Introduction: Thalassemic arthropathy refers to the spectrum of joint-related complications observed in individuals with thalassemia, a genetic blood disorder characterized by abnormal hemoglobin synthesis. There is sparse literature comparing the effects of repeated blood transfusions and chelation therapy on bone and joint health in these patients. Hence, we conducted a prospective observational study to see the prevalence of thalassemic arthropathy symptoms in transfusion dependent β-Thalassemia (TDBT) patients. Materials and methods: A total of 105 TDBT patients were evaluated over a 1-year period for the occurrence of arthralgia, swelling, restriction of joint range of motion, and soft tissue contractures. Our study was divided into two groups: TDBT patients on blood transfusions only (group I) (n = 58) and TDBT patients on blood transfusions and iron chelation therapy with deferiprone (L₁) (group II) (n = 47). The patients also underwent a radiological evaluation to detect evidence of joint space narrowing or arthritis. Results: Arthropathy was more common in group II (chelated) patients than group I (nonchelated) patients, and the correlation was statistically significant (p = 0.039); however, there was no statistical correlation between arthropathy and age; gender; age at initiation of transfusion therapy; pretransfusion hemoglobin status or the thalassemia subtype. Soft tissue contractures were more common in the arthropathy group than in those without arthropathy, and the difference was statistically significant (p = 0.041). There was no statistically significant correlation between soft tissue contractures and age, sex, age at first transfusion or thalassemia subtype. Discussion: Patients with TDBT receiving transfusions from an early age should be followed up regularly to diagnose musculoskeletal manifestations in the early stages when they can be reversed. Management of such patients requires a multidisciplinary approach involving the hematologist, rheumatologist, and orthopedic surgeons to diagnose thalassemic arthropathy before irreversible joint changes set in.

Aims and background: Nephrectomy for xanthogranulomatous pyelonephritis (XGPN) is inherently difficult due to the loss of fat planes and fibrosis; thus, traditionally, an open approach was recommended. Our objectives are to evaluate the safety of laparoscopic nephrectomy in XGPN, to determine the predictors of conversion from laparoscopic to open nephrectomy in XGPN, and to compare the perioperative outcomes and complications of laparoscopic and open nephrectomy for XGPN. Materials and methods: A retrospective review of 103 patients with a pathological report of XGPN who underwent nephrectomy between 2013 and 2022 in our hospital was done. A total of 65 patients had open nephrectomies, 26 had laparoscopic nephrectomies, and 12 had laparoscopic nephrectomies that were converted to open surgery. Open nephrectomy was performed using the extraperitoneal approach, and laparoscopic operations were performed via the transperitoneal route. Results: Laparoscopic nephrectomy was successful in most patients, with a conversion rate of 31.6%. The most common reason for conversion was difficulty in progression. Laparoscopic nephrectomy was equally safe, with comparable postoperative outcomes, similar operative time, and length of hospital stay. Patients with anemia, loss of fascial planes on CT, and hilar lymphadenopathy had a higher chance of conversion. Conclusion: Laparoscopic nephrectomy for XGPN was equally safe when compared to open nephrectomy with regard to intraoperative and postoperative outcomes. Well-chosen patients with XGPN can benefit from the laparoscopic approach more than from the traditional open approach. Clinical significance: Laparoscopy is equally safe for XGPN, and preoperative imaging can serve as a clue for selecting the appropriate surgical approach.

Research on clinical prognostic risk factors in coronavirus disease 2019 (COVID-19) is still ongoing to shed light to the pathogenesis and the treatment of viral infections. Coenzyme Q10, which is an important antioxidant that plays a role in energy conversion and adenosine triphosphate (ATP) production, has been suggested as one of the targets of COVID-19. In our study, we aimed to investigate the effects of serum coenzyme Q10 levels on survival and clinical prognosis in critically ill COVID-proven and COVID-suspected patients. After ethics committee approval, adult patients who were admitted to COVID intensive care unit (ICU) between 1^st January 2021 and 1^st January 2022 were included into the study. Patients were divided into two groups: those whose four consecutive polymerase chain reaction (PCR) results were negative and whose clinical symptoms could be explained by another pathology constituted the COVID-negative control group, and patients with positive PCR results constituted the COVID-positive group. Demographic data, comorbidities, admission symptoms, Acute Physiology and Chronic Health Evaluation II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) scores, length of stay (LOS), laboratory results, mechanical ventilation (MV) and vasopressor (VP) requirement, and mortality of the patients were recorded prospectively. Serum coenzyme Q10 levels were measured at ICU admission and weekly afterward with high-performance liquid chromatography (HPLC) method. COVID-positive group had 96 and COVID-negative group had 62 patients. The COVID-positive groups had higher median serum coenzyme Q level at admission than the negative group (p = 0.022). No significant relationship was found between serum coenzyme Q10 values and length of ICU or hospital stay, SOFA or APACHE-II values, duration of VPs, need for renal replacement therapy (RRT), and survival analysis both in COVID-positive and -negative groups. When coenzyme Q10 levels at ICU admission were analyzed in all patients, the median coenzyme Q10 level was significantly higher in women than in men (1.28 vs 1.18 mg/L, p = 0.035). Patients with malignancy (p = 0.008), neurological disease (p = 0.038), or malnutrition (p = 0.001) had lower coenzyme Q10 levels than the patients without these clinical diagnoses. The presence of malnutrition increased the risk of mortality in the ICU [hazard ratio (HR): 3, 95% confidence interval (CI): 1.6–5.4, p < 0.001]. In conclusion, plasma coenzyme Q10 level alone cannot be a factor predicting mortality and morbidity in the COVID ICU patient group. However, low serum coenzyme Q10 level may be an important component of malnutrition, and malnutrition is one of the major risk factors of ICU mortality.

A 36-year-old male truck driver presented to the emergency department with fever of 5 days’ duration, shortness of breath, and an episode of seizure 1 day ago. The fever was not associated with chills, rigor, or rash and was relieved with medication. One day prior to admission, the patient started experiencing shortness of breath, which was acute in onset and rapidly progressed to modified Medical Research Council (mMRC) grade IV. It was associated with cough and expectoration but not with chest pain or palpitations. He was admitted to an outside facility, where he was managed with antibiotics and fluids. Due to worsening symptoms, he was referred to our center, where he had a brief hospital stay of about 3 hours. Renal/liver function tests, coagulogram, and electrolytes were deranged. Thrombocytopenia was present. Blood cultures grew multidrug-resistant (MDR) Klebsiella pneumoniae. Soon after, he suffered a cardiac arrest and succumbed to his illness. A partial autopsy was performed, which revealed florid myocarditis and hemorrhages in the heart, thrombotic microangiopathy (TMA) in the kidneys and liver, pulmonary artery thrombi, pulmonary edema, hemorrhage, and congestion in all organs. Viral polymerase chain reaction (PCR) was positive for chikungunya (CHIKV) virus.

Background: Trauma is the most frequent cause of subdural hemorrhage (SDH). Spontaneous, nontraumatic SDH is a rarely encountered entity in an elderly cirrhotic patient. Case description: A middle-aged gentleman, a known cirrhotic, presented with fever and altered sensorium. An initial diagnosis of hepatic encephalopathy (HE) was made. Upon subsequent evaluation, a diagnosis of SDH was made. Treatment and outcome: An immediate burr hole was placed, and the hematoma was evacuated. The patient was discharged on day 7. Take-home message: Clinicians should keep SDH in mind as one of the differential diagnoses when a cirrhotic patient presents with altered sensorium, even in the absence of trauma.

Tuberculosis, caused by Mycobacterium tuberculosis, is a persistent and significant health challenge that continues to affect people worldwide. Genitourinary tuberculosis is considered the second most common type of extrapulmonary tuberculosis after tubercular lymphadenitis. However, it is frequently missed due to its insidious onset and nonspecific symptoms, leading to complications like ureteric stricture, pyelonephritis, and pyonephrosis followed by nonfunctioning kidney and end-stage renal disease. Here, we report the case of a 37-year-old male who presented to the outpatient department with complaints of pain and burning micturition, accompanied by intermittent fever persisting for 1 week. A comprehensive diagnostic evaluation revealed hydronephrosis with significantly reduced cortical function of the left kidney (5.38%), an evolving abscess, and ureteric strictures. Due to multiple negative cultures for bacteriuria and persistent symptoms, the urine was also tested using cartridge-based nucleic acid amplification test (CBNAAT) to detect M. tuberculosis, which turned out to be positive. Consequently, the patient was scheduled for a planned nephrectomy after 4-month course of antitubercular treatment (ATT) with rifampin, isoniazid, pyrazinamide, and ethambutol. Nephrectomy confirmed tubercular pyonephrosis on the basis of histopathological findings of granulomatous lesions with caseous necrosis and a positive stain for acid-fast bacilli (AFB). Thus, adequate knowledge and awareness of tuberculosis combined with early detection can prevent severe complications, resulting in nephrectomy.