bluuebunny/crossref_metadata_2025 huggingface dataset:
The many faces of secondary angle closure glaucoma: A practical approach to unveil
Authors: Venkataraman Prasanna , Kisthurmal Chetna , Ramanathan Anjana , Ramamoorthy Deepa , Mohan Neethu , Shroff Anahita
Published: September 2024

Background:

Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early.

Purpose:

As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management.

Synopsis:

This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same.

Highlights:

Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same.

Video link:

https://youtu.be/N0bIw7Uknww.
Clinicopathological presentations of eyelid malignancy in COVID era versus pre-COVID era
Authors: Mounica B , Pushker Neelam , Kashyap Seema , Sen Seema , Agrawal Sahil , Meel Rachna , Bajaj Mandeep S , Bakhshi Sameer
Published: September 2024

Purpose:

The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era.

Methods:

This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation.

Results:

In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities.

Conclusion:

During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future.
Clinico-microbiological Study on Otitis Externa (Necrotizing) in Patients with Diabetes Mellitus
Authors: Teronpi Mirbon , Bhattacharjee Abhinandan , Senapati Arup , Nath Sudip Kumar
Published: September 2024

Aim:

This study aims to find out the microbiological profile associated with necrotizing otitis externa (NOE) in patients with diabetes mellitus (DM).

Methods:

A prospective observational study was done from February 2022 to January 2023 in the patients diagnosed with OE with DM.

Results:

Out of 30 patients, 18 patients were male and 12 were female having DM presented with OE. The mean age was 60.53 ± 9.822. Severe night otalgia, otorrhea, and edema of the external auditory canal were present in all patients. Four cultures had no growth. whereas pus culture in 13 patients had Pseudomonas sp. and 5 patients in the study had mild conductive hearing loss. In 2 out of 30 patients, one had involvement of facial nerve causing facial nerve palsy and the other had facial nerve palsy along with injury to the glossopharyngeal nerve in high-resolution computed tomography findings.

Conclusions:

NOE is common in patients with DM mainly in the age group of 60–80 years. Pseudomonas sp. is the most commonly cultured microorganism.
Tinnitus Prevalence, Impact on Quality of Life, and Health-care-seeking Behavior among Adults: A Cross-sectional Study
Authors: Alkahtani Rania , Alkhalaf Alanoud , Aljabr Areej , Alharbi Deemah , Almulafikh Nojoud , Almotairi Shoug
Published: September 2024

Introduction:

Tinnitus, a widespread condition affecting millions globally, has a substantial impact on individuals’ quality of life. This study aimed to (1) explore the prevalence of tinnitus among adults in Saudi Arabia, (2) assess its impact on their quality of life, and (3) evaluate their inclination to seek medical support.

Materials and Methods:

A cross-sectional study was conducted using the Arabic version of the Tinnitus Handicap Inventory (THI) questionnaire.

Results:

A total of 4416 participants completed the survey, revealing a tinnitus prevalence of 37.6% (n = 1662). Among those affected, 39.7% sought medical support. The mean THI score was 16.7 indicative of mild handicap. Statistically significant associations were identified between age, gender, tinnitus duration, and the emotional subscale of the THI (P = 0.01, P = 0.01, and P < 0.001, respectively). Moreover, age, tinnitus duration, laterality, type, and persistence demonstrated statistically significant associations with seeking medical support (P < 0.001).

Conclusions:

Tinnitus prevalence among adults in Saudi Arabia is considerably high, with a higher occurrence in females and an association with advancing age. While tinnitus detrimentally affects the quality of life, a substantial proportion refrain from seeking medical support.
Clinical utility of computed tomography coronary calcium scoring in real-life practice
Authors: Kaushik Atul , Dey Nilashish , Jain Peeyush
Published: September 2024

BACKGROUND:

Cardiovascular disease remains one of the leading causes of morbidity and mortality. The need for the cardiovascular prevention is undeniable. Numerous risk scores are available for the same and current guideline shows the need for starting the statin therapy in high-risk individuals.

AIM:

To assess the clinical utility of CT coronary calcium scoring in real world.

OBJECTIVE:

To assess the use of CT coronary calcium scoring in patients with low to intermediate 10-year risk by modified Framingham risk score.

MATERIALS AND METHODS:

It was a cross-sectional retrospective study conducted at a tertiary cardiac care centre of Delhi from January 2024 to May 2024. Two hundred and twenty consecutive subjects were found to have low (10-year risk <10%) to intermediate (10-year risk 10%–19%) by modified Framingham risk score (FRS) based on conventional risk factor profiling and were advised CT coronary calcium scoring were selected. Based on calcium score, the subjects were reclassified into “low risk” (Agatston Score 0–100) or “high risk” (Agatston score >100).

RESULTS:

CTCA score of 129 patients with low- and intermediate modified FRS reclassified them into low risk (72.8%), high risk (6.2%), and very high risk (9.3%). Overall, 15.5% of patients at low and intermediate risk by modified FRS were reclassified as high risk or very high risk after calcium scoring.

CONCLUSION:

The re-evaluation of ASCVD risk by CT coronary calcium score prompted us to start statin therapy in 15.5% of our patients which is likely to reduce the incidence of future cardiovascular events.
Fibro-adipose vascular anomaly of the left forearm: A multifaceted exploration with molecular insights into the PIK3CA pathway
Authors: Meganathan Prabhu , Apoorva N. , Sathyanarayanaprasad Manjunatha
Published: September 2024

This case report delves into the intricacies of a fibro-adipose vascular anomaly in the left forearm, offering a comprehensive examination from clinical presentation to molecular analysis. The patient reported a protracted, slow-growing lesion with episodic pain exacerbated by activity. Microscopic scrutiny unveiled a heterogeneous histopathological landscape with abnormal vessels, skeletal muscle islands, and fibro-adipose tissue. Molecular investigation uncovered a PIK3CA mutation, spotlighting potential implications within the PI3K-Akt signaling pathway.
Improvised polarising light microscopy using low-cost linear polarised film sheets: An experience in a low-resource pathology laboratory setting in Nigeria
Authors: Folaranmi Olaleke Oluwasegun , Ibiyeye Kehinde Muibat , Fodeke Israel Olayinka , Ighodalo Ehigie Joshua , Olayiwola Oladunni Ismail , Balogun Abdulquadri
Published: September 2024

Background:

Polarizing microscopy is widely used in pathology to demonstrate the deposition of endogenous materials, the presence of anisotropic exogenous in tissue samples and to evaluate materials that demonstrate optical birefringence. Polarizing microscopes are costly and can cost up to several thousands in dollars; a cheaper alternative includes using a regular light microscope with polarizer kits but this may also be out of reach in low-resourced pathology practice.

Aims/Objectives

The aim is to share our experience with the use of improvised polarizing film to demonstrate birefringence in tissue samples.

Materials and Methods:

Two films measuring 6x7cm were cut out from generic linear polarizing films procured from an online store. The cutout films were placed on each other and crossed such that their polarizing planes were at a right angle. While maintaining this polarizing plane, one of the films was placed over the light source (polarizer) and the other over the slide (analyzer). The light microscope was adjusted for desirable intensity and contrast.

Results:

Tissue sections of suture granuloma, gout, and medullary thyroid carcinoma were used for demonstrating birefringent suture material, brightly anisotropic urate crystals, and birefringent amyloid deposits respectively.

Conclusion:

We present a practical and cost-effective solution for performing polarizing microscopy in low-resource pathology laboratory settings using linear polarizing films.
A study of patterns of peripheral neuropathy in chronic kidney disease patients on maintenance hemodialysis with and without type 2 diabetes mellitus: Our experience from tertiary care centres in South India
Authors: Jasti Dushyanth , Mulpuri Niharika , Mallipeddi Sarat , Anumolu Apparao , Vengamma Bhuma , Sivakumar V
Published: September 2024

Objective:

To study the prevalence, clinical features, electrophysiological features, and severity of peripheral neuropathy in chronic kidney disease (CKD) patients on maintenance hemodialysis and the effect of the presence of diabetes mellitus.

Materials and Methods:

200 CKD patients on maintenance hemodialysis were assessed prospectively for peripheral neuropathy.

Results:

Prevalence of peripheral neuropathy was 45% based on clinical symptoms and 98% based on electrophysiological parameters. The mean age was 54.4 ± 10.4 years and 70% were male. 100 patients (50%) had positive symptoms and 48 patients (24%) had negative symptoms. Autonomic symptoms were seen in 8 patients (4%). Definite damage was seen in 144 patients (72%) and early damage was seen in 52 patients (26%). In hemodialysis patients with diabetes mellitus (n = 100), 92 patients (92%) had definite damage. In hemodialysis patients without diabetes mellitus (n = 100), 52 patients (52%) had definite damage. In CKD patients on hemodialysis, patients aged >50 years (definite damage in 77.4%) and males (definite damage in 82.9%) showed more severe peripheral neuropathy compared to patients aged ≤50 years (definite damage in 57.9%) and females (definite damage in 46.7%). The most common nerves involved were sural nerve, common peroneal nerve, and ulnar sensory nerve. The most common pattern was mixed axonal sensorimotor polyneuropathy.

Conclusion:

Peripheral neuropathy is common in CKD patients on hemodialysis with higher prevalence and severity in elderly males and diabetics. Early and effective management of diabetes and use of high-flux dialyzers in CKD patients on hemodialysis probably lowers the prevalence and severity of peripheral neuropathy.
Predictive analytics for “SMART”er hospitals and health care: Virtuality versus reality
Authors: Pattanshetty Renu
Published: September 2024

Healthcare is a booming sector of economy in many countries including India. With the boom and the growth comes the challenges that include exorbitant costs, inefficiencies in the healthcare delivery, complexities involving the disease status, diagnosis, treatment, and recovery. Predictive Analytics” is an advanced form of analytics and has gained a scientific repute as the “BIG DATA” related to health care. It is a branch of data engineering that predicts true existences and/or probability by utilizing the existing data that would use the “data mining method” to predict two things that would happen in the future providing necessary advice. Predictive analytics uses artificial intelligence, statistical methods to reveal surprising results which physician or clinician would never suspect. It would help hospital management, pharmaceutical companies, insurance providers to seek changes from the past treatment approach, adopt latest medical research like fewer complications, shorter hospital stay, and fewer readmissions to name a few. . Prediction using real-time data is the golden key to quality patient care and boost to health economy.
Awareness and perception of consumers regarding food labels on packaged foods with special emphasis on front of package labels
Authors: Patil Purva D. , Kulkarni Meenal V. , Saoji Ajeet V.
Published: September 2024

Background:

The purpose of food labeling is to tell consumers about important information–nutritional facts and ingredients of the food they purchase. Nowadays, noncommunicable diseases cause high morbidity as well as mortality. Awareness regarding food labels helps consumers make healthy food choices which result on the prevention of noncommunicable diseases. A number of front of package labeling systems have arisen during the past 10 years with the goal to improve the effectiveness of nutritional labeling.

Objectives:

1) To find out the attitude and practices of consumers regarding food labels on packaged foods 2) To study the perception about different types of front of package labels (FOPL).

Methods:

Following institutional ethics committee approval, a semistructured, pretested, and prevalidated questionnaire was used to collect data by circulating as Google Forms. Besides sociodemographic information, it also covered consumers’ attitudes and practices regarding food labels on packaged foods. Data was then analyzed using EPI INFO software.

Result:

85.4% of the participants consumed packaged food. Although 70.3% read the food labels, only 58.5% read nutritional information on labels. Thirty-one percent have not noticed any of the given labels on the front of the package. 89.6% of respondents agreed that labels on the front of a package convey nutritional information in a better manner. 72.8% of participants were alerted by warning labels.

Conclusion:

The practice of reading nutritional labels on packaged foods and awareness regarding FOPL was found to be low. There is a need to increase awareness regarding nutritional labels among Consumers.
Evaluation of antihypertensive drugs use in a tertiary hospital setting – A cross-sectional study
Authors: Buchineni Madhavulu , Reddy Jeevimani V. S. , Saritha M. , Souris Kondavedti , Neeraja Pothula , Kudagi B. L. , Chandra Vurimi B. , Nelavala Anjani D.
Published: September 2024

Background:

Hypertension, a well-known risk factor for cardiovascular diseases, significantly impacts life expectancy. Managing antihypertensive medications effectively is critical in this context.

Aim:

To analyze prescription patterns of antihypertensive drugs.

Method:

This cross-sectional study, spanning six months within the Department of General Medicine, investigated physicians’ prescribed treatment regimens.

Results:

Most patients fall within the 51–60 age group (35.56%). Notably, males represent the majority demographic (68.15%). Among comorbidities, diabetes mellitus emerged as the most prevalent (51.85%), followed by chronic obstructive pulmonary disease (22.22%). Monotherapy dominated (68.15%), with amlodipine reigning as the most prescribed single medication. Combination therapy was utilized in 31.85% of cases, with amlodipine again playing a prominent role.

Conclusion:

All prescribed regimens were deemed rational. Amlodipine emerged as the most commonly prescribed monotherapy medication, while combination therapy targeted patients with more complex hypertension cases. Interestingly, amlodipine remained the most frequent drug even within combination regimens.
Role of magnetic resonance imaging in evaluation of perianal fistulas
Authors: Narra Ramakrishna , Janam Revanth , Kamaraju Suseel K.
Published: September 2024

The term “fistula in ano” refers to an aberrant track connecting the anal canal with the perineum and is one of the common anorectal disorders.[1] It is a common disorder that affects both men and women with male predominance and can cause substantial discomfort and pain. Therefore the effective management of a perianal fistula is crucial to avoid complications, including abscess development, incontinence, and recurrence. Identification of the fistula’s internal opening, the primary source of cryptoglandular infection, the path of the primary track, and the location of any secondary tracks or abscesses are all crucial for effective fistula care.MRI(Magnetic resonance imaging) of the pelvis is the preferred imaging modality to detect and evaluate perianal fistulas due to its high spatial resolution and multiplanar capabilities, which provide exquisite details of the pelvis.
The Role of Combined Treatment of Granulocyte Colony-stimulating Factor and Oestrogen in Treatment of Thin Endometrium: A Rat Model
Authors: Kahyaoglu Inci , Kaplanoglu Gülnur Take , Erol Gökçe Nur Arik , Kahyaoglu Serkan
Published: September 2024

Background:

Thin endometrium, described as endometrial thickness below 7 mm on embryo transfer day in assisted reproduction cycles, is associated with decreased pregnancy rates. Granulocyte colony-stimulating factor (G-CSF) and oestrogen (E) are two medications used for treatment.

Aim:

The aim of this study is to demonstrate the effect of combined G-CSF+E treatment on thin endometrium in a rat model.

Settings and Design:

Gazi University Laboratory Animals Breeding and Experimental Researchers Center provided the veterinary care.

Materials and Methods:

Forty-eight female rats were divided into 8 groups (6 rats/group). Groups were named as group 1: control, group 2: control that received G-CSF, group 3: control that received E, group 4: control that received G-CSF+E, group 5: thin endometrium model, group 6: thin endometrium model that received G-CSF, group 7: thin endometrium model that received E and group 8: thin endometrium model that received G-CSF+E. Twelve days after the establishment of thin endometrium model, G-CSF and/or E treatment was started and continued for 5 days according to the groups. Tissue specimens were collected at the end of the treatment period. Proliferation, apoptosis and angiogenesis were evaluated.

Statistical Analysis Used:

The data were analysed using one-way analysis of variance and Tamhane post hoc test.

Results:

Significant increase in uterine wall and endometrial thickness was detected in the thin endometrium + G-CSF group when compared to the thin endometrium group. G-CSF was demonstrated to cause an extensive proliferative response and induction of angiogenesis in thin endometrium without restoration of endometrial glands. E alone restored thin endometrium to almost normal histology. Morphological changes representing the dominant effects of G-CSF were observed in thin endometrium model receiving G-CSF+E.

Conclusion:

G-CSF+E is not an effective treatment modality in thin endometrium rat model.
Does Serum Estradiol Prior to Progesterone Administration in Programmed Frozen Embryo Transfer Cycle Impacts Live Birth Rate: A Prospective Cohort Study
Authors: Singh Neeta , Saisree Bakkireddy , Malhotra Neena , Kumari Supriya , Mahey Reeta , Nisha  , Saini Monika
Published: September 2024

Background:

There is a paucity of data on the optimal threshold of oestradiol (E2) levels required for successful implantation as this is a valid question to be answered, considering that significant number of in vitro fertilisation cycles are deferred for FET cycles.

Aim:

The aim of this study is to investigate the serum E2 levels before starting exogenous progesterone in artificial autologous frozen thawed embryo transfers on pregnancy outcomes.

Settings and Design:

This was a cohort study wherein clinical data of 213 artificial autologous programmed hormone-regulated frozen embryo transfer (HR-FET) cycles were collected.

Materials and Methods:

The HR-FET cycles were divided into three groups based on the E2 levels before starting progesterone: Group A: E2 ≤300 pg/mL, Group B: E2 301–500 pg/mL and Group C: E2 >500 pg/mL. After adequate endometrial stripe was appreciated by transvaginal ultrasonography, single blastocyst transfer was performed in all the cycles.

Statistical Analysis Used and Results:

The clinical pregnancy rate (CPR) in Groups A, B and C were 41.8%, 73.5% and 0.95%, respectively (P = 0.0001). The live birth rate (LBR) in Groups A, B and C was 18.1%, 62.2% and 0%, respectively (P = 0.0001). The miscarriage rate (MR) was significantly lower (15.3%) when E2 was between 301 and 500 pg/mL (P = 0.001). At both the extremes of serum E2 values, the rate of miscarriage increased. If serum E2 levels were ≤300 pg/mL or >500 pg/mL, the rate of miscarriage was 56.5% and 100%, respectively.

Conclusion:

Serum E2 levels in the range of 301–500 pg/mL before starting progesterone in programmed FET cycle are associated with an improved CPR and LBR and also decreased MR as compared to the extreme values of E2 ≤300 pg/mL or >500 pg/mL.
Is there a Possible Association between Multiple Myeloma Relapse and Coronavirus Disease 2019 Vaccination? A Case Report
Authors: Shirzad-Yazdi Nasrin , Namdari Nasrin , Noorani Anahid , Karimzadeh Iman
Published: September 2024

ABSTRACT

Due to the high morbidity and mortality of the coronavirus disease 2019 (COVID-19) in patients with malignancy, the necessity of vaccination in this group of patients became particularly important. Although a large number of studies have reported the safety of COVID-19 vaccination in multiple myeloma (MM) patients, the effect of the COVID-19 vaccine on MM relapse has not yet been reported. Here, we report a case of a possible association between relapse of MM and COVID-19 vaccination with Sinopharm®, an inactivated virus vaccine, in a patient with MM who has remained in complete remission for about 4 years. The MM relapse in the patient was diagnosed by both clinical findings and laboratory workup including serum protein electrophoresis, bone marrow aspiration, and biopsy. Despite this possible association between COVID-19 vaccination and MM relapse in the patient, given its importance in reducing mortality and having an acceptable safety profile, the COVID-19 vaccine should be administered to all cancer patients. However, careful monitoring and follow-up are recommended in patients with MM after COVID-19 vaccination.
Clear lens extraction and refractive lens exchange for the treatment of amblyopia
Authors: Sun Emily , Kraus Courtney L.
Published: September 2024

Treatment of amblyopia typically involves spectacles or penalization of the nonamblyopic eye with occlusive patching or pharmacological penalization. However, these methods can be ineffective or difficult in certain children who may be unable to tolerate or are poorly compliant with such therapies. Untreated high refractive error can result in dense amblyopia, and thus, other treatment methods are necessary in this subset of children. With technological advances in ocular surgery, clear lens extraction (CLE) and refractive lens exchange (RLE) have emerged as popular alternative treatments for amblyopia, as they may avoid some of the challenges surrounding traditional methods. CLE involves lensectomy for refractive purposes in patients without cataracts, while RLE involves lensectomy followed by intraocular lens implantation. The purpose of this review was to summarize the use of CLE and RLE for the treatment of amblyopia in the pediatric population, discussing indications, techniques, treatment outcomes, safety, and potential complications.
Changes over time in treatment for obstructive jaundice
Authors: Aoki Hideki
Published: September 2024

This editorial discusses an article by Peng et al . This study reviewed the efficacy and safety of a new approach for treating obstructive jaundice. Although the pathophysiology of obstructive jaundice has not yet been fully elucidated, progress has been made in its management. There are two aspects of obstructive jaundice: Cholestatic status and absence of bile in the intestinal lumen. Internal biliary drainage resolved both the conditions. Clinically, endoscopic retrograde biliary drainage (ERBD) has replaced percutaneous transhepatic biliary drainage, and ERBD is transitioning to endoscopic ultrasound guided biliary drainage. This editorial briefly explains the mechanism and treatment of obstructive jaundice and the prospects of this new internal biliary drainage technique.
Single incision laparoscopic surgery for hepatocellular carcinoma
Authors: Karabicak Ilhan , Yildirim Kadir , Gursel Mahmut Fikret , Malazgirt Zafer
Published: September 2024

Single incision laparoscopic liver resection (SILLR) is the most recent development in the laparoscopic approach to the liver. SILLR for hepatocellular carcinoma (HCC) has developed much more slowly than multiport LLR. So far, 195 patients completed SILLR for HCC. In this paper, we reviewed all published papers about SILLR for HCC and discussed the feasibility of the SILLR, peri and postoperative findings, tricks of patient selection and whether SILLR compromise the oncological principles.
Clinical significance of peri-appendiceal abscess and phlegmon in acute complicated appendicitis patients undergoing emergency appendectomy
Authors: Min Ling-Qiang , Lu Jing , He Hong-Yong
Published: September 2024

BACKGROUND

Although antibiotic therapy has become the primary treatment for acute uncomplicated appendicitis, the management of acute complicated appendicitis necessitates careful consideration of various treatment options.

AIM

To analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon, identify factors influencing the postoperative length of hospital stay (LOS), and improve treatment strategies.

METHODS

The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at The Department of Emergency Surgery, Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed.

RESULTS

A total of 234 patients were included in our study. The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis (P < 0.001 and P = 0.015, respectively). Patients with symptoms lasting longer than 72 h had a significantly longer postoperative LOS compared to those with symptoms lasting 72 h or less [hazard ratio (HR), 1.208; 95%CI: 1.107-1.319; P < 0.001]. Additionally, patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon (HR, 1.217; 95%CI: 1.095-1.352; P < 0.001). The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess: Those with abscesses smaller than 5.0 cm (n = 69) and those with abscesses 5.0 cm or larger (n = 82). Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm (P = 0.038).

CONCLUSION

The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis. Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.
Postoperative serum tumor markers-based nomogram predicting early recurrence for patients undergoing radical resections of pancreatic ductal adenocarcinoma
Authors: He Hang , Zou Cai-Feng , Yang Feng , Di Yang , Jin Chen , Fu De-Liang
Published: September 2024

BACKGROUND

Early recurrence (ER) is associated with dismal outcomes in patients undergoing radical resection for pancreatic ductal adenocarcinoma (PDAC). Approaches for predicting ER will help clinicians in implementing individualized adjuvant therapies. Postoperative serum tumor markers (STMs) are indicators of tumor progression and may improve current systems for predicting ER.

AIM

To establish an improved nomogram based on postoperative STMs to predict ER in PDAC.

METHODS

We retrospectively enrolled 282 patients who underwent radical resection for PDAC at our institute between 2019 and 2021. Univariate and multivariate Cox regression analyses of variables with or without postoperative STMs, were performed to identify independent risk factors for ER. A nomogram was constructed based on the independent postoperative STMs. Receiver operating characteristic curve analysis was used to evaluate the area under the curve (AUC) of the nomogram. Survival analysis was performed using Kaplan-Meier survival plot and log-rank test.

RESULTS

Postoperative carbohydrate antigen 19-9 and carcinoembryonic antigen levels, preoperative carbohydrate antigen 125 levels, perineural invasion, and pTNM stage III were independent risk factors for ER in PDAC. The postoperative STMs-based nomogram (AUC: 0.774, 95%CI: 0.713-0.835) had superior accuracy in predicting ER compared with the nomogram without postoperative STMs (AUC: 0.688, 95%CI: 0.625-0.750) (P = 0.016). Patients with a recurrence nomogram score (RNS) > 1.56 were at high risk for ER, and had significantly poorer recurrence-free survival [median: 3.08 months, interquartile range (IQR): 1.80-8.15] than those with RNS ≤ 1.56 (14.00 months, IQR: 6.67-24.80), P < 0.001).

CONCLUSION

The postoperative STMs-based nomogram improves the predictive accuracy of ER in PDAC, stratifies the risk of ER, and identifies patients at high risk of ER for tailored adjuvant therapies.
Massive simultaneous hepatic and renal perivascular epithelioid cell tumor benefitted from surgery and everolimus treatment: A case report
Authors: Yang Han-Teng , Wang Fu-Rong , He Na , She Yuan-Hua , Du Yong-Yue , Shi Wen-Gui , Yang Jing , Chen Gang , Zhang Shu-Ze , Cui Feng , Long Bo , Yu Ze-Yuan , Zhu Jun-Min , Zhang Geng-Yuan
Published: September 2024

BACKGROUND

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm that predominantly affects the kidney and uterus. The occurrence of this tumor in the liver, particularly with simultaneous involvement of the liver and kidney, is exceedingly uncommon. Pathological diagnosis is the gold standard. PEComas usually show positive immunohistochemical staining for melanocytic (HMB-45, Melan-A) and myoid (SMA, muscle-specific actin) markers.

CASE SUMMARY

We presented a noteworthy case of malignant PEComa affecting both the liver and kidney in a 53-year-old man with tuberous sclerosis complex (TSC). FAT2 and TP73 mutations in the kidney were identified and positive expression of diagnostic markers including HMB-45, Melan A, and TFE3 were detected. In addition, we demonstrated that hepatic artery perfusion chemotherapy was ineffective for hepatic PEComa, while surgery remained the most effective approach. Everolimus showed an excellent efficacy in the postoperative treatment of the tumor.

CONCLUSION

Surgical treatment is preferred for malignant PEComa affecting liver and kidney, especially with TSC; everolimus is effective postoperatively.
Leukopenia-a rare complication secondary to invasive liver abscess syndrome in a patient with diabetes mellitus: A case report
Authors: Niu Chun-Yan , Yao Bang-Tao , Tao Hua-Yi , Peng Xin-Gui , Zhang Qing-Hua , Chen Yue , Liu Lu
Published: September 2024

BACKGROUND

Thrombocytopenia is a common complication of invasive liver abscess syndrome (ILAS) by Klebsiella pneumoniae (K. pneumoniae ) infection, which indicates severe infection and a poor prognosis. However, the presence of leukopenia is rare. There are rare reports on leukopenia and its clinical significance for ILAS, and there is currently no recognized treatment plan. Early and broad-spectrum antimicrobial therapy may be an effective therapy for treating ILAS and improving its prognosis.

CASE SUMMARY

A 55-year-old male patient who developed fever, chills, and abdominal distension without an obvious cause presented to the hospital for treatment. Laboratory tests revealed thrombocytopenia, leukopenia, and multiple organ dysfunction. Imaging examinations revealed an abscess in the right lobe of the liver and thrombophlebitis, and K. pneumoniae was detected in the blood cultures. Since the patient was diabetic and had multi-system involvement, he was diagnosed with ILAS accompanied by leukopenia and thrombocytopenia. After antibiotic treatment and systemic supportive therapy, the symptoms disappeared, and the patient’s condition almost completely resolved.

CONCLUSION

Leukopenia is a rare complication of ILAS, which serves as an indicator of adverse prognostic outcomes and the severity of infection.
Acute gastric volvulus combined with pneumatosis coli rupture misdiagnosed as gastric volvulus with perforation: A case report
Authors: Zhang Qi , Xu Xiu-Juan , Ma Jun , Huang Hai-Ying , Zhang Ya-Ming
Published: September 2024

BACKGROUND

Acute gastric volvulus represents a rare form of surgical acute abdomen, which makes it difficult to establish an early diagnosis. As the disease progresses, it can lead to gastric ischemia, necrosis, and other serious complications.

CASE SUMMARY

This paper reports a 67-year-old female patient with a history of abdominal distension and retching for 1 day. After admission, a prompt and thorough examination was performed to confirm the diagnosis of acute gastric volvulus. Notably, the patient had free air in the abdominal cavity. The first consideration was gastric volvulus with gastric perforation, but the patient had no complaints, such as abdominal pain or signs of peritoneal irritation in the abdomen, and imaging examination revealed no abdominal pelvic effusion. Following endoscopic reduction, the abdominal organs, such as the stomach and spleen, returned to their normal anatomical positions, and the free intraperitoneal air disappeared, suggesting a rare case of acute gastric torsion. The source of free air within the abdominal cavity warrants careful consideration and discussion. Combined with the findings from computed tomography, these findings are hypothesized to be associated with the rupture of colonic air cysts.

CONCLUSION

Patients with gastric torsion combined with free gas in the abdominal cavity should consider nongastrointestinal perforation factors to avoid misdiagnosis.
Differential diagnosis of gastric submucosal masses and external pressure lesions
Authors: Na Ying , Liu Xiang-Dong , Xu Hui-Min
Published: September 2024

Lesions of the left triangular ligament of the liver are rare, and there are even fewer cases of vascular tumors misdiagnosed as gastrointestinal stromal tumors. We comment on the two cases reported in the article. The article did not include pictures of laparoscopic surgery, making it unconvincing. For gastric submucosal lesions, enhanced computed tomography venous phase imaging may be beneficial for differential diagnosis. Although endoscopic ultrasound is an effective tool for diagnosing submucosal lesions of the stomach, due to various factors, it cannot achieve an accurate diagnosis. During endoscopic examination, a more accurate diagnosis can be made depending on the personal experience of the operators.
Successful use of Upadacitinib in the child patient with very early onset of ulcerative colitis and refractory to therapy
Authors: Usoltseva Olga V. , Potapov Alexandr S. , Anushenko Anton O. , Vinokurova Anna V. , Krasnovidova Anastasia E. , Zenkova Karina I. , Movsisyan Goar B.
Published: September 2024

Ulcerative colitis is a chronic relapsing inflammatory disease of the colon with continuous spread of lesions from the rectum in the proximal direction. The etiology of the disease is unknown, but it is assumed to be developed as a result of a combination of several factors. The clinical picture is often similar to the picture of intestinal infection, which complicates the timely diagnosis of the disease, especially in children. Refractory to standard therapy limits therapeutic options and increases the frequency of surgical interventions. However, the emergence of new drugs, such as upadacitinib, opens up new opportunities for treating such patients and studying the effectiveness of therapy. We present a case of successful treatment of ulcerative colitis with upadacitinib in a child with the onset of the disease at the age of 6 months. The purpose of the description is to show the possibilities of using the janus kinase blocker Upadacitinib in severe ulcerative colitis in a child with a very early onset of the disease and without effect from previous therapy. The importance of early diagnosis and therapy is emphasized.
Regional Logistics Capability and Foreign Direct Investment Location Choice of Multinational Corporations
Authors: Lu Qing , Wu Jie , Khan Zaheer
Published: September 2024

Multinational corporations (MNCs) are encountering real challenges in a post-COVID-19 world to find suitable locations for channeling their investments. However, how can two locations be compared? A new index for the logistics capability of countries or within-country regions is presented as a tool to assist managers in location-related decision-making. A survey among MNC managers in Asia reveals that MNCs investing in locations with higher regional logistics capability tend to perform better, suggesting that logistics capability is vital in foreign direct investment (FDI) location choices.
Pengaruh Return on Assets, Leverage, dan Company Size Terhadap Tax Avoidance dengan Institutional Ownership Sebagai Variabel Moderasi pada Industri Konsumen Barang Primer Periode 2018-2022
Authors: Danikhtiarananda Bagas Anugrah , Santioso Linda
Published: September 2024

Penelitian ini bertujuan untuk menguji secara empiris terkait pengaruh Returrn on Assets, Leverage, dan Company Size yang dimoderasi oleh Institutional Ownership terhadap Tax Avoidance pada perusahaan industri barang primer yang terdaftar di Bursa Efek Indonesia (BEI) periode 2018-2022. Pemilihan data dilakukan dengan teknik purposive sampling dan diperoleh 33 perusahaan dengan total 30 data outlier dan 135 sampel selama lima tahun. Pengujian hipotesis menggunakan analisa regresi berganda yang diolah menggunakan aplikasi SPSS. Hasil penelitian ini menunjukkan bahwa Returrn on Assets dan Company Size dinilai tidak memiliki pengaruh signifikan terhadap Tax Avoidance, sedangkan Leverage memiliki pengaruh positif dan signifikan terhadap Tax Avoidance. Sementara itu, Institutional Ownership sebagai variabel moderasi dinilai hanya berhasil mempengaruhi hubungan Leverage dengan Tax Avoidance.
Analisis Biaya dan Waktu pada Proyek Pembangunan Dermaga di Tuban dengan Metode Earned Value Analysis
Authors: Yoedianto Meidijas , Hidayat Sutanto , Ratna Winanda Lila Ayu
Published: September 2024

Pembangunan suatu proyek harus memperhatikan biaya, mutu dan waktu pelaksanaan. Perencanaan dan pengendalian perlu dilakukan untuk meningkatkan keberhasilan proyek. Kondisi proyek pembangunan dermaga di Tuban sebagai objek penelitian, mengalami keterlambatan. Penelitian ini dimaksudkan untuk memberikan hasil analisa biaya dan waktunya. Salah satu metodenya adalah Earned Value Analysis (EVA). Status proyek bisa diidentifikasi lebih awal dan akurat dengan EVA, sehingga dapat digunakan sebagai dasar perbaikan kondisi proyek dengan menghitung tiga indikator, yaitu Planned Value, Earned Value dan Actual Cost. Analisis tersebut digunakan pada penelitian ini. Prosedur penelitian dilakukan dengan cara mengumpulkan, merangkum  dan menganalisis data. Data-data yang dibutuhkan yaitu rencana anggaran biaya, time schedule, laporan progress mingguan proyek dan biaya aktual mingguan. Pemrosesan data-data tersebut menghasilkan nilai perencanaan (PV), nilai hasil (EV) dan nilai aktual (AC). Analisis penelitian ini memperoleh hasil  indeks kinerja biaya, CPI, sampai minggu ke 29  di bawah 1, berarti mengalami cost overrun, minggu ke 30 sampai minggu ke-49 di atas 1, berarti cost underrun. Minggu ke-49 bernilai 1,11. Indeks kinerja waktu, SPI, sampai dengan minggu ke-19 di atas 1, berarti mengalami percepatan, minggu ke-20 sampai ke-49  di bawah 1, berarti mengalami keterlambatan. Minggu ke-49 bernilai 0,81.  Dengan total kontrak Rp. 10.403.914.724 dan CPI 1,11, maka diharapkan proyek dapat diselesaikan dengan sisa biaya sejumlah Rp. 2.047.216.930 saja. Penelitian dilakukan pada minggu ke-49, dari jadwal rencana proyek selama 54 minggu. Dengan asumsi perubahan kinerja proyek tetap, maka diharapkan proyek akan selesai dalam waktu 62 minggu, berarti memerlukan penambahan waktu selama 8 minggu dari kontrak awal.
PENGARUH PLATFORM MEDIA SOSIAL “X” TERHADAP KEPUTUSAN INVESTASI REKSADANA DI APLIKASI BIBIT PADA GENERASI MILENIAL
Authors: Hakim Maulana Arief Rahman , Habibatulillah Adinda , Sendianto Sendianto
Published: September 2024

Penelitian ini bertujuan untuk menganalisis pengaruh platform media sosial "X" terhadap keputusan investasi reksadana di Bibit pada generasi milenial. Dalam penelitian ini, sebanyak 95 responden yang merupakan bagian dari generasi milenial dipilih melalui metode penyebaran kuesioner online. Penelitian ini menggunakan pendekatan kuantitatif dengan analisis regresi untuk menguji hipotesis mengenai hubungan antara penggunaan media sosial "X" dan keputusan investasi reksadana.Hasil penelitian menunjukkan bahwa terdapat pengaruh signifikan antara penggunaan platform media sosial "X" terhadap keputusan investasi reksadana di Bibit. Faktor-faktor seperti informasi yang diperoleh dari platform, interaksi dengan komunitas pengguna, dan rekomendasi investasi yang tersedia di media sosial "X" memainkan peran penting dalam mempengaruhi keputusan investasi responden. Temuan ini menegaskan bahwa media sosial dapat menjadi alat yang efektif dalam mendukung keputusan investasi bagi generasi milenial.Penelitian ini memberikan implikasi praktis bagi pengelola platform investasi seperti Bibit untuk lebih mengoptimalkan penggunaan media sosial sebagai sarana edukasi dan promosi, serta bagi pengembang platform media sosial "X" untuk menyediakan konten yang relevan dan kredibel yang dapat membantu pengguna dalam membuat keputusan investasi yang lebih baik.
Effects of shoulder manipulation on electromyography measures in archery athletes during recovery from fatigue: a comparison between sexes
Authors: Studnicki Rafał , Naderza Weronika , Niespodziński Bartłomiej , Hansdorfer-Korzon Rita , Kawczyński Adam
Published: September 2024

The aim of this study was to analyze the effects of manual therapy on electromyography (EMG) measures of the primary muscles involved in archery, considering the differences between sexes. Twenty trained archery athletes (men: 14, age: 32.1±6.6 years; women: 6, age: 25.3±5.0 years) participated in this experimental study. The athletes were subjected to 100 archery shots, after which they received regenerative manual therapy. EMG measurements were taken from the middle deltoid, posterior deltoid, upper trapezius, middle trapezius, lower trapezius, and infraspinatus muscles before the shots, after the shots, and after the manual therapy. The outcomes measured included the mean and maximal amplitude of the EMG root mean square (EMGRMS) and the median frequency of the raw surface EMG signal power spectrum (EMGMED). Sex comparisons revealed a significantly higher EMGMED in the upper trapezius following manual therapy in women compared to men (F=5.096; p=0.037). No other significant differences were found between sexes (p>0.05). Repeated measures conducted at baseline, after 100 shots, and after manual therapy showed a significantly greater mean amplitude EMGRMS in the infraspinatus following manual therapy compared to after 100 shots (169.7 vs. 109.8 µV; p=0.008). Similar results were noted for maximal amplitude EMGRMS (372.7 vs. 209.5 µV; p=0.010). Additionally, a significantly lower maximal amplitude EMGRMS was observed at baseline compared to after manual therapy in low trapezius (312.6 vs. 551.2 µV; p=0.045). In summary, and overall, manual therapy did not play a significant role in restoring the EMG parameters in the primary muscles of archers after exposure to a fatigue condition. However, it showed efficacy in the case of the infraspinatus. Furthermore, apart from the upper trapezius, no significant effects were observed between genders, indicating similar effects in both.
Keywords: archery; muscle fatigue; recovery; physical therapy modalities.