Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography

Purpose

To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT).

Patients and Methods

For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen's Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid.

Results

Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia.

Conclusion

M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.

High Expression of WT1 and Low Expression of p53 in Archived Blocks of Children with Wilms Tumor in South Western Uganda

Purpose

The determination of the presence or absence of anaplasia in Wilms tumor is difficult sometimes creating diagnostic errors and is worsened by the use of neoadjuvant chemotherapy, which causes cellular alterations that may mimic anaplasia. This study described the histological features of Wilms tumor and their association with WT1 and p53 expression in archived specimens in South Western Uganda.

Patients and Methods

A series of 308 formalin-fixed paraffin-embedded tissue blocks belonging to 85 children were retrospectively recruited in the only public Histopathology laboratory in South Western Uganda. Rabbit monoclonal Anti-Wilms tumor protein antibody [(CAN-R9) IHC-56-2] ab89901 and rabbit monoclonal Anti-p53 antibody [E26] ab32389 were used to assess the expression of WT1 and p53, respectively. The expression of WT1 and p53 were reported as proportions, Chi-square was also performed to assess for associations and statistical significance was considered when the p-value was less than 0.05.

Results

The median age was 3.5 with an interquartile range of (2-6) years. Mixed histology was the most common at 35.29% (95% CI:25.77-46.14). Anaplasia was present in 5.88% (95% CI:2.44-13.52) of the specimens. p53 and WT1 expressions were 13.0% (95% CI:7.25-22.04), and 41.0% (95% CI: 31.11-52.04), respectively.

Conclusion

Mixed-type histology is the most common histologic feature of Wilms tumor with high expression of WT1 and a low expression of p53 implying that these can be used routinely to confirm the diagnosis as well as anaplasia in South Western Uganda.

Navigating Quality Assessment Hurdles in Clinical Laboratory Services: A Comprehensive Review in Resource-Limited Settings

External quality assessment is the process of evaluating the performance of a laboratory and the competence of professionals. Participation in EQA and standardizing the quality of laboratory services are a mandatory requirements for accreditation. This review is aimed at identifying and discussing challenges that hinder the effective implementation of an EQA program in countries with resource limited setting. To obtain abundant information, articles were identified by searching the literature publishedin English using the National Library of Medicine, PubMed, Science Direct and AMC digital library databases. The articles identified in the references were manually searched and included. After the article was identified, it was imported to Endnote version 8.1 and exported to Microsoft Word for citation. Based on this review, the major identified challenges that hinder the implementation of an EQA program include the high cost of control materials, malfunction and lack of maintenance for equipment failure and breakdown, a knowledge gap among laboratory professionals, noncommutability of control samples, and difficulty in assigning target values. In addition, failing to participate in EQA and failing to take corrective action are the major challenges identified. As a result, applying to an EQA program in resource-limited counties was highly challenging. To attain high performance in the laboratory and to provide quality laboratory service for patient care, the EQA supplier and the user laboratory must pay attention to these issues and take appropriate corrective actions for ongoing quality improvement and accreditation.

Efficacy and Safety of High-Voltage Pulsed Radiofrequency versus Standard-Voltage Pulsed Radiofrequency for Patients with Neuropathic Pain: A Literature Review and Meta-Analysis

Background

Neuropathic pain (NP) is recognized as one of the most difficult pain syndromes which lacks a safe, well-tolerated and effective treatment. Pulsed radiofrequency (PRF), a novel and minimally invasive interventions, has been introduced to alleviate various types of NP. Previous studies reported PRF with higher voltage could further improve the treatment efficacy. Therefore, we conducted this systematic review and meta-analysis to determine whether high-voltage PRF is superior to standard-voltage PRF for the treatment of NP patients.

Methods

Databases published from the date of inception until 15 March 2022 on PubMed/MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for RCTs comparing high-voltage PRF and standard-voltage PRF in NP patients. The primary outcome measures were the efficiency rates of NP patients with high-voltage PRF or standard-voltage PRF treatment. Data analysis was conducted using the Review Manager software (RevMan V.5.3).

Results

Six RCTs involving 423 patients were included in our meta-analysis. Compared with standard-voltage PRF group, the high-voltage PRF group attained a higher efficiency rate at 1 month (P = 0.04; I2 = 0%), 3 months (P = 0.04; I2 = 0%), 6 months (P = 0.002; I2 = 0%) post-procedure respectively. There was no significant difference in the complications between the two groups.

Conclusion

Our study supported that high-voltage PRF attained more satisfactory efficacy than standard-voltage PRF without increased side effects. High-voltage PRF could be a promising, effective, minimally invasive technology for NP patients.

Prognostic Value of Leukocyte-Based Risk Model for Acute Kidney Injury Prediction in Critically Ill Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

Purpose

Acute kidney injury (AKI) is a common complication of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and inflammation is the potential link between AKI and AECOPD. However, little is known about the incidence and risk stratification of AKI in critically ill AECOPD patients. In this study, we aimed to establish risk model based on white blood cell (WBC)-related indicators to predict AKI in critically ill AECOPD patients.

Material and Methods

For the training cohort, data were taken from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) database, and for the validation cohort, data were taken from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The study employed logistic regression analysis to identify the major predictors of WBC-related biomarkers on AKI prediction. Subsequently, a risk model was developed by multivariate logistic regression, utilizing the identified significant indicators.

Results

Finally, 3551 patients were enrolled in training cohort, 926 patients were enrolled in validation cohort. AKI occurred in 1206 (33.4%) patients in training cohort and 521 (56.3%) patients in validation cohort. According to the multivariate logistic regression analysis, four WBC-related indicators were finally included in the novel risk model, and the risk model had a relatively good accuracy for AKI in the training set (C-index, 0.764, 95% CI 0.749-0.780) as well as in the validation set (C-index, 0.738, 95% CI: 0.706-0.770). Even after accounting for other models, the critically ill AECOPD patients in the high-risk group (risk score > 3.44) still showed an increased risk of AKI (odds ratio: 4.74, 95% CI: 4.07-5.54) compared to those in low-risk group (risk score ≤ 3.44). Moreover, the risk model showed outstanding calibration capability as well as therapeutic usefulness in both groups for AKI and ICU mortality and in-hospital mortality of critical ill AECOPD patients.

Conclusion

The novel risk model showed good AKI prediction performance. This risk model has certain reference value for the risk stratification of AECOPD complicated with AKI in clinically.

Model-Informed Precision Dosing of Imipenem in an Obese Adolescent Patient with Augmented Renal Clearance and History of Schizophrenia

Imipenem is a broad-spectrum antibiotic that has been used in treating severe infections and exhibits a time-dependent PK/PD profile. Its dose should be adjusted based on renal function. However, there is little experience with imipenem dosing in obese adolescent patients with augmented renal clearance (ARC) and history of schizophrenia. This case reported successful dosing of imipenem in an obese adolescent patient with ARC based on therapeutic drug monitoring (TDM) and model-informed precision dosing (MIPD). A 15-year-old male adolescent patient with history of schizophrenia was diagnosed with ventilator-associated pneumonia due to carbapenem-susceptible Klebsiella pneumoniae and received imipenem treatment (0.5 g every 8 hours with a 1-hour infusion). However, the exposure of imipenem was suboptimal due to ARC, and there is no available model for MIPD in this patient. Thus, we utilized prediction error to find a population pharmacokinetic model that fit this patient and ran Maximum a posteriori Bayesian estimation and Monte Carlo simulation based on screened models to predict changes in drug concentrations. The dose of imipenem was adjusted to 0.5 g every 6 hours with a 2-hour infusion, and subsequent TDM revealed that dosing adjustment was accurate and successful. Finally, the patient's status of infection improved. This study will be beneficial to imipenem dosing in similar cases in the future, thereby improving the safety and effectiveness of imipenem or other antibiotics.

Pharmacoeconomic Evaluation of Costs of Myelomeningocele and Meningocele Treatment and Screening

Background

The prevention of myelomeningocele (MMC) and meningocele (MC) is a public health concern. A systematic review on economic factors associated with MMC and MC can help the policy makers to evaluate the cost-effectiveness of screening and treatment. To our knowledge, this is the first systematic review to provide up-to date pharmacoeconomic evidence of all economic studies present in literature on different aspects of MMC and MC.

Methods

We searched in the National Health Service Economic Evaluation Database (NHSEED), PubMed, Cost-effectiveness Analysis Registry (CEA Registry), Centre for Reviews and Dissemination (CRD), Health Technology Assessment Database (HTAD), Cochrane Library, and Econlit. The PRISMA guidelines were followed in the search and evaluation of literature. Only articles in English not limited by the year of publication that fulfilled the eligibility criteria were included in this systematic review.

Results

Nineteen papers were included in the study. The studies were very heterogeneous and reported a comparison of the costs between prenatal versus postnatal repair, the cost of fetoscopic approach versus open surgery, the cost of ventriculoperitoneal shunting (VPS) versus endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization (ETV/CPC), the cost of hospitalization, and the cost of diagnosis for MMC.

Conclusion

The results of this study can help in implementing new policies in different countries to assist MC and MMC patients with the cost of treatment and screening.

Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review

The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.

Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients

Background

The relationship between acute gastrointestinal symptoms and cortisol or adrenocorticotropic hormone (ACTH) levels has rarely been reported. We hypothesized that the elevation of serum cortisol or ACTH levels may be correlated with the severity of the acute gastrointestinal injury grade (AGI).

Methods

This study was an observational study. All patients were admitted to the ICU between 2019.1.1 and 2020.1.1.. Serum ACTH and cortisol levels and clinical data were collected from the electronic medication records. The highest AGI grade during the ICU stay was the major endpoint to observe. The patient was treated in a standard procedure in the ICU.

Results

A total of 235 patients were included in our study, 132 of whom developed AGI. In univariate regression, cortisol level was found to be a risk factor for 28-day mortality. Serum cortisol and ACTH levels correlated with APACHE II, AGI grade, PCT, and CRP levels. Spearman analysis and partial correlation analysis indicated that cortisol and ACTH levels were correlated with AGI grade.

Conclusion

The ACTH and cortisol levels were positively correlated with the higher severity of AGI grade. The cortisol level may be a useful way to access the GI injury.

Age-Related Study of Anthropometry Indicators, Body Composition, Strength and Vital Capacity at Masters Athletics: How to Postpone Sarcopenia

Purpose

The purpose of this study was to compare the anthropometric indicators of sports veterans, former athletes who stopped training, and non-sports people aged 40 years and older to assess the impact of regular sports on the stability of the body.

Patients and Methods

100 athletes and 31 people non-sports were included in the study. Athletes were divided into two groups depending on the mode of motor activity. The first group (n=75) continued their regular sports activities. The second group (n=25) stopped training. Height, weight, chest circumference, mobility, waist, shoulder circumference, forearm, hip, ankle, fat mass, and muscle mass were measured, and dynamometry was performed.

Results

Body weight is statistically significantly (p<0.05) less in those who continue sports (70.7±10.2) classes after 60 years compared with the control group (82.4±9.3). In sports veterans, the chest excursion and the shoulder circumference is statistically significantly (p<0.05) greater than in the control group. In the subjects of the first group aged from 40 to 49 (4551±612) and from 50 to 59 (4242±416), the FVC index was statistically significantly (p<0.05) higher than in the control group (3890±344 and 3786±401, respectively). The body composition of veterans is characterized by a high level of muscle mass and a low level of fat mass. At the age of 40-49, the percentage of muscle tissue in sports veterans was statistically significantly higher (46.32±2.74) (p<0.05) than in the group of athletes who stopped sports activities (44.09±5.29).

Conclusion

Veterans of sports demonstrate higher indicators of limb girth and muscle strength compared to untrained people of the same age. In addition, sports veterans have a lower content of adipose tissue and a greater expression of muscle mass. Thus, the data obtained by us show that sports prevent the development of sarcopenia and can also affect cardiovascular risk.

Imaging-Derived Biomarkers Integrated with Clinical and Laboratory Values Predict Recurrence of Hepatocellular Carcinoma After Liver Transplantation

Purpose

To investigate the prognostic value of computed tomography (CT) derived imaging biomarkers in hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) and develop a predictive nomogram model.

Patients and Methods

This retrospective study included 178 patients with histopathologically confirmed HCC who underwent liver transplantation between 2007 and 2021 at the two academic liver centers. We evaluated dedicated imaging features from baseline multiphase contrast-enhanced CT supplemented by several clinical findings and laboratory parameters. Time-to-recurrence was estimated by Kaplan-Meier analysis. Univariable Cox proportional hazard regression and multivariable Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to assess independent prognostic factors for recurrence. A nomogram model was then built based on the independent factors selected through LASSO regression, to predict the probabilities of HCC recurrence at one, three, and five years.

Results

The rate of HCC recurrence after LT was 17.4% (31 of 178). The LASSO analysis revealed six independent predictors associated with an elevated risk of tumor recurrence. These predictors included the presence of peritumoral enhancement, the presence of over three tumor lesions, the largest tumor diameter greater than 3 cm, serum alpha-fetoprotein (AFP) levels exceeding 400 ng/mL, and the presence of a tumor capsule. Conversely, a history of bridging therapies was found to be correlated with a reduced risk of HCC recurrence. In addition, Kaplan-Meier curves showed patients with irregular margin, satellite nodules, or small lesions displayed shorter time-to-recurrence. Our nomogram demonstrated good performance, yielding a C-index of 0.835 and AUC values of 0.86, 0.88, and 0.85 for the predictions of 1-year, 3-year, and 5-year TTR, respectively.

Conclusion

Imaging parameters derived from baseline contrast-enhanced CT showing malignant behavior and aggressive growth patterns, along with serum AFP and history of bridging therapies, show potential as biomarkers for predicting HCC recurrence after transplantation.

Influence of Participation in a Medical-Themed Science Café on Patient Activation

Purpose

This study aims to investigate the impact of a Science Café (SC) dealing with medical topics on participants' patient activation (PA), a concept that refers to patients' involvement in managing their own health, working with their healthcare providers, and maintaining their health.

Material and Methods

Semi-structured interviews were conducted with patients who had participated in a medical SC (n = 10) to identify the medical SC-associated factors that influenced PA. Through a questionnaire of medical SC participants (n = 23), the impact on PA and correlations with relevant psychological measures were quantitatively assessed.

Results

The interviews revealed three factors: "Experience & acceptance of chronic conditions", "Features of medical SC" and "Changes as a result of participation." The questionnaire results showed a positive correlation between PA and resilience and a negative correlation with decision regret.

Conclusions

Participation in a medical SC by people with illnesses can improve PA by improving knowledge and skills for self-management and increasing self-awareness of illness in a supportive environment. The study highlights the potential benefits of using medical SC as a strategy for healthcare providers to improve PA and health outcomes.

The Correlation Between Thyroid Parameters and the Ratios of Neutrophil/Lymphocyte and Platelet/Lymphocyte in Euthyroid Type 2 Diabetic Patients

Purpose

To investigate the thyroid parameters (thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4)) and their relationship with inflammatory indicators (neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR)) in euthyroid individuals with type 2 diabetes mellitus (T2DM).

Patients and Methods

Our study included 672 participants diagnosed with T2DM, and 336 healthy individuals matched in terms of age and gender. The laboratory inspection data of both type 2 diabetic patients and healthy individuals as controls were analyzed separately.

Results

Compared with a control group, the individuals with T2DM presented elevated levels of inflammatory indicators, including white blood cells (WBC), neutrophils (NEUT), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). The levels of TSH are elevated in the T2DM group, whereas the levels of FT3 or FT4 are reduced. TSH levels were significantly positively correlated with NLR or PLR, while the levels of FT3 and FT4 were significantly negatively correlated with NLR or PLR. Furthermore, thyroid parameters were correlated with gender, age, and blood lipid metabolism. Multiple stepwise regression analysis identified gender, NLR, PLR, and low-density lipoprotein (LDL) as significant contributing factors for TSH. Additionally, gender, age, NLR, PLR, glycated hemoglobin A1c (HbA1c), and LDL were identified as contributing factors for FT3, while PLR and total cholesterol (TC) were identified as contributing factors for FT4.

Conclusion

Abnormal metabolism of thyroid parameters is associated with increased inflammatory activity and impaired glycolipid metabolism in euthyroid type 2 diabetic patients.

Research Progress on Mechanism and Management of Adverse Drug Reactions of Anlotinib

Anti-angiogenesis therapy plays a vital role in the treatment of tumors, with anlotinib as its representative targeted drug. Anlotinib is a novel oral tyrosine kinase inhibitor (TKI) with inhibitory effects on tumor growth tumor angiogenesis. In Phase III clinical trials, anlotinib demonstrated better overall survival and progression-free survival than placebo in patients with advanced non-small cell lung cancer (NSCLC), and was approved for the first time as a third-line treatment for refractory advanced NSCLC. Going far beyond that, anlotinib has shown encouraging results in a variety of malignancies, including medullary thyroid carcinoma, renal cell carcinoma, gastric cancer and esophageal squamous cell carcinoma. Nevertheless, anlotinib has been subject to some controversy in terms of adverse events due to its widespread use. In this review, the mechanism of action, pharmacokinetic characteristics, adverse reactions in clinical use and management of anlotinib were summarized.

Tissue Augmentation Techniques in the Management of Ligamentous Knee Injuries

Despite early reports of high failure rates in knee ligament repair techniques resulting in favor of reconstruction, newer advances in surgical technology have shifted the attention back to repair with the addition of various tissue augmentation techniques. Ligament repair preserves proprioceptors in the native ligament and avoids autograft tendon harvest, minimizing the complications associated with donor site ruptures in reconstruction techniques. Tissue augmentation has been successfully used in knee ligamentous and tendon repair procedures, as well as in some upper extremity procedures. This study provides a clinical update on the surgical techniques, biomechanics, and outcomes with the application of various tissue augmentation techniques in the ligaments surrounding the knee joint.

Colon Metastasis from Pancreatic Cancer: A Case Report

Pancreatic cancer commonly metastasizes to the liver, lung or adrenal glands, but rarely spreads to the colon. We describe a case of a 65-year-old man with operation history of endoscopic submucosal dissection for rectal adenoma, who visited our department with a lesion in the sigmoid colon. A biopsy of the sigmoid pathologic lesion found heterologous cells in the muscularis mucosa, which indicated that this lesion did not originate in the colon. Abdominal enhanced CT results revealed a soft tissue mass in pancreatic tail and several masses in the liver and rectovesical pouch. 18-FDG PET-scan results showed pancreatic neoplastic mass. Biopsy result of pancreatic pathologic area was positive for ductal pancreatic adenocarcinoma. Immunohistochemical staining confirmed that the sigmoid lesion was a metastasis from a primary pancreatic adenocarcinoma-an unusual pattern of spread. The patient accepted chemotherapy after an oncologic evaluation. To our knowledge, there were only nine reported cases of metastatic pancreatic cancer spreading to the colon. This was a rare route of metastasis for pancreatic cancer. It is important to keep this possibility in mind when patients present with a colon lesion. Furthermore, our case highlights the importance of considering metastases when a colon mass is found in patients with a history of colon cancer, although primary colon cancer is still more likely.

Barriers and Intention to Get Vaccinated for COVID-19 and Associated Factors Among Adults in Southwest Ethiopia: A Theory of Planned Behavior Approach

Background

Different vaccines have been approved for use against coronavirus disease and distributed globally in different regions. Efforts should be made on the vaccination to control the spread and impacts of the coronavirus pandemic. However, the general population's attitudes and intention to uptake coronavirus disease 2019 (COVID-19) vaccinations were poor.

Objective

This study aimed to assess the barriers to and intention to be vaccinated against COVID-19 and the associated factors among adults in the Jimma zone, Ethiopia.

Methods

A community-based cross-sectional study with multistage sampling was conducted with 621 participants from 16 April to 17 May 2022. Multivariable logistic regression was used to identify factors associated with the outcome of interest. Statistical p-value ≤0.05 was set at p ≤ 0.05. Qualitative data were supplemented with quantitative results.

Results

The majority of the study participants (382 [61.5%]) intended to uptake the COVID-19 vaccine. In this study, travel history (Adjusted Odds Ratio (AOR) = 2.18, 95% CI 1.23-3.87), vaccination history (AOR = 2.64, 95% CI 1.69-4.12), perceptions of infection prevention for COVID-19 (AOR = 1.97, 95% CI 1.28-3.03), subjective norm (AOR = 2.27, 95% CI 1.52-3.39), and perceived behavioral control (PBC) (AOR = 2.30, 95% CI 1.55-3.41) were significantly associated with the intention to be vaccinated against COVID-19.

Conclusion

More than half of the adult participants intended to be vaccinated against COVID-19. The study participant's traveling history, vaccination history, perception of infection prevention for COVID-19, subjective norms, and Perceived Behavioral Control were significantly associated with the intention to be vaccinated.

Prevalence and Management of Spermatic Cord Torsion (SCT): A Five-Year Review in Souro Sanou University Hospital of Bobo-Dioulasso (Burkina Faso)

Introduction

Spermatic cord torsion (SCT) is a rare urological emergency that can jeopardize the fertility of the patient. Our study aimed to investigate the epidemiological, diagnostic and therapeutic aspects of SCT in Souro Sanou University Teaching Hospital.

Materials and Methods

This was a descriptive cross-sectional study with retrospective data collection from January 1, 2017, to December 31, 2021, in the emergency surgical and urology division of Souro Sanou University Hospital.

Results

The annual frequency of SCT was 4.4 patients/year. The mean age of the patients was 17.82 ± 6.74 years. Painful swelling of the hemi-scrotum was the main presenting symptom. The torsion involved the left spermatic cord in 50% of cases and both spermatic cords in 5% of cases. The mean time of symptoms before presentation was 78.8 hours ± 153 hours. Only 27.3% of patients presented before the 6th hour after the onset of pain. The average time from presentation to surgical intervention was 5.6 hours ± 5 hours. Orchiectomy was performed in 11 patients (47.8%). The average hospital stay was 3.1 ± 1.4 days.

Conclusion

SCT is a rare urological emergency. The prognosis depends on the duration and degree of torsion. A high orchidectomy rate can be observed with a delay in presentation.

Successful Treatment of Atopic Dermatitis with a Predominant Nipple Involvement by Abrocitinib During COVID-19 Pandemic: A Case Report

Background

There is limited literature on AD with a predominant involvement of nipple among the adult male group. SARS-CoV-2 infection might have been an exacerbating factor of AD by initiating the "cytokine storm". Conventional treatment suffers from a dilemma of poor efficacy and a high recurrence. The JAK inhibitors have been clinically applied to treat the AD with a good outcome.

Patients and Methods

We present a case of a 28-year-old male AD patient with a predominant nipple involvement successfully treated with JAK inhibitor abrocitinib, with no adverse affects.

Results

The case shows a good clinical efficacy of JAK inhibitor abrocitinib in the treatment of AD with a predominant nipple involvement during the COVID-19 pandemic with a rapid and long-term symptomatic relief.

Conclusion

JAK inhibitor abrocitinib might become a promising agent for the treatment with AD with a predominant uncommon region like nipple that might be resistant to conventional therapies during the COVID-19 pandemic.

The Clinical Usefulness of Mean Corpuscular Hemoglobin Concentration in Patients with Pneumoconiosis

Aim

We investigated the clinical usefulness of mean corpuscular hemoglobin concentration (MCHC) in patients with pneumoconiosis.

Methods

We retrospectively investigated the medical records from 52 patients with pneumoconiosis, and erythrocyte parameters were analyzed in pneumoconiosis patients with different stages.

Results

Here, we found that the values of MCHC were significantly lower in III stage pneumoconiosis than those with I/II stage (p = 0.024), and there was no significantly difference in MCHC between smoking pneumoconiosis patients and non-smoking pneumoconiosis patients. A negatively correlation between MCHC and disease stage was observed in patients with pneumoconiosis (r = -0.298, p = 0.032). In multiple linear regression analysis, the MCHC was found to be independently associated with advanced pneumoconiosis in patients with pneumoconiosis (p=0.011). The results of logistic regression analysis indicated that decreased MCHC was an independent risk factor of advanced pneumoconiosis in patients with pneumoconiosis (OR: 0.936, CI95%: 0.877-0.999, p = 0.046). Receiver operating characteristic curve analysis showed that the optimal cutoff value of MCHC was 330 g/L to identify advanced pneumoconiosis with the area under the curve of 0.694 (CI95%:0.550-0.839, p = 0.018).

Conclusion

The decreased MCHC is associated with advanced pneumoconiosis, and MCHC may be used as a monitoring marker for follow-up of pneumoconiosis patients.

Inviting Newton to Visit the Delivery Room. The Role of Gravity During Childbirth

Throughout history, the upright position was the norm for most deliveries. However, due to cultural reasons, this practice was changed in the 17th century, and since then, the majority of deliveries have been conducted with the parturient lying on her back. The aim of this review article is to challenge the nowadays recumbent birth position and to emphasize the added value of gravity to the childbirth. Physiologically there is a strong argument for delivering in an upright position due to the significant role of gravity. The baby's presenting part does not move back between contractions as happens in today's recumbent position when due to the anatomy of the pelvis, the presenting part moves uphill. In this position, the second stage is shorter, and the signal for active pushing occurs spontaneously. It is recommended that any parturient should be informed about the risks and benefits of each birthing option to decide the birthing position that suits her.

Burkholderia cepacia Induced Occipital Subcutaneous Abscess and Fracture in a Brain-Dead Woman

Burkholderia cepacia is an aerobic opportunistic Gram-negative pathogen that mainly infects immunodeficiency patients. However, soft tissue infections with fractures due to Burkholderia cepacia are rare with no cases reported. Here, we report a rare case of 3 years of brain death in a 43-year-old woman with Burkholderia cepacia resulting in an occipital subcutaneous abscess and fracture. Through the second-generation sequencing of the whole genome of this strain, it was found that there were no high virulence genes and virulence factors. The patient received targeted antibiotic therapy and showed improvement in clinical symptoms and radiological signs. Bone destruction because of Burkholderia cepacia is easily overlooked due to the lack of characteristic symptoms and limited clinical examination. This case reminds us that Burkholderia cepacia without major virulence factors could damage the bone in immune-compromised patients.

A Novel Circ_Arf3/miR-452-5p/Mbnl1 Axis Regulates Proliferation and Expression of Fibrosis-Related Proteins of Mouse Mesangial Cells Under High Glucose

Background

Diabetic nephropathy (DN) is a serious microvascular complication of diabetes that may lead to chronic renal failure and end-stage renal disease. Circular RNAs (circRNAs) play important roles in DN progression. However, the action of circRNA ADP ribosylation factor 3 (circ_Arf3) in high glucose (HG)-induced change is still unclear.

Methods

Mouse mesangial cells (MCs) were treated with 30 mM HG as a DN cell model in vitro. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to examine the expression levels of circ_Arf3, microRNA (miR)-452-5p and muscleblind like splicing regulator 1 (Mbnl1). The proliferation of HG-treated MCs was assessed using 5 Ethynyl 2' deoxyuridine (EdU) and cell counting kit-8 (CCK-8) assays, and the levels of proliferation and fibrosis-related proteins and Mbnl1 were detected by Western blot. Dual-luciferase reporter and RNA pull-down assays were utilized to determine the relationship between miR-452-5p and circ_Arf3 or Mbnl1.

Results

Our results discovered that circ_Arf3 and Mbnl1 were lowly expressed in HG-treated MCs, while miR-452-5p expression was up-regulated. Moreover, circ_Arf3 was mainly located in the cytoplasm and had a ring-like stable structure. Functional assays demonstrated that overexpression of circ_Arf3 prevented cell proliferation and fibrous formation in HG-treated MCs. Circ_Arf3 could sponge miR-452-5p, and the effect of circ_Arf3 overexpression was reversed by enhanced expression of miR-452-5p. Mbnl1 was a direct target of miR-452-5p. Knockdown of Mbnl1 abolished the suppressive effects of miR-452-5p inhibitor on proliferation and fibrosis-related protein expression in HG-treated MCs. Moreover, circ_Arf3 regulated Mbnl1 through miR-452-5p.

Conclusion

Overexpression of circ_Arf3 prevents cell proliferation and fibrous formation in HG-treated MCs by regulating the expression of Mbnl1 via miR-452-5p.

Prevalence of Sarcopenia in Africa: A Systematic Review

Objective

The world population gradually getting older, age-related sarcopenia is becoming more frequent. Known to be highly prevalent in high income countries, relative data in Africa are still scarce. This review aims to estimate the prevalence of sarcopenia in Africa and its characteristics.

Study Design and Setting

A literature search in PubMed, Web of Science, Google Scholar, and Scopus was conducted in October 2022. All studies reporting the prevalence of sarcopenia in Africa within 15 years were included, and we did an assessment of bias with Hoy et al's risk bias assessment tool. The estimated prevalence of sarcopenia was the outcome and we performed secondary analyses by age, gender, and diagnostic criteria. The random effect model was used for the prevalence estimation. The prevalence of sarcopenia and 95% confidence interval (95% CI) were calculated using the inverse-variance method.

Results

A total of 17 studies met our eligibility criteria, for a study population of 12,690 participants with 44.3% males and 55.7% females. The overall prevalence of sarcopenia was 25% (95% CI: 19-30%). The prevalence of sarcopenia among 50 years old and older was 23% (95% CI: 17-29%). We had a higher prevalence of sarcopenia among males (30%, %95 IC: 20-39%) than females (29%, %95 IC: 21-36%). The prevalence of sarcopenia was different depending on the diagnosis criteria used.

Conclusion

The prevalence of sarcopenia in Africa was relatively high. However, the fact that the majority of included studies were hospital-based studies shows the necessity of further community-based studies in order to have a more accurate representation of the situation in the general population.

A Comparative Study of Unilateral Biportal Endoscopic Decompression and Percutaneous Transforaminal Endoscopic Decompression for Geriatric Patients with Lumbar Lateral Recess Stenosis

Purpose

The purpose of this research was to compare the efficacy of unilateral biportal endoscopic decompression (UBE) and percutaneous transforaminal endoscopic decompression (PTED) in the treatment of elderly patients with single-level lumbar lateral recess stenosis (LRS).

Materials and Methods

Data from January 2020 to March 2022 were analyzed. Thirty-eight patients in the PTED group and thirty-nine patients in the UBE group completed the minimum 12-month follow-up. The demographic data and perioperative outcomes were reviewed. Clinical outcomes were evaluated using the VAS for back and leg pain, the Oswestry Disability Index (ODI), and the modified MacNab criteria.

Results

Both groups of patients completed surgery and a one-year follow-up. There was no significant difference between the two groups in demographics data. UBE has the advantage in operative duration and X-ray time; as far as incision length, blood loss, and drainage volume are concerned, PTED is advantageous. Under the modified MacNab criteria, UBE exhibited a good-to-excellent rate similar to that of PTED (84.6% vs 81.6%, P>0.05). There were no significant differences at any point in time between UBE and PTED with respect to ODI, VAS, or back pain scores (P>0.05). UBE and PTED did not differ significantly in terms of complications.

Conclusion

Both PTED and UBE achieved favorable outcomes in single-level LRS. For operative time and X-ray times, UBE is more advantageous, while PTED offers better estimates of blood loss, incision length, and drainage volume.

Trends of the Global, Regional and National Incidence, Mortality, and Disability-Adjusted Life Years of Malaria, 1990-2019: An Analysis of the Global Burden of Disease Study 2019

Background

Malaria remains a substantial concern in the realm of public health on a worldwide level. Using information from the global burden of disease (GBD) 2019 for 204 countries and territories between 1990 and 2019, we assessed the burden of malaria.

Methods

Data on malaria were derived from the GBD 2019 study between 1990 and 2019. We evaluated the number of incidence, deaths, disability-adjusted life years (DALYs), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR), examining them across variables such as age, year, gender, country, region, and socio-demographic index (SDI).

Results

The burden of malaria decreased globally between 1990 and 2019. There were 2313.57×10⁵ incident cases and 6.43×10⁵ deaths in 2019, contributing to 464.38×10⁵ DALYs. Largest incident cases were observed in Western Sub-Saharan Africa [1151.72 (95% UI: 890.01-1527.17)] ×10⁵ in 2019. The only region where deaths increased between 1990 and 2019 was Western Sub-Saharan Africa. ASRs of malaria are distributed heterogeneously in different regions. The highest ASIR was observed in Central Sub-Saharan Africa [21,557.65 (95% UI: 16,639.4-27,491.48)] in 2019. From 1990 to 2019, the ASMR of malaria declined. Compared to other age cohorts, the ASIR, ASMR, and ASDR for children aged between 1 to 4 years were found to be higher. Worst-affected regions by malaria infection were the low-middle SDI region and low SDI region.

Conclusion

Malaria threatens global public health, especially in Central Sub-Saharan Africa and Western Sub-Saharan Africa. Children 1-4 years old continue to bear the most significant burden of malaria. The study's results will guide efforts to reduce malaria's impact on the global population.

The Milestones of Clinical Research for Young Generalist Physicians: Conducting and Publishing Studies

Clinical physicians have the potential to contribute to the progress of medicine and healthcare through research based on their diagnostic and treatment practices and supported by their educational background. However, in the field of general medicine in Japan, publication of such research in international journals may be limited by challenges in English proficiency and the lack of opportunities to focus on specific research themes amidst the diverse range of diseases treated in clinical practice. Furthermore, novice researchers without prior research experience may lack a comprehensive understanding of the overall research process, including study design and article publication. To address these challenges, we developed a set of 22 milestones that highlight the necessary skills required to conduct and successfully publish clinical research. This guideline will enable novice researchers to identify and address individual barriers to undertaking a research project. These milestones are categorized into five parts: 1) preparing to undertake research; 2) conducting clinical research; 3) writing the article; 4) submitting and achieving acceptance for publication; and 5) advanced skills. For each part, we provide detailed recommendations on the specific steps and methods involved. By working through these 22 milestones, novice researchers can objectively assess their own level of achievement as researchers and continuously clarify the next step of each round of research. Through this set of milestones, we aim to increase the quality and quantity of research publications in general medicine in academic journals, ideally enhancing the overall research process and advancing the field of medicine and healthcare overall.

Emotional Distress in a Patients Following Polytrauma

Introduction

Emotional affectivity can be described under two general dimensions: positive affectivity and negative affectivity. It is often assessed by means of questionnaires completed retrospectively by the subjects. The most common scales used are PANAS, DES, and PANA-X. All these scales are based on the concept of two dimensions, negative and positive affective emotions, respectively. Both dimensions mentioned, positive and negative affectivity, can be associated with a bipolar dimensional entity called pleasant-unpleasant. Specifically, a high level of positive emotions and a low level of negative emotions are associated with pleasant/positive feelings (happiness, well-being, satisfaction, cheerfulness, etc.), while a low level of positive emotions and a high level of negative emotions are associated with negative feelings (sadness, anger, nervousness, depression, anxiety, etc.).

Materials and Methods

This study is an observational and cross-sectional study. The elements that led to the production of the final database were collected by means of a questionnaire, which included 43 items, 39 of which were specific questions found in the affective distress profile. The questionnaire was administered to 145 patients who had suffered polytrauma and were admitted to the Emergency Hospital of Galati in October 2022. The final centralizing tables included the characteristics of 145 patients, aged between 14 and 64 years.

Results

The aim of this study is to identify the level of emotional distress in patients who have suffered polytrauma, so the following scores were evaluated, obtained after the application of PDA: STD, ENF, END. The total distress score was obtained by summing all the negative items found in the PDA questionnaire.

Conclusion

Men show a high level of emotional distress compared to women. Polytrauma has a negative effect on patients' emotional status, with a worrying prevalence of negative functional and dysfunctional emotions. The level of distress in polytrauma patients is high.

Student Performance on Course Objectives in a First-Year Medical School Foundational Science Course Correlate with USMLE Step 1 Scores

PURPOSE

Early identification of students at risk for poor United States Medical Licensing Examination^® (USMLE) Step 1 examination (Step 1) performance allows medical schools to provide targeted intervention for those students. Therefore, determination of metrics that identify struggling students is necessary for proper intervention. We hypothesize that; 1) student performance on pre-matriculation metrics will correlate with their Molecular and Cellular Foundations of Medicine (FDNS) course performance and 2) student performance in the FDNS course and on specific FDNS course objectives will correlate with their Step 1 performance.

METHODS

This was a retrospective cohort study analyzing data for students matriculating to the University of South Carolina School of Medicine Greenville in 2018 and 2019. Linear regression analysis was conducted to assess the correlation between pre-matriculation metrics, performance in the FDNS course, performance on FDNS objectives, and USMLE Step 1 performance. Adjusted R-squared (adjusted r²) values were compared with a p-value at <0.05.

RESULTS

The FDNS course grade correlated with pre-matriculation metrics of science undergraduate grade point average (uGPA), total uGPA, and the Medical College Admission Test (MCAT), adjusted r² of 0.139, 0.121, 0.223, respectively. The FDNS course grade showed a stronger correlation to USMLE Step 1 performance (adjusted r² = 0.257) than pre-matriculation metrics. USMLE Step 1 performance strongly correlated with FDNS course performance when two objectives, pertaining to anabolic and catabolic processes, regulation of cell cycle, and DNA replication and repair, were combined, adjusted r² of 0.357.

CONCLUSION

The FDNS course grade and performance on specific course objectives could serve as a predictor for USMLE Step 1 performance and provides a more targeted and concise approach to identification of low-performing students and subsequent intervention.

Clinicopathological Characteristics and Risk Factors for Rapid eGFR Decline in Chinese Patients with Biopsy-Proven Obesity-Related Glomerulopathy

AIM

To investigate the clinicopathologic features and the related risk factors for rapid estimated glomerular filtration rate (eGFR) decline in Chinese obesity-related glomerulopathy (ORG) patients.

METHODS

A total of 63 ORG patients, who underwent a renal biopsy and received follow-up for at least 12 months, were recruited in our study. These patients were classified as rapid decliners and slow decliners based on the eGFR slope value (-5.0 mL/min/1.73 m²/year). Logistic regression analysis was used to determine the risk factors for rapid eGFR decline.

RESULTS

Of the 63 ORG patients, 48 (76.2%) were male, the mean age was 38.7 ± 9.0 years, the median of urinary protein excretion was 1.62 g/24 h, 27.0% of them had nephrotic-range proteinuria, while hypoalbuminemia was observed in 7.9% of them. The incidence of obvious hypertriglyceridemia, hypertension, glucose dysmetabolism and hyperuricemia were 71.4%, 60.3%, 36.5% and 27.0%, respectively. 13 (20.6%) patients became rapid decliners during the median 45 months of follow-up. Their mean BMI was 31.8 ± 3.6 kg/m², the median of baseline eGFR and urinary protein excretion were 71.8 (range of 30.5-118.2) mL/min/1.73 m²/year and 3.57 g/24 h, respectively. Multivariate logistic regression analysis showed that smoking (OR 9.205, 95% CI 1.704-49.740, P = 0.01), hyperuricemia (OR 5.541, 95% CI 1.079-28.460, P = 0.04) and nephrotic-range proteinuria (OR 6.128, 95% CI 1.311-28.637, P = 0.021) were the independent risk factors for rapid eGFR decline.

CONCLUSION

Chinese ORG patients were more likely to have clinical characteristics with hypertriglyceridemia, hypertension and hyperuricemia, and mild to severe degrees of urinary protein excretion at diagnosis, while patients with nephrotic-range proteinuria lacked hypoalbuminemia and hypercholesterolemia. Smoking, hyperuricemia and nephrotic-range proteinuria were independent risk factors for rapid eGFR decline in ORG patients.

Prognostic Lysosome-Related Biomarkers for Predicting Drug Candidates in Hepatocellular Carcinoma: An Insilco Analysis

Background

Lysosomes play an important role in enhancing tumorigenesis and chemoresistance in hepatocellular carcinoma (HCC). Therefore, a detailed analysis of the role of lysosome-related genes could improve the poor prognosis of HCC patients.

Methods

Lysosome-associated genes were downloaded from the GO and Genome Enrichment Analysis (GSEA) databases. After analyzing lysosome-associated differentially expressed genes (DEGs) between the TCGA and GTEx cohorts, we used univariate Cox regression, LASSO-Cox regression, stepwise Cox regression, and multivariate Cox regression analyses to build a predictive risk model. The ICGC cohort was used as a test cohort for the prognostic signature's validation. It was also assessed how significantly the signature affected the tumor microenvironment (TME) and sensitivity to immune checkpoint inhibitors. To investigate the expression of this signature in clinical samples, qRT-PCR and immunohistochemistry (IHC) were carried out in 50 normal tissues and 59 HCC tissues.

Results

A total of 894 lysosome-associated genes were obtained. After identifying 113 lysosome-associated DEGs, we constructed a five-gene prognostic signature (RRAGD, AP1M2, CRHBP, NCSTN, and SLCO4C1) that can be effectively applied to the prognostic classification of HCC patients in TCGA and ICGC cohorts. Additionally, we discovered that this signature can affect the proportion of macrophage infiltration in TME. We also evaluated several tumor-sensitive medicines that affect this signature. Finally, we discovered that HCC tissues had lower amounts of CRHBP compared to normal tissues by the qRT-PCR and IHC assay.

Conclusion

We developed and validated a predictive signature of five lysosome-related genes for HCC patients and verified the downregulation of CRHBP expression in clinical samples, which may provide fresh perspectives for customized immunotherapy.

Ophthalmic Manifestations Among Patients Surviving COVID-19

Background and Aim

To identify ocular findings related to SARS-CoV-2 infection in patients after the resolution of COVID-19 using complete ocular examinations and optical coherence tomography (OCT).

Methods

In this cross-sectional study, conducted from May 30 to October 30, 2020, patients who recovered from various stages COVID-19 underwent eye examination and multimodal retinal imaging (Retinographies and Spectral-OCT).

Results

We included 50 patients, 29 (58%) males, median age of 46.5 [standard deviation 15.8]. Of these, 42% (21) had mild, 18% (9) had severe and 40% (20) had critical disease. The median time interquartile range (IQR) between symptom onset and ocular examination was 55 days [IQR 39-71]. Seven patients (14%) reported ophthalmic symptoms, transitory low visual acuity (6%) and retroocular pain (8%). On OCT, one patient without comorbidities had sectoral retinal pallor suggestive of acute retinal ischaemia and oedema of the retina's inner layers and atrophy. All findings progressively and spontaneously improved months after resolution of COVID-19.

Conclusion

Patients with COVID-19 present findings compatible with the general population depending on age and comorbidities; nevertheless, acute retinal findings associated with the disease may be present, such as caused either by the direct effects of retinal SARS-CoV-2 infection, by indirect effects of the cytokine storm or by the pro-thrombotic state associated with COVID-19. Therefore, retinal involvement in patients with COVID-19 remains subject to considerable discussion and study.

Innovations in Kidney Stone Removal

Urolithiasis is a common clinical condition, and surgical treatment is performed with different minimally invasive procedures, such as ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy. Although the transition from open surgery to endourological procedures to treat this condition has been a paradigm shift, ongoing technological advancements have permitted further improvement of clinical outcomes with the development of modern equipment. Such innovations in kidney stone removal are new lasers, modern ureteroscopes, development of applications and training systems utilizing three-dimensional models, artificial intelligence and virtual reality, implementation of robotic systems, sheaths connected to vacuum devices and new types of lithotripters. Innovations in kidney stone removal have led to an exciting new era of endourological options for patients and clinicians alike.

Epidemiology and Risk Factors of Convulsive Status Epilepticus Patients Admitted in the Emergency Department of Tertiary Hospital in Mogadishu, Somalia

INTRODUCTION

Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu.

METHODS

This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0-18 years) and adult group (18 years and above). Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated.

RESULTS

The mean age for pediatric patients was 6 (SD±4.7), while the mean age for adult patients was 38 (SD±10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years.

CONCLUSION

CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.

Systemic Therapy in Advanced Hepatocellular Carcinoma: Patient Selection and Key Considerations

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. Most patients with HCC have advanced disease at initial diagnosis, and sorafenib has been the only systemic treatment option for more than a decade in patients with advanced, unresectable HCC. However, there has been a dramatic change in the treatment algorithm in the last several years, given new drug approvals in the field. Most importantly, the combination of atezolizumab and bevacizumab has demonstrated clinically meaningful benefits in terms of response rate, progression-free survival, and overall survival compared to sorafenib in the first-line setting. Recently a phase III trial showed that the combination of durvalumab with a single dose of tremelimumab improved overall survival compared to sorafenib, while durvalumab monotherapy was found to be noninferior to sorafenib, making it an attractive alternative single agent in selected patient populations. As immunotherapy makes its way into the therapeutic landscape of HCC, other novel targeted therapies, such as lenvatinib, cabozantinib, ramucirumab, and regorafenib, have also been approved by regulatory authorities for treatment of advanced, unresectable HCC. This review article focuses on the first-line systemic treatment options for HCC while addressing some of the most important questions aimed at optimization of HCC treatment.

Prevalence of the Retro-Renal Colon: A Systematic Review and Meta-Analysis with Implications for Percutaneous Nephrolithotomy

BACKGROUND

This systematic review and meta-analysis aims to determine the prevalence of the retrorenal colon (RRC) and its implications in percutaneous nephrolithotomy with the overall objective of promoting the prevention of associated iatrogenic complications.

METHODS

A systematic search of literature was conducted on the electronic databases PubMed, ScienceDirect, and Hinari to identify studies eligible for inclusion. Search results were screened by title and abstract, and those potentially relevant were evaluated by full text. Studies were deemed eligible for inclusion if they reported clear extractable data regarding the prevalence of the retro-renal colon. A meta-analysis was completed using MetaX1 to calculate the pooled prevalence of the retro-renal colon. Sub-group analysis was performed based on geographical regions from which the studies originated, imaging modality, and patient position.

RESULTS

174 records were screened and a total of 10 records included in the analysis with retrospective cohort studies being the most common study design. A male predominance was seen in most sample sizes that had reported data on gender demographics ranging from 41.5-62%. The most common imaging modality utilized was computerized tomography (CT) scan followed by ultrasound. The range of the unweighted prevalence of retro-renal colon across all studies that had absolute numbers reported was from 3.5-25%. One of the studies reported a colonic perforation rate of 0.3% in patients without CT images.

CONCLUSION

The retro-renal colon is a relatively common finding with observed preponderance to females and left lateralization. The presence of RRC increases the likelihood of colon perforations while gaining percutaneous access to the kidney. Pre-procedural imaging can help detect its presence and choose an appropriate route of entry. USG and CT have both been found useful as a modality to pick up RRC.

The Treatment Based on Ruxolitinib and Amphotericin B is Effective for Relapsed Leishmaniasis-Related Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review

BACKGROUND

Hemophagocytic lymphohistiocytosis (HLH) is known as a life-threatening syndrome, and Leishmania is the most common protozoan that triggers infection-related HLH. It is thus important to find the root cause and treat it effectively.

CASE REPORT

This paper reports a 44-year-old man who developed antisynthetase antibody syndrome previously. The patient progressed rapidly to the extent of meeting the HLH-2004 diagnostic criteria, despite the unknown etiology. Although the patient was promptly treated in line with the HLH-1994 protocol to achieve remission, he still relapsed after glucocorticoid reduction. Afterwards, it was found out that HLH was secondary to Leishmania infection. The symptoms of HLH were alleviated quickly by the treatment with Ruxolitinib and Amphotericin B.

CONCLUSION

Etiological screening plays a crucial role in leishmaniasis-related HLH. An experienced pathologist and real-time PCR are essential for treating Leishmania. The treatment of Ruxolitinib and Amphotericin B proved effective in alleviating the relapse of visceral leishmaniasis-related HLH.

Treating and Managing Laryngopharyngeal Reflux Disease in the Over 65s: Evidence to Date

Purpose

The clinical presentation and therapeutic outcomes of elderly patients may be different from those in younger populations, leading to additional diagnostic and therapeutic difficulties. The present study reviewed the findings on the epidemiology, and clinical, diagnostic, and therapeutic outcomes of elderly patients with laryngopharyngeal reflux (LPR).

Methods

A PubMed, Cochrane Library, and Scopus literature search was conducted on the epidemiological, clinical, diagnostic, and therapeutic findings of elderly LPR patients.

Findings

The prevalence of LPR in the elderly population remains unknown. From a clinical standpoint, older LPR patients report overall lower symptom scores and related quality-of-life outcomes at the time of the diagnosis. The required treatment time to obtain symptom relief appears to be longer in older compared with younger patients. Particular attention needs to be paid to prolonged medication use because the elderly population is characterized by polypharmacy and there is a higher risk of proton-pump inhibitor (PPI) interactions and adverse events. The plasma clearance of most PPIs is reduced with age, which must be considered by practitioners in the prescription of antireflux therapy.

Conclusion

The clinical presentation and treatment efficacy of elderly LPR patients differ from those in younger patients. Practitioners need to carefully consider the risk of drug interactions and adverse events in elderly patients.

Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications

Purpose

Methods

Results

Conclusion

The Prognostic Value of Baseline Clinical and Radiologic Imaging Features in Patients with Unresectable Hepatocellular Carcinoma Treated with Atezolizumab Plus Bevacizumab

Purpose

To identify prognostic clinical and radiologic features in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab.

Patients and Methods

Clinical and imaging records of patients with unresectable HCC were retrospectively reviewed, and baseline features were recorded. Patients’ records and imaging studies were used to determine the patients’ overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analyses were performed to determine prognostic features. Subanalyses of treatment-naïve patients (who never received local or systemic therapy) and previously treated patients were also performed.

Results

Fifty-five patients were included in the final analysis, 23 (41.8%) of whom were treatment naïve. The median PFS and OS for the entire cohort were 3.0 months and 7.9 months. The 3-, 6- and 12-month OS rates were 85.5%, 79.8% and 45.7%, respectively. The 3-, 6- and 12-month PFS rates were 50.1%, 41.2% and 20.1%, respectively. On multivariate analysis, independent prognostic features for poor PFS of the entire cohort were pleural effusions (p = 0.047, HR: 6.3; CI: 1.03–38.90) and hepatic vein tumor thrombus (p = 0.005; HR: 23.37; CI: 2.63–207.67); independent prognostic features for poor OS were ascites (p = 0.008; HR: 37.37; CI: 2.53–467.64), pleural effusion (p = 0.003; HR: 110.17; CI: 5.00–2426.54), and low (<40HU) pre-contrast attenuation on CT images (p = 0.007; HR: 0.09; CI: 0.02–0.53). On subanalysis of treatment-naïve patients, the median OS and PFS were 7.4 months and 2.8 months, respectively. The 3-, 6- and 12-month PFS rates were 43.5%, 38.6% and 24.8%, respectively. Pleural effusion was the only independent poor prognostic feature (p = 0.036; HR: 206.34; CI: 1.41–30,167.58).

Conclusion

Independent prognostic features for survival outcomes include the presence of ascites, pleural effusions, hepatic vein tumor thrombus, and HCC with low attenuation (<40 HU) on unenhanced CT images. Although several biochemical variables were significant on univariate analysis, none were independent predictors of OS or PFS.

Ophthalmology Inquiries on Reddit: What Should Physicians Know?

Purpose

Patients are seeking answers to personal medical questions on social media. Reddit, a popular social media site, has been overlooked as a source of data in the field of ophthalmology. We analyzed posts in the subreddit, r/Ophthalmology, to better understand the most common ophthalmic conditions patients are discussing online and how often those making posts are being advised to seek professional medical care.

Patients and Methods

This cross-sectional study analyzed posts and comments from March 18, 2018 to November 9, 2020. All posts and comments on r/Ophthalmology are public and were accessed using the Python Reddit API Wrapper. This text was analyzed for unique references to common ophthalmic conditions and for mentions and recommendations to different types of medical care.

Results

Nine hundred and nineteen posts were collected from the above timeframe. An auto-moderator makes a comment on every post to discourage patients from asking personal medical questions. Despite this, over two-thirds of posts discussed medical treatment for eye conditions in either a post, comment, or both. Almost half of all posts mention “ophthalmology”, but only 9% go as far as to recommend ophthalmic care. One-third of posts have no reference to medical care. Within posts, flashes and floaters were the most common condition mentioned, making up 15% of unique mentions, followed by glaucoma (7.4%) and retinal detachments (6.7%). Within comments, cataracts were most commonly discussed, making up 12% of unique mentions, followed by glaucoma (8.9%).

Conclusion

These findings show that patients are seeking information about their eye health on the r/Ophthalmology subreddit and that Reddit users are engaging with these types of posts, instead of recommending professional care in most cases. It is important for ophthalmologists to recognize the most common conditions patients are asking about online and learn how they can do a better job of educating their patients in the office.

Modified Perineal Reconstruction Combined with Anal Sphincter Repair for Obstetric Anal Sphincter Injuries

Objective

The aim of this study was to investigate the clinical effectiveness of modified perineal reconstruction combined with anal sphincter repair in the treatment of obstetric anal sphincter injuries (OASIS).

Methods

Twenty consecutive patients with an OASI who underwent modified perineal reconstruction combined with anal sphincter repair in the Department of Colorectal and Anal Surgery of the First Hospital of Jilin University from October 2015 to September 2017 were retrospectively enrolled in this study. Anal function was evaluated using the Williams grade, the Wexner score, anorectal manometry, and transrectal ultrasound.

Results

Differences in both the Williams grade and the Wexner score prior to operation and following surgery indicated that anal function had improved, and these differences were statistically significant (P < 0.05). These indices also showed further improvement six months after surgery as compared with values at one month, and again, these differences were statistically significant (P < 0.05). In addition, anorectal manometry at six months following surgery showed statistically significant differences in the maximum anal resting pressure, maximum anal systolic pressure, and anal defecation pressure as compared with values prior to operation (P < 0.05). Postoperative endorectal ultrasound revealed that the anal sphincter presented with close imbricated overlapping.

Conclusion

Modified perineal reconstruction combined with anal sphincter repair in the treatment of female perineal defect is associated with a good clinical outcome, strengthening anal function, and reconstructing the perineum, and is a possible method for clinical treatment.

Patients’ Experiences with Management of Benign Paroxysmal Positional Vertigo: Insights from the Vestibular Disorders Association Registry

Introduction

Benign paroxysmal positional vertigo (BPPV) is the most frequently occurring peripheral vestibular disorder. Clinical practice guidelines (CPG) for BPPV exist; however, little is known about how affected patients perceive their condition is being managed. We aimed to leverage registry data to evaluate how adults who report BPPV are managed.

Material and Methods

We retrospectively analyzed of data from 1,262 adults (58.4 ± 12.6 years old, 81.1% female, 91.1% White) who were enrolled in the Vestibular Disorders Association Registry from 2014 to 2020. The following patient-reported outcomes were analyzed by proportions for those who did and did not report BPPV: symptoms experienced, falls reported, diagnostics undertaken, interventions received (eg, canalith repositioning maneuvers [CRMs], medications), and responses to interventions.

Results

Of the 1,262 adults included, 26% reported being diagnosed with BPPV. Many adults who reported BPPV (83%) also endorsed receiving additional vestibular diagnoses or may have had atypical BPPV. Those with BPPV underwent magnetic resonance imaging and were prescribed medications more frequently than those without BPPV (76% vs 57% [χ²=36.51, p<0.001] and 85% vs 78% [χ²=5.60, p=0.018], respectively). Falls were experienced by similar proportions of adults with and without BPPV (55% vs 56% [χ²⁼=11.26, p=0.59]). Adults with BPPV received CRMs more often than those without BPPV (86% vs 48%, χ²=127.23, p<0.001). More registrants with BPPV also endorsed benefit from CRMs compared to those without BPPV (51% vs 12% [χ²=105.30, p<0.001]).

Discussion

In this registry, BPPV was often reported with other vestibular disorders. Healthcare utilization was higher than would be expected with care based on the CPG. The rates of falls in those with and without BPPV are higher than previously reported. Adults with BPPV reported significant differences in how their care is managed and their overall outcomes compared to those without BPPV.

Conclusion

Patient-reported outcomes provide useful information regarding the lived experience of adults with BPPV.

From “Cure” to “Care”: The Role of the MultiDisciplinary Team on Colorectal Cancer Patients’ Satisfaction and Oncological Outcomes

Background

Methods

Results

Conclusion

Tumor DNA Methylation Profiles Enable Diagnosis, Prognosis Prediction, and Screening for Cervical Cancer

Background

DNA-methylation-based machine learning algorithms have demonstrated powerful diagnostic capabilities, and these tools are currently emerging in many fields of tumor diagnosis and patient prognosis prediction. This work aimed to identify novel DNA methylation diagnostic biomarkers for differentiating cervical cancer (CC) from normal tissues, as well as a prognostic prediction model to predict survival of CC patients.

Methods

The methylation profiles with the available clinical characteristics were downloaded from the Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA) program. We first screened out the differential methylation sites in CC and normal tissues and performed multiple statistical analyses to discover DNA methylation diagnostic markers that are used to distinguish CC and normal control. Then, we developed a methylation-based survival model to improve risk stratification.

Results

A diagnostic prediction panel consists of five CpG markers that could predict cervical cancer versus normal tissue with highly correct rate of 100%, and cg16428251, cg22341310, and cg23316360 which in diagnostic prediction panel all could yield high sensitivity and specificity for detection of CC and normal in six cohorts (area under curve [AUC] > 0.8), in addition to excellent performance in discriminating between CC and normal sample. The diagnostic marker panel also effectively predicted the CIN3 versus normal tissue with high accuracy in two datasets (AUC = 0.80, 0.789, respectively). Furthermore, a prognostic prediction model aggregated two CpG markers that effectively stratified the prognosis of high-risk and low-risk groups (training cohort: hazard ratio [HR] 4, 95% CI: 1.7–9.6, P = 0.0021; testing cohort: hazard ratio [HR] 1.9, 95% CI: 1.2–3.1, P = 0.0072).

Conclusion

The findings of our study showed that DNA methylation markers are of great value in the diagnosis and prognosis of CC.

Effect of Light Conditions and Accommodation on Implantable Phakic Contact Lens Vault by Anterior Segment Optical Coherence Tomography

Purpose

To investigate the dynamic pupil and vault changes in eyes with implantable phakic contact lens (IPCL) under photopic and scotopic settings, as well as during accommodation using the anterior segment optical coherence tomography (AS-OCT).

Methods

A prospective observational study included consecutive 36 eyes of myopic patients who underwent IPCL V2.0 implantation. Under photopic and scotopic light settings, as well as during accommodation, all patients were scanned using CASIA OCT (CASIA2; TOMEY, Nagoya, Japan). The pupil size, the vault (distance between the back surface of the IPCL and the anterior lens capsule), ACD-lens (distance between the posterior corneal surface and the anterior lens surface), IPCL-lens (distance between the posterior corneal surface and the anterior IPCL surface), and lens thickness (LT) were the study parameters.

Results

The vault was significantly lower under photopic conditions (p-value<0.001). The pupil size was significantly smaller in photopic conditions (p-value<0.001). LT (p-value=0.975) and ACD-lens (p-value=0.917) were not significantly different between scotopic and photopic conditions, while the ACD-IPCL was significantly larger during photopic conditions (p-value=0.013). There were significant changes in all parameters between accommodative and non-accommodative conditions.

Conclusion

The IPCL vault decreased significantly under photopic light conditions and accommodation.

Imaging and Chemical Analysis of External and Internal Ureteral Stent Encrustation

Introduction

Ureteral stents are effective in alleviating flow disruptions in the urinary tract, whether due to ureteral stones, strictures or extrinsic ureteral obstruction. However, significant stent encrustation on the external and/or internal stent lumen walls can occur, which may interfere with stent functioning and/or removal. Currently, there is only limited, generally qualitative, information on the distribution, mineral structure, and chemical content of these deposits, particularly in terms of stent lumen encrustation.

Objective

To quantify, in an initial investigation, external and internal encrustation in representative, intact ureteral stents. The study investigates possible correlations between patterns of external and internal encrustation, determines mineral structure and chemical composition, and examines the potential for stent lumen obstruction even in the absence of external stent wall encrustation.

Study Design

High-resolution, laboratory micro-computed tomography (micro-CT) was used to non-destructively image external and internal stent encrustation in four representative stents. X-ray diffractometry (XRD) and scanning electron microscopy–energy dispersive x-ray spectroscopy (SEM-EDS) enabled parallel analysis of mineral structure and chemical content of samples collected from external and internal encrusted material along the distal, proximal and mid-ureteral stent regions.

Results

Extensive stent lumen encrustation can occur within any region of a stent, with only incidental or minor external encrustation, along the entire length of the stent. External and internal encrusted materials in a given stent are generally similar, consisting of a combination of amorphous (mostly organic) and crystalline mineral deposits.

Conclusion

Micro-CT demonstrates that significant stent lumen encrustation can occur, which can lead to partial or full stent lumen occlusion, even when the exterior stent wall is essentially free of encrusted material.

Egyptian Consensus on the Role of Lung Ultrasonography During the Coronavirus Disease 2019 Pandemic

Background & Aims

Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic.

Methods

A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement.

Results

The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement.

Conclusion

Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.

Treatment and Outcome of Castleman Disease: A Retrospective Report of 31 Patients

Background

Castleman disease (CD) is a rare and heterogeneous lymphoproliferative disorder with a spectrum of characteristic pathological abnormalities of lymph node. Furthermore, its clinical diagnosis is very challenging until pathological results are available. This study aimed to investigate the clinical presentations, treatment and prognosis of CD, thereby improving the understanding and diagnosis of CD.

Methods

This study retrospectively analyzed the clinical data of 31 patients with CD admitted to the First Hospital Affiliated Hospital of Chongqing Medical University January 2013 to December 2020. The chi-square test and the Mann–Whitney rank sum test were employed to calculate between-group differences for categorical and quantitative data, respectively.

Results

Clinically, patients with unicentric CD (UCD) usually present with lymphadenopathy. However, the clinical presentation of patients with multicentric CD (MCD) ranged from mild lymphadenopathy with B-symptoms (5/8, 62.5%) to intense inflammation, vascular leak syndrome (3/8, 37.5%), hepatosplenomegaly (3/8, 37.5%), organ insufficiency (3/8, 37.5%), and even death (2/8, 25.0%). Compared with UCD patients, patients with MCD had significantly lower levels of hemoglobin (104 (90,129) vs 137 (120,149), p=0.018) and plasma albumin (31.5 (27.0,37.0) vs 45.0 (40.0,46.5), p=0.001), but IgG levels were significantly increased. Patients with UCD were mainly treated with surgical resection alone, with a five-year survival rate of 95.65%. When siltuximab is not an option, steroid plus rituximab-based chemotherapy and specific supportive care are common options for MCD. Except for 2 deaths, the remaining MCD patients have stable disease or partial remission.

Conclusion

CD describes a heterogeneous group of disorders characterized by morphologically benign lymphoid hyperplasia. Notably, patients with MCD present varying degrees of inflammation responses, even involving multiple systems. Surgery is a direct and effective way to diagnose and treat UCD. In the absence of IL-6 antagonists, anti-inflammatory and immunosuppressive therapeutic strategies, and cytotoxic clearance of cells responsible for hypercytokinemia could be adopted.