Acute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage.

A 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding.

The application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed.

Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

Acromioclavicular joint cyst (AJC) is a very uncommon condition of the shoulder observed in elderly patients, caused by a degenerative acromioclavicular (AC) joint, frequently associated to a rotator cuff tendon tear. There are two possible cause for the cyst formation. We report two different cases of a AC synovial cyst, with and without rotator cuff tear.

We report two cases, in patients aged respectively 80 and 77 years, with a very large AJC. In one case, the cyst was associated to a rotator cuff tear, while in the other case, the rotator cuff did not present any evident lesion. Both cysts were successfully surgical excised and a distal clavicle resection was performed.

AJC is a rare complication observed in degenerative AC joint and in the majority of cases is associated to a rotator cuff tear. The diagnosis may be made by ultrasound and conventional radiographic examination, although MRI of the shoulder is generally preferred as it allows to better identify the condition of the rotator cuff. Generally, local aspiration of the cyst and corticosteroid injection fails with recurrence of the cyst and surgically treatment is indicated, especially in painful cases.

Painful AJC should be surgically treated by excision of the cyst associated to a lateral clavicle resection; when a symptomatic massive rotator cuff is present, a reverse total shoulder arthroplasty may be considered. However, in elderly patients, who have no discomfort, watchful waiting may be the treatment of choice.

Painful AJC should be surgically treated by excision of the cyst associated to a lateral clavicle resection; when a symptomatic massive rotator cuff is present, a reverse total shoulder arthroplasty may be considered. However, in elderly patients, who have no discomfort, watchful waiting may be the treatment of choice.

Lymph node metastasis in bladder cancer (BC) is common and has been associated with a very poor prognosis. Bc rarely metastasizes to inguinal lymph nodes.

We reported an unusual case of right inguinal lymph node metastasis of transitional cell carcinoma of the bladder. Metastasis occurred 9 months after radical cystectomy for BC. The patient refused chemotherapy and underwent only surgical excision of lymph nodes without any adjuvant therapy. During a follow-up period of 3 years, the patient still having complete remission.

Multiple studies showed an improved clinical outcome with adjuvant chemotherapy for pathological node-positive patients with BC. Long-term survival could be achieved for some patients with limited lymph node metastasis who underwent metastasectomy. Some studies supported the benefit of surgical consolidation after a good response to systemic chemotherapy. The best management plan for clinically node-positive BC is not established yet.

There is little evidence on which to base the management of inguinal lymph node metastasis from BC. Metastasectomy could be an option with good outcomes.

There is little evidence on which to base the management of inguinal lymph node metastasis from BC. Metastasectomy could be an option with good outcomes.

Glomus tumor located in the lower limb could be easily mistaken as lower extremity pain whether it is radiating, sciatic, or just a localized one. This could lead to misdiagnosis and improper management.

This case reported a 56-year-old man complaining of pain in his left thigh. The pain was characterized as sharp and sometimes radiated to the skin of the calf muscles region. There was no history of trauma. Physical examination of the left thigh region revealed a small and barely palpable deep subcutaneous mass. Ultrasound examination showed a 6 × 5.3 mm partly cystic subcutaneous mass in the posteromedial region of the left distal femur. Doppler USG showed that the blood flow in the cystic lesion originated from the medial genicular artery. Surgical tumor excision through the medial femoral approach exposed a 15 × 10 × 5 mm yellowish-white thin encapsulated subdermal tumor attached to the vascular wall. Histopathology examination resulted in a Glomus Tumor.

Glomus tumor usually occurs in areas that are rich in glomus bodies. Thigh is not a specific location for glomus bodies. It presented as bluish small nodule that are sensitive to touch and temperature changes. Glomus tumors in the thigh region rarely recurs since they are solitary and encapsulated, making them easily recognizable from the surrounding tissue during the operation.

Meticulous history taking, physical examination, and imaging modalities are necessary to differentiate between tumor and non-tumor lesions in less common areas.

Meticulous history taking, physical examination, and imaging modalities are necessary to differentiate between tumor and non-tumor lesions in less common areas.We use retail scanner data on purchases of high calorie food to study the causal relationship between recreational marijuana laws (RMLs) and consumption of high calorie food. To do this we exploit differences in the timing of introduction of recreational marijuana laws among states and find that they are complements. Specifically, in counties located in RML states monthly sales of high calorie food increased by 3.2 percent when measured by sales and 4.5 percent when measured by volume when using our preferred identification strategy. Results are robust to including placebo effective dates for RMLs in treated states and products as well as when using Synthetic Control Methods as an alternative methodology.The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 made sweeping changes to school nutritional standards. We estimate the impacts of shifts in school nutritional standards on dietary quality as well as dietary quantity of children’s food intakes from school and away-from-school food sources. We find the average effect of consuming school food, rather than away-from-school food, on children’s overall dietary quality significantly increased from the pre- to post-HHFKA implementation period. This effect was solely driven by substantial improvements in the dietary quality of foods acquired at school, mainly among older and higher-income children. Our indirect effect analysis indicated that children shifted towards consuming lower-quality diets at home in the post-HHFKA period, thereby partially offsetting the positive effects of the HHFKA on their overall dietary quality. Indirect impacts were primarily driven by a subset of children consuming more than a third of their daily calories from school food. Additionally, we find suggestive evidence of a modest decrease in daily calorie intake, particularly among older and higher-income children. Together, our findings imply that the HHFKA, despite its unintended negative indirect effects, led children to consume more-nutritious, less-energy-dense diets.Behavioral practices are one of the key factors facilitating zoonotic disease transmission, especially in individuals who have frequent contact with wild animals, yet practices of those who work and live in high-risk animal-human interfaces, such as wild animal 'bushmeat’ markets in the Congo Basin are not well documented in the social, health and medical sciences. This region, where hunting, butchering, and consumption of wild animal meat is frequent, represents a hotspot for disease emergence, and has experienced zoonotic disease spillover events, traced back to close human-animal contact with bats and non-human primates. Using a One Health approach, we conducted wildlife surveillance, human behavioral research, and concurrent human and animal biological sampling to identify and characterize factors associated with zoonotic disease emergence and transmission. Research was conducted through the USAID Emerging Pandemic Threats program between 2010 and 2019 including qualitative studies of bushmeat markets, win measures in markets and bushmeat alternative strategies are discussed.Microplastics (MPs) are contaminants of emerging concern in the Arctic, but knowledge of their potential effects on Arctic plankton food webs remains scarce. We experimentally investigated ingestion and effects of MPs (20 μm polyethylene spheres) on the arctic copepods Calanus finmarchicus, C. glacialis and C. hyperboreus. These species dominate arctic zooplankton biomass and are relevant target species to investigate the potential impacts of MPs on the Arctic marine ecosystem. Females of each species were exposed to two concentrations of MPs (200 and 20,000 MPs L-1) in combination with different food (diatom) concentrations, reflecting high (3000-5000 cells mL-1, spring phytoplankton bloom) and low (50-500 cells mL-1, pre/post bloom) food conditions. MPs did not affect negatively fecal pellet production rates in any of the species at the studied exposure concentrations. However, egg production rates of copepods exposed to MPs were 8 times higher compared with the controls, which suggests that MP exposure can cause stress-induced spawning in arctic copepods. Microscopic examination of the fecal pellets confirmed ingested MPs in the three species (up to aprox. 1000 MPs cop-1 d-1). The number of MPs per pellet decreased exponentially with increasing food concentration. The daily ingestion of MPs per copepod was higher at low- food concentrations (250-500 cells mL-1). At our exposure conditions, the presence of MPs inside C. hyperboreus fecal pellets did not affect their sinking rates. Overall, our experimental research show that 1) acute exposure to virgin polyethylene MPs has a low impact on arctic Calanus species at environmentally relevant MP concentrations, independent of food availability, and 2) arctic copepods influence the environmental fate of plankton-sized MPs by exporting buoyant MPs from the surface layer to the sea floor via fecal pellets.