hemi-cavity with hematometra, while menstruation occurs from the other hemi-cavity. This may be misdiagnosed as a unicornuate uterus with a non-communicating horn with hematometra. Suspicion of this anomaly, diagnosis, and its management including reproductive outcomes poses a challenge as the anomaly itself is rarely reported. We present a 19-year-old girl with worsening dysmenorrhea due to Robert’s uterus who was managed by resection of the uterine septum and unification of the two hemi-cavities. Seven years later, she underwent in vitro fertilization, had an uncomplicated pregnancy, and delivered by caesarean section at term. Until date, only two successful pregnancy outcomes were reported with Robert’s uterus. With advances in imaging modalities and minimally invasive surgery, diagnosis of Robert’s uterus is early, and hysterolaparoscopy has now become the gold standard therapy.

The incisional hernia is a result of an inadequate healing process of the operatory incision, it may or may not have protuberance and its diagnosis is clinical or through imaging. In this report, we present the case of a 48-year-old female patient who presented with a protuberance of high volume in the hypogastric area which extended to the iliac fossa and became bigger when the Valsalva Maneuver was performed. From this diagnosis, the open surgery approach was adopted, in which we performed hernia exploration, identification of vital structures, resection of a septate seroma and the hernia sac, relocation of the intestinal loops to the peritoneum, setting a polypropylene prosthetic, raffia of the layers, setting a Penrose drain and the skin raffia. In the immediate post-op, the patient did not present with surgical complications, she was discharged from the hospital the next day and continued with ambulatorial monitoring. In this monitoring, this patient presented a new seroma due to rejection of the polypropylene prosthetic and surgery wound infection that were treated of according to the references in current medicine practices.

Introduction Keratitis caused by saprophytic fungi is on the rise in rural areas, often caused by ocular trauma with wooden objects. Early detection of causative organisms and sustained, supervised management can prevent visual disabilities. Case presentation A middle-aged patient from a rural, semi-arid region who presented with pain, redness, and a foreign-body sensation in his left eye resulting from a corneal ulcer induced by trauma from a wooden stick. Due to a history of uncontrolled diabetes and progression of his corneal lesions, he was admitted to our institution for treatment of infectious keratitis. Microbiological examination of corneal scrapings revealed thin, septate hyaline hyphae without conidia or conidiophores, and the patient was diagnosed with a fungal keratitis caused by a Malbranchea species. Though the patient initially responded to treatment with topical natamycin, his condition worsened. He was subsequently successfully treated with topical amphotericin B (1 mg/mL) twice hourly and systemic antifungals. Four months after discharge, the patient returned with symptom recurrence. Conclusion We report the case of a patient with a Malbranchea species causing a rare and recurrent fungal keratitis with corneal infiltrates, subsequently cured by medical management with salvaging of his vision. In patients with a suspected fungal keratitis, early treatment is crucial and should be combined with tight glycemic control for as long as 6 months after presentation to avoid recurrence., Highlights • Fungal keratitis can lead to visual disability if not treated adequately. • Malbranchea species are rare pathogens resistant to many antifungal agents. • Malbranchea keratitis treatment is difficult and can result in poor outcomes. • Treating fungal keratitis is an indolent process often requiring months. • Standard protocols are necessary for managing fungal keratitis.

When do we label a left ventricle as small? How is the decision made regarding suitability for a two-ventricle repair? Are dimensions the only criteria with which we decide, whether a ventricle will support the systemic circulation? Can we actually stimulate the growth of a borderline small left ventricle, so that it could support the systemic circulation in future? What role does mass and shape have to play in whether a borderline ventricle will support a biventricular repair? What role does the morphology and segmental anatomy play in this decision-making? This is a review article to address these issues.

Background: Mitotically active fibrothecoma associated with sclerosing peritonitis is an enigmatic and rare condition, described by Clement et al. in 1994, with fewer than 50 pathologically characterized cases. Association of these two lesions is extremely rare and the etiology currently remains unclear; therefore, association with anti-epileptic drugs was suggested. Case presentation: We report the case of young female, with history of epilepsy, presented with acute severe abdomenal pain. Ultrasound revealed a 20 cm mass, possibly arised from ovary, which was associated with septate ascites. The microscopic examination of the mass showed a morphology fibrothecoma with areas of oedema and high mitotique index but without severe atypia.

Urginea indica belongs to Hyacinthaceae family. It is also known as Indian squill, commonly called as wild Onions. The over exploitation and habitat degradation has resulted in the loss of habitat and it has caused genetic depletion and loss of genetic diversity. Immediate Measures have to be undertaken for conservation, to save this economically important medicinal plant. The present investigation is an attempt to highlight the occurance of arbuscular mycorrhizal (AM) and Dark Septate Endophyte (DSE) fungal association found in the root bulbs of Urginea indica. 8 Accessions of Urginea was examined in Urginea indica kunth and Urginea wightii accessions, collected from various regions of Karnataka and South India. Fungal Symbiosis was present in all the accessions, with 100% root infection. Urginea has DSE fungal association and AM Association. This is the first report on the DSE fungal association in Urginea indica kunth. In addition to the prevalance of AM fungal symbiosis. The role of DSE is still in infancy. Though noclear relationship between AM and DSE fungal colonizations was recognized. Our studies suggests the coexistence of AM and DSE fungal colonizations are common terrestrial habitats especially the xerophytic environment. DSE-plant symbiosis should not be limited to nutritional uptake but mediates other parameters such as drought resistance, stress tolerance and herbivore resistance. Our results show 100% infection by AM and DSE fungal colonies. Infection levels were high throughout the year, the highest levels occurring in the most nutrient-stressed situations. Their occurrence and variaton in different accessions is discussed below.

Plant fungal relationships should vary with abiotic and biotic factors to minimise plant stress and are likely to vary seasonally and with age. We investigated how fungal colonisation, specifically arbuscular mycorrhizal fungi and dark septate fungal endophytes, would vary with species identity and season, and how these interactions change with ontogeny. Plant roots of adults and seedlings of 9 species were collected from heathland and coastal dune habitats along the Australian east coast in New South Wales. Roots were stained and investigated for arbuscular mycorrhizal fungi and dark septate endophyte structures to determine colonisation strength. Species identity was the most important factor driving colonisation strength, while low rainfall and heatwaves were associated with declining arbuscular mycorrhizal fungi colonisation in the warmest sampling period. AMF colonisation may be supressed by plants under heat and water stress as a way of avoiding loss of limited photosynthates. Dark septate endophyte colonisation was more common in this time period and may assist with the stress of the warmer, drier conditions. Colonisation by arbuscular mycorrhizal fungi differed with age but in unpredictable ways and, along with dark septate endophytes, was evident even in plants that are considered non-mycorrhizal, although more extensive in known mycorrhizal species. The lack of arbuscular mycorrhizal fungi colonisation and the increase in dark septate endophyte colonisation during the most stressful period suggest an uncoupling mechanism in the symbiotic relationship which needs further investigation.

Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations. Study Design: A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013–2018) was done along with culture/histopathologic confirmation. Results: Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30–83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture. Conclusions: Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy.

Background and objective: Congenital anomalies of the female genital tract is a known cause for infertility and recurrent pregnancy losses. This study aimed to evaluate the pattern and prevalence of each type of congenital malformation of the reproductive tract among infertile women attending the IVF center in the Maternity Teaching Hospital in Erbil city. Methods: A retrospective study was conducted in Center of Dr. Khawer for Infertility and IVF in the Maternity Teaching Hospital in Erbil city. Data of five years from the 1st January 2010 to the 1st January 2015 were collected from patient files, such as age, sex, residence, type of infertility, type of anomaly, duration of infertility, Karyotype, Intervention, Success rate of intervention, cycle, parity, history of abortions, history of preterm deliveries, and history of ectopic pregnancy. Results: The prevalence of congenital reproductive system anomaly was 4.1% among infertile women. The sub-septate uterus was the most common type (23.24%) anomalies. No significant association was found between the types of the anomaly and the type of infertility. The genetic factor was found to has a significant role in developing such a condition. Success rate after management significantly raised to 61.1% with sub-septate uterus (91.3%) bicornuate/ partial (85.7%), and septate/ complete (72.2%). Conclusion: One of the causative factors of female infertility is congenital anomaly. Most types have a good prognosis in achieving pregnancy after proper management.

PMID: 32231852 Objective: To evaluate the prevalence of uterine anomalies in infertile patients with polycystic ovary syndrome (PCOS) admitted to our tertiary hospital inSoutheastern Turkey.Materials and Methods: The files of 3033 patients with infertility who presented to the infertility polyclinics were retrospectively analyzed, and uterine anomalieswere detected in 131 patients. Seven hundred ten of these patients were evaluated as having PCOS, 55 of whom had uterine anomalies. Patients with PCOS werealso divided into two subgroups as those with primary and secondary infertility.Results: Of the 3033 patients with infertility who were evaluated, 57 (8%) of 710 infertile patients with PCOS, and 74 (3%) of 2323 non-PCOS patients withinfertility had uterine anomalies. A statistically significant difference was found between the two groups (p

Background: A large number of uterine anomalies are detected routinely in reproductive medicine. The prevalence of these congenital uterine anomalies in women with repro-ductive failure remains unclear especially in Upper Egypt.The Aim of Study: Was to estimate the prevalence of congenital uterine anomalies in women with infertility in Sohag by Transvaginal Three Dimensional Ultrasound (TV3DUS).Methods: This study was a descriptive cross-sectional study carried out for 977 infertile women in 2018 based on reviewing of radiological images at Sohag governorate. After taking informed and written consent, a detailed history, general and systemic examination was done. All the cases underwent TV3DUS performed during the postmenstrual phase. Exami-nations had been performed using flips iu220 machine by a single operator and was commented as either normal or abnormal uterine cavity.Results: A total of 977 women were included in the study. 808 (82.7%) had a normal uterus and 169 (17.3%) had a congenital uterine anomalies. The most common anomalies were arcuate [n=84 (49.7%)] and septate [n=62 (36.8%)] uterus, followed by unicornate [n=9 (5.3%)] and then T-shaped and hypoplastic uterus [n=4 each (2.3% each)], lastly didelphys and bicornate [n=3 each (1.8% each)].Conclusions: TV3D ultrasound is an accurate and simple method to detect and classify congenital uterine anomalies and should become the first diagnostic step in the assessment of the uterine cavity. Prevalence of uterine congenital anomalies in Sohag was 17.3%. The most common type of uterine congenital anomalies was arcuate uterus.

Rhino-orbital-cerebral mucormycosis (ROCM) with intracranial extension is a fatal disease. A case of extensive ROCM, with rare intracranial fungal granuloma, seen in a COVID-19 positive young male is described. A successful therapy consisting of a multidisciplinary approach for sinuses debridement, orbital exenteration, and intracranial granuloma excision was done. Nonseptate hyphae of Mucor and septate filamentous Aspergillus grew concurrently from exenterated orbital specimen.

This is the first study to discuss the effects of dark septate endophytes (DSE) on the growth promotion and berberine concentration in Mahonia oiwakensis, whose extract (MOE) has been suggested to have potential therapeutic effects against human lung cancer. First, as per phylogenetic analysis, the strains were divided into four groups: CkDB2, CkDB5, MoAL2 and MoAL5. All of these were DSEs, which could form microsclerotia in M. oiwakensis. The growth response experiment revealed that inoculation of the plant with MoAL5 and CkDB5 promoted an increase in the total fresh weight of the seedlings. Chemical composition analysis showed that seedlings inoculated with CkDB5 had the highest berberine concentration. These results showed that some DSEs have the ability to promote growth and induce phytochemical responses in the host plant.

A peritonite esclerosante encapsulante é uma doença rara e insidiosa associada a espessamento e fibrose peritoneal, afectando sobretudo doentes com historial de diálise peritoneal. Uma evolução clínica desfavorável com encarceramento de ansas intestinais culmina numa taxa de mortalidade de 25%-55%. Apresenta-se homem de 47 anos, com antecedentes de doença renal crónica previamente sob diálise peritoneal. Avaliado no serviço de urgência por febre, anorexia e ascite com 1 semana de evolução. Laboratorialmente referia-se elevação dos parâmetros inflamatórios. Radiologicamente documentou-se ascite não pura septada, com espessamento do peritoneu e compressão de ansas intestinais. A paracentese foi compatível com ascite hemática exsudativa. Após início de tamoxifeno e corticoterapia, verificou-se melhoria clínica significativa e redução da ascite e do espessamento peritoneal em tomografia computorizada abdominal. Neste trabalho descreve-se uma complicação rara e potencialmente fatal da diálise peritoneal. Visto cursar com manifestações e achados inespecíficos, exige uma avaliação clínica meticulosa em casos suspeitos., Medicina Interna, Vol. 28 N.º 2 (2021): Abril / Junho

Co-infection of cystic echinococcosis and aspergillosis is a rare finding. The patient was a 10-year-old boy complaining of chest pain and malaise with a cyst in the right lung who underwent surgical resection of the cyst. Medical therapy with albendazole was started for the patient with the initial clinical impression of cystic echinococcosis. Later, the microscopic evaluation revealed a laminated layer of cystic echinococcosis involved by acute angle branching hyaline hyphae with septate. Thus, the diagnosis of a cystic echinococcosis and aspergillosis co-infection was established. Surgery is the mainstay of treatment along with anthelminthic and anti-fungal therapy, especially in immunocompromised patients.

Background: Venous malformations (VMs) are slow flowing congenital vascular malformations that demonstrate continuous growth. They are prone to bleeding and frequent invasion of adjacent structures. It is therefore important to differentiate them from schwannomas, which can appear similar on imaging. Currently, the literature demonstrates only a few examples of pathology misdiagnosed as a schwannoma, and of VMs associated with neurological deficits. We will illustrate the characteristics and management of VMs causing compressive neuropathy in the cervical and upper extremity regions and contrast them against the features of peripheral nerve sheath tumors. Case description: Two case reports are presented, one of a 55-year-old woman with a chronic cervical mass due to a venous malformation (VM) originally misdiagnosed as a schwannoma, and another of a 35-year-old man with a vascular malformation of predominantly venous pathology in the antecubital fossa. Both patients were surgically managed. Conclusions: Patients presented with chronic pain, weakness and paresthesia. Venous malformations were seen as thinly encapsulated, multilobular, heterogeneously enhancing lesions with internal fluid levels and venous lakes. Post-contrast septate enhancement, intrinsic foci of T1 hyperintensity, phleboliths, T2 hyperintensity, and nodular enhancement of torturous vessels we also noted. MEP, SSEP, and EMG monitoring was used during surgical resection. Both patients had favorable outcomes. Keywords: Venous, Malformation, Schwannoma, Antecubital, Cervical, Mass, Misdiagnosis

To characterize the clinical and mycological features of favus of scrotum due to Trichophyton rubrum. A single-site prospective study was carried out in an outpatient dermatology clinic. Microscopic examination and fungal culture were done using skin scrapings. Scales on the scrotum were stained with PAS and visualized by microscopy, including in vivo reflectance confocal microscopy (RCM). Two strains were analyzed by RAPD typing. Scutular lesions were fixed for scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Cultures of the scale from the scrotum and/or groin in all patients showed a growth of T. rubrum. T. rubrum strains from scrotum and groins in one patient were demonstrated as the same strain by RAPD typing. The average age of patients was 34.1 ± 12.78 years. The mean course was 8.2 ± 5.07 days. All the patients received only topical treatment for 2 weeks without recurrence. Direct smear, calcofluor-white staining and in vivo RCM study of the scrotal favus in patients showed a massive number of septate branching hyphae, while fewer septate hyphae in scales in the groin. Abundant hyphae were found only in the outer layer of the stratum corneum of the scrotum under SEM and TEM with intact bilateral cell walls, and normal nucleus, liposomes and reticulum. Few distorted hyphae structures, cell wall degeneration, degenerated cytoplasm and the autophagy phenomenon could be seen in scales from groin under TEM. Scrotal favus due to T. rubrum is still a true infection, which most often occurred in immunocompetent patients.

Objective To review the current understanding of the role the uterus plays in recurrent pregnancy loss. Findings Congenital and acquired uterine abnormalities are associated with recurrent pregnancy loss in the first and second trimester. Relevant congenital Mullerian tract anomalies include unicornuate, didelphys, bicornuate and septate uteri. Pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as intrauterine adhesions and submucosal myomas. Initial evaluation of women with recurrent pregnancy loss should include a uterine assessment such as a pelvic ultrasound or sonohysterography. Uterine abnormalities such as uterine septum, intrauterine adhesions and submucosal myomas may be managed surgically with operative hysteroscopy. Conclusion Uterine abnormalities, both congenital and acquired, can be responsible for recurrent pregnancy loss.

To estimate the diagnostic accuracy of three-dimensional ultrasonography (3D US) compared to hysteroscopy/laparoscopy, in the investigation of uterine congenital anomalies using the ESHRE/ESGE classification of female genital tract congenital anomalies. Prospective blind, comparative, cohort study. University Tertiary Hospital and affiliated private Hospital. Sixty-two women consecutively referred with a suspected diagnosis of uterine congenital anomalies. The ESHRE/ESGE classification of congenital anomalies of the female genital tract was used for the description of abnormal findings. All patients underwent (1) 3D US and (2) hysteroscopy with laparoscopy to establish the final diagnosis. Concordance between 3D US and hysteroscopy with laparoscopy about the type and the classification of uterine anomaly was verified in 61 cases, including all those with septate uterus, dysmorphic uterus, bicorporeal, hemi-uterus or unicorporeal, and aplastic uterus and one out of two with normal uterus. For the diagnosis of septate uteri, which was the most common anomaly, the sensitivity of 3D US was 100%, the specificity was 92.3%, the PPV was 98% and the NPV was 100%, with kappa index 0.950. For bicorporeal, dysmorphic uterus, hemi-uteri or unicorporeal and aplastic uterus the sensitivity, specificity, PPV and NPV were all 100% with K = 1.00. Overall, 3D US showed perfect diagnostic accuracy (Kappa index = 0.945) in the detection of congenital uterine anomalies. 3D US appears to be a very accurate method for the diagnosis of congenital uterine anomalies.

Purpose: To report a case of presumed bilateral chorioretinitis secondary to alendronate therapy. Observations: A 71-year-old female presented to the clinic in July 2017 with six months history of difficulty in reading along with floaters in both eyes which were more severe in the right eye. Past medical and surgical history revealed a history of hypertension, gout, hyperthyroidism, osteoporosis, and humerus fracture. She was started on alendronate three months before developing ocular symptoms. On ocular examination, best corrected visual acuity was 20/30 in the right and 20/25 in the left eye. Slit-lamp examination demonstrated normal anterior chamber examination in both eyes. Dilated fundus examination revealed geographic chorioretinal lesions around the optic nerve head in both eyes, more extensively in the right eye; and superior and temporal to the macula in the right eye. Past ocular records in February 2015 did not reveal any such findings. Fundus autofluorescence demonstrated hyper-autofluorescence in the peripapillary lesions in both eyes. The lesion adjacent to the macula in right eye displayed mixed hyper and hypo-autofluorescence. Fluorescein angiography showed combined hyper- and hypo-fluorescence compatible with window defect, staining and blockage. However, no leakage was appreciated in the macula, peripapillary, and peripheral lesions in both eyes. Optical coherence tomography scan showed septate hyporeflective intraretinal spaces in the right eye. Conclusion and importance: The index report underscore the importance of considering alendronate as an etiologic cause of chorioretinitis, especially in subjects with atypical lesions developing after alendronate therapy. We, therefore, recommend discontinuation of this medication in subjects who develop chorioretinitis after employing this medication. Keywords: Uveitis, Drug-induced, Alendronate, Chorioretinitis, Bisphosphonates

Aim: To compare the surgical results and reproductive Performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for Gynaecologic Endoscopy) class U1a and U2b uterine anomalies after hysteroscopic correction. Methods: A retrospective cohort study was conducted at a university hospital infertility clinic. Ninety-six patients with class U2b (complete septate Uterus) and 78 patients with class U1a (T-shaped Uterus) uterine anomalies who underwent hysteroscopic correction between January 2009 and December 2015 were recruited. Results: The Operation time was significantly longer in class U2b anomalies (26.5 ± 5.3 minutes) than class U1a anomalies (22.8 ± 5.8 minutes; mean difference [95% confidence interval [Cl]: 3.6 ± 0.9 [1.8–5.3]; P < .001). Six out of all complete septate patients and 3 of T-shaped patients were reoperated due to postoperative synechia or to further enlarge the cavity. There were no differences between the groups regarding intraoperative (blood loss and uterine rupture) and postoperative (bleeding and infection) complications. After surgical correction, the term delivery rates increased from 3% to 71 % (P < .001) in class U2b and from 4% to 62.1 % (P < .001) in class U1a. The chance of live birth significantly increased after hysteroscopic correction both in class U2b (odds ratio [OR] 106.1; 95% Cl, 29.1–387.1; P < .001) and class U1a (OR 35.7; 95% Cl, 11.6–109.9; P < .001). The postoperative reproductive Performances of both anomalies were similar. Conclusion: Both types of anomalies seem to have similar severity and prognosis. Patients with both types of anomalies have excellent reproductive outcome after hysteroscopic correction.

Summary Six Bull Terrier puppies of 2 months had ultrasound exam for detection of any liver, kidney and heart anomalies before sale. All had hyperechogenic septa, in the gall bladder, giving it a honeycomb appearance. The puppy, whose septa were the biggest developed cholecystitis and a gall bladder abscess with two gall stones at the age of 5. Septation of the gall bladder is a very rare malformation in humans. One author formulated the hypothesis of a vacuolation anomaly of the gall bladder which occurred during embryo development. Among the 44 human cases published, 12 concerned asymptomatic patients. Clinical manifestations are most frequently biliary symptoms: vomiting and nausea combined with a pain in the upper quadrant of the abdomen. The prevalence of the anomaly among the population is unknown. This case is, as far as we know, the first description of ultrasound modifications and clinical development of multi-septate gall bladder in dog.

Arbuscular mycorrhizal fungi (AMF) and dark septate endophytes (DSE) are two fungal groups that colonize plant roots and can benefit plant growth, but little is known about their landscape distributions. We performed sequencing and microscopy on a variety of plants across a high-elevation landscape featuring plant density, snowpack, and nutrient gradients. Percent colonization by both AMF and DSE varied significantly among plant species, and DSE colonized forbs and grasses more than sedges. AMF were more abundant in roots at lower elevation areas with lower snowpack and lower phosphorus and nitrogen content, suggesting increased hyphal recruitment by plants to aid in nutrient uptake. DSE colonization was highest in areas with less snowpack and higher inorganic nitrogen levels, suggesting an important role for these fungi in mineralizing organic nitrogen. Both of these groups of fungi are likely to be important for plant fitness and establishment in areas limited by phosphorus and nitrogen.

Introduction Existing guidelines do not settle on a specific length to indicate surgical incision of subseptations because of differences in the four published diagnostic methods: AFS-10 mm classification, 1988/2003, ESHRE-ESGE classification, 2013, ASRM criteria, 2016- and 5.9-mm length cut-off, 2017. With this review and data analysis we sought to identify the classification method with the most accurate association with early pregnancy loss, as to identify a subseptation length cut-off to indicate surgical correction. Evidence acquisition We performed an exhaustive literature search of PubMed (MEDLINE), Embase, and Cochrane Library databases until April 20, 2020 (limited to articles published in English) of the terms "uterine septum," "arcuate uterus," "subseptation," "Mullerian anomalies," from 1980-2020. After identifying all the available classifications for uterine subseptations, we performed a secondary data analysis of our departmental database on uterine subseptations and compared the identified classification criteria. Measurement of the subseptation's length was obtained on 2-D and 3-D ultrasound in accordance with the different methods. The incidence of uterine subseptations according to each method's specifications was compared among the groups and the association with pregnancy loss was evaluated. Evidence synthesis The database comprised 125 women with uterine subseptations and all four diagnostic systems identified septate uteri within it. The 5.9-mm cut-off diagnosed 89 septate, and 36 normal uteri and was the most inclusive while the ASRM cut-off was the most restrictive one, diagnosing 92/125 as arcuate uteri, only 8/125 as septate, and 25 in the gray zone. The AFS-10 mm criteria diagnosed 92/125 as arcuate, and 33 (26.4%) as septate uteri. Subseptations were inconsistently diagnosed by the ESHRE-ESGE classification, as some subseptations longer than 10 mm would be classified as normal uteri. Five/24 women had had one previous early loss and 19/24 had recurrent pregnancy loss. The 5.9-mm system was the most sensitive, while the ASRM was the least sensitive in predicting pregnancy loss (71.2% vs. 9.5% of septate uteri). Conclusions The proposed 5.9-mm cut-off was the most sensitive in diagnosing a septate uterus and in predicting an associated early pregnancy loss. Conversely, the AFS-10 mm and the ASRM were the most restrictive, potentially missing treatment for hazardous subseptations. This update highlights the major weaknesses in the current diagnosis of uterine subseptations and indication for surgical treatment. Standardization of clinical practice is essential for reproductive clinicians and efforts should be made to prevent even one further early pregnancy loss to uterine subseptations.

Plant roots are abundantly colonized by dark septate endophytic (DSE) fungi in virtually all ecosystems. DSE fungi are functionally heterogeneous and their relationships with plants range from antagonistic to mutualistic. Here, we consider the role of by-product benefits in DSE and other root-fungal symbioses. We compared host investments against symbiont-derived benefits for the host plant and categorized these benefits as by-products or benefits requiring reciprocal investment from the host. By-product benefits may provide the variability required for the evolution of invested mutualisms between the host and symbiont. We suggest that DSE could be considered as 'a by-product mutualist transitional phase' in the evolution of cooperative mycorrhizal symbionts from saprotrophic fungi.

Although an early Cambrian origin of cephalopods has been suggested by molecular studies, no unequivocal fossil evidence has yet been presented. Septate shells collected from shallow-marine limestone of the lower Cambrian (upper Terreneuvian, c. 522 Ma) Bonavista Formation of southeastern Newfoundland, Canada, are here interpreted as straight, elongate conical cephalopod phragmocones. The material documented here may push the origin of cephalopods back in time by about 30 Ma to an unexpected early stage of the Cambrian biotic radiation of metazoans, i.e. before the first occurrence of euarthropods., Hildenbrand, Austermann et al. present new material from the early Cambrian of Newfoundland that potentially backdates the evolution of cephalopods to before euarthropods. The material is most closely aligned with the Cephalopoda, lending a tentative assignment and significant potential implications for the origin of this molluscan group.

Objective To review the diagnosis and management of 3 variations of incomplete mullerian duct fusion and reabsorption. Design Narrated video delineating the surgical management of 3 mullerian anomalies; this video was deemed exempt from review by the institutional review board of the Mayo Clinic. Setting Tertiary care academic medical center. Patient(s) This video focuses on 3 mullerian anomalies: complete septate uterus with a single septate cervix (septate uterus unicollis); complete septate uterus with duplicated cervix (septate uterus bicollis); and complete duplication of the uterus and cervix (uterine didelphys). Intervention(s) Magnetic resonance imaging (MRI), cervical septoplasty, operative hysteroscopy, and uterine septoplasty. Main Outcome Measure(s) Several variations of uterine malformations exist. In our practice, we differentiate complete septate uteri as either unicollis or bicollis via MRI and vaginal examination. The bicollis presentation can be identified on MRI by the “lambda sign,” which is seen as the 2 cervices that diverge as they enter the vagina. This is in comparison with the unicollis presentation when the single septate cervix can be traced with parallel lines as it enters the vagina. The circle method is described in this video to help distinguish between a single and duplicated cervix on examination. Result(s) The cervical and uterine septa were resected completely in the patient with a complete septate uterus unicollis. In contrast, the uterine septum was resected completely and the 2 cervical canals were not incised in the case of the complete septate uterus bicollis. Although uterine and cervical septa resection is controversial, our practice is to avoid the incision of the 2 cervical canals in cases that are more clearly consistent with a bicollis classification. Conclusion(s) Mullerian anomalies represent a continuum of disorders caused by different degrees of disruption in embryogenesis. MRI with vaginal gel and vaginal examination are tools to help classify the anomaly and guide surgical management.

This is a case of Conidiobolus lamprauges rhinitis in a Goldendoodle, that was presented for evaluation of sneezing, coughing, lethargy, as well as right-sided epistaxis and clear ocular discharge. Computed tomography revealed a large amount of soft tissue within the right nasal passage that obscured the osseous turbinates from the right maxillary canine tooth to the right side of the choanae. Biopsies revealed eosinophilic granulomas with variable number of basophilic to negatively staining, septate, fungal hyphae with non-parallel walls and irregular branching that were subsequently determined to be Conidiobolus lamprauges via panfungal PCR and sequencing. Complete and sustained resolution of clinical disease was achieved after 75 days of systemic antifungal therapy. This report describes for the first time, important clinical features of a dog with nasal conidiobolomycosis that will facilitate its recognition, prognostication, and treatment in clinical practice.

International audience; Congenital and acquired uterine anomalies are associated with recurrent pregnancy loss (RPL). Relevant congenital Müllerian tract anomalies include unicornuate, bicornuate septate, and arcuate uterus. Recurrent pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as, notably, intrauterine adhesions, polyps, and submucosal myomas. Initial evaluation of women with RPLs should include an assessment of the uterine anatomy. Even if proof of efficacy of surgical management of certain uterine anomalies is often lacking for managing RPLs, surgery should be encouraged in certain circumstances for improving subsequent pregnancy outcome. Uterine anomalies such as uterine septa, endometrial polyps, intrauterine adhesions, and submucosal myomas are the primary surgical indications for managing RPLs.

Background: Forensic odontology, a branch of dentistry includes identification of individuals in variouscrime scenes, natural calamities, and mass disasters. The identification is possible because every individualbody is unique and so is our tongue due to its morphological variations. The primary objective of the studywas to assess the morphological features of the tongue and its use in sex determination.Methods: The study included a sample size of 100 individuals (50 males and 50 females) in the age rangeof 20-50 years old. Photographs were taken of front and side view of the tongue; visual inspection wasdone and lastly impressions of the tongue were made with help of alginate and then poured with the helpof dental stone. IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analysesof the data. Microsoft word and Excel were used to generate graphs, tables etc. Females presented withtriangular shape, presence of shallow fissures more commonly and a sharp lingual apex of tongue. Malespresented with rectangular shape, presence of deep fissure/absence of fissures more commonly and septate/sharp lingual apex of the tongue.Conclusion: Tongue exhibits various unique characteristics and can be used in sex determination.

Background Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication. Case presentation Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L. Conclusions This case shows that unusual location and bile duct communication can be present in MCN-L.