Stereocontrol via Propeller Chirality in FLP-Catalyzed Asymmetric Hydrogenation

Utilization of chiral frustrated Lewis pairs as catalysts in enantioselective hydrogenation of unsaturated molecules represents a promising approach in asymmetric synthesis. In our effort to improve our current understanding of the factors governing the stereoselectivity in these catalytic processes, herein we examined the mechanism of direct hydrogenation of aromatic enamines catalyzed by a binaphthyl-based chiral amino-borane. Our computational analysis reveals that only one particular conformer of the key borohydride reaction intermediate can be regarded as a reactive form of this species. This borohydride conformer has a well-defined chiral propeller shape, which induces facial selectivity in the hydride transfer to pro-chiral iminium intermediates. The propeller chirality of the reactive borohydride conformer is generated by the axially chiral binaphthyl scaffold of the amino-borane catalyst through stabilizing π-π stacking interactions. This new computational insight can be readily used to interpret the high degree of stereoinduction observed for these reactions. We expect that the concept of chirality relay could be further exploited in catalyst design endeavors.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Didymin protects against polystyrene nanoplastic-induced hepatic damage in male albino rats by modulation of Nrf-2/Keap-1 pathway

Polystyrene nanoplastics (PS-NPs) are ubiquitous environmental pollutants that can cause oxidative stress in various organs, including the liver. Didymin is a dietary flavanone that displays multiple pharmacological activities. Therefore, the present study evaluated the palliative role of didymin against PS-NPs-induced hepatic damage in rats. Albino rats (n=48) were randomly distributed into 4 groups: control, PS-NPs treated group, PS-NPs + didymin co-administered group, and didymin supplemented group. After 30 days, PS-NPs intoxication lowered the expression of Nrf-2 and anti-oxidant genes [catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GSR), glutathione-S-transferase (GST), and heme oxygenase-1 (HO-1)], whereas the expression of KEAP1 kelch like ECH associated protein 1 (Keap-1) was increased. PS-NPs exposure also reduced the activities of anti-oxidants enzymes (CAT, SOD, GPx, GSR, GST, GSH, and OH-1), while malondialdehyde (MDA) and reactive oxygen species (ROS) levels were increased. The levels of alanine transaminase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were increased in PS-NPs-exposed rats. Moreover, inflammatory indices [interleukin-1β (IL-1β), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), nuclear factor-kappa B (NF-κB), and cyclooxygenase-2 (COX-2)] were increased in PS-NPs-exposed rats. Furthermore, PS-NPs intoxication increased the expressions of apoptotic markers including Bax and Caspase-3, as well as reducing Bcl-2 expression. The histopathological analysis showed significant damage in PS-NPs-treated rats. However, didymin supplementation ameliorated all the PS-NPs-induced damage in the liver of rats. Therefore, it was concluded that didymin can act as a remedy against PS-NPs-induced liver toxicity due to its anti-apoptotic, anti-oxidant, and anti-inflammatory activities.

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

BACKGROUND

Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.

METHODS

The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.

RESULTS

A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).

CONCLUSION

Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).

Physical Activity and the Impact of Continued Exercise on Health-Related Quality of Life Prior to and during Pregnancy: A German Cohort Study

The goal of this study was to examine how regular physical activity before and during pregnancy affected life quality throughout pregnancy. Between July 2020 and May 2021, 218 pregnant women were recruited from 11 outpatient clinics for this survey. Data were collected prospectively in a panel format beginning with the 10th gestational week over a 20-week period. Prior to pregnancy, a previous time point was also defined. The International Physical Activity Questionnaire, the EQ-5D-3L questionnaire, and the EQ-VAS questionnaire were used to collect data on the duration and intensity of daily physical exercises, as well as to assess health-related quality of life and self-estimated health status. The final survey included data from 113 women. During pregnancy, physical activity decreased dramatically. The duration of strenuous activities, but not moderate activities, was significantly reduced. Continuous physical activity independently predicted higher life quality scores at all points of assessment. Cases who participated in moderate and strenuous activities on a regular basis had higher self-estimated health status scores than cases who only participated in moderate activity. Instead of focusing solely on specific types of physical activity, we believe that strategies for motivating all pregnant women to be constantly active should be developed.

Accuracy of Whole Blood Cardiac Troponin I in the Diagnosis of Childhood Heart Failure at the University College Hospital, Ibadan

OBJECTIVE

To determine the accuracy of cardiac troponin I (cTnI), a marker of myocardial cell injury or necrosis, in correctly identifying heart failure in children.

PATIENTS, MATERIALS, AND METHODS

This was a crosssectional study in which 45 children aged 12 years or below admitted into the paediatric wards of the University College Hospital, Ibadan, who, on evaluation with the Ibadan Childhood Heart Failure Index (ICHFI) had a score of ≥ 3, were consecutively recruited. Forty-five age- and sex-matched apparently healthy children with ICHFI score of <3 were similarly evaluated as controls. Demographic, clinical data and cTnI values were documented. Statistical analysis was done using IBM SPSS version 23.

RESULTS

There was a strong positive correlation (0.592) between the whole blood cTnI values and ICHFI scores (rs = 0.592, P = 0.000). At a cut-off value of 0.07ng/ml, the whole blood cTnI had a sensitivity of 26.7%, specificity of 97.8%, a positive predictive value of 92.8% and a negative predictive value of 57.1%. The receiver operating characteristic curve plotted had an AUC of 0.800 at the 95% CI, 0.704 - 0.896; P < 0.001.

CONCLUSION

Whole blood cTnI level is elevated in children in heart failure and may predict severity of the condition. Whole blood cTnI was found to be an accurate tool for the exclusion of heart failure in children and is therefore recommended for use in children with suspected heart failure for its rapid diagnosis.

Recommendations of the AGG (Working Group for Obstetrics, Department of Maternal Diseases) on How to Treat Thyroid Function Disorders in Pregnancy

Objective These recommendations from the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat thyroid function disorder during pregnancy aim to improve the diagnosis and management of thyroid anomalies during pregnancy.

Methods Based on the current literature, the task force members have developed the following recommendations and statements. These recommendations were adopted after a consensus by the members of the working group.

Recommendations The following manuscript gives an insight into physiological and pathophysiological thyroid changes during pregnancy, recommendations for clinical and subclinical hypo- and hyperthyroidism, as well as fetal and neonatal diagnostic and management strategies.

Is There a Role for Cerebral Ultrasonography in Near-Term/Term Neonates Following Assisted Vaginal Delivery? A Prospective, Single-Center Study

AIM

 To evaluate the role of cerebral ultrasonography studies (CUSS) in detecting intracerebral and cranial pathologies (hemorrhages, ischemia, skull fractures) in near-term and term neonates following assisted vaginal delivery.

PATIENTS AND METHODS

 Prospective single-center study (11/2017-11/2018) at the University Children's Hospital of Saarland, Homburg, Germany including newborns with a gestational age ≥ 36 weeks born by assisted vaginal delivery. In all newborns, a standardized CUSS was performed within the first three days of life prior to discharge.

RESULTS

 200 neonates (43.0 % female, 57.0 % male; gestational age 39.6 ± 1.3 weeks) were included in this study (birth weight 3345.6 ± 450.6 g, body length 51.7 ± 2.5 cm, head circumference 35.0 ± 1.5 cm). 67 (33.5 %) neonates had minor external injuries of the scalp. 5 children showed clinical neurologic abnormalities: 4 (2.0 %) seizures and 1 facial palsy (0.5 %). In 34 (17.0 %) patients, minor incidental intracranial abnormalities unrelated to mode of delivery were detected on CUSS. No intracerebral, cranial pathologies or skull fractures were seen on routine CUSS.

CONCLUSION

 Routine CUSS in newborns after assisted vaginal delivery did not yield clinically relevant results in our cohort. Clinical observation and selective CUSS in symptomatic newborns might be more efficient than routine CUSS.

Cryptococcus Infection Mimicking Lipoid Pneumonia in a Lung Biopsy

Introduction/Objective

Lipoid pneumonia is a non-infectious, rare entity which results from accumulation of exogenous or endogenous lipids in the lungs. It appears as intraalveolar macrophages filled with lipids in the form of fine spherical vacuoles. Cryptococcosis can also appear as vacuolated macrophages filled with yeasts. At low magnification, the distinction is very difficult. The co-existence of the two entities is noted in literature but is exceedingly rare.

Methods/Case Report

A 33-year-old male, status post renal and pancreatic transplant, on chronic immunosuppression therapy presented with dysphagia. Imaging studies showed cavitary and non-cavitary nodules, patchy, confluent consolidations in the bilateral lungs, and a patulous, debris filled esophagus. This raised the possibility of atypical infections as well as aspiration. Biopsy of a right lower lobe lung lesion was performed. Histology demonstrated fibrotic lung parenchyma with vacuolated histiocytes containing small spherical substances. The differential diagnosis included Cryptococcus infection versus exogenous lipoid pneumonia, both of which were consistent with clinical and radiologic findings. Few, scattered foreign body giant cells were found. Additionally, GMS and mucicarmine stains were positive in the small spheres within the macrophages. The final diagnosis of lung parenchyma with numerous yeast forms, morphologically consistent with cryptococcus species was rendered. The patient was additionally found to have esophageal candidiasis. Concurrent lipoid pneumonia was considered unlikely based on the patient's history of immunosuppression (which made infection a much more likely etiology) and paucity of foreign body giant cell reaction.

Results (if a Case Study enter NA)

NA

Conclusion

This case highlights the importance of knowledge of rare entities and correlation with clinical and radiologic findings in arriving at an accurate diagnosis.

Rare Urinary Bladder Tumor with Unusual Morphology: A Potential Diagnostic Pitfall

Introduction/Objective

Transurethral resection of bladder tumor (TURBT) is a common surgical pathology specimen. The purpose of this report is to describe an unusual case encountered on a TURBT specimen with discussion of the differential diagnoses to avoid potential diagnostic pitfall.

Methods/Case Report

A 68-year-old male presented with history of urinary frequency, urgency and nocturia. Cystoscopy showed nodular, pedunculated lesion at the bladder trigone. Transurethral resection was performed. Histologic section showed a 4 mm polypoid lesion with classical appearance of cystitis glandularis and an adjacent area of relatively more atypical yet bland cells in tubular growth pattern. This elicited a differential diagnosis of nephrogenic adenoma / metaplasia, prostate type polyp / ectopic prostatic tissue and urothelial carcinoma with tubule formation. Immunohistochemical stains showed the lesional cells to be positive for high molecular weight cytokeratin and racemase (AMACR) and negative for GATA3, NKX 3.1, PAX-8, CK 7, CK 20, p63, PSA and PSAP. Literature review suggested that racemase is frequently positive in neuroendocrine tumors. Additional immunohistochemical stains performed showed the lesional cells to be positive for synaptophysin and chromogranin and negative for TTF-1 and CDX-2. Ki-67 proliferation index was less than 1%. Therefore, final diagnosis of well-differentiated neuroendocrine tumor, grade 1 involving urothelial mucosa was rendered. Patient did not have any history of prior malignancies. A subsequent PET / CT did not demonstrate any evidence of metastatic disease. Additional work up was also negative for carcinoid tumor of lung and well differentiated neuroendocrine tumor of gastrointestinal and pancreaticobiliary tracts. Multidisciplinary discussion recommended cystoscopy every 3 months for a year, then every 6 months for 2 more years and annually thereafter.

Results (if a Case Study enter NA)

n/a.

Conclusion

This case reminds pathologists that although rare, well differentiated neuroendocrine tumors can occur in the urinary bladder, they can show unusual histology with tubular growth, and can be racemase positive.

The eyes don't see, what the mind doesn't know

Introduction/Objective

Calcifying fibrous tumor is a rare benign mesenchymal neoplasm. The etiology and pathogenesis of this tumor are uncertain. It has wide anatomical distribution. The tumor is most commonly found in the soft tissues of the extremities in younger individuals. However, in middle aged patients it tends to affect the visceral locations more commonly. In visceral location it can mimic aggressive lesions clinically. The purpose of this report is to describe a case of calcifying fibrous tumor in a 71-year-old female with a history of breast carcinoma who was found to have an incidental small bowel mass on her follow up. Clinically and radiologically and the main diagnostic consideration were metastatic disease and gastrointestinal stromal tumor.

Methods/Case Report

The patient underwent an open small bowel resection, and a 6.5 cm segment of small bowel was sent to pathology. Grossly, a 2.0 cm tan-pink smooth round submucosal polyploid mass protruding into the lumen, mimicking gastrointestinal stromal tumor was identified. The tumor was hard and serially sectioned to reveal a white, calcified cut surface. Microscopically, the tumor appeared hypocellular and composed of scant spindle cells embedded in a dense, hyalinized and calcified, collagenous stroma. Immunohistochemical stains for pan cytokeratin, DOG1, desmin, S100, CD34, and MUC4 were negative, and diagnosis of calcifying fibrous tumor was rendered.

Results (if a Case Study enter NA)

NA.

Conclusion

This case highlights the importance of knowledge of rare entities in providing accurate diagnosis for lesions that can clinically mimic common tumors.

Paraneoplastic Nephropathy with Peculiar Immunofluorescence Pattern: Report of a Rare Case

Introduction/Objective

Hematolymphoid neoplasms are commonly associated with medical renal disease; however, association of renal cell carcinoma and nephrotic/nephritic syndrome is exceedingly rare. Paraneoplastic nephropathy in setting of renal cell carcinoma can manifest as membranous nephropathy, IgA nephropathy, or minimal change disease. The purpose of this report is to describe a rare case of clear cell renal cell carcinoma with associated membranous nephropathy with concurrent glomerular IgG and IgA deposition.

Methods/Case Report

A 68-year-old male presented with a penile mass. Diagnostic work up reveled an 11cm renal mass. Urinalysis demonstrated nephrotic range proteinuria (&gt;5 g/d). Subsequently, the patient underwent nephrectomy and penectomy. Pathologic evaluation showed clear cell renal carcinoma with sarcomatoid component and metastasis to penis. Nonneoplastic kidney workup revealed membranous glomerulopathy, with 3+ granular IgG predominantly within glomerular capillaries and 2+ IgA and 1+ C3 in a similar pattern. Electron microscopy demonstrated numerous subepithelial and intramembranous immune deposits, and few small mesangial deposits. Concurrent membranous and IgA nephropathy has been reported, but the IgA in that case is typically mesangial. The peculiar pattern of IgG and IgA deposition in this case can be seen with membranous nephropathy secondary to lupus or neoplasia. Lupus was excluded based on patient’s history, serology, and absence of significant C1q staining. Therefore, the findings were consistent with membranous glomerulopathy secondary to patient’s cancer. Patient’s proteinuria improved after nephrectomy. He is alive and disease-free 10months after nephrectomy, with proteinuria in 0.1-0.6 g/d range.

Results (if a Case Study enter NA)

NA

Conclusion

This case highlights the importance of thorough evaluation of non-neoplastic kidney in nephrectomy specimens for cancer, thus guiding the type of surgical intervention. Non-orthodox presentation of immunoglobulin deposition may be the herald of neoplasia in select cases.

Undifferentiated Melanoma: A Rare Phenomenon and a Challenging Diagnosis

Introduction/Objective

Undifferentiated melanoma is defined as a primary or metastatic melanoma lacking histologic and immunophenotypic features of melanoma. Dedifferentiated melanoma shows transition between undifferentiated and conventional melanoma components. Dedifferentiation and transdifferentiation (implying dedifferentiation with heterologous elements) in melanoma are exceedingly rare and occur mostly in metastatic deposits. The purpose of this report is to describe a case of undifferentiated melanoma that proved to be a diagnostic challenge and to highlight the importance of the multimodality approach and utilization of advanced diagnostic tools in reaching an accurate diagnosis.

Methods/Case Report

Methods: A 43-year-old white male who was diagnosed with metastatic melanoma on the right axillary biopsy at a local hospital presented to our institution with a rapidly enlarging 30 cm peritoneal mass. He underwent debulking surgery to lower his tumor burden. On pathologic evaluation, the tumor showed a heterogeneous appearance ranging from highly cellular fascicles of spindle cells to sheets of primitive round cells and epithelioid cells with abundant eosinophilic cytoplasm. One metastatic focus showed heterologous cartilaginous differentiation. This morphologic appearance elicited the differential diagnosis of metastatic melanoma, primitive neuroectodermal tumor, synovial sarcoma, and metastatic germ cell tumor with somatic transformation. Immunochemical staining showed the tumor cells to be positive for SALL4, CD99 (patchy), and TLE1 (patchy) and negative for pan-cytokeratin, S100, SOX- 10, HMB-45, desmin, myogenin, DOG1, CD 117, CDX2, TTF-1, PAX-8, CK7, CK20, chromogranin, CD30, and OCT4. Fluorescence in situ hybridization for EWSR1, SS18(SYT), and isochromosome 12p were negative. BRAF gene mutation analysis detected p.V600E / p.V600D. Subsequently, a diagnosis of undifferentiated melanoma was rendered after expert consultation. Unfortunately, the patient passed away 1 month after surgery.

Results (if a Case Study enter NA)

NA.

Conclusion

Diagnosis of undifferentiated melanoma by the conventional H&E and immunohistochemical profile is extremely challenging. Multimodality approach and utilization of advanced diagnostic tools such as molecular studies are helpful in this regard.

Hypertension in Young Adults: Think Juxtaglomerular Cell Tumor!

Introduction/Objective

Juxtaglomerular cell tumor is a benign, renin-secreting neoplasm. The tumor arises from the juxtaglomerular apparatus cells of the kidney. Because the tumor is hormonally active, patients usually suffer from hypokalemia, hyperaldosteronism, and hypertension. The typical patient population is adolescents and young adults with slight female predominance. Herein, we describe a case of a 19-year-old Asian female with a somewhat atypical presentation.

Methods/Case Report

A 19-year-old Asian female presented with upper extremity weakness, numbness, and tingling. On physical examination, the only notable finding was hypertension. Extensive work up reveled an aldosterone level of 71 nanograms per deciliter and plasma renin activity of 6.25 nanograms per milliliter per hour. A CT scan of the abdomen revealed a 2.4cm mass in the lower pole of the left kidney. The mass was resected by partial nephrectomy. Sectioning of the specimen revealed a 2.4cm well-circumscribed, encapsulated tumor. On microscopic evaluation, the tumor had glomoid appearance with sheets of uniform, round to polygonal cells with clear to eosinophilic cytoplasm. The stroma was scanty, mitoses were rare, and necrosis was not identified. Immunohistochemical stains showed the tumor cells to be positive for CD117, CD34, Cathepsin K, Synaptophysin, and CD10 and negative for ER, PR, CK7, PAX-8, pancytokeratin, EMA, S100, Melan-A, HMB45, SMA and CAIX. Diagnosis of Juxtaglomerular cell tumor was rendered. The patient was alive and well and without signs of recurrence 14 months after surgery.

Results (if a Case Study enter NA)

NA.

Conclusion

This case highlights the importance of a regular physical exam and having a high index of suspicion in patients presenting with unusual complaints.

Langerhans’ Cell Histiocytosis Masquerading as Metastatic Melanoma on Frozen Section

Introduction/Objective

Langerhans’ cell histiocytosis (LCH) involving the lungs usually presents as multiple interstitial, bilateral, peribronchiolar pulmonary nodules. As lungs are a common site of metastatic involvement LHC can masquerade as a metastatic lesion. The distinction can be challenging, especially on a frozen section.

Methods/Case Report

We present a case of a 35-year-old male with history of metastatic melanoma who presented with pulmonary nodules and underwent lung wedge resection. Frozen section was requested at the time of surgery. Grossly there was a 2.8 cm tan-grey irregular lesion abutting the pleura. Frozen section of a representative piece showed a discohesive lesion composed of large cells with prominent nuclei resembling melanocytes. The eosinophilic infiltrate in the frozen slide was extremely scant, and presence of anthracotic macrophages resembled the melanin pigment frequently seen with melanoma. CT imaging prior to the surgery had raised the differential of LCH and metastatic disease. The frozen section was favored to be negative for carcinoma and metastatic melanoma and final diagnosis was deferred to permanent sections. Permanent tissue sections showed classic features of LCH and positivity for CD1a confirming the diagnosis.

Results (if a Case Study enter NA)

NA

Conclusion

This case emphasizes the importance of multidisciplinary approach and knowledge of imaging impression during a frozen section.

Every TURP Is not Just BPH

Introduction/Objective

Transurethral resection of prostate is a common specimen in surgical pathology practice. These specimens usually demonstrate benign prostatic hyperplasia. However, occasionally incidental prostate cancer is identified. Finding a true mesenchymal tumor in these specimens is exceedingly rare. We present a unique case of prostatic adenocarcinoma Gleason score 3 + 4 =7 and concurrent solitary fibrous tumor identified on a TURP specimen. Solitary fibrous tumor in this anatomical location is rare with approximately 50 cases reported in the English language literature.

Methods/Case Report

An 86-year-old male presented with symptoms and signs of urinary retention. On clinical evaluation the prostatae was profoundly enlarged with a calculated volume of 283cc; firm in consistency. He was given trial of medical management including finasteride, tamsulosin and Foley catheter placement. Subsequently, the patient underwent transurethral resection of prostate. Complete morcellation was not possible at the initial surgery due to hard consistency of the gland. Pathologic evaluation showed prostatic adenocarcinoma Gleason grade 3 + 4=Score 7 (Grade group 2) involving 10% of submitted tissue in addition to the changes of benign prostatic hyperplasia. Additionally, the background stroma demonstrated short plump oval to spindle cells with inconspicuous nucleoli and collagenous background, arranged in a haphazard (‘‘patternless’’) pattern. Immunohistochemical stains showed these lesional cells to be positive for STAT6 and CD34 and negative for desmin, S100, SOX-10, CD 117, DOG-1 and NKX 3.1. Morphology and immunohistochemical profile were compatible with solitary fibrous tumor involving the prostate. The patient is alive and symptom-free 9 months after the procedure.

Results (if a Case Study enter NA)

NA.

Conclusion

This case highlights the value of thorough evaluation of prostatic tissue in TURP specimens not only for prostate cancer but other tumors as well. It also reminds the practising pathologist to keep an eye out for the stromal lesions of the prostate gland. Also finding one lesion should not dissuade one from looking for additional concurrent lesions.

Concurrent Prostatic Adenocarcinoma and Lymphoma: Clinicopathologic Study of 10 Cases

Introduction/Objective

Synchronous and meta-synchronous hematolymphoid neoplasms and prostatic adenocarcinomas are known to occur, albeit rarely. The purpose of this study is to identify the clinicopathologic features of patients with coexisting prostatic adenocarcinoma and a lymphoma diagnosis.

Methods/Case Report

The institutional pathology archive was searched from 2016 to 2021. Data such as patient age, Gleason score, pathologic tumor stage, type of lymphoma and follow up data were collected.

Results (if a Case Study enter NA)

Ten patients were identified. Mean patient age was 65.4 ± 5.7 years. Nine specimens were prostatectomies and 1 was a needle core biopsy. Four patients had previous lymphoma diagnoses while 6 were diagnosed with lymphoma on lymph node dissection for prostatectomies. Seven patients had Gleason grade 3 + 4=7 disease, two had Gleason grade 4 + 3=7 and one had Gleason grade 4 + 5=9. Seven patients had small lymphocytic lymphoma/chronic lymphocytic leukemia, one had follicular lymphoma, one had mantle cell lymphoma and one had peripheral T-cell lymphoma. The patient with peripheral T-cell lymphoma died 18 months after lymphoma diagnosis and 11 months after prostate cancer diagnosis. The remaining 9 patients were alive for a mean of 27.7 ± 22.6 months after prostate cancer diagnosis.

Conclusion

There is minimal literature on patients with synchronous/meta-synchronous hematolymphoid neoplasms and prostatic adenocarcinoma. Our data provides one of the largest institutional series in this regard. Additional data and follow up is needed to evaluate if the concurrent low grade hematolymphoid malignancy, specifically small lymphocytic lymphoma/chronic lymphocytic leukemia, affects the survival outcome in these patients.

P01.18.B Structural abnormalities related to chemotherapy in cancer survivors: an ALE meta-analysis of neuroimaging studies

Background

Chemotherapy induced cognitive impairment (CICI) is a term used for the cognitive dysfunction reported with non-central nervous system cancer patients during or after chemotherapy. Recent neuroimaging studies have shown decreased activation in cancer patients during cognitive tasks post-chemotherapy. Structural changes are sought to be associated with cognitive decline in cancer survivors after chemotherapy. Here we aim to investigate the neuroimaging findings of structural abnormalities and gray matter alterations associated with chemotherapy in cancer survivors.

Material and Methods

A systematic search through PubMed database for peer-reviewed English-language studies yielded a total of 302 studies. Eligible studies were included in the activation likelihood estimation (ALE) meta-analysis if they reported coordinates in a stereotactic format (MNI or Talairach space) for voxel-based morphometric (VBM) studies on gray matter volume and post-chemotherapy cancer survivors compared to matched healthy controls. GingerALE (3.0.2) software from Brainmap.org was used to perform the ALE meta-analysis with threshold settings of uncorrected P-value &lt; 0.001 for multiple comparisons.

Results

The study sample included 299 patients comprised of breast cancer survivors (BCS), childhood acute lymphocytic leukemia (ALL) survivors, ovarian cancer survivors (OCS) and lung cancer with 279 matched healthy controls from 12 studies and 21 experiments. ALE-maps for post-chemotherapy cancer survivors showed reduced gray matter volume in comparison to healthy controls in the left inferior frontal gyrus, right thalamus, right superior frontal gyrus, right medial frontal gyrus and right cerebellum (peak coordinates: [-43,40,-6], [23,-29,2], [14,30,55], [9,57,-16], [9,-78,-41] respectively, and cluster size of 544 mm3, 312 mm3 and 257 mm3, 296 mm3, 297 mm3 respectively).

Conclusion

This is the first ALE meta-analysis that studied the converged areas of reduced gray matter volume in post-chemotherapy cancer survivors. Our findings of reduced gray matter volume in frontal regions and cerebellum might be responsible for the cognitive dysfunction in executive function, attention, and memory observed in cancer survivors. Further studies are needed to assess the impact of different chemotherapeutic regimens related to CICI .

Intrahepatic cholestasis of pregnancy: an evaluation of obstetric management in German maternity units

Purpose

Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse fetal and neonatal outcome. Evidence for improvement by obstetric management is sparse. Common international guidelines recommend induction of labor before term, however, they differ in recommendations of monitoring the disease and time point of active management. So far, an official guideline for treatment and management of ICP in Germany does not exist. This study aims to compile common practice and policy in obstetric management of ICP in German maternity units. The objective is to gather obstetricians’ opinion on management of ICP, and to estimate the need for standardization of current practice in Germany on the background of existing evidence.

Methods

A questionnaire focusing on indications for interventions was developed including fourteen multiple-choice questions comprising the areas of diagnostic criteria, laboratory testing, fetal monitoring, treatment, and delivery timing. The survey was sent to 699 maternity clinics and was distributed to participants of the annual congress hosted by the German society of perinatal medicine (DGPM). Collected data were summarized and evaluated in relation to available evidence and existing guidelines. Descriptive statistics and Fisher's exact test were used.

Results

334 completed questionnaires returned corresponding to a response rate of 48.1%. Coinciding with existing international guidelines, 48.8% of the participants acknowledge bile acid concentrations above 10 µmol/L to be indicative of ICP. 85.0% of obstetricians recommend antenatal testing with cardiotocography, exceeding common standards of maternity policy guidelines; 50.3% execute active management in ICP-affected pregnancies as they generally recommend a delivery between 37 + 0 and 38 + 6 weeks of gestation. Although recent studies evinced a risk of stillbirth in ICP-affected pregnancies not until a bile acid concentration of > 100 µmol/L, 22.2% of the respondents recommend delivery before 37 + 0 weeks of gestation due to raised bile acids of 40–99 µmol/L.

Conclusions

Opinions on the management of ICP in German maternity units differ widely and partly deviate by large from international standards. Reasons for this may be the lack of a national guideline and the low awareness due to the rarity of the disease on the one hand and the very slow dynamics in evidence generation and thus the uncertainty about the actual risks and optimal management on the other. The present data highlight the need for further research and clinical guidelines to standardize and optimize treatment based on the best available evidence.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Comparison of Maternal Serum Levels and Placental mRNA Levels of Dickkopf-1 in Preeclamptic and Normal Pregnant Women at Delivery

Background Preeclampsia remains a major cause of perinatal and maternal mortality and morbidity worldwide. Wnt/β-catenin signaling is known to be critically involved in placenta development processes. Dickkopf-1 (DKK1) is a key regulator of this transduction pathway. The aim of this study is to compare maternal serum DKK1 levels and placental mRNA levels of DKK1 and β-catenin in preeclamptic and normal pregnant women at delivery.

Methods The present study included 30 women with preeclampsia and 30 women with normal pregnancy. Maternal serum DKK1 levels were measured by ELISA. Placental mRNA levels of DKK1 and β-catenin were detected using RT-PCR.

Results Decreased maternal serum DKK1 levels were associated with worse maternal and fetal complications including HELLP syndrome, determination of one or more pathological symptom and IUGR diagnosis. No significant difference in maternal serum DKK1 levels was reported between preeclamptic women and women with normal pregnancy. Placental mRNA DKK1 levels were lower in preeclamptic women compared with normal pregnant women. Placental mRNA β-catenin levels showed no significant difference between two groups.

Conclusions Our findings reported the aberrant placental mRNA DKK1 levels in patients with preeclampsia. In addition, worse preeclampsia features were associated with decreased maternal serum DKK1 levels. Hence, aberrant Wnt/β-catenin signaling might present a plausible mechanism in preeclampsia pathogenicity. Dysregulated expression of DKK1 at gene level in the placenta but not at protein level in the maternal serum might confirm the notion that preeclampsia is a type of placenta-derived disease.

Cervical and Lower Uterine Parameter Ultrasound and Elastographic Parameters for the Prediction of a Successful Induction of Labor

PURPOSE

 The prediction of successful induction of labor (IOL) has been the subject of a series of studies. The predictive role of cervical sonographic and elastographic parameters has been controversially discussed. Lower uterine segment (LUS) thickness and strain values have not been discussed yet in this regard.

MATERIALS AND METHODS

 A prospective cohort study was performed to examine the predictive power of Bishop score parameters, sonographic cervical length (CL), cervical funneling, cervical strain values, LUS thickness and its strain values regarding successful IOL within 24 hours and intervals to onset of labor, ROM and delivery of the fetus. A p-value of < 0.05 was considered statistically significant.

RESULTS

 135 patients were examined. A cervical length of 25 mm, the presence of cervical funneling and digital shorter cervix was significant for the prediction of successful induction of labor (IOL) within 24 hours. There was weak correlation between the functional CL and the onset of labor (r² = 0.10) and ROM (r² = 0.13). There was also a weak correlation between the cervical funnel width and the time interval to the onset of labor (r² = 0.25), ROM (r² = 0.23) and delivery of the fetus (r² = 0.22). Cervical elastography, LUS thickness and strain values were not significant for the prediction of a successful IOL.

CONCLUSION

 We were able to show that cervical structural changes at the level of the internal os, i. e., shortening through funneling, may be the determining factor for successful IOL.

COVID-19: Factors associated with psychological distress, fear, and coping strategies among community members across 17 countries

Background

The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally.

Objectives

We aimed to examine the extent and identify factors associated with psychological distress, fear of COVID-19 and coping.

Methods

We conducted a cross-sectional study across 17 countries during Jun-2020 to Jan-2021. Levels of psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale), and coping (Brief Resilient Coping Scale) were assessed.

Results

A total of 8,559 people participated; mean age (±SD) was 33(±13) years, 64% were females and 40% self-identified as frontline workers. More than two-thirds (69%) experienced moderate-to-very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (1.56 [1.29-1.90]), comorbidity with mental health conditions (3.02 [1.20-7.60]) were associated with higher levels of psychological distress and fear. Doctors had higher psychological distress (1.43 [1.04-1.97]), but low levels of fear of COVID-19 (0.55 [0.41-0.76]); nurses had medium to high resilient coping (1.30 [1.03-1.65]).

Conclusions

The extent of psychological distress, fear of COVID-19 and coping varied by country; however, we identified few higher risk groups who were more vulnerable than others. There is an urgent need to prioritise health and well-being of those people through well-designed intervention that may need to be tailored to meet country specific requirements.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00768-3.

A ruptured cornual pregnancy successfully managed in a patient with a history of oophorectomy and salpingectomy: A rare case report

Cornual pregnancy is a rare condition that accounts for approximately 2-4% of ectopic pregnancies worldwide. Herein, we report an unstable case of a 32-year-old woman with a history of oophorectomy and salpingectomy who was admitted for a ruptured cornual pregnancy in the left cornu, which was successfully managed by laparotomy.

Students' attitudes toward digital learning during the COVID-19 pandemic: a survey conducted following an online course in gynecology and obstetrics

PURPOSE

The purpose of this survey was to assess medical students' opinions about online learning programs and their preferences for specific teaching formats during COVID 19 pandemic.

METHODS

Between May and July 2020, medical students who took an online gynecology and obstetrics course were asked to fill in a questionnaire anonymously. The questionnaire solicited their opinions about the course, the teaching formats used (online lectures, video tutorials featuring real patient scenarios, and online practical skills training), and digital learning in general.

RESULTS

Of 103 students, 98 (95%) submitted questionnaires that were included in the analysis. 84 (86%) students had no problem with the online course and 70 (72%) desired more online teaching in the future. 37 (38%) respondents preferred online to traditional lectures. 72 (74%) students missed learning with real patients. All digital teaching formats received good and excellent ratings from > 80% of the students.

CONCLUSION

The survey results show medical students' broad acceptance of the online course during COVID 19 pandemic and indicates that digital learning options can partially replace conventional face-to-face teaching. For content taught by lecture, online teaching might be an alternative or complement to traditional education. However, bedside-teaching remains a key pillar of medical education.

Unicentric Castleman disease in the mesentery with ambiguous symptoms: a rare case report

Castleman disease (CD) is a rare clinical entity characterized by enlarged lymph nodes. It may affect a single lymph node (unicentric) or multiple lymph nodes in the body (multicentric). However, it is exceptionally uncommon for unicentric Castleman disease (UCD) to present in the mesentery. Herein, we report a case of 38-year-old female complaining of polymenorrhea and abdominal discomfort for 4 months. Her past medical history was unremarkable; however, she has started smoking recently. The physical examination and radiography indicated a large, well-defined mass in the right hypochondrium. Eventually, the patient underwent laparotomy and the mass was excised totally. The Pathologic study confirmed the diagnosis as mesenteric CD, hyaline-vascular type. After 5 months of follow-up, the patient showed no evidence of recurrence. In conclusion, this case underscores the importance of taking mesenteric CD into consideration in each patient who presents with solid abdominal mass or ambiguous abdominal discomfort.

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine - Section on Maternal Disorders

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.

Conservative management of a large brain abscess in a child with severe manifestations: A case report from Syria

Otogenic brain abscesses are rare but usually life-threatening conditions particularly in developing countries. Our patient attended to the emergency department with extremely serious manifestations due to a large brain abscess. The borderline dimensions of the abscess (2.4 cm) with (GCS <12) as well as the lack of surgical capabilities were the factors that addressed to treat her with the available medication only. Fortunately, 2-year follow-up did not show any recurrence. This case sheds a light on unusual management of large abscesses in imperfect circumstances, which makes it high educational value.

COVID-19: Factors Associated with Psychol­­­ogical Distress, Fear, and Coping Strategies among Community Members Across 17 Countries.. [DOI: 10.21203/rs.3.rs-654989/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. Objectives: We aimed to examine the extent and identify associated factors of psychological distress, fear of COVID-19, and coping.Methods: We conducted a cross-sectional study across 17 countries during Jun-2020 to Jan-2021. Levels of psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale), and coping (Brief Resilient Coping Scale) were assessed. Results: A total of 8,559 people participated; mean age (±SD) was 33(±13) years, 64% were females and 40% self-identified as frontline workers. More than two-thirds (69%) experienced moderate-to-very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (1.56 [1.29-1.90]), comorbidity with mental health conditions (3.02 [1.20-7.60]) were associated with higher levels of psychological distress and fear. Doctors had higher psychological distress (1.43 [1.04-1.97]), but low levels of fear of COVID-19 (0.55 [0.41-0.76]); nurses had medium to high resilient coping (1.30 [1.03-1.65]). Conclusions: The extent of psychological distress, fear of COVID and coping varied by country; however, some groups were more vulnerable than others. There is an urgent need to prioritise health and well-being of these people through well-designed intervention that may need to be tailored to meet country specific requirements.

A child with Ewing's sarcoma in scapula: A rare case report

Introduction

Ewing's sarcoma is considered to be the second most frequent primary sarcoma in children. It affects children and young adults with a male predominance. Ewing's sarcoma is usually found in the femur, humerus, ilium and tibia; and in extremely rare cases Ewing's sarcoma might affect the scapula. There are only 15 papers in PubMed database regarding scapular Ewing's sarcoma.

Case presentation

A 14-year-old male, with no significant medical or surgical history, presented with a swelling in the right scapular area for two months. The patient also experienced mild pain and fever. On physical examination, there was a tender mass and restriction in the right shoulder joint movements. MRI showed a large scapular mass with the characteristics of a sarcoma. The final diagnosis was made based on pathologic findings. Eventually, the patient was subjected to neoadjuvant chemotherapy.

Discussion

The most common tumors affecting scapula are chondrosarcoma and osteosarcoma. In a cohort study about patients diagnosed with ES between 1988 and 2018, only 29 cases were involved in the scapula. There are 12 cases of congenital ES have been reported in the medical literature, 3 of them were in the shoulder girdle. Surgery with neoadjuvant chemotherapy is considered better for total survival in ES of scapula in comparison with chemotherapy and/or radiotherapy alone.

Conclusion

Ewing sarcoma is extremely rare in the scapula and should be considered as a differential diagnosis for any patient with scapular tumor.

•

The most common tumors affecting scapula are chondrosarcoma and osteosarcoma.

•

In extremely rare cases, Ewing’s sarcoma (ES) might affect the scapula.

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Surgery with neoadjuvant chemotherapy is considered better for total survival.

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ES should be considered in each child presents with a swelling over scapular region.

Incidence of and risk factors for vaginal cuff dehiscence following total laparoscopic hysterectomy: a monocentric hospital analysis

PURPOSE

Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk factors being sparse with contradictive results. The aim of this study was to assess the incidence rate of and risk factors for VCD in a homogenous cohort of women treated for benign uterine pathologies via total laparoscopic hysterectomy (TLH) with standardized follow-up.

METHODS

All patients undergoing TLH at the Department of Gynecology and Obstetrics, Saarland University Hospital between November 2010 and February 2019 were retrospectively identified from a prospectively maintained service database.

RESULTS

VCD occurred in 18 (2.9%) of 617 patients included. In univariate and multivariate analyses, a lower level of surgeon laparoscopic expertise (odds ratio 3.19, 95% confidence interval (CI) 1.0-9.38; p = 0.03) and lower weight of removed uterus (odds ratio 0.99, 95% CI 0.98-0.99; p = 0.02) were associated positively with the risk of VCD.

CONCLUSION

In this homogenous cohort undergoing TLH, laparoscopic expertise and uterine weight influenced the risk of postoperative VCD. These findings might help to further reduce the rate of this complication.

[Intrahepatic cholestasis of pregnancy]

Die Schwangerschaftscholestase („intrahepatic cholestasis of pregnancy“, ICP) ist die häufigste schwangerschaftsspezifische Lebererkrankung. Das Leitsymptom Juckreiz sowie eine begleitende Serumkonzentrationserhöhung von Gallensäuren und/oder der Alaninaminotransferase (ALT) sind wegweisend in der Diagnosestellung. Die mütterliche Prognose ist gut. Das fetale Outcome ist abhängig von der Gallensäurenkonzentration. Die ICP ist dabei sowohl mit Frühgeburt als auch mit intrauterinem Fruchttod (IUFT) assoziiert. Dieser ist Folge einer akuten fetalen Asphyxie, nicht einer chronischen uteroplazentaren Dysfunktion. Ein prädiktives Monitoring, z. B. durch Kardiotokographie (CTG) oder Ultraschall gibt es nicht. Eine medikamentöse Therapie mit Ursodeoxycholsäure (UDCA) bessert den Juckreiz, aber beeinflusst das fetale Outcome nicht nachweislich. Eine Entbindungsindikation ist in Abhängigkeit von Gallensäurenkonzentration und Gestationsalter gegeben. In Folgeschwangerschaften besteht ein hohes Wiederholungsrisiko.

Recommendations of the AGG (Task Force for Obstetrics, Section Maternal Diseases) on the Management of Maternal Hepatitis B, C and D Infection in Pregnancy

These statements and recommendations should provide appropriate information about maternal and fetal routes of infection, screening, detection of risk factors, diagnostic procedures, treatment, birth planning and peripartum and postpartum management of maternal hepatitis infection and offer pointers for prenatal counselling and routine clinical care on delivery wards.

Urogynecology in obstetrics: impact of pregnancy and delivery on pelvic floor disorders, a prospective longitudinal observational pilot study

Purpose

To assess changes in the pelvic floor anatomy that cause pelvic floor disorders (PFDs) in primigravidae during and after pregnancy and to evaluate their impact on women’s quality of life (QoL).

Methods

POP-Q and translabial ultrasound examination was performed in the third trimester and 3 months after delivery in a cohort of primigravidae with singleton pregnancy delivering in a tertiary center. Results were analyzed regarding mode of delivery and other pre- and peripartal factors. Two individualized detailed questionnaires were distributed at 3 months and at 12 months after childbirth to determinate QoL.

Results

We recruited 45 women, of whom 17 delivered vaginally (VD), 11 received a vacuum extraction delivery (VE) and 17 a Cesarean section in labor (CS). When comparing third-trimester sonography to 3 months after delivery, bladder neck mobility increased significantly in each delivery group and hiatal area increased significantly in the VD group. A LAM avulsion was found in two women after VE. Connective tissue weakness (p = 0.0483) and fetal weight at birth (p = 0.0384) were identified as significant risk factors for the occurrence of PFDs in a multivariant regression analysis. Urinary incontinence was most common with 15% and 11% of cases at 3, respectively, 12 months after delivery. 42% of women reported discomfort during sexual intercourse, 3 months after delivery and 24% 12 months postpartum. Although 93% of women engage a midwife after delivery, only 56% participated in pelvic floor muscle training.

Conclusion

Connective tissue weakness and high fetal weight at birth are important risk factors for the occurrence of PFDs. Nevertheless, more parturients should participate in postpartal care services to prevent future PFDs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00404-021-06022-w.

Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction

Purpose

To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction.

Methods

Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation.

Results

The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good).

Conclusion

Undergraduate student’s medical education can be enhanced by teaching breast US skills.

An unusual manifestation of Hand-Foot-Genital Syndrome: Embryonal Rhabdomyosarcoma - A case report

Hand-Foot-Genital Syndrome (HFGS) is a dominantly inherited condition and one of the rarest cases encountered in clinical practice. It might be presented with a wide variety of limb malformations and urogenital defects manifestations. In this report, a unique and novel case of HFGS accompanied with Embryonal Rhabdomyosarcoma of the urinary bladder is described in a two-year-old male. The patient was admitted to the hospital in order to investigate a progressively enlarging mass in the lower abdomen. During hospitalization, oliguria was noted by resident physicians. However, hypospadias and dysmorphic abnormalities, demonstrated upon physical examination, were the cornerstone in the diagnosis of HFGS. An accurate visual examination of the abdomen showed dilated superficial veins, and abdominal rigidity appeared through palpation. Furthermore, the radiologic evaluation showed delayed ossification of carpal bones, and abdominal CT scan revealed a necrotic mass in the hypogastric region measuring 12 × 10 cm. A biopsy was performed through which the mass was confirmed as Embryonal Rhabdomyosarcoma of the urinary bladder. The kidney function follow-up showed normal results. Neoadjuvant chemotherapy was started to diminish the tumor size. However, the patient eventually passed away during the treatment phase. This report emphasizes the need for a high index of suspicion to establish early detection of Embryonal Rhabdomyosarcoma in each newborn diagnosed with Hand-Foot-Genital Syndrome (HFGS) to avoid potential fatal consequences.

Perspective of Covid-19 pandemic in South Asian countries

COVID-19 is rapidly spreading throughout the world since December 2019. It has hit South Asian countries with faded impact, which can be attributed to (a) availability of kits, (b) number of people tested for COVID-19, (c) immunity, (d) environmental conditions and (e) vaccination.

ACTUALITIES IN ENDOCRINE PHARMACOLOGY: ADVANCES IN THE DEVELOPMENT OF ORAL FORMULATIONS FOR CALCITONIN AND SEMAGLUTIDE

As the medical utility of injectable therapeutic peptides is expanding, so is the challenge of developing technologies that allow the administration of such molecules via alternative routes, considering that chronic patients requiring treatment with parenteral formulations are less adherent and compliant to the therapeutic regimens. Hence, substantial efforts have been made to develop technologies that allow the oral formulation of peptides. Due to their importance in the field of pharmaceutical technology, we describe the latest advancements made in the development of oral salmon calcitonin and oral semaglutide, in co-formulation with absorption enhancers such as 8-[(5-chloro-2-hydroxybenzoyl) amino] octanoic acid (or 5-CNAC) and N-[8-(2-hydroxybenzoyl) amino] caprylate (or SNAC). Oral semaglutide is considered to be a landmark for oral peptide delivery technology, as it is one of the very few successful examples of peptides that can be administered orally. Unlike semaglutide, oral calcitonin is still not approved by the regulatory authorities because it failed to demonstrate the anticipated effects in phase III clinical trials conducted so far. However, the efforts for obtaining an oral form of calcitonin have significantly contributed to the development of technologies that facilitate the absorption of peptide-structure macromolecules.

Benign multicystic peritoneal mesothelioma (BMPM) presenting with ambiguous symptoms: A rare case report

Introduction

Benign multicystic peritoneal mesothelioma (BMPM) represents a very rare clinical entity, with only 130 registered cases in the medical literature, therefore it is usually overlooked from the list of differential diagnoses. The treatment consists of surgery and other authors suggest complementing it with hyperthermic intraperitoneal chemotherapy.

Presentation of case

A 25-year-old multiparous female experienced periodic abdominal discomfort for two weeks. She developed constipation, urinary urgency, and irregular menstruation. Family history was remarkable for endometrial and breast cancer. Abdominal examination revealed a palpable mass. Abdominal ultrasound and computed tomography scan identified the multicystic appearance of the mass. The diagnosis was unclear, therefore exploratory laparotomy was performed, which revealed multiple grape-like clusters of cysts that were excised immediately. BMPM was diagnosed based on the pathology report. Eventually, the follow-up did not reveal any recurrence.

Discussion

Mesothelial tumors include three pathological entities, including Benign multicystic peritoneal mesothelioma (BMPM). BMPM is an uncommon neoplasm and has a high recurrence rate after surgery. BMPM consists of clear cysts that take the shape of a grape-like cluster. Clinically, BMPM resembles a tangible abdominal mass and it is challenging to be diagnosed, due to its numerous differential diagnoses.

Conclusion

The definitive diagnosis of intraperitoneal cystic masses is usually challenging. Therefore, BMPM -although very rare- should always be thought of when dealing with an intraperitoneal cystic mass, especially in women in the reproductive years. In our case cytoreductive surgery solely was sufficient to achieve a disease free follow up, however, further studies regarding treatment and follow-up are required.

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The incidence of Benign multicystic peritoneal mesothelioma (BMPM) is exceptionally rare.

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Pathological evaluation is considered the best technique to diagnose.

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BMPM is most common in women in reproductive age.

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BMPM should be considered as a differential diagnosis for abdominal masses.

Treatment algorithm for women with endometriosis in a certified Endometriosis Unit

INTRODUCTION

Endometriosis is a chronic hormone-dependent disease affecting approximately 25-30% of women in the third and fourth decade. Despite its frequency, it is often detected late. The aim of this overview article was to present a standardized treatment algorithm for an interdisciplinary endometriosis consultation considering conservative and surgical approaches.

EVIDENCE ACQUISITION

Despite the frequency of endometriosis and a high number of publications dealing with the disease there is a lack of evidence in literature for standardized treatment algorithms allowing a rational diagnostic and therapeutic approach. In May 2019 we did a literature search in Medline. While finding 26702 publications under the term "endometriosis" there was only one publication for the search term "endometriosis consultation treatment algorithm." After screening the abstracts 144 publications in English, French or German language had been assessed as relevant for the diagnosis and therapy of endometriosis (143 overview articles and one guideline).

EVIDENCE SYNTHESIS

Based on clinical evidence, we have developed a treatment algorithm for women with suspected endometriosis. The diagnosis includes a structured medical history with the identification of endometriosis-typical symptoms and a gynecological examination, if necessary additional examinations. The treatment algorithm is essentially divided into the phase of diagnosis and the phase of therapy as well as the prevention of recurrence or long-term treatment. A multi-professional team of visceral surgery, urology, nutritional medicine, physiotherapy and psychology can be consulted for support.

CONCLUSIONS

The treatment of endometriosis should be multiprofessional, standardized and reproducible during specialized consultations at certified centers. So far, there are few publications on a standardized and clinically proven treatment algorithm for women with suspected endometriosis. The presented treatment algorithm could be helpful in the diagnosis and treatment of endometriosis patients, even at other centers.