bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Recurrence Rate with some Characteristics in Patients with Thyroid Carcinoma
Authors: Tri Bui D. M. , Chi Bui D. P. , Hiep Bui T. , Trung Nguyen H. , Minh Tong D. , Dung Nguyen T. N. , Bui Thanh D. , Tran Viet Q. , Nguyen Hiep T.
Published: January 2024

Background:

Determining the clinical and subclinical characteristics related to the recurrence status in patients with a thyroid carcinoma has great significance for prognosis, prediction of recurrence and monitoring of treatment outcomes. This study aimed to determine the association between recurrence rate and some characteristics in patients with thyroid carcinoma.

Patients and Methods:

The study was conducted by descriptive method with longitudinal follow-up on 102 thyroid carcinoma patients at 103 Military Hospital, Hanoi, Vietnam, from July 2013 to December 2016.

Results:

Univariate analysis showed that there was a relationship between the recurrence characteristics in the studied patients and the characteristics of lymph node metastasis (P = 0.026; OR = 15; 95% CI = 1.4–163.2) and BRAF V600E mutation status (P = 0.01; OR = 3.41; 95% CI = 1.31–8.88). When analysing the multivariable Logistic regression model, there was a positive correlation between the occurrence of BRAF V600E gene mutation (P = 0.032; OR = 17.649; 95% CI = 1.290–241.523) and male sex (P = 0.036; OR = 12.788; 95% CI = 1.185–137.961) and the occurrence of recurrence in study patients. The mean time to relapse was earlier in male patients than in female patients (P = 0.02). The mean time to relapse in patients with the BRAF V600E mutation (31.81 ± 1.14 months) was shorter than the mean time to relapse in the group without the mutation (57.82 ± 2.08 months) (P = 0.01). The group of patients with mutations in the BRAF V600E gene increased the risk of recurrence compared with the group without the mutation (HR = 9.14, P = 0.04).

Conclusion:

There is a positive correlation between recurrence and masculinity, lymph node metastasis and the occurrence of BRAF V600E mutations in thyroid carcinoma patients.
Post-COVID-19 Vaccination and Thyrotoxicosis (ASIA Syndrome): Single-Centre Experience from India with Review of Literature
Authors: Singhal Vaibhav , Gupta Sushil
Published: January 2024

Introduction:

Thyrotoxicosis is not uncommon after immunization. It is known as ‘autoimmune/autoinflammatory syndrome by adjuvants (ASIA syndrome)’ and is caused by immunological reaction to adjuvants. However, there is insufficient information on thyrotoxicosis after COVID-19 vaccination in the Indian subcontinent.

Aims/Objectives:

To investigate the spectrum of thyrotoxicosis after COVID-19 immunization.

Settings and Design:

A single-centre retrospective study was conducted at a tertiary care academic institute in India.

Materials and Methods:

We studied the clinical symptoms, biochemical markers, imaging characteristics and treatment of every patient who was diagnosed with thyrotoxicosis within 60 days of receiving the COVID-19 vaccine.

Results:

Following COVID-19 vaccination, we diagnosed ten people (mean age 39.9 years, range 22-63 years) with thyrotoxicosis [Graves’ disease (GD, n-6) and subacute thyroiditis (SAT, n-4)]. The typical duration for symptoms to appear was 2 to 60 days. The majority of patients (n-9) received the COVISHIELD™ vaccine, whereas only one received the COVAXIN® vaccine. After vaccination, two patients with GD developed mildly severe Graves’ orbitopathy, with symptoms emerging two days and sixty days later, respectively. Anti-thyroid drugs (methimazole or carbimazole) were required for all GD patients. All SAT patients were treated conservatively with nonsteroidal anti-inflammatory medications and had positive outcomes.

Conclusions:

SAT, GD and GO may occur as a manifestation of ASIA syndrome, following immunization with COVISHIELD™ and COVAXIN®. Despite the obvious benefits of the COVID-19 vaccine, clinicians should be aware of any potential autoimmune and inflammatory thyroid problems.
Evolving Landscape of Diabetes Epidemic in Southeast Asia: Insights from National Family Health Survey
Authors: Gupta Rahul , Upadhyay Aashish , Kohli Shweta , Khadgwat Rajesh
Published: January 2024

Background:

Limited evidence on diabetes prevalence trends from the Indian subcontinent prompted this study to estimate the trends in diabetes prevalence using the National Family Health Survey (NFHS) data.

Method:

A cross-sectional survey carried out between 2015–2016 (NFHS-4) and 2019–2021 (NFHS-5) in a nationally representative sample of adults (aged 20 to 54 years) was used. Diabetes was defined as the presence of: diagnosed diabetes (self-reported), fasting plasma glucose (FPG) ≥ 126 mg/dl, or a random plasma glucose (RPG) ≥200 mg/dl. “Fasting” was defined as the last food intake >8 hours and “random” as irrespective of the last meal. Diagnosed diabetes was defined as the presence of “self-reported diabetes” and undiagnosed diabetes was defined as FPG > 126 mg/dl or RPG ≥200 mg/dl.

Findings:

The crude prevalence of total diabetes increased from 3.5% (95% confidence interval (CI): 3.46–3.55) in 2015–2016 to 3.99% (95% CI: 3.94–4.04) in 2019–2021, a relative change of 14%. The increase was more in the poorest (1.77% vs 2.48%; P < 0.001) as compared to the rich (5.35%% vs· 5.43%; P = 0.847), rural areas (2.71% vs 3.38%; P < 0.001) as compared to urban (4.95% vs. 5.26%; P = 0.051), in normal weight individuals (1.87% vs. 2.16%; P < 0.001) as compared to obese (7.12% vs. 7.03%; P = 0.384).

Interpretation:

While the absolute prevalence of diabetes is highest amongst individuals residing in urban areas belonging to the rich wealth centile, the relative increase in the prevalence is disproportionately higher in those residing in rural areas, belonging to the poorest wealth centiles and having normal weight.
Effect of Zoledronic Acid in Hepatic Osteodystrophy: A Double-Blinded Placebo-Controlled Trial
Authors: Raj Henith , Kamalanathan Sadishkumar , Sahoo Jayaprakash , Mohan Pazhanivel , Nagarajan Krishnan , Reddy Sagili V. B. , Durgia Harsh , Palui Rajan
Published: January 2024

Purpose:

Literature on the treatment of pre-transplant hepatic osteodystrophy (HOD) is limited. The general treatment measures and their timing are currently adopted from the literature on postmenopausal osteoporosis. Therefore, we conducted this randomized study to investigate the effect of zoledronic acid (ZA) on HOD.

Methods:

We randomized 36 male patients with cirrhosis (Child–Pugh class A and B) into 19 to the ZA arm and 17 to the placebo arm, respectively. Patients in the ZA arm received a single infusion of 4 mg ZA dissolved in 100 mL of normal saline at baseline, while patients in the placebo arm received a similar infusion of normal saline at baseline. The primary outcome of the study was the change in lumbar spine bone mineral density (LS-BMD) at 12 months.

Results:

Of 36 patients, 28 completed the study (15 in the ZA arm and 13 in the placebo arm). The mean increase in LS-BMD (g/cm2) in the ZA and placebo arms was 5.11% (3.50) and 0.72% (4.63) [P = 0.008], respectively. The trabecular bone score (TBS) did not improve significantly in either arm. The incidence of vertebral fractures (VFs) was similar in both arms. There was a significant decrease in plasma beta-C-terminal telopeptide (β-CTX) levels in the ZA arm compared to the placebo arm, while the change in plasma levels of procollagen 1 intact N-terminal propeptide (P1NP) was similar in both arms. Six patients (31.6%) in the ZA arm experienced adverse reactions such as fever and myalgia.

Conclusion:

ZA improved LS-BMD in male patients with HOD by decreasing bone resorption. However, it may not improve trabecular microarchitecture or prevent morphometric VFs in this population.
Incidence of Prostate Cancer in Transgender Women Undergoing Androgen Deprivation Therapy: A Review
Authors: Tyagi Saurabh , Tyagi Surbhi
Published: January 2024

Transwomen frequently undergo androgen deprivation therapy (ADT) incorporated with oestrogen, but they are still prone to the occurrence of prostatic cancer since the prostate remains intact. The probability of this clinical condition reduces as compared with the general male population. This study aimed to study the occurrence of prostatic malignancy under hormonal therapy such as ADT in transwomen. An extensive literature search was performed using online searches on transgender health, centring on the incidence, diagnosis, treatment and management of prostate cancer in transgender women. Original articles from 1975 to 2022 were searched using PubMed, Scopus, EMBASE, DOAJ and Cochrane databases. Physical, mental and communal deliberation of health development is the major constituent of trans-health. It exhibits a fivefold reduction in prostatic malignancies in transwomen undergoing hormonal therapy contrasted with the extensive male community of indistinguishable age.
Primary sclerosing encapsulating peritonitis
Authors: Mishra Swati , Chaudhary Kuldeep , Tyagi Swati , Mishra Pratibha , Misra Vatsala
Published: January 2024

Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3–4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.
Systemic xanthogranuloma involving bone marrow and skin in a case of B-Lymphoblastic Leukemia
Authors: Mundada Manasi C. , Ahmed Faiq , Kodandapani Suseela , Patil Veerendra
Published: January 2024

Juvenile xanthogranuloma is a benign self-limiting lesion commonly described in infants and young children. It most commonly involves the skin presenting as single or multiple yellowish-brown papules. Clinical scenario with the classic histomorphology showing histiocytic aggregates in the dermis with xanthomatous cytoplasm, toutan type giant cells, immunohistochemistry with positive CD68, CD163, factor XIIIa and negative CD1a and S-100 help in diagnosis. However, diagnosis becomes challenging with predominant systemic bone marrow involvement in post-B-lymphoblastic leukemia settings.
Primary extranodal NK/T cell lymphoma of stomach: A case report and review of literature
Authors: Mane Prashant , Ramteke Prashant , Singh Anand , Gogia Ajay , Mallick Saumyaranjan
Published: January 2024

Extranodal Natural killer/T (NK/T) cell lymphoma nasal type is an aggressive non-Hodgkin lymphoma and has a constant association with Epstein-Barr virus (EBV) infection. Approximately more than 75% cases are located in upper aero-digestive tract, of which stomach is a very rare site. Very few cases of gastric extranodal NK/T cell lymphoma have been reported in the literature. A 22-year-old male patient presented with complaints of abdominal pain and hematemesis. Endoscopy showed a large ulcer in the stomach. Partial gastrectomy done and histopathology showed transmural infiltration by intermediate size atypical lymphoid cells which are immunopositive for CD3, CD56, TIA, EBV-encoded RNA (EBER) and negative for CD4, CD8, CD20. A diagnosis of extranodal NK/T cell lymphoma nasal type was made.
Case of angioimmunoblastic T-cell lymphoma presenting as peripheral and bone marrow plasmacytosis: A diagnostic conundrum
Authors: Gupta Deepika , Jaine Nagarjun S. , Bairwa Sandeep K. , Thirunavukkarasu Balamurugan , Vishwajeet Vikarn , Purohit Abhishek H. L.
Published: January 2024

Angioimmunoblastic T-cell lymphoma (AITL), a subtype of peripheral T-cell lymphoma (PTCL), is associated with unique clinical, morphological, and immunohistochemical features. The peripheral circulation might show presence of an occasional reactive plasma cell but significant plasmacytosis masquerading as plasma cell leukemia is rare. We report a case of AITL in a 42-year-old male, who presented with two-month history of generalized lymphadenopathy. On investigations, he had hypergammaglobulinemia and plasmacytosis in the peripheral blood and bone marrow masquerading as plasma cell leukemia. Immunohistochemistry and serum protein electrophoresis revealed polyclonal nature of plasma cells. Diagnosis of AITL was made on cervical lymph node biopsy. This case highlights the diagnostic challenge faced due to heterogeneity in the clinical presentation and pathological findings and to alert the clinician so that timely accurate diagnosis can be made to initiate the treatment.
Expression of CD68+ Tumor associated macrophages in relation to β-catenin in carcinoma stomach
Authors: Sharma Nikhil , Panigrahi Ranjita , Pradhan Prita , Parida Sabyasachi , Sahoo Saroj R.
Published: January 2024

Background:

With no unified system for tumor associated macrophages (TAMs) density assessment, limited information is available on their relationship with β-catenin expression.

Aim:

To evaluate the density of CD68+ TAMs in gastric adenocarcinoma samples by immunohistochemistry and correlate it with grade, stage, invasion, and beta-catenin.

Designs and Settings:

Formalin fixed paraffin embedded (FFPE) blocks from gastrectomy specimens of proven gastric adenocarcinoma were prospectively and retrospectively were studied over a period of two years.

Materials and Methods:

Immunohistochemistry with CD68 and β-catenin was performed. TAM density was qualitatively compared in “tumor” versus “stroma” and “tumor” versus “non-tumor” regions. Quantitative CD68+ TAM density was assessed using different methods and compared. Cases were classified as high and low TAM based on the median value and correlated with histologic type, location, grade, stage and β-catenin expression pattern.

Statistical Analysis:

Spearman’s rank correlation test was used to compare the different methods of TAM density evaluation. The categorical variables were studied using Pearson’s Chi-square or Fisher’s exact test. CD68+ TAM density and β-catenin expression were correlated by analysis of variance. A P value ≤ 0.05 was taken as statistically significant.

Results:

The CD68+ TAMs in the “tumor” versus “non-tumor” area (p = 0.34) and “tumor” versus “stroma distribution” (p = 0.81) did not show any statistical significance. All methods of TAM density were found to be comparable. High TAM group is significantly associated with lymphovascular invasion, tumor depth, lymph node metastasis, and abnormal β-catenin expression.

Conclusion:

TAMs density plays an important role in the tumor stage. Macrophages may possibly induce gastric cancer invasiveness by activating β-catenin pathway.
Papillary urothelial neoplasm of low malignant potential with osseous metaplasia in a 19-year-old chronic smoker: A case report with review of literature
Authors: Gupta Rakesh K. , Wasnik Poonam , Sharma Amit R.
Published: January 2024

Urothelial tumors characteristically occur in elderly persons, more commonly in males with typical complaints of hematuria. Although few studies attempted to describe clinic-pathological features of urothelial malignancies in young patients, due to heterogeneity in the inclusion of age groups under “young patients” no reliable conclusions can be derived. Herein, we are describing an interesting case of papillary urothelial neoplasm of low malignant potential with osseous metaplasia in a 19-year-old chronic smoker young patient presented with chief complaints of abdominal pain with a review of the literature.
Resin related enterocolitis: An underreported co-occurrence
Authors: Mishra Sonali , Yadav Gajendra K. , Gupta Rohit , Kumar Arvind
Published: January 2024

Medication resins are often encountered in gastrointestinal biopsy specimens of patients being treated for renal compromise. As important as they are for the electrolyte equilibrium of the patients, they often come with a cost of fatal but reversible damage to the gastrointestinal tract. This often manifests as inflammatory bowel disease in the affected individuals. This misleading manifestation coupled with the lack of patient history further masks resin-related colitis from a pathologist’s eyes. Through this report, we convey how meticulous history-taking, representative endoscopic sampling, and recognition under the microscope are vital for timely reporting in conditions like this.
Plasmacytoid urothelial carcinoma with duodenal metastasis—A rare tumor with unusual site of metastasis with grim outcome
Authors: Chenniappan Aparna , Stephen Norton S. , Srinivas Bheemanathi H. , Sreenivasan Sreerag K. , Govindarajalou Ramkumar
Published: January 2024

Plasmacytoid urothelial carcinoma (PUC) is a newly recognized rare variant of urothelial carcinoma, which is now being increasingly diagnosed prospectively as well as by retrospective analysis of cases with a poor prognosis. Morphologically, these tumors simulate plasma cell neoplasms and pose a diagnostic challenge. Identifying this variant is essential in two aspects: therapy and prognosis. Here, we present a case who underwent multiple transurethral resection of bladder tumor (TURBT) procedures, each with a diagnosis of urothelial carcinoma, the plasmacytoid type which was confirmed on radical cystectomy, and after 1 year, the patient presented with duodenal metastasis. We discuss the morphological aspects of differentiating this tumor from variants of urothelial carcinoma and other tumors with a plasmacytoid appearance. Despite the recognition and aggressive treatment, the patient expires within 2 years of the first diagnosis of bladder carcinoma.
Extra-ocular sebaceous carcinoma - A rare case report
Authors: Sindhura Manda , Santosh Tummidi , Kumar Jarang Rajesh , Shankaralingappa Arundhathi , Pannerselvam Naresh Kumar , Balakrishna Pavithra
Published: January 2024

Sebaceous gland carcinoma is a rare and aggressive skin cancer derived from the sebaceous glands. Sebaceous carcinomas are divided into those occurring in ocular (75%) and extra-ocular locations. A 45-year-old female patient presented with rapidly growing swelling over the upper back region. It was provisionally diagnosed as an infected sebaceous cyst, and an excision biopsy was received in the pathology department. Histopathology was reported as sebaceous carcinoma, Grade II, Stage P T3 Nx. Immunohistochemistry was positive for epithelial membrane antigen. Sebaceous carcinoma accounts for 0.2–4.6% of all malignant cutaneous neoplasms, and the estimated rate of occurrence is only 1–2 per 1 million individuals per year. These tumors frequently present with a painless sub-cutaneous nodule, but they can also present as pedunculated lesions, irregular mass, or diffuse thickening of the skin. Hence, they are misinterpreted as other benign tumors or inflammatory conditions, thereby leading to delay in diagnosis, inappropriate treatment, increased morbidity, and mortality.
Single monoclonal spike characterized as double monoclonal gammopathy in a patient with multiple myeloma: A rare finding
Authors: Saijpaul Rajni , Khurana Vatsala , Verma Rashmi , Kaushik Smita
Published: January 2024

Multiple myeloma (MM) is associated with the secretion of a unique monoclonal protein (M-protein) due to overproduction of immunoglobulin (Ig) by a clone of abnormally proliferating plasma cells. However, in 4% of the cases more than one M-protein can be found. This category of gammopathies is called “double monoclonal gammopathies.” Here, we present a rare case of MM with double monoclonal gammopathy, where the presence of both M-proteins was observed in the single sharp peak on capillary zone electrophoresis (CZE). Further the interference of Hook effect is also discussed. Double monoclonal gammopathies need to be identified to increase diagnostic accuracy and reliability, and to get a better understanding of the disease pathogenesis and progression.
Orbital spindle cell hemangioma with acute presentation
Authors: Anand Aishwarya , Shanmugam Sridhar , Veluswamy Anand
Published: January 2024

We report an unusual presentation of an orbital spindle cell hemangioma in a 40-year-old male, who noted sudden redness and swelling of the left eye on waking up. On examination, the patient was found to have edema of upper eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage in the left eye at presentation. On treatment with topical medications, patient had transient symptomatic relief; however, he later developed blurring of vision. When seen 10 days later, the patient’s left eye showed axial proptosis. Radiological investigations revealed an intraconal soft tissue mass in the left medial rectus. Emergency orbital decompression with mass excision was done; histopathological examination of the excised mass revealed spindle cell hemangioma. Postsurgery patient had complete restoration of vision. To our knowledge, an acute presentation of an orbital hemangioma with subconjunctival hemorrhage and periorbital ecchymosis, visual loss doesn’t occur commonly; hence, such presentations have to be reviewed with care.
Physicians’ attitudes and confidence to dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia
Authors: Al-Awad Feras A. , Al-Zahrani Mohammed A. , Bawazeer Abdullah O. , Al-Qahtani Faisal S. , Al-Jabari Sulaiman A. , Jayaseeli Nithya J. , Alabdulkader Assim M. , Al-Harkan Khalid S. , Al-Shammari Malak O. , Mohammedin Ahmed S. , Rohaiem Shaimaa N. , Al-Muslim Nora I. , Al-Shurem Mohammed A. , Albakr Dalal M.
Published: January 2024

BACKGROUND:

Primary care physicians play an essential role in the health of older adults, as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills.

MATERIALS AND METHODS:

This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data was collected using a structured questionnaire that included questions related to demographic characteristics, number of dementia patients encountered, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables.

RESULTS:

The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding.

CONCLUSION:

Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.
Analyzing Cardiovascular Response in Neonates with Perinatal Asphyxia by Combining Echocardiographic, Electrocardiographic, and Biochemical Parameters: Collaborating Bench and Bedside in Low- and Middle-income Country Setups
Authors: Tomar Munesh , Goel Tanvi , Chaudhuri Maitri , Rastogi Anuj , Agarwal Vikas , Saxena Vineet
Published: January 2024

Background:

Perinatal asphyxia (PA) is a neonatal emergency causing multi-organ dysfunction, and neurological insult called hypoxic-ischemic encephalopathy (HIE). The traditional focus is on neuroprotection. However, the immature cardiovascular system simultaneously undergoes tremendous hypoxic-ischemic insult especially during the secondary phase of HIE. The hemodynamic consequences, comprehensive cardiac assessment, and care are often overlooked in bedside practice.

Objective:

The objective is to quantitatively document myocardial dysfunction in neonates with PA using electrocardiography (ECG), echocardiography, and cardiac enzymes (creatinine kinase-MB [CK-MB], B-type natriuretic peptide [BNP], and troponin I).

Design and Methods:

This was a single center, case–control prospective study. Sixty-four neonates with PA were enrolled. Myocardial function was assessed by clinical, ECG, echocardiography, and biomarkers assay. The same number of healthy neonates was taken as control.

Results:

15 (23.4%) had mild, 28 (43.7%) moderate, and 21 (32.8%) severe HIE in the case arm. Abnormal ECG was observed in 42 (65.6%), of which 20 (47.6%) had Grade I, 13 (30.9%) Grade II, 8 (19.04%) Grade III, and 1 (2.38%) had Grade IV changes. Serum levels of CK-MB, BNP and Troponin I were raised in 29 (45.3%), 30 (46.8%) and 10 (15.6%) neonates, respectively. Echocardiographic parameters such as ductal shunting pattern, mitral and tricuspid regurgitation, pulmonary hypertension, and systolic and diastolic ventricular function were significantly abnormal in cases versus controls as demonstrated by P value.

Conclusion:

Abnormal ECG, echocardiography, and cardiac enzymes in PA are markers and prognosticators of cardiac injury affecting overall outcomes in neonates with PA. Early detection can help in better management and survival of these neonates.
Transoral endoscopic thyroidectomy vestibular approach versus conventional open thyroidectomy for the treatment of benign thyroid tumours: A prospective cohort study
Authors: Ngo Quy Xuan , Ngo Duy Quoc , Le Duong The , Nguyen Duc Dinh , Tran Toan Duc , Le Quang Van
Published: January 2024

Introduction:

Thyroid tumours are a common condition and open surgery is a conventional method for treating benign thyroid tumours when surgery is indicated. In this study, we evaluate the outcomes of benign thyroid tumour treatment using transoral endoscopic thyroidectomy via vestibular approach (TOETVA) and compare the results with those of conventional open thyroidectomy (COT).

Patients and Methods:

We conducted a prospective cohort study between 100 patients who underwent TOETVA and 100 who underwent COT surgery for benign diseases from June 2018 to December 2021 in our hospital. Outcomes between the two groups, including post-operative complications, operative time and length of stay, were compared.

Results:

The surgical time in the TOETVA group was significantly longer than in the COT group. The operative time of lobectomy in the TOETVA and COT groups was 77.5 ± 13.3 and 51.5 ± 4.2 min, respectively, with a P < 0.001. The operative time of total thyroidectomy in the TOETVA and COT groups was 108.1 ± 7.0 and 65.0 ± 4.1 min, respectively, with a P < 0.001. There was no difference in post-operative length of stay between the two groups. In TOETVA group, there were no patients who converted to open surgery. Amongst all 200 patients in the study, there were no cases of post-operative bleeding. The transient hypoparathyroidism rate after surgery in the TOETVA and COT groups was 3% and 2%, respectively, with no statistically significant difference (P = 0.651). Similarly, the transient recurrent laryngeal nerve injury rate showed no difference between the two groups, with rates of 5% and 4% in the TOETVA and COT groups, respectively (P = 0.733). There were no cases of post-operative infection in either group in our study. At 3 months postoperatively, the cosmetic satisfaction were significantly higher in the endoscopic groups than in the conventional group (P < 0.001).

Conclusions:

TOETVA is a safe and effective method, with a low complication rate and optimal aesthetic results compared to traditional surgery to treat benign thyroid tumours.
Application of percutaneous biliary drainage in the treatment of post-operative bile leakage after liver rupture: A case report
Authors: Chen Jinlong , Wang Zhikuan , Zhang Lixin , Chen Xi , Liu Yuanyuan , Chen Hong , Tong Xiaoqiang , Dong Yanchao
Published: January 2024

Post-operative bile leakage (POBL) is a serious complication following hepatobiliary surgery, with potentially life-threatening consequences if left untreated. This article presents a successful case of POBL management without surgical intervention. A 31-year-old male, diagnosed with bile leakage before hospitalisation, underwent percutaneous biliary drainage (PTBD) to address bilomas. Follow-up after 3 months indicated biloma atrophy and POBL healing but revealed bile duct stenosis. The patient received a larger biliary drainage tube, and after 1 month, the biloma and tube were removed. A 1-year follow-up confirmed the patient’s excellent health. This case underscores the safety and efficacy of PTBD for managing POBL, offering a non-invasive alternative for patients with this complication. PTBD presents a viable treatment option for POBL cases, minimising the need for surgical interventions and their associated risks.
An Unusual Presentation of Carcinoma Urinary Bladder with Multiple Skeletal Muscle Metastasis
Authors: Dave Rushang Mukeshbhai , Kumar Vinod , Kumar Manish
Published: January 2024

ABSTRACT

Lymph nodes, bones, lungs, liver, and the peritoneum are common sites for bladder cancer metastasis. Skeletal muscle involvement is rare. We report the case of a 55-year-old male who has a poorly differentiated carcinoma of the urinary bladder with multiple skeletal muscle metastases.
Health literacy and self-care among patients with chronic kidney disease in a primary care setting
Authors: Ho Han-Kwee , Koh Eileen Yi-Ling , Abdullah Adina , Tan Ngiap-Chuan
Published: January 2024

Introduction:

The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD).

Methods:

This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21–80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0–240, domain range 0–80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0–50, limited literacy ≤33).

Results:

The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9–40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = −5.29, 95% CI −10.56 to −0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001).

Conclusion:

Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.
Caregivers’ Satisfaction with Telemedicine for Aural Rehabilitation of Cochlear Implant Patients during Coronavirus Disease 2019: A Cross-sectional Study
Authors: Hajr Eman , Almufleh Auroabah , Alotaibi Tahani
Published: January 2024

Objective:

During the coronavirus disease 2019 (COVID-19) pandemic, teletherapy was a reasonable alternative to in-person therapy. However, teletherapy has certain limitations, including technological issues, reduced rapport, and challenging difficulties in engaging with patients. Therefore, this study aimed to investigate the effectiveness of virtual rehabilitation sessions during the COVID-19 pandemic in children with cochlear implants (CIs).

Materials and Methods:

This cross-sectional study was conducted in a specialized tertiary care ear center to assess virtual aural rehabilitation after cochlear implantation during the COVID-19 pandemic. We included prelingually deaf children aged ≤7 years who underwent unilateral or bilateral CIs and were enrolled in aural rehabilitation with a minimum of one virtual rehabilitation session during the COVID-19 pandemic. Children with other disabilities or technical issues related to the implant devices were excluded. Parental experience and satisfaction with the virtual rehabilitation were evaluated using an interview-based questionnaire scored on a five-point Likert scale.

Results:

We recruited 34 participants, including 19 males (55.9%) and 15 females (44.1%). Only nine participants (26.5%) had siblings with CIs. None of the participants disagreed with the survey questionnaire. When caregivers were stratified based on their level of education, family experience with CIs, and place of residence, no significant differences were found in ease of access to the virtual sessions.

Conclusion:

High levels of satisfaction were observed between caregivers and professionals regarding usage comfort. However, future studies are required to evaluate the effectiveness of telemedicine rehabilitation compared with conventional methods, particularly after the COVID-19 pandemic, with respect to different age groups.
Clinical Practice Trends in Otolaryngology for the Prevention of Ear Ventilation Tube Blockage
Authors: Alenazi Abdulaziz Saud , Alzhrani Atheer Ahmad , Alshehri Waleed M. , Alherz Ahmed Hussain , Ashoor Mona Mohammed Saleh
Published: January 2024

Context:

Tympanostomy tube (TT) placement has become one of the most common surgical procedures performed in children. The tube drains fluid trapped behind the eardrum, thereby maintaining middle ear cavity ventilation and preventing hearing loss. One of the common postoperative complications is obstruction of the TT lumen.

Aims:

We aimed to identify common practices among general otolaryngologists (not subspecialized) and pediatric otolaryngologists for the prevention of middle ear TT blockage in children.

Settings and Design:

The design involves a cross-sectional, web-based survey.

Subjects and Methods:

The survey was conducted using Google Forms and delivered through e-mails to general and pediatric otolaryngologists between January and December 2022. Otolaryngologists of >2 years’ experience were included in the study.

Statistical Analysis Used:

For the descriptive analysis of the data, frequency, percentages, and bar diagrams were used. For inferential analysis, the Chi-square test was used to study the relationship between two categorical variables.

Results:

Among the 196 otolaryngologists who participated in this survey, 78 (39.8%), 68 (34.7%), 44 (22.4%), and 6 (3.1%) were residents, consultants, specialists, and fellows, respectively. A majority of the practitioners were pediatric otolaryngologists (n = 140, 71.4%). A higher proportion of respondents (60.5%) with <5 years of experience in ear, nose, and throat practice agreed that ear drops should be prescribed postoperatively, than respondents with >5 years of experience (44.2%) (P = 0.029).

Conclusions:

This study identified the different practices used for managing ventilation tube blockage postoperatively. Further studies are required to determine optimal approaches for the prevention of postoperative tube blockage.
Current treatment concepts for Achilles tendon rupture
Authors: Wang Chen-Chie , Chen Pei-Yu , Yang Kai-Chiang , Wang Chung-Li , Chen Ing-Ho
Published: January 2024

Achilles tendon rupture is a common and primary cause of lower limb tendon injury suffered during sports-related activities. The causes of Achilles tendon rupture include the calf muscle and tendon overuse, poor tendon quality, and various medical conditions. Historically, acute Achilles tendon rupture was treated conservatively. However, historical techniques are now associated with an increased risk of rerupture. To address this problem, open repair has been proposed. Open repair is associated with a reduced risk of rerupture; however, it is also closely associated with wound complications, like wound infection, whose treatment is time-consuming and costly. Therefore, minimally invasive Achilles tendon repair has been proposed as a promising option with acceptable functional outcomes. Nevertheless, despite its benefits, minimally invasive Achilles tendon repair is associated with increased risks of sural nerve injury and rerupture. In this review, we evaluate the currently used treatment strategies for acute Achilles tendon rupture and their historical evolution to provide evidence-based recommendations for physicians.
Tangential contact between free and fixed boundaries for variational solutions to variable-coefficient Bernoulli-type free boundary problems
Authors: Moreira Diego , Shrivastava Harish
Published: January 2024

In this paper, we show that, given appropriate boundary data, the free boundaries of minimizers of functionals of type

J(v;A,\lambda_+,\lambda_-,\Omega)=\int_{\Omega} ( \langle A(x)\nabla v,\nabla v \rangle + \Lambda(v))\,dx

and the fixed boundary touch each other in a tangential fashion. We extend the results of Karakhanyan, Kenig, and Shahgholian [Calc. Var. Partial Differential Equations 28 (2007), 15–31] to the case of variable coefficients. We prove this result via classification of the global profiles, as per Karakhanyan, Kenig, and Shahgholian [Calc. Var. Partial Differential Equations 28 (2007), 15–31].
Operator norm localization property for equi-approximable families of projections
Authors: M. Braga Bruno , Farah Ilijas , Vignati Alessandro
Published: January 2024

The rigidity problem for uniform Roe algebras was recently positively solved. Before its solution was found, there were positive solutions under the assumption of certain technical geometric conditions. In this paper, we introduce weaker versions of the operator norm localization property (ONL) which turn out to characterize those technical geometric conditions. We use this to obtain new rigidity results for nonmetrizable coarse spaces. As an application, we provide a novel partial answer to a question of White and Willett about Cartan subalgebras of uniform Roe algebras. We also study embeddings between uniform Roe algebras.
On the properties of the set where a generalized function of bounded variation takes an infinite value
Authors: Cucinotta Alessandro
Published: January 2024

We study the properties of the set where a generalized function of bounded variation has infinite approximate limit, highlighting in this way the main geometric difference with functions of bounded variation. To this aim, we prove a new result on strict approximation of the sets of finite perimeter from the outside with open sets.
Characterization of Coinfections in Patients with COVID-19
Authors: Pai Alexander , Kanji Zahra , Douglas James Joshua
Published: January 2024

Background: Little is known about coinfections in patients with COVID-19, with antibiotics often initiated empirically. Objectives: To determine the rates and characteristics of early and late coinfections in COVID-19 patients and to characterize the use of anti-infective agents, especially antibiotics.
Methods: This retrospective chart review involved patients with COVID-19 who were admitted to Lions Gate Hospital (Vancouver, British Columbia) between January 1 and June 30, 2020. Data were extracted from electronic medical records, and descriptive statistics were used to analyze the data.
Results: Of the 48 patients admitted during the study period, 10 (21%) were determined to have coinfections: 3 (6%) had early coinfections and 7 (15%) had late coinfections. Early empiric use of antibiotics was observed in 32 (67%) patients; for 29 (91%) of these 32 patients, the therapy was deemed inappropriate. Patients with coinfections had longer hospital stays and more complications.
Conclusions: Despite low rates of early coinfection, empiric antibiotics were started for a majority of the patients. Most late coinfections occurred in patients in the intensive care unit who required mechanical ventilation. Patients with coinfections had poorer outcomes than those without coinfections.
RÉSUMÉ
Contexte : On sait peu de choses sur les co-infections chez les patients atteints de COVID-19, les médicaments antibiotiques étant souvent initiés de manière empirique.Objectifs : Déterminer les taux et les caractéristiques des co-infections précoces et tardives chez les patients atteints de COVID-19 et caractériser l’utilisation d’anti-infectieux, en particulier les antibiotiques.
Méthodes : Cet examen rétrospectif des dossiers portait sur des patients atteints de COVID-19 qui ont été admis à l’hôpital Lions Gate, à Vancouver (Colombie-Britannique), entre le 1er janvier et le 30 juin 2020. Les données ont été extraites des dossiers médicaux électroniques et des statistiques descriptives ont été utilisées pour analyser les données.
Résultats : Sur les 48 patients admis au cours de la période d’étude, 10 patients (21 %) présentaient des co-infections : 3 patients (6 %) avaient des co-infections précoces et 7 (15 %), des co-infections tardives. Une utilisation empirique précoce d’antibiotiques a été observée chez 32 patients (67 %); pour 29 de ces 32 patients (91 %), le traitement a été jugé inapproprié. Les séjours à l’hôpital des patients co-infectés étaient plus longs et ils présentaient davantage de complications.
Conclusions : Malgré de faibles taux de co-infection précoce, des antibiotiques empiriques ont été instaurés pour la majorité des patients. La plupart des co-infections tardives sont survenues chez des patients de l’unité de soins intensifs nécessitant une ventilation mécanique. Les résultats des patients avec co-infections étaient moins bons que ceux sans co-infections.
Case-Finding for Sarcopenia in Community-Dwelling Older Adults: Comparison of Mini Sarcopenia Risk Assessment with SARC-F and SARC-CalF
Authors: Chua Shiyun , Chia Jia Qian , Lim Jun Pei , Chew Justin , Lim Wee Shiong
Published: January 2024

Background: We compared the diagnostic performance of the short five-item and full seven-item Mini Sarcopenia Risk Assessment Questionnaire (MSRA-5 and MSRA-7) against the Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and SARC-F with calf circumference (SARC-CalF) scales for sarcopenia in healthy community-dwelling older adults. Methods: We conducted a post-hoc cross-sectional secondary data analysis of a prospective cohort study, using data from 230 older adults (mean age 67.2±7.4 years, 92% Chinese, and 73% female) from the “Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study” (GeriLABS-2) conducted between December 2017 and March 2019 in Singapore. We performed receiver operating characteristic curve analysis to ascertain the area under the curve (AUC) for sarcopenia diagnosis using the Asian Working Group for Sarcopenia 2019 consensus criteria. We applied the Delong method to compare the AUCs of the four instruments.Results: The MSRA-5 and MSRA-7 demonstrated poor diagnostic performance (AUC of 0.511, 95% confidence interval [CI] 0.433–0.589 and AUC of 0.526, 95% CI 0.445–0.606, respectively), compared to that in SARC-CalF (AUC of 0.739, 95% CI 0.671–0.808) and SARC-F (AUC of 0.564, 95% CI 0.591–0.636). The SARC-CalF demonstrated significantly superior discriminatory ability compared to that in the SARC-F, MSRA-5, and MSRA-7 (all p<0.01). The MSRA-5 demonstrated lower sensitivity (0.464) and specificity (0.597) than in the SARC-CalF (0.661 and 0.738, respectively), whereas the MSRA-7 had higher specificity (0.887) and lower sensitivity (0.145).Conclusions: The poor diagnostic performances of the MSRA-5 and MSRA-7 in our study suggest limitations of self-reported questionnaires for assessing general and dietary risk factors for sarcopenia in healthy and culturally diverse community-dwelling older adults. Studies in different populations are needed to ascertain the utility of the MSRA for the community detection of sarcopenia.
Urinary exosomal microRNA-145-5p and microRNA-27a-3p act as noninvasive diagnostic biomarkers for diabetic kidney disease
Authors: Han Lu-Lu , Wang Sheng-Hai , Yao Ming-Yan , Zhou Hong
Published: January 2024

BACKGROUND

Diabetic kidney disease (DKD), characterized by increased urinary microalbumin levels and decreased renal function, is the primary cause of end-stage renal disease. Its pathological mechanisms are complicated and multifactorial; Therefore, sensitive and specific biomarkers are needed. Urinary exosome originate from diverse renal cells in nephron segments and partially mirror the pathological changes in the kidney. The microRNAs (miRNAs) in urinary exosome are remarkably stable and highly tissue-specific for the kidney.

AIM

To determine if urinary exosomal miRNAs from diabetic patients can serve as noninvasive biomarkers for early DKD diagnosis.

METHODS

Type 2 diabetic mellitus (T2DM) patients were recruited from the Second Hospital of Hebei Medical University and were divided into two groups: DM, diabetic patients without albuminuria [urinary albumin to creatinine ratio (UACR) < 30 mg/g] and DKD, diabetic patients with albuminuria (UACR ≥ 30 mg/g). Healthy subjects were the normal control (NC) group. Urinary exosomal miR-145-5p, miR-27a-3p, and miR-29c-3p, were detected using real-time quantitative polymerase chain reaction. The correlation between exosomal miRNAs and the clinical indexes was evaluated. The diagnostic values of exosomal miR-145-5p and miR-27a-3p in DKD were determined using receiver operating characteristic (ROC) analysis. Biological functions of miR-145-5p were investigated by performing Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment.

RESULTS

Urinary exosomal expression of miR-145-5p and miR-27a-3p was more upregulated in the DKD group than in the DM group (miR-145-5p: 4.54 ± 1.45 vs 1.95 ± 0.93, P < 0.001; miR-27a-3p: 2.33 ± 0.79 vs 1.71 ± 0.76, P < 0.05) and the NC group (miR-145-5p: 4.54 ± 1.45 vs 1.55 ± 0.83, P < 0.001; miR-27a-3p: 2.33 ± 0.79 vs 1.10 ± 0.51, P < 0.001). The exosomal miR-145-5p and miR-27a-3p positively correlated with albuminuria and serum creatinine and negatively correlated with the estimated glomerular filtration rate. miR-27a-3p was also closely related to blood glucose, glycosylated hemoglobin A1c, and low-density lipoprotein cholesterol. ROC analysis revealed that miR-145-5p had a better area under the curve of 0.88 [95% confidence interval (CI): 0.784-0.985, P < 0.0001] in diagnosing DKD than miR-27a-3p with 0.71 (95%CI: 0.547-0.871, P = 0.0239). Bioinformatics analysis revealed that the target genes of miR-145-5p were located in the actin filament, cytoskeleton, and extracellular exosome and were involved in the pathological processes of DKD, including apoptosis, inflammation, and fibrosis.

CONCLUSION

Urinary exosomal miR-145-5p and miR-27a-3p may serve as novel noninvasive diagnostic biomarkers or promising therapeutic targets for DKD.