Open Access Pub publishes peer-reviewed, free-to-read open-access articles. Showing
articles matching Retrospective — open any to read the full text,
or download the PDF or XML.
Dec 2025 DOI 10.14302/issn.2574-4496.jtc-25-5497
Our study gathered information on the diagnosis, treatment, and long-term outcome in adult and pediatric Hispanic patients with Well Differentiated Thyroid Cancer. Methods We performed a retrospective review of the clinical and imaging nuclear medicine records of cases of WDTC evaluated and treated in the Nuclear Medicine CLINICc. Evaluation included the clinical PROFILE, histology, radioiodine (RAI) therapies and treatment response, long-term outcome and survival. The data was ASSESED using the 2015 ATA Risk level guidelines and recommendations. Results Three hundred eleven cases were reviewed, 81% females, 19% males, median age of 41 years. Eleven percent (34 patients) of the patients were in the pediatric group and 49% were between 16-45 years. The tumor histology was 60.5% Papillary, 28.2% Papillary-Follicular variant and 11.3% Follicular type. All patients had a total thyroidectomy. A total of 287 (92%) of the patients were treated with RAI. The median RAI dose was 128 mCi. Patients in the low risk group received a dose range of 25-105 mCi, 73 cases in the intermediate RISK group received 106-160mCi and 104 cases in the high-risk group received doses greater than 160 mCi. The overall median cumulative dose was 151 mCi (55-926 mCi). Annual follow up was done in all cases , WITH A median follow-up OF 5-10 years. Residual functioning tissue in the neck was found in 52% of the cases by US and/or RAI imaging. of those, 43% belonged to the low risk group, while 57% were in the intermediate and high-risk groupS. The mean treatment dose received by those with persistent functional thyroid tissue in the neck was 157 mCi. Recurrent disease was found in 15% of the patients, 85% of them belonged to the intermediate and high-risk GROUPS. Forty-seven percent of the patients with recurrent disease had residual disease. Conclusion We believe ablative and/or adjuvant RAI treatment early in the disease is important to decrease residual thyroid tissue and/or residual disease, and to improve disease-free survival. We recommend total thyroid surgery in all tumors above 1 cm, post-operative evaluation with RAI Whole Body (with 123-I or 131-I), planar and SPECT/CT imaging and RAI ablation to remnant tissue. Follow-up post treatment evaluation is also recommended.
Jun 2024 DOI 10.14302/issn.2574-450X.jom-24-5114
Objective We aimed to assess outcomes in patients undergoing sequential intragastric balloon (IGB) treatment for obesity. Methods Consecutive patients who underwent treatment between May 2014 and February 2023 were identified. We recorded outcomes including: weight at 3-monthly intervals, progression to definitive bariatric procedure and morbidity. Results 45 patients were identified. Median weight loss with first IGB was 15.2kg (8.8%). 11 patients (26.7%) had a second IGB, with median weight loss of 3.3kg (1.9%). 21 patients (46.7%) were suitable for definitive surgery after first IGB treatment. One further patient (2.2%) was suitable for surgery after a second IGB. During first IGB, median weight loss was observed during the each of the first three quartiles (months 0-3: 10.1kg; months 3-6: 2.3kg; months 6-9: 4.2kg). There was a median 2kg weight gain during months 9-12. Conclusions Greatest weight loss was achieved during first IGB treatment. Sequential IGB treatment did not lead to beneficial weight loss or progression to surgery. Weight loss with first IGB was not uniform across the 12 month period of treatment, with net weight gain during the last quartile.
Apr 2024 DOI 10.14302/issn.2994-6743.ijstd-24-5006
Objectives This study explores the clinical characteristics, associated infections, and management outcomes of syphilis within a specific population over the years 2018 to 2022. With a focus on the frequency, clinical manifestations, and co-infections of syphilis, the research addresses a critical gap in understanding the nuanced dynamics of this sexually transmitted infection and its impact on public health. Methods The study employs a retrospective analysis of data collected from 2018 to 2022, utilizing three key serological tests (Syphilis AB, RPR/VDRL, and TPHA) to characterize syphilis infections within the population. Clinical manifestations and associated infections, including HIV, HBV, HCV, Chlamydia, Gonorrhea, and HPV, are systematically assessed. Treatment rates and re-infection patterns are also analyzed, providing a comprehensive overview of syphilis epidemiology within the studied timeframe. Results The frequency of syphilis, particularly indicated by the Syphilis AB test, exhibited a marked increase in 2020, reaching 96%, suggesting a heightened frequency within the population. RPR/VDRL test results demonstrated consistent frequency, emphasizing the persistent presence of active syphilis infections. Clinical manifestations, such as chancre, skin rashes, alopecia syphilitica, and lymphadenopathy, displayed dynamic patterns over the study years. Co-infection rates varied, with fluctuations observed in HIV, Chlamydia, Gonorrhea, and HPV, while HBV and HCV showed infrequent but stable frequency. The management of syphilis cases demonstrated commendable treatment rates, but an increase in re-infection rates in 2021 highlights the need for continued vigilance. Conclusion This study provides a comprehensive evaluation of syphilis epidemiology, clinical characteristics, and associated infections within the studied population. The results offer valuable insights into the dynamic nature of syphilis and its co-infections, informing public health initiatives and interventions. The findings contribute to our understanding of the epidemiological landscape and underscore the importance of sustained efforts in both prevention and treatment to curb the transmission of syphilis and its associated infections. The study, however, calls for continued vigilance and research to address the evolving trends and challenges in syphilis management within the specified population.
Apr 2024 DOI 10.14302/issn.2994-6743.ijstd-24-5005
Objectives This study examined the frequency and dynamics of syphilis in the United Arab Emirates (UAE) between 2018 and 2022. Recognizing the significance of understanding syphilis trends, this study intends to conduct further research on sexually transmitted diseases in the context of the UAE. Methods This was a retrospective cross-sectional study. This study focused on patients who underwent syphilis screening between January 2018 and December 2022. Cases were classified as conclusive only if they passed the first screening and subsequent confirmatory tests. Results The findings demonstrate that Syphilis frequency varied throughout the UAE during the study period. Demographic trends and sex variations were discovered, providing insight into how syphilis patterns change. Additionally, this study identified a broad spectrum of clinical manifestations, confirming the complexity of the disease. It was also noted that males had a higher frequency of syphilis than females. Conclusion Understanding the complexity of the frequency of syphilis is critical for developing effective public health interventions. Variations in frequency, demographic trends, sex disparities, and clinical manifestations indicate the need for personalized preventive and control measures. This study provides important information that may be utilized to motivate focused initiatives to address the difficulties associated with syphilis in the UAE, thus enhancing overall public health.
Jun 2023 DOI 10.14302/issn.2578-2371.jslr-23-4446
A retrospective study quantifies chronic liver disease burden and trends in Eastern Amhara. It summarizes demographics, etiologies, and outcomes to inform regional planning.
Dec 2021 DOI 10.14302/issn.2692-1537.ijcv-21-4045
Introduction In December 2019, cases of serious illness causing pneumonia and death were first reported in Wuhan, China.2 The clinical features of Corona Virus Disease-19 (COVID-19) are ranging from asymptomatic to multi organ dysfunction. The disease can progress to pneumonia, respiratory failure and death.4 Thus, a tool is needed that can predict the severity and in-hospital mortality risk of a patient with COVID-19 Pneumonia. The PIRO (predisposition, insult, response, and organ dysfunction) scoring was developed for use in the emergency department to risk stratify sepsis cases.15 Eventually it was adapted in pneumonia cases to predict its severity. Objective To validate PIRO score as an assessment tool for COVID-19 mortality risk among patients with confirmed COVID-19 RT-PCR test among patients aged 19 and above admitted in World Citi Medical Center from March 2020 to August 2020 Methods This study included 93 patients aged 19 and above admitted in World Citi Medical Center with a primary diagnosis of COVID-19 Confirmed with pneumonia between March 2020 to August 2020. The patients’ charts were retrieved from the hospital medical records and case notes were reviewed. A severity assessment score was developed based on PIRO score (Predisposition comorbidities and age; Insult multilobar opacities and viremia; Response shock and hypoxemia; Organ Dysfunciton) were extracted. The patients were stratified in four levels of risk: a)Low,0-2 points; b)Mild,3 points; c)High,4 points; d)Very High,5-8 points. The PIRO score and the clinical outcome were compared. The discriminative ability of PIRO score to predict mortality risk was evaluated under receiver operating characteristic curve (AUC). Results The PIRO score had an excellent predictive ability for in-hospital mortality (AUC0.9197). Analysis of variance showed that higher levels of PIRO scores were significantly associated with higher mortality (p<0.001). Patients with Mild PIRO risk category were 98.65% less likely to expire (p<0.001, 95%CI 0.0015) and High PIRO risk category were 94.47% less likely to expire (p<0.001, 95%CI 0.0124), both compared to patients with Very high PIRO risk category. Finally, Very High PIRO risk category were more than 44 times likely to expire compared to patients with Low, Mild and High PIRO risk category (p<0.001, 95%CI 11.738). Conclusions The PIRO score is a valid risk model that can be used to predict in-hospital mortality, that can help clinicians provide timely and accurate assessment, and hence appropriate management to patients with COVID-19 Pneumonia.
Dec 2021 DOI 10.14302/issn.2692-1537.ijcv-21-4025
Introduction The COVID-19 pandemic continues to affect a large swath of the global population. The Philippine records four hundred seventy-four thousand sixty-four (474, 064) confirmed COVID 19 cases since December 31 2020. The COVID 19 pandemic recently highlighted the role of systemic hyperferritenemia as a major cause of death. In this study, we were able to correlate the serum ferritin level and predict 30 day in hospital mortality in COVID 19 pneumonia. Objective The aim of the study is to investigate the correlation between serum ferritin level and disease mortality in COVID19 pneumonia with subset analysis on demographics and co-morbidities of patients with COVID 19 pneumonia. Methodology We reviewed the records of all laboratory confirmed COVID 19 patients from World Citi Medical Center from April 2020 up to April 2021.A statistically significant sample size of seventy nine (79) admitted patients were used in this study. A serum ferritin level was assayed using electrochemilumenescence immunoassay with a Roche COBAS analyzer. Results Result showed that high ferritin level is associated with in hospital mortality. With ferritin level of 1437.07ng/ml, poor clinical outcome and in hospital mortality was considered. We also observed that demographics and co morbidities of patients in this study were significant to predict in hospital mortality. Further sub-analysis of co morbidities such as Hypertensive cardiovascular disease, Type 2 Diabetes Mellitus, Chronic kidney disease, Liver disease, Chronic obstructive pulmonary disease and Cerebrovascular disease showed poor outcome which were directly related to ferritin levels with p value of <0.0001. Conclusion This study has demonstrated that elevated ferritin levels were shown to correlate with 30 day in hospital mortality as well as medical comorbidities such as Hypertensive Cardiovascular disease, Type 2 Diabetes Mellitus, and chronic kidney disease have shown significant evidence for in hospital mortality.
Aug 2021 DOI 10.14302/issn.2578-2371.jslr-21-3912
Background Liver disease has caused significant morbidity and mortality worldwide. Its epidemiologic and clinical pattern, however, is not well characterized in sub-Saharan countries. Objective This study aimed to describe demographic, clinical characteristics, and patterns of liver disease in a community hospital in Addis Ababa, Ethiopia. Method A retrospective hospital-based study was conducted on patients with liver disease admitted at Ras Desta Damtew memorial hospital, in Addis Ababa-Ethiopia, from February 2015 to April 2020. Result Of the total 212 patients majority, 78.8% were male, 49.1% of patients were in the age range of 31-50 with a median age of 42. The most common initial clinical presentation was ascites (87.7 %), and more than half of patients (56.6%) had a history of alcohol misuse documented on their medical charts. Chronic liver disease (cirrhosis) was found in 177 (83.5%), and Hepatocellular Cancer accounted for 7.5% of the patients. Alcohol misuse caused 45% of chronic Liver Disease, followed by Hepatitis B virus infection. Conclusion Chronic liver disease is the most common form of liver disease, and the most affected were middle-aged men. The common cause of chronic liver disease was alcohol followed by hepatitis B virus infection.
Dec 2020 DOI 10.14302/issn.2578-2371.jslr-20-3362
Background and Aim Gallbladder (GB) cancer is a highly fatal malignancy and approx. 10% new cases are diagnosed every year in India. The GB cancer has poor prognosis due to progressive nature. Understanding of risk factors that lead to GB development is urgently required for better management of the disease. Presence of stones in gall bladder generates varied mucosal reactions, which leads to different types of histopathological changes in mucosa. Here, our aim is to study the correlation between various types of mucosal responses e. g. inflammation, hyperplasia, metaplasia and carcinoma with different characteristics e. g. number and morphology of gallstones both in males and females. Materials and Methods A retrospective study of gallstones was performed on 438 cases of cholecystectomies operated laparoscopically based on the histological changes. Out of 438 cases, 394 (89.95%) were associated with gallstones and the rest 44 (10.05%) belonged to acalculous cholecystitis. The mucosal changes in calculous gall bladder were studied in 394 cases and its correlation with number and types of observed gallstones were evaluated. Tissue sections were taken from the fundus, body, neck and abnormal area of gallbladder for histopathological studies. Results Our study has revealed the higher incidence of inflammatory changes in males, while gall bladder hyperplasia, intestinal metaplasia and cancer cases were found mostly in females. Conclusion Our study showed that changes in the number and morphology of gallstones are directly associated with the mucosal changes in gallbladder e.g. inflammation, hyperplasia, metaplasia and gall bladder carcinoma.
Nov 2020 DOI 10.14302/issn.2766-8630.jrnm-20-3594
Purpose The purpose of this study was to assess the efficacy (overall survival, local control, progression free survival (PFS) and toxicities between two dimension (2D) and three dimension (3D) CT guided brachytherapy without using interstitial needles in cervical cancer patients. Material and Methods A retrospective case-control study was performed in Figo stage IB-IVA cervical cancer patients treated between March 1990 and August 2018. Concurrent chemoradiation using external beam radiotherapy followed by brachytherapy (BT) was the treatment method used in all patients. Clinical endpoints were overall survival, local control, progression free survival, acute toxicities and late toxicities. Results A 102 cervical cancer patients were included,52 patients have been treated with 2D and 50 patients with 3D using CT scan brachytherapy without interstitial needles. Baseline characteristics were similar between both groups. External beam was used in all patients during concurrent chemoradiation period before brachytherapy. All patients completed the treatment. Similar 3-year overall survival and local control was reported between 2D and 3D techniques. Overall 3-year survival rate was 95.7% in 2D and 91.8% in 3D brachytherapy (P value = 0.188). Local control at the 3 year follow up was 88.6% in 2D and 93.3% in 3D (P value = 0.571). Progression free survival was better in 2D rather than 3D (86.13% in 2D vs 27.4% in 3D, p value = 0.006). No grade 3 or 4 toxicity in 3D technique was observed whereas there are 1.9% of grade 3 acute GI toxicity and grade 3 late GI and GU toxicities in 2D technique (7.7% and 5.8 %). The 3D brachytherapy significantly reduced acute grade 2-3 GI side effect and grade 2-3 late GU side effect (acute GI 25% in 2D vs 4% in 3D, late GU (56% in 2D vs 16% in 3D). Conclusion Using CT guided 3D brachytherapy in treatment of cervical cancer showed similar outcomes in survival and local control but reduced toxicity compared to the 2D technique. Disease progression including metastasis was found better in the 2D brachytherapy technique. CT guided brachytherapy helped reduce dose to organs at risk and long term follow up for survival outcome and toxicities was needed.
Aug 2020 DOI 10.14302/issn.2381-862X.jwrh-20-3439
Background Pregnancy and parturition are events of considerable significance in the life cycle of women. Though it is supposed that the quality of care during labor, birth, and postpartum period plays a great role for adverse outcomes of birth, various reports claimed that cesarean delivery carries a higher maternal and fetal morbidity and mortality compared to vaginal delivery. Therefore, this study assessed the Rate, Maternal and Fetal Outcome of Cesarean delivery performed by IESO at Shenen Gibe General Hospital, Jimma south west Ethiopia. Integrated Emergency surgical officer is a health professional qualified and authorized to perform emergency obstetrical-gynecological and emergency general surgical procedures. The training has started in 2010 in 3 universities and 10 affiliated sites with intake of 43 students. The MSc program in integrated emergency surgery is intended to achieve one of the millennium development goals (MDG): reducing the overwhelming maternal mortality ratio and perinatal mortality rate at the local and national level. (1) Methods Hospital based two-year retrospective descriptive cross-sectional study design was employed and data collected from November to December 2019 in shenen Gibe General Hospital ,Jimma south west Ethiopia. A total of 185 mothers who delivered by cesarean delivery from December 2017 to December 2018 and complete data were included in the study. Data were extracted using structured data collection format and cleaned, and entered into Epi data software version 3.1 and exported into SPSS version 26 for further descriptive analysis. Result Among 2115 deliveries in the two years of retrospective data, a total of 186 mothers were delivered by cesarean section, giving cesarean delivery rate 8.8 %. The leading indication for cesarean delivery was fetal distress (24.2%). Among the total cesarean delivery, 22 neonates were died, giving the proportion of neonate mortality rate 16.8%. One mothers were died following cesarean delivery, giving maternal mortality rate following cesarean delivery 12 per 1000 live births. The leading cause for maternal mortality was hemorrhagic shock Conclusion However, cesarean delivery rate in this study was within the WHO recommended range, the health outcome of mothers and neonates’ following cesarean delivery was not acceptable. The neonatal and maternal mortality following cesarean delivery was 16.8% and12 per 1000 live births respectively. The main cause of neonatal death was birth asphyxia.
Jan 2019 DOI 10.14302/issn.2574-4496.jtc-18-2473
This study aimed to investigate the trend of patients with thyroid cancer undergoing thyroidectomy and those undergoing fine needle aspiration (FNA) and its relationship with thyroid cancer, using a large-scale, real-world database established based on the employment-based health insurance claims data in Japan. In this retrospective descriptive study, annual incidence rates of patients with thyroid cancer undergoing thyroidectomy and FNA from 2005 to 2014 were calculated. Among the 3,130,757 enrollees, 926 patients were diagnosed with thyroid cancer and underwent thyroidectomies. The annual incidence of patients with thyroid cancer undergoing thyroidectomy increased from 5.4 (95% confidence interval 95% CI, 3.4–8.5) in 2005 to 11.7 (10.1–13.5) per 100,000 patient-years in 2013, with a gradual increase among patients in their 20s and 30s and with the most notable increase among those in their 40s and 50s. The annual FNA rate also increased during those years, whereas no noticeable change was observed in the thyroid cancer detection rate. The incidence rates of patients with thyroid cancer undergoing thyroidectomy and those undergoing FNA were strongly correlated, with Pearson’s correlation coefficients of 0.935 for men and 0.886 for women. In conclusion, an increasing trend in the incidence of patients with thyroid cancer undergoing thyroidectomy was observed from 2005 to 2013 among a large group of Japanese employees of working age and their dependents. These results provide useful information on the impact of patients with thyroid cancer undergoing thyroidectomy on the working population.
May 2018 DOI 10.14302/issn.2643-6655.jcap-18-2086
In 1979, a study conducted by Ehrhardt et al. retrospectively examined childhood behavioral patterns of 30 adults; 15 identified as lesbian women and 15 identified as transmen. All 30 adults had been assigned female at birth, and, as children, all were regarded as “tomboys.” The study found several key factors that distinguished the two cohorts. The goal of this study was to replicate and extend the 1979 study, utilizing a larger sample size and including a reference group of heterosexual women. Given the major social, technological, medical, and legal paradigm shifts that have occurred over the past four decades, we sought to determine if the previous findings still differentiate the cohorts. In light of the exponential rise in the number of gender diverse and dysphoric youth who request treatment, providing optimal, affirmative care and education is paramount, especially since many of these young people seek social and/or medical transition. Exploration of the early behavioral indices of the diverse trajectories may help to inform best practices for optimal care for these young people and their families.
Sep 2017 DOI 10.14302/issn.2572-3030.jcgb-17-1737
Objective P16INK4a and Ki-67 are adjuncts to current histological assessment of cervical biopsies in identifying cases that require strict follow up and prompt intervention. This study aimed to evaluate P16INK4a and Ki-67 expression in squamous intraepithelial and other benign cervical lesions. Methods A retrospective cross-sectional study of 153 cases of cervical biopsies diagnosed as CIN and benign cervical lesions between 2006 and 2013 at the University College Hospital, Ibadan, Nigeria. Slides and tissue blocks of all the selected cases were retrieved and classified using the 2003 WHO classification for intraepithelial and benign cervical lesions and were stained with p16INK4a and Ki-67 immunohistochemical stains following heat-induced antigen retrieval. Results were evaluated and compared with histologic diagnosis. Results Cases were classified as chronic cervicitis (12.3%), squamous Metaplasia (0.7%), CIN 1 (47.1%), CIN 2 (36.6%) and CIN 3 (3.3%). Majority of the non-dysplastic cervical lesions (including chronic cervicitis cases) showed low P16INK4a reactivity. Positive P16INK4a reactivity was seen in 80% of CIN 3 cases, 83.9% of CIN 2 cases, and, surprisingly, in 97.2% of CIN 1 cases. Ki-67 positivity was seen in 36.6% of cases (75% CIN 2 and 60% CIN 3). There was a significant correlation between the H&E diagnoses of CIN and P16INK4a/Ki-67 immunoreactivities. Conclusion Majority of the CIN 1 cases showing low grade p16INK4a immunereactivity strongly suggesting that cervical squamous intraepithelial neoplasia in this environment is likely associated with high grade HPV subtype infections and may predict possible progression to high grade squamous intraepithelial neoplasia. The use of P16INK4a and Ki-67 in the evaluation of cervical biopsies for benign mimics of high grade intraepithelial lesion will aid proper single Pathologist evaluation and help in patients triaging for follow up.
Jul 2017 DOI 10.14302/issn.2577-2279.ijha-17-1538
Status thymico-lymphaticus had ever been explained as a cause of sudden death usually in children, but few cases were reported in adults. We sought to determine the relationship between thymic hypertrophy and sudden unexpected death in adult (SUDA), and associated macroscopic and microscopic findings. Adult post mortems from 1984 to 2014 were reviewed and 23 thymic hypertrophy patients without SUDA, 33 thymic hypertrophy patients with SUDA and 172 SUDAs without thymic hypertrophy entered. The data of thymus, lymph nodes, spleen, heart, aorta, and adrenal glands were collected for macroscopic and histological analysis. Ten antibodies were used and applied to 3 children and 46 adult thymus specimens. We found, as an independent factor, thymic hypertrophy increased significantly the risk of SUDA (6.9 folds) in both male and female. What’s more, SUDAs associated with thymic hypertrophy were quite younger (22.5 years) than those without it. A majority of patients with hypertrophic thymus had a variable number of accompanied anomalies described as the typical characteristics of status thymico-lymphaticus, but no macroscopic and microscopic findings related to SUDA in patients with thymic hypertrophy. Cytokeratins (CKs) showed distinctly different immunohistochemical expression patterns in individuals who had different death causes and disease background. Instead of a disease entity “status thymico-lymphaticus” is a systematic abnormality with thymic hypertrophy as a feature involving mainly immune and/or cardiovascular system, probably caused by gene mutations.
Jul 2016 DOI 10.14302/issn.2473-1005.jdoi-16-999
Purpose: The aim of the study was to analyze the spatial relationship between the sinus floor and the alveolar bone of maxillary premolars and molars in order to assess the amount of basal bone available for immediate extraction placement of endosseous implants. Materials and Methods: All the cone-beam computerized tomographic (CBCT) scans taken over a three-year period at four centers were identified. The subsinus bone height (SBH) was evaluated by measuring the distance between the sinus floor and the first and second premolar root apexes. The interradicular septum bone height (ISBH) of all the first and second molars was also measured, and the presence or absence of sinus-floor invagination between the molar roots was recorded. Results: Five hundred twenty-six (526) CBCT scans of fully or partially dentate maxillary arches were examined. The root apex was inside the sinus of 1.8% of all the first premolars. It approximated the sinus floor of 5.3% of them, and the distance between the two points was between 1 and 3mm of 20%, between 3 and 7mm for 34.1%, and more than 7mm for 34.1%. For the second premolars, the findings were 13.5% (inside the sinus), 10.5% (touching the sinus), 32.8% (1-3mm of distance) 28% (3-7 mm), and 15.2% (more than 7mm). Root invagination was noted in 50.2% of the first molars and 43.1% of the second molars, with the ISBHs ranging from 13.4% to 56.9%. Conclusion: Radiological evaluation is essential to determining whether implants should be placed immediately after extraction of maxillary premolars and molars.
Jun 2026 DOI 10.14302/issn.2574-4496.jtc-26-6304
Objective To evaluate the treatment outcomes of patients with Differentiated thyroid cancer (DTC) who underwent total thyroidectomy followed by RAI therapy at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) in Oman. Methods This is a retrospective observational clinical study conducted at SQCCCRC. The study included all patients diagnosed with DTC who were admitted to SQCCCRC between June 2021 and November 2023. A total of 255 patients were identified and met the inclusion criteria for this study. Results The mean age at diagnosis was 39.9 ± 12.4 years (range: 14–79), with 78% of patients being female. The mean BMI was 30.3 ± 6.4 kg/m², with nearly half of the cohort (48.2%) classified as obese (BMI ≥ 30). Most patients had papillary thyroid carcinoma (92.9%), while follicular and Hürthle cell carcinoma accounted for 5.9% and 0.8% of cases, respectively. Based on the American Joint Committee on Cancer (AJCC) staging, 86.3% of the patients were classified as stage I and 3.9% as stage II. Six patients (2.4%) had stage IVB disease. According to American Thyroid Association (ATA) risk stratification the majority were low-risk. Patient age was strongly associated with disease stage. The distribution of metastatic cases varied by region, with the highest proportion observed in Dhofar. Most patients (87.1%) received a single dose of radioactive iodine (RAI), with a median cumulative dose of 3.7 mCi). At six months post-treatment, 70.2% of patients had a TG level < 0.2 ng/mL. Conclusion The outcome of therapy in majority of our patients is favorable with 72% having excellent biochemical response at last follow up. None of the patients with distant metastasis achieved excellent response and a high proportion of them came from the Dhofar governorate, a targeted intervention would be of benefit. Low risk patients require special attention and may need radioactive iodine during follow up, unlike other regions and hence warrant very close follow up and further review to establish the best practice guidelines in our region.
Mar 2026 DOI 10.14302/issn.2994-6743.ijstd-26-6060
Objective To describe the clinical features and real-world treatment of people living with human immunodeficiency virus (PLHIV) using fixed-dose or free combinations of 2-drug regimens (2DR) of antiretroviral therapy (ART). Design Italian retrospective cohort study. Methods Data were extracted from PLHIV who initiated or switched to 2DR: Group 1 (fixed dose), Group 2 (free combination). Results Group 1 was younger and more predominantly male, and had shorter time from AIDS-defining diagnosis to 2DR-ART and from diagnosis to baseline, a lower prevalence of resistance, and fewer comorbidities than Group 2. Median baseline viral load was <50 copies/mL in both groups, but Group 1 had a higher mean due to outliers. The most common ART classes before switching to 2DR were Integrase Strand Transfer Inhibitor (INSTI)-based (48.97%), Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based (22.73%), and Protease Inhibitor (PI)-based (16.53%). Distribution varied: Group 1: INSTI-based (53.13%), NNRTI-based (24.31%), and PI-based (15.04%); Group 2: INSTI-based (29.41%), PI-based (23.53%), and NNRTI-based (15.29%). After switching, Group 1 was on dolutegravir/lamivudine (79,33%) and dolutegravir/rilpivirine (20,67%); Group 2 mostly on INSTI-PI (52.81%), followed by NNRTI combinations, mainly with doravirine (19.10%). Duration of ART after switching was shorter in Group 1. Conclusion Italian PLHIV on 2DR fixed-dose combinations were younger, virologically suppressed individuals at baseline, with a shorter lead time from diagnosis, lower prevalence of resistance and lower comorbidity rate compared to those on free combinations. These findings underscore an unmet need for 2DR fixed-dose combinations, as the free combinations were predominantly utilized for more challenging populations.
Dec 2025 DOI 10.14302/issn.2691-5014.jphn-25-5577
Infants with single ventricle (SV) physiology are at increased risk of undernutrition, which can contribute to adverse outcomes. This is a retrospective case series examining factors associated with undernutrition in patients with SV physiology at one year of age. It includes 56 infants from a single institution who underwent SV palliation between 2003 and 2023. Undernutrition was defined as a weight-for-length z-score (WLZ) below -1, based on World Health Organization (WHO) normative data. Independent variables included surgical interventions, cardiorespiratory factors, and nutritional interventions. Associations between these variables and nutritional status were assessed using Fisher’s exact test. At one year, a total of nine infants (16%) were undernourished. Undernutrition rates significantly declined after 2013 (p=0.02), demonstrating improvements in nutritional outcomes over our study period. Those who used supplemental oxygen or pulmonary medications were undernourished at lower rates. While this difference was not statistically significant, the number of undernourished patients in the cohort may have limited the study’s power. Our findings suggest that early respiratory interventions may provide nutritional benefits in infants with SV physiology.
Nov 2025 DOI 10.14302/issn.2470-0436.jos-25-5503
Purpose Create a new diagnostic and therapeutic framework for patients with Exudative Age-Related Macular Degeneration (ARMD) and choroid imaging biomarkers of non-neovascular choroidal pathology who have persistent neovascular exudation during the course of monotherapeutic interventions. Methods Retrospective, longitudinal case series study of 25 eyes from 23 patients with the referral diagnoses of treatment resistant Exudative ARMD who had persistent neovascular exudation despite various monotherapies. Inclusion criteria required choroidal imaging biomarkers of non-neovascular pathology including a thickened subfoveal choroid (greater than 300 microns) and vessels (subjectively dilated choroidal vessels in Haller’s layer) on Optical Coherent Tomography (OCT), choroidal neovascularization on IVFA and OCT Angiography (OCTA), as well choroidal leakage noted on indocynanine green videoangiography (ICG). Treatment consisted of OCTA and ICG - Directed Photodynamic Therapy (PDT) Triple Therapy, hereafter described as Combination Therapy, to areas of choroidal hyperpermeability and choroidal neovascularization. Combination therapy consisted of an anti-Vascular Endothelial Growth Factor (VEGF) intravitreal injection on Day 0 followed by half-fluence PDT and 2 mg intravitreal triamcinolone acetonide on Day 3-14. Results All study patients had treatment resistant Exudative ARMD defined as persistent subretinal and/or intraretinal fluid during their course of monotherapeutic interventions. Complete resolution of all exudation occurred in 23 eyes (92.0%) at 8 weeks. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. The mean vision at baseline was 0.46 ± 0.42 LogMAR, best corrected visual acuity (BCVA). 8 weeks after treatment, the vision was 0.35 ± 0.38 LogMar, an improvement of over one line, and this was maintained at one year. The baseline central subfield thickness (CST) was 296.4 ± 136.1 microns and improved by 111.4 ± 105.4 microns at 8 weeks after treatment. Treatment duration was negatively associated with the Caucasian race. Conclusions Patients with subretinal and/or intraretinal fluid secondary to Exudative ARMD should have a complete baseline multimodality imaging study to confirm the presence of neovascularization and whether choroidal hyperpermeability coexists. This study shows that patients with Exudative ARMD and persistent neovascular exudation despite monotherapuetic interventions often have choroidal biomarkers of non-neovascular choroidal pathology and that ICG and OCTA-directed PDT Triple Therapy resulted in complete resolution of all exudation in 92.0% of patients at 8 weeks with a reduction in central subfield thickness (CST) of 111.4 microns. The vision improvement at 8 weeks was 0.11 ± 0.38 LogMar and was sustained over 1 year. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. Additionally, this study shows that the treatment that addresses both pathological processes is successful and should be considered as a primary protocol when the biomarkers are present at baseline or as a secondary protocol if indeed the neovascular leakage is persistent despite monotherapy. Summary Patients with an Exudative ARMD with persistent neovascular exudation despite anti-VEGF monotherapy and who have imaging biomarkers of non-neovascular choroidal pathology often have two pathophysiological processes: choroidal hyperpermeability and angiogenesis. A proposed framework provides the rationale for OCTA and ICG-directed PDT Triple Therapy which successfully resolves 92% of the leakage that was persistent after various monotherapeutics.
Sep 2025 DOI 10.14302/issn.2379-8572.joa-25-5687
Depending upon the species, the brainstem auditory evoked potential (BAEP) consists of four or five major high frequency components. According to longstanding doctrine, each wave represents the sequential activation of successively higher nuclei and tracts from the 8th (auditory) nerve to the midbrain (inferior colliculus). Although this conceptual framework has acquired the status of near dogma, surprisingly little evidence exists in support. In the present analysis, a new interpretation of the electrogenesis of the BAEP is proposed which is simpler although it retains skeletal elements of the older explanation. The revised model is mostly derived from two distinct sources. In the first, the timing of the BAEP waves is compared with that of cortical activity for a range of mammals including humans, monkeys, cats, rats and guinea pigs. It is demonstrated that for each of these, the conduction time of the acoustic signal to the cortex from the putative midbrain component (wave IV or V) is so unrealistically long that it implies that the entire waveform must arise in the peripheral pathways of the auditory system. In the second, a retrospective analysis is made of click repetition rates on the BAEP using extradural electrodes. It was shown that at high rates of stimulation (about 100/sec), the behavior of the waveform is almost totally at variance with the expectations of the conventional model. The essence of the revised conception is that all BAEP waves are just variations of the compound action potential of the 8th nerve, albeit generated or regenerated via separate routes and different methods. Such an explanation would thereby account for their near uniform sharp morphology as well as creating the impression of a composite neuronal response. More specifically, in the case of a four component BAEP, wave I is assumed to be generated by the normal air conduction route in an identical manner to the conventional explanation. In contrast, wave ll is assumed to be generated via bone conduction in the temporal skull thereby bypassing the transduction process in the middle ear. Wave lll is assumed to be generated by the first echo of the bone-conducted sound wave. Likewise, the second rebound within the temporal bone serves as the stimulation to evoke wave lV. As the energy of the auditory stimulus gradually dissipates, it may still continue to generate a train of lower amplitude potentials. It is concluded that the BAEP may contain little or no brainstem or midbrain activity and therefore the term BAEP may be a misnomer. A more appropriate epithet might therefore be the auditory nerve evoked potential or ANEP.
Dec 2024 DOI 10.14302/issn.2642-9241.jrd-24-5320
Introduction Mortality is one of the most important demographic phenomena in public health, and its rate is the primary indicator of a population's state of health. The aim of this study was to describe the profile of patients in the pneumo-phthisiology department of the Hospital National Ignace Deen CHU in Conakry. Methodology This was a retrospective descriptive study lasting one year, from 01 January to 31 December 2023, on 176 records of hospitalized patients who died in the pneumophthisiology department of the Ignace Deen National Hospital. Results A total of 1043 patients were hospitalized during our study period, 176 of whom died, giving a mortality rate of 16.87%. The mean age of the deceased patients was 49.57±18.8 years, with a male predominance (sex ratio=1.93). Clinical signs on admission were dominated by dyspnoea (70.45%) and chest pain (61.36%). Tuberculosis was the most common diagnosis with a frequency of 42.61%, followed by TB/HIV co-infection with a frequency of 22.16%. The average length of hospitalization was 8.79 days. Probable cause of death was dominated by respiratory distress (54.44%) and decompensated anaemia (32.95%). Conclusion Mortality in the pneumo-phthisiology department of the Ignace Deen National Hospital remains high. Anemia and respiratory distress were the most common diagnoses of severity, hence the need to improve management of these probable causes of death.
Aug 2024
Ambulatory blood pressure monitoring is widely used in pediatric patients to identify hypertension and its complications. Previous studies correlating obesity and hypertension using ABPMs showed increasing blood pressure loads with increasing BMI. However, BMI percentiles are more reliable indicators of obesity in children. Our study aimed to describe the association between BMI percentiles and systolic and diastolic blood pressure load using ABPM in children and adolescents. Retrospective analysis of ABPMs (Welch Allyn) was performed on a total of 115 patients between 7 and 18 years of age who were referred for elevated BP without a diagnosis of hypertension at our institution from Jan 2011 to Oct 2013. Patients were divided into 4 groups based on BMI percentile: <94th percentile, 94–98th percentile, 98–99th percentile, and >99th percentile. Analysis between blood pressure loads and BMI percentiles revealed greater mean systolic and diastolic loads with increasing BMI percentiles, but the P value was not statistically significant. Analysis of the systolic loads between children from different racial backgrounds revealed higher values in African American children than in Hispanic and Caucasian children, but the P value was not statistically significant.
Mar 2024 DOI 10.14302/issn.2372-6601.jhor-24-4962
While highly curable in developed countries, Hodgkin's lymphoma (HL), remains a significant challenge for resource-limited ones. This study aimed to describe the profile of HL in Togo. This was a retrospective, descriptive study conducted at the Clinical Hematology Department of the Campus University Hospital Center in Lomé, Togo. It focused on patient records diagnosed with HL between January 1, 2006, and December 31, 2022. Various variables such as age, gender, histological type of HL, Ann Arbor stage, prognostic classification, therapeutic protocol used, and patient outcomes were examined. The annual incidence of HL was 1.5 with a mean age of 38.7 years (range 12-63). Lymph node enlargement was the primary clinical sign (100%). Histologically, classical HL was found in 21 patients (87.5%). Staging was conducted for 16 (66.7%) patients, among whom 11 (66.7%) were at an advanced stage, and 6 (37.5%) had an unfavorable prognosis. The ABVD protocol was used in 13 patients (54.2%), receiving between 1 and 6 cycles. One patient achieved complete remission (4.1%), three deceased (12.5%), and 17 (71%) were lost to follow-up. Hodgkin's lymphoma prognosis remains unfavorable with low remission rates in Togo. Improving the technical facilities will ensure better management of this lymphoma.
Feb 2024 DOI 10.14302/issn.2693-1176.ijgh-23-4879
Background Cancer and diabetes are risk factors for COVID-19 mortality rates. Remdesivir, dexamethasone, and vaccines are used to improve clinical outcomes. We aimed to evaluate the factors associated with COVID-19 mortality rates. Methods This retrospective study enrolled moderate to critical COVID-19 patients. The index day was the day of the COVID-19 diagnosis. Patients were followed up until either death or discharge. A two-way analysis of variance examined the interaction between independent mortality risk factors. Results A total of 205 patients were analyzed, and the mortality rate was 29.5% (n=60/205). The cumulative survival rate was significantly lower in patients with a CCI score ≥ 6, cancer, and diabetes. In multivariate analysis, critical illness, cancer, diabetes, chronic liver disease, a CCI score ≥ 6, unvaccinated, and early use of remdesivir/dexamethasone were independent risk factors for mortality. The onset of remdesivir/dexamethasone ≥ 2 days and < 3 doses of vaccinations were higher mortality rate, with its impact being more significant amongst patients with cancer/diabetes, compared to those without cancer/diabetes (p for interaction = 0.046/0.049, 0.060/0.042, and 0.038/0.048 respectively). Conclusions COVID-19 vaccination ≥ 3 doses and early administration of remdesivir and dexamethasone can significantly reduce mortality rates, particularly in patients with cancer or diabetes.
Jul 2023 DOI 10.14302/issn.2997-1977.jd-23-4588
Introduction Acute diarrhea remains one of the major health problems in developing countries. According to the WHO, rotavirus contributes to approximately 40% hospitalizations and is the leading cause of severe diarrhea in children 0-5 years old. The objective was to determine the prevalence of rotavirus and the sociodemographic and clinical profile among children with diarrhea in 4 hospitals in the DRC. Methods This study is documentary, retrospective and analytical taking two periods, before and after introduction of the vaccine, i.e. January 2017 to December 2018 and January 2020 to December 2021 in 4 hospitals, i.e. 2 in Kinshasa and 2 in Lubumbashi. Results Total 1872 children, 924 (49.4%) of whom were enrolled before the introduction of the vaccine and 948 (50.6%) after. Only 1737 had performed serology, of which 875 (50.4%) were rotavirus positive and 862 (49.6%) were negative. Positive results, a reduction of 30.6% is noted since the introduction of the vaccine. The predominant age range was 6 to 11 months. The male gender was predominant at 56.7%. Diarrhea was found in 88.5%, vomiting in 73.7% and fever in 73.9%. Before vaccination, the risk was more: 11 times to have diarrhea, 9-10 times the frequency between 3-10 times a day, 9 times vomiting, 2 times fever and 2 times to have a positive result. Conclusion From this study, we note a reduction frequency due to diarrhea unlike previous years, probably attributable to the vaccine.
Jul 2023 DOI 10.14302/issn.2470-5020.jnrt-23-4576
Background The evolution of multiple sclerosis (MS) is highly variable. Predicting this evolution at the beginning of the disease will help in the therapeutic management. The objective of this study was to describe the clinical characteristics and to identify early predictors of long-term disability among MS patients in Algeria. Methods We performed a descriptive and retrospective study of 400 MS patients followed over a 4-years period from July 2012 to July 2016 in the neurology department of Mustapha Bacha hospital in Algiers. The following parameters were systematically assessed for each patient: Age at onset, gender, relapses, initial demyelinating event, interval between first and second attack, residual deficit after first attack, onset of the progressive course, time of assignment of the successive scores of irreversible disability and type of disease modifying therapies. Univariate and multivariate Cox models were used to determine factors influencing time to Expanded Disability Status Scale (EDSS) 4 and 6. Results During the follow-up of this cohort of MS patients, a total of 144 (36%) and 83 (20%) patients reached EDSS scores 4 and 6 respectively. The median times from the onset of MS to assignment of a score 4 and 6 was 10 years and 19 years, respectively. Using the MSSS severity score, and after univariate analysis we identified several risk factors predictive of disease severity. These included male sex (P= 0.002), age of onset ≥ 40 years (P= 0.001), pyramidal (P= 0.0001), cerebellar (P= 0.002), and poly-symptomatic (P=0.0001) onset of the disease, incomplete recovery after the first attack (P= 0.0001), a high number of attacks during the first 2 years (P= 0.04) and the progressive form (P=0.001), and all these factors were correlated with a high MSSS score. However, prognostic factors in the multivariate binomial logistic regression analysis were limited to pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack, and progressive onset. Conclusion On the whole, the early predictive factors of disability in MS among Algerian patients were age of onset over 40 years, pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack and progressive form at onset. To increase the generalizability of findings, a national MS registry is strongly recommended, as well as long-term follow-up epidemiological studies.
May 2023
Background and Aim Breast cancer is the second most common cause of brain metastases after lung cancer. However, the incidence of cerebral metastases from breast cancer has increased during the last years. The purpose of this study is to determine the prognostic value of chemotherapy after whole-brain radiotherapy for patients with brain metastases from breast cancer. Methods We analyzed retrospectively 63 records of patients diagnosed with brain metastases from breast cancer and treated in the radiotherapy department at the Salah Azaiz Institute of oncology over a 5-year period between 2007 and 2011. All patients received whole-brain radiotherapy. Only 4 patients had surgical resection of the metastases before radiotherapy and 36.5% of patients received systemic treatment after irradiation. Results Overall survival was 19% at 1-year and median survival was 4,5 months. Univariate analysis indicated that systemic treatment after irradiation was correlated significantly with longer survival. (p=0,046). Conclusion Determining prognostic factors might help optimize individual treatment for metastatic breast cancer. The results of our study suggest that chemotherapy is more effective on brain metastases after irradiation. This can be explained by the fragilization of the blood-brain barrier by radiation and subsequently a better passage of cytotoxic agents.
Apr 2023 DOI 10.14302/issn.2694-1201.jsn-23-4385
Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.
Mar 2023 DOI 10.14302/issn.2766-8630.jrnm-22-4093
Attenuation differences from 2 x-ray sources allow differentiation and characterization of stone types with similar radiation dose compared to single-energy CT scan. The difference is shown in colours, allowing preoperative prediction and management of stones. We determined the effect of DECT-KUB on urological management of patients with uric acid stones since it was first introduced in our centre. 50 patients with uric acid stones were selected from 2 year groups, each with 25 patients and their urological managements were reviewed retrospectively. We concluded that DECT-KUB is an accurate way of determining the chemical characteristics of renal calculi and can alter patients’ management. It has gained wide acceptance among clinicians in our centre and is now widely used to plan urological management of patients with renal calculi. Based on urological management comparison of patients who presented in the year 2011 with uric acid stones and patients in the year 2020, we concluded that patients with uric acid stones based on DECT-KUB findings can start dissolution therapy instead of surgical extraction or lithotripsy prior to biochemical analysis results become available. Although utility of DECT-KUB is widely accepted among clinicians in our centre it may not be available worldwide and this is the limiting factor in its universal use.
Dec 2022 DOI 10.14302/issn.2690-6759.jpar-22-4382
Background Intestinal parasitic infections, especially intestinal protozoan parasites remain significant public health problem in Senegal. Several studies have demonstrated the endemicity of the diseases. The study was carried out with the objective of assessing the epidemiolocal profile of intestinal protozoan infection diagnosed among patients attending to Fann University Hospital in Dakar, Senegal. Materials and Method A retrospective study was conducted from 2016 to 2020. Samples were collected from patients attending to the laboratory for parasitological confirmation. Fresh stool samples were observed using direct examination, formal-ether concentration method and modified Zeilh Nielsen staining method. Descriptive analysis was performed using Stata MP 16 software. The significance level was set at 5%. Results Among 3825 patients selected in the study, 1009 were found with at least one intestinal protozoan parasite representing an overall prevalence of 26.4% (CI 95% (24.7– 28)). Mono-parasitic and di-parasitic infection represent 81.6% and 18.2% respectively while polyparasitism was observed in 26 patients representing 2,6%. Among positive samples, 16 (8.7%) were associated with helminths. Blastocystis sp. (40.8%), Entamoeba Coli (38.2%), Endolimax nana (8.2%) and Giardia intestinalis (8.1%) were mainly observed. Trophozoites Entamoeba histolytica was observed with 2.3%. Frequency of intestinal protozoa was higher in the 15 – 30 age group (28.3%) and in male group (26.9%). The parasite carriage was most important during the wet season comparing the dry season (p = 0.65). Asymptomatic patients (29.5%) were more infected than symptomatic patients (23.5%) (p <10-3). The main clinical symptoms were diarrhea, abdominal pain, dysenteric syndrome, fever, dyspeptic disorders, and vomiting. Conclusion These results showed that intestinal protozoan infections remain prevalent in Senegal with a high proportion of asymptomatic who constitute an important reservoir of parasites. Effective control strategies such as water supply, hands washing, and mass deworming campaign could reduce the prevalence of these diseases.
Oct 2022 DOI 10.14302/issn.2381-862X.jwrh-22-4228
Background Gender based violence (GBV) refers to any violence targeted at an individual or group on the basis of their gender. It could occur in different forms with several clinical manifestations. The authors have described several clinical manifestations of GBV in a tertiary health centre, knowledge of which would help in case identification and early clinical management. Methods Retrospective descriptive study of all clients seen at a gbv clinic over a sixteen months period.Data was obtained from case records and clinical presentations were entered into excel. Data analysis was done usingIBM SPSS Statistics for Windows, version 25. The results were presented in frequency tables and graphs Results Of 86 clients studied, 56(65.1%) were of pediatric age (< 18years) while 30(34.9%) were adults with a mean age of 18.33+11.64(range 1-64years).72(82.6%) belonged to the low social class. Physical abuse in the forms of battering, human bite, walking and sitting disturbances, hearing loss possibly from slapping or hitting and red eye possibly from trauma on the eye, constituted 37.6% of the clinical presentations. Other presentations were; sexual abuse in the form of forced sex which constituted 34.9%, while gynaecological / obstetrics presentations in the forms of bleeding per vagina, pregnancy due to forced sex and vaginal pain made up 13.9%. Emotional/psychological abuse was observed in all clients irrespective of their different presenting complaints. Conclusion While various forms of physical abuse were common, emotional abuse was present in all clients but masked probably due to prioritization of physical injuries. Therefore we recommend that all GBV survivors be screened for psycholocal abuse and psychotherapy given.
Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4325
The aim of this study is determine the prevalence and factors associated with caesarean section among women delivered at Kirehe District Hospital. A retrospective study was conducted among women delivered at Kirehe District Hospital from January 2018 to December 2019. The medical files of all women delivered at the hospital who meet the inclusion criteria were reviewed. Data were checked for completeness, cleaned, coded and entered into excel sheet, and then exported to SPSS version 22.0 for further analysis. Descriptive statistics was used to estimate the prevalence and description of study participants. Multivariable logistic regression models were used to estimate risk for CS with 95% confidence intervals (CIs). The study was conducted in accordance with the research protocol Mount Kenya University Rwanda research ethical committee. The majority 806 (69.9%) of women who delivered at Kirehe district hospital from January 2018 to December 2019 were aged 22-35 years old. The prevalence of C-section at Kirehe District Hospital was 23.1%. Demographic and economic factors associated with Caesaren section in bivariate and multivariate analysis was respondent’s type of health insurance where women who used private health insurance were 3 times more likely to deliver by C-section. The findings from multivariate analysis revealed that women who experienced eclampisa had 45% risk of C-Setion compared to those without Eclampsia. Women in rural area of Rwanda seem to have increased access to and use of CS. However, the significant increase in the rate of CS is of concern due to the potential of unnecessary CS.
Jun 2022 DOI 10.14302/issn.2470-5020.jnrt-22-4106
Background SARS-CoV-2 pandemic represented an unexpected psychological stress, being a major threat to health and limiting daily’s life, especially for the fragile population. How could the people with (pw) Multiple Sclerosis (MS) cope with this emergency? Objective To observe the pwMS’s psychological reaction in comparison with non affected persons and to evaluate the impact of lifestyle changes on psychological symptoms, due to the pandemic. Methods The study was observational, retrospective, controlled, focused on good clinical practice and conducted at Niguarda Hospital. PwMS and controls filled a web survey containing anamnestic data, habits, depression and anxiety self-questionnaires. The primary outcome was the pwMS’s psychological anxiety and depression score compared with controls. Results On April, 10 2020, 88/165 pwMS and 187 controls joined the study. Unexpectedly, no significant differences between groups were observed for depression mean score: 6.6(5.2) in pwMS and 6.2(4.8) in controls and for anxiety: 5.9(4.8) and 5.0(4.2). PwMS focused on health concern more often than controls, but they respected the restrictions more easily and benefited from practical activities more than controls. Conclusion PwMS showed a proper psychological resilience in comparison with controls. These findings might guide the clinical interviews and suggest both the areas to be supported and the strengths to be promoted in pwMS.
Jan 2022 DOI 10.14302/issn.2379-7835.ijn-21-4059
Aim There is limited published data describing the characteristics of the paediatric population prescribed semi elemental formulas. This retrospective observational audit aimed to describe the characteristics of the paediatric patients who have been prescribed a hydrolysed whey protein, medium chain triglycerides (MCT) based formula, Peptamen Junior® and the nutritional outcomes. Methods A retrospective observation audit was completed on a cohort of patients that was prescribed a semi elemental formula between 2016 and 2019 from a single tertiary paediatric medical centre. Data variables were collated such as patient characteristics, indications and modalities of administration, duration and tolerance to the formula. Results Data was collated on 375 patients with a median age of 6.2 years. The main underlying medical conditions were haematological/oncology (67%), gastrointestinal disorders (10.7%) and neurological conditions (9.4%). The most common indications for use were chemotherapy related side effects (36.2%), post bone marrow transplant (25.8%) and gastrointestinal symptoms (17.9%). The formula was rarely used as a sole source of nutrition, with 88% patients requiring accompanying forms of nutrition support. The majority of orders prescribed were of standard concentration (80.8%) and tolerance was recorded in 82.8% of patients. Conclusion The semi elemental formula Peptamen Junior® appears to be well tolerated in paediatric patients with a variety of medical conditions that have complex pathologies and may have wider scope of use in a more diverse group of medical conditions than currently indicated.
Jul 2021 DOI 10.14302/issn.2576-2818.jfb-20-3559
Background Male Infertility accounts for 30-40% of all cases of infertility and its evaluation requires a good history, thorough physical examination, and several investigations to include testicular biopsy which might be used to further categorize infertile males for proper management and prognostication. This study aims to determine the predominant histopathological patterns of testicular biopsies in infertile males and to compare the findings with previous studies. Methods A retrospective cross-sectional study of 225 selected cases of testicular biopsies reviewed for the evaluation of male infertility in the Pathology department, of a tertiary hospital, Southwest, Nigeria, between 1987 and 2012. Relevant clinical and histopathological information was extracted from the departmental records. All histologic cases were reviewed, and a classification based on histological patterns of spermatogenesis was utilized to group the cases into normal findings, hypo spermatogenesis, maturation arrest, Sertoli cell-only syndrome, peritubular hyalinization/ tubular fibrosis and mixed patterns. The data obtained were analysed using descriptive and inferential statistics at a 5% level of significance. Results Among the 225 cases reviewed with a mean age of 37.7 years (SD - 8.61), 82.7% had primary infertility of which 92.9% were azoospermic, while 7.1% had oligospermia. The histological patterns included 34.2% of Hypospermatogenesis, 32% of Peritubular hyalinization/ tubular fibrosis, 14.2% had maturation arrest and Sertoli cell-only syndrome was found in 6.7% of cases, only 0.9% had normal histologic pattern while the mixed histologic pattern was seen in 12% of cases. Conclusion The commonest morphological pattern was Hypospermatogenesis, which is similar to some of the previous local and international studies. A high percentage of peritubular fibrosis was noted with few tubules containing scanty late spermatids or spermatozoa when proper sampling and evaluation were made. Multiple patterns within a biopsy were seen with careful review, especially in non-obstructive azoospermic cases. This is significant in male infertility patient management in our environment because it suggests greater chances of successful sperm extraction for Assisted Reproduction Technique in such patients.
May 2021 DOI 10.14302/issn.2766-8681.jcsr-21-3783
Background Klippel-Feil Syndrome (KFS) is described as the clinical triad of short neck, low posterior hairline, and limitation of neck mobility. Objective Topresent our clinical experience with KFS patients who also had adjacent segment disease (ASD) and to propose a novel classification system for these patients. Methods This retrospective study was performed in the neurosurgery department of our tertiary care center. Data were gathered using the medical records of 22 KFS patients (10 males, 12 females) with ASD. Diagnosis was confirmed with imaging modalities including X-ray, computerized tomography, and magnetic resonance imaging. Clinical and radiological findings as well as therapeutic outcomes were noted. Results The average age of our series was 56.09 (range: 41 to 67) years. The operative technique was selected as for our novel “Yilmaz-Yucesoy Classification System”. Accordingly, one patient (4.54 %) received non-surgical treatment (Yilmaz-Yucesoy Grade 1), six cases (27.27 %) underwent anterior cervical arthroplasty, seven patients (31.81 %) underwent anterior cervical discectomy or corpectomy and fusion with cervical cage and plate (Yilmaz-Yucesoy Grade 3). Eight patients (36.36 %) with cervical spinal instability had anterior cervical discectomy or corpectomy and fusion with cervical cage and plate (Yilmaz-Yucesoy Grade 4). No mortality or remarkable complications were detected. Conclusion Appropriate and timely recognition and classification of patients with KFS and ASD based on our newly proposed “Yilmaz-Yucesoy Classification System” yielded promising treatment outcomes. However, further prospective, randomized, controlled trials are warranted on larger series to validate our preliminary results.
Feb 2021 DOI 10.14302/issn.2641-4538.jphi-21-3725
This brief report article is a retrospective, descriptive, first-person account of following-up on a difficult-to-find client of an HIV/AIDS community-based pre-post intervention and disease prevention Research and Demonstration project in Houston, TX. Through the story about the personal journey of searching for the client, the author experiences an epiphany, especially in light of current events. Specifically, as opposed to social distancing and disconnection, public health disease prevention probably would be better served through leveraging the powerful and positive natural human features of social connectivity and closeness.
Jan 2021 DOI 10.14302/issn.2470-5020.jnrt-20-3686
Background By the start of year 2020, the whole world was attacked by a rapidly spreading epidemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) which later was classified by WHO as Pandemic. some physicians reported multiple neurological manifestations including cerebrovascular strokes in patients with severe infection. Aim to assess the incidence of admitted stroke cases during 2019 in comparison to 2020 during COVID-19 pandemic in King Fahd Hospital, Saudi Arabia. Methodology A record based retrospective comparative study was conducted by reviewing all medical records for patients who admitted with stroke at King Fahd Hospital during March and April 2019 and March and April 2020. All data were extracted from patients’ medical files included personal data, nationality, date of admission, and stroke related data. Results The study included 121 patients whose ages ranged from 33 to 98 years with mean age of 59.9 years. At March 2019, there were 45 cases compared to 26 in March 2020. In April 2019 there were 20 admitted stroke cases compared to 30 in April 2020. Regarding clinical features of admitted stroke cases, Table 3 illustrates that 36.9% of stroke cases in 2019 were small vessel stroke compared to 58.9% of 2020 cases. Conclusions & Recommendations In conclusion, the study revealed there was no recorded significant change in the trend of admitted cases with stroke before and during COVID-19 pandemic.
Dec 2020 DOI 10.14302/issn.2470-5020.jnrt-20-3629
Introduction The extra dural hematoma is a blood collection between the cranial vault and the dura mater. It is a neurosurgical emergency whose statistical data are poorly known in the Republic of Benin. Objective The aims of this study are to assess epidemiology, therapeutic and outcome of traumatic extra dural hematomas for children admitted to the surgical department of CHUD-B/A from 2012 to 2017. Methods This was a cross-sectional, descriptive and retrospective study over a period from January 1st, 2012 to December 31st, 2017. Results One hundred and seventy-eight cases of children aged between 0-15 years were examined for brain traumatic injury. Twenty-seven 27 (15.2%) cases of extra dural hematomas were retained. The most represented age group was between 11-15 years with a frequency of 42.1%. The male sex was more represented (78.9%). Road traffic accidents were the main aetiology (57.9%). 52.6% had a mild head injury, 26.3% had a moderate head injury and 21.1% had a severe head injury. On brain scan the frequently observed location was temporo-parietal (31.6%). Acute anemia was observed in 16 children. Seventeen children were operated on. The operation involved evacuation of extra dural hematoma by cranial bone flap with suspension of the dura mater. There were no deaths. Conclusion The availability of brain CT makes the diagnosis of extra dural hematoma easier. Its management is neurosurgical with a favourable post-operative evolution in all cases in this series.
Dec 2020 DOI 10.14302/issn.2641-5518.jcci-20-3636
Objective To highlight the value of 3D ultrasound and Doppler angiography imagingin the prenatal assessment of left fetal isomerism. Methods A retrospective offline analysis of volume datasets of 3 fetuses with left atrial isomerism by 3D ultrasound was conducted. Conclusion We believe that parasagittal view demonstrating the heart and the abdominal vessels is easy to obtain and interpret, offer a realistic anatomic image, needs no mental reconstruction of spatial relationships and is very beneficial mainly in detecting the situs. We propose to use 3D ultrasound systematically in suspected cases of atrial isomerism, and better understand and interpret fetal anatomy.
Sep 2020 DOI 10.14302/issn.2694-1201.jsn-20-3554
Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3461
Background and Purpose The ability to respond effectively to perturbations is a key element of reactive postural control and is a crucial mediator of falls. Several studies exist in the literature that determine older adults’ responses to perturbations, however those studies typically involve procedures that lack objectivity or applicability outside a laboratory. A study involving waist-pull perturbations with a spring-scale (SS) is an exception. In that study, fall history was most accurately differentiated by a reactive stepping response to a perturbing force of 10% total body weight. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. For perspective, the association of fall history with Timed-Up-and-Go (TUG) and single limb stance (SLS) times was also determined. Methods Fifty-eight healthy older adults (mean age = 80.7 years) participated in the study. Their 2-year fall history (yes, no) was recorded. All participants underwent SS testing with one-pound incremental, horizontal sagittal plane manual waist-pull perturbations. The number of steps in response to perturbation with 10% total body weight was recorded; TUG and SLS tests were performed. Associations between variables were examined using Spearman (rank-biserial) correlations. Results The median number of steps for fallers was 5 in both anterior and posterior directions. For non-fallers, the median number of steps was 1 and 2 in the anterior and posterior directions, respectively. The significant correlations between fall status and number of steps were 0.772 and 0.813 for the anterior and posterior directions, respectively. Similarly, the significant correlations between fall status and balance tests were 0.722 and -0.456 for the TUG and the SLS, respectively. Conclusions The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years.
Feb 2020 DOI 10.14302/issn.2768-0207.jbr-20-3194
Rhinosinusitis is one of widely spread diseases in the region and the role of the anatomical variations in its pathogenesis remains unresolved. A retrospective study using CBCT scan was employed to locate and measure the diameter of 320 primary maxillary ostium (PMO) (n = 160 subjects) among the Malay and Chinese populations (Mongoloid race) in Malaysia. Image analysis was performed using the i-CAT Vision Software, employing the multiplanar reconstruction window in which axial, coronal and sagittal planes were visualized in 0.3 mm intervals. The mean diameter of the PMO was significantly larger in the Chinese than the Malay. Females had larger size than the male and bilateral asymmetry was noticed, where the right side PMO was larger than the left side (p < 0.05). In addition, PMO opened more in the posterior third position of the hiatus semilunaris (61.9%) than anterior and middle third. The PMO showed a statistically significant posteriorly placed position in the Chinese than the Malays and this was more evident in the right side PMO (p < 0.01). In conclusion, the PMO commonly opens in the posterior third of the hiatus semilunaris and its diameter is significantly greater in the Chinese female with evidence of bilateral asymmetry. Awareness the anatomical variation of the Ostium diameter and location among the Malay and Chinese populations potentially has important clinical effects during surgical procedures.
Jan 2020 DOI 10.14302/issn.2690-4721.ijcm-19-3154
Background The morbidity and mortality associated with the multi drug resistant Gram negative bacterial infections pose a significant and growing challenge to clinical practitioners. Klebsiella pneumoniae, which is a substantial nosocomial pathogen and confer high levels of resistance to broad-spectrum antibiotics including carbapenems. The aim of this study is to determine the resistance profiles of Klebsiella pneumoniae strains isolated from various clinical specimens. Material and Method In this study, the antibiotic susceptibility profiles of 2452 Klebsiella pneumoniae strains isolated from various clinical specimens between July 2015 and November 2019 were considered retrospectively. Blood culture vials were incubated in Bac T / Alert 3D automated system, other samples were cultured on blood and Eosin Methylene-blue (EMB) medium. The identification and antibiotic susceptibility tests of the isolated bacteria were performed by VITEC 2 Compact ID-AST cards (BioMérieux, Marcy l’Etoile, Fransa) and the results were evaluated according to the standards of the Europian Committee on Antimicrobial Susceptibility testing (EUCAST). The first sample of each patient was included in the study. The strains with inappropriate results were re-studied with gradient agar diffusion test (BioMérieux, Marcy l’Etoile, Fransa). Results The study included a total of 2452 Klebsiella pneumoniae strains and the distribution of samples was as follows: 894 (36, 5 %) blood, 790 (32, 2%) bronchial lavage, 211 (8,6 %) wound, 148 (6 %) drainage, 148 (6 %) peritoneal fluid, 95 (3, 9 %) tracheal aspirates, 64 (2,6%) catheter, 62 (2,5 %) urine, 40 (1,6%) other samples (pleural fluid, cerebrospinal fluid, throat ). In this study, antibiotic susceptibility test results indicated that the resistance to tigecycline was lowest (0, 3%). High colistin resistance ratio (33, 5 %) in carbapenem-resistant Klebsiella pneumoniae was considered to be of concern. Conclusion In this study, high rates of resistance to carbapenems were noteworthy. Determination of hospital antimicrobial resistance rates will be useful in developing antibiotic use policies of each hospital, in the treatment of causative agents, in selecting antibiotics according to antimicrobial susceptibility.
Sep 2019 DOI 10.14302/issn.2470-0436.jos-19-2829
Purpose To study outcome and spectral domain optical coherence tomography (SD-OCT) macular findings in patients who underwent surgery for spared macula giant retinal tear (GRT) retinal detachment. Methods a retrospective study of 12 patients with spared macula giant retinal tear (GRT) retinal detachment who underwent vitrectomy (N=7), vitrectomy with an encircling scleral buckle (n=4) and scleral buckle (n=1) with at least 3 months follow up after silicon oil removal (SOR) . Post-SOR macular SD-OCT scans were studied in all eyes. Results Final reattachment achieved in all eyes with single primary surgery. Post-SOR SD-OCT macular finding was photoreceptors layer disruption in 6 eyes, epiretinal membrane (ERM) in 4 eyes, Macular hole in 1 eye and choroidal neovascularisation in 1 eye. Significant correlation found between final Best-Corrected Visual Acuity (BCVA) and macular pathology on SD-OCT p value (0.048). Conclusion SD-OCT plays a high role in diagnosis of macular alterations that can be associated with poor functional outcome in anatomically successful GRT surgery with spared macula pre-operatively.
Apr 2019 DOI 10.14302/issn.2470-0436.jos-19-2480
Purpose To describe spectral domain optical coherence tomography (SD-OCT) and enhanced depth image OCT (EDI-OCT) findings of multifocal serpiginoid choroditis (MSC) , including affected layer of retinal involvement, changes at the vitreoretinal interface, and response to therapy. Methods A retrospective review of 20 eyes (14 patients) with MSC. Each patient underwent a complete ophthalmologic examination, fundus photography, fundus autoflorecence (FAF) and OCT imaging of the affected retina at the initial visit and on each follow-up. Results In acute stage, SD-OCT showed hyperreflective areas involving the outer retinal layers which include retinal pigment epithelium (RPE), photoreceptor outer segment tips (POST), inner segment–outer segment (IS/OS) junction, external limiting membrane (ELM), and outer nuclear layer (ONL) with choroidal and intraretinal layer cells infiltrate. EDI-OCT showed increase choroidal thickness. As the lesions began to heal, irregular, knobby elevations of outer retinal layers appeared (RPE, POST, IS/OS junction, and ELM could not be distinguished) with significant decrease in choroidal and intraretinal cells. On complete healing, loss of RPE, POST, IS/OS junction, and ELM in SD-OCT scan and absent of the choroidal and intraretinal cells and continous hyperreflactivity of the choroid (increased penetrance). Conclusion SD-OCT and EDI-OCT provides high-resolution detail regarding ultrastructural changes in vitreoretinal interface, outer retina and choroid during the course of the lesion. Serial SD-OCT and EDI-OCT also provides further insight into response to therapy by observing choroidal and intraretinal cells.
Mar 2019 DOI 10.14302/issn.2642-9241.jrd-18-2499
Distant metastases generally indicate disseminated disease and the standard treatment for these patients is palliative chemotherapy. Retrospective series showed that selected patients with metastatic lung cancer and a solitary extrathoracic disease could be effectively treated with curative intention by resection of both primary tumor and the single site of metastatic disease. According to current data, adrenalectomy might be considered as an alternative option for patients with isolated adrenal metastases. Significant morbidity and mortality may be happened by these procedures, and a cautious analysis of pros and cons should be discussed with the patient. We present a review of the literature and updated recommendations focusing lung cancer with solitary adrenal metastasis.
Feb 2019
Background: Chest wall deformities may be managed with skeletal manipulation, which risks life-threatening complications. Custom-made prostheses are a less invasive surgical option, manufactured from silicone elastomer using 3D computed tomographic reconstruction and 3D-printed thoracic models. Methods: All patients undergoing custom-made implants between January 2010 and March 2017 were identified from the prosthetic department records. A retrospective review of the clinical records was performed. Mean follow up period was 1.8 years. A comparison was made with our earlier results from 1995 to 2009. Results: Twenty-six patients underwent insertion of custom-made implants for chest wall deformity. Pectus excavatum was present in 50% (n=13), and Poland syndrome 42% (n=11). All 11 female patients underwent 3D reconstruction and 3D printed models, and 3 of 15 males. Four underwent simultaneous bilateral breast augmentation, and three had staged breast augmentation. Seroma occurred in 27% (n=7), and hypertrophic scar in 12% (n=3). The reoperation rate was 23% (n=6), including autologous fat graft in two patients. Surgical suction drains were used in 42% (n=11) patients, of whom 36% (n=4) developed seroma, compared with 17% (n=2) of those without drains (p=0.08). Conclusions: Custom-made prostheses are an effective and safe option for patients with chest wall deformities. The majority have a short postoperative inpatient stay (81%) and are satisfied with the outcome (77%). Seroma was the commonest complication (27%), and drains did not reduce seroma risk. Single dose intravenous antibiotic prophylaxis is adequate. A minority of patients opt for further aesthetic procedures.
Jan 2019 DOI 10.14302/issn.2379-7835.ijn-19-2599
Background: Severe acute mal nutrition (SAM) among children still remains the major problem in Ethiopia. The shortening of the SAM recovery time by applying appropriate dietary means during treatment and also after recovery, can save huge sums of public health spending. Objectives: Determining the recovery time of SAM affected children and developing complementary food supplement (CFS). Methods: Hospital based retrospective cohort study was carried out on 401 SAM affected children. A structured and pre tested data abstraction form was used for data collection. The data were entered into Epi info and exported to SPSS for analysis. All of the nutritional properties of the developed product in three different ratios of the flours of maize, soybean and powder of moringaolifera leaves were assessed and compared to the control (100% maize). Results: The median recovery time was 16 days. There was a significant increase in protein, mineral and beta carotene content with increasing level of Moringaolifera leaf powder in the CFS. Conclusion: To increase the rate of recovery from sever acute malnutrition and also to prevent relapsing, moringa incorporated cheaper complementary fod supplements could be recommended for SAM affected children.
Jan 2019 DOI 10.14302/issn.2470-5020.jnrt-18-2555
Introduction: Tension-type headache (TTH) is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. TTH, divided into episodic and chronic types, introduced in the manual "International Classification of Headache Disorders"(ICHD-I), is of practical importance. Infrequent episodic headaches (no more than once a month) may not require drug therapy, but, on the contrary, frequent forms may require expensive treatment. Objective: To study the state of cerebral hemodynamics and cerebrovascular reactivity in patients with Tension-type headache and evaluate the efficacy of treatment with Phenibite using Doppler ultrasound. Materials and Methods: A retrospective analysis of the results of ultrasound dopplerography of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA), Vertebral and Basal (VA, BA) arteries was performed in 188 patients with TTH. Among them are infrequent episodic TTH - 68 (36,2%) patients, frequent episodic TTH - 64 (34,0%) patients, chronic TTH - 56 (29,8%) patients. The age of the subjects was 18-45 years, among them 85 (45.2%) men and 103 (54.8%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance and pulsativity indexes (RI, PI) in all vessels were determined. Patients were given consent to participate in the study. Results: Infrequent episodic (IFE) TTH were recorded in 86.4% of cases, frequent episodic (FE) — in 88.9%, and chronic (Ch) TTH — in 81.6% of cases. Bilateral TTH was noted in 39.2%, frontal localization - in 35.6%, in the occipital region - in 25–7% of cases. The asymmetry of the maximum systolic blood flow velocity (Vs) in the paired arteries within 20-30% was considered a violation of cerebral hemodynamics, which was detected in 38.7% of patients. An increase in Vs was noted in all cerebral vessels, especially in patients with FE TTH and chronic Ch TTH compared with the control group. In patients with IFE TTH the average value of RcFMt was 1.24±0.03, in patients with FE TTH - 1.25±0.02, in patients with Ch TTH - 1.27±0.03. In patients with TTH, hyper-responsiveness to hypercapnic test was detected: RcCO2 was 1.43±0.05 in the group with FE TTH; 1.39±0.07 in the group of Ch TTH and 1.37±0.04 in the group of IFE TTH, which indicates a tendency for the tension of the vasodilator regulation mechanism even in clinically insignificant forms of TTH. In the study of reactivity to the O2-test, a hyporeactive response was observed in the groups with FE TTH and Ch TTH (0.38±0.04 and 0.35±0.05, respectively. The treatment with Phenibut carried out in a step-by-step manner - during the first week the drug was applied at a dose of 250 mg 2 times a day, over the next 6 weeks the dose increased to 500 mg 2 times a day, then the dose was reduced back to 250 mg 2 times a day. Among patients with FE TTH, the frequency of headache decreased from 5.7±2.3 to 3.6±2.1 days/month, and in patients with Ch TTH - from 22.8±1.7 to 17.7±1,3 days/month (P<0,05). Influence of the drug was manifested at the initially increased RcFMt and RcCO2. A decrease in initially elevated RcCO2 was noted in all (FE TTH, ChTTH, IFETTH) clinical groups. However, this decrease was not statistically significant. Conclusion: In patients with TTH, an increase in the Vs is more often recorded, their asymmetry in the middle cerebral artery. Hyperreactivity on CO2-load is typical for patients with chronic TTH, and reflects the mobilization of metabolic regulation of cerebral blood flow. Conducting FMt was the most informative method for detecting autoregulatory disorders mainly in patients with IFE TTH. FE TTH in patients is characterized by the presence of a hyperactive reaction to hypercapnic and orthostatic tests, probably due to mobilization of humoral-metabolic and neurogenic links of regulation. In the group of patients with chronic TTH prevails hyporeactivity for hyperventilation test, reflecting the depletion of vasoconstriction reserve. The use of Phenibut(Noophen® (JSC Olainfarm Latvia in the treatment of TTH is accompanied by a decrease in the frequency of pain, and of pericranial muscle tone, most pronounced in patients with FE TTH. It's effectiveness is evident in the normalization of the coefficients of cerebrovascular reactivity in a patients with chronic TTH. The minimal statistical significance was observed on the dynamics of blood flow only in the VA.
Oct 2018 DOI 10.14302/issn.2578-2371.jslr-18-2213
Introduction: Granulomas in gastric biopsy specimens are extremely rare. The final diagnosis of granulomatous gastritis is based on morphological findings, clinical and laboratory data. The aim of our study is to evaluate the clinical fields and to determine the etiology of gastric granulomatosis in our experience Patients and Methods: Thirty nine patients were reviewed retrospectively in the department of pathology of Habib Thameur between 2000 and 2018. Slides from all cases were stained by hematoxylin and eosin. The clinic-pathologic findings and the associated lesions were analyzed and the final etiology of the gastric granulomatosis was noted. Results: Biopsies from the 39 patients diagnosed as having granulomatous gastritis were reviewed. Mean age was 49 years (24 – 96) and sex ratio was 0,25 (M/F=8/31). Indication of endoscopy was gastric pain in 12 cases, chronic diarrhea in 6 cases, anemia in 2 cases, vomiting in 4 cases. Other symptoms were rare. Upper endoscopy was normal in 8 cases, showed antral gastropathy in 20 cases (erythematous in 6 cases, nodular in 8 cases and ulcerated in 6 cases). In four cases, fundic lesions were observed. Granuloma was unique in 14 cases and multiple in 25 cases. Localisation of granuloma was the antrum in 25 cases, the fundus in 7 cases, and both of them in 7 cases. An associated chronic gastritis was noted in 25 cases. Concerning the etiology, 10 of our patients had Crohn's disease while 6 of them had gastric tuberculosis. In five cases, H Pylori was the retained cause of gastric granulomatosis. In the other patients, the final diagnosis was sarcoidosis (n=3), foreign body reaction (n=1), yersiniosis (n=1). In our series, thirteen cases were unclassifiable. Conclusion: Although many cases remain unclassified, in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or tuberculosis could be established. If this cases are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out. The others causes are extremely rare.
Apr 2018
The presence of bronchiectasis is considered an aggravating factor in COPD patients. In particular, the coexistence of bronchiectasis and COPD was associated with greater frequency and severity of exacerbations. The aim of this study is to investigate the impact of bronchiectasis in patients with COPD exacerbation. We retrospectively collected data from 212 patients admitted to the hospital with diagnosis of COPD exacerbation. In order to detect the presence of bronchiectasis, only patients that had received a chest HRCT scan examination were included in the study. We compared clinical and functional data between COPD patients with bronchiectasis and those without bronchiectasis. The prevalence of bronchiectasis was 31,6% in this study. The presence of bronchiectasis in COPD patients was associated with increased risk for isolation of PPMs in the airway (56,1% vs 28,3%, p 0,02), and in particular of Pseudomonas Aeruginosa (17,5% vs 5,6% p 0,02), and with a longer duration of hospitalization (8,22 ±3,67 vs 6,88 ± 3,43 days, p=0.004). These results could encourage efforts to optimize medical care for patients with COPD and bronchiectasis. Clinical trials with treatments for infective component are needed to investigate their impact on the reductions of exacerbations and improvements in the disease course.
Dec 2017 DOI 10.14302/issn.2576-9359.jot-17-1807
Purpose Intra-operative insults may subject living kidney transplants to poor outcomes. Therefore, we investigated whether intra-operative recipient and donor hemodynamics could act as predictors of delayed graft function and subsequent outcomes. Materials and Methods Living kidney donors and recipients from 2010-2016 at this institution underwent a retrospective chart review. Graft function by post-operative day 7 was used to classify recipients as delayed graft function (need for dialysis), slow graft function (creatinine > 2.5) and good function. Groups were analyzed for intra-operative hemodynamic differences and at one year, incidence of rejection, graft function and survival were compared. Results A total of 111 living renal transplants were performed. Average recipient age was 50 and just over halfwere male (53%). 9% (n=10) and 10% (n=11) developed delayed graft function and slow graft function, respectively. Minimum recipient post re-perfusion central venous pressure ≥12 mmHg was associated with poor graft function (delayed graft function/slow graft function/good function=67%/56%/24%, p=0.009), while intra-operative hypotension (systolic <90 mmHg or diastolic <50 mmHg) was not. Delayed graft function and slow graft function had higher incidences of rejection than good function (30% and 36% vs 9%, p=0.012). Graft function and survival were similar. One patient died with a functioning graft. Conclusions This single center retrospective study suggests that a post re-perfusion central venous pressure ≥12 mmHg is associated with delayed graft function.
Aug 2017
Objectives: To describe the frequency, clinico-laboratory characteristics and treatment outcomes of patients with juvenile idiopathic arthritis (JIA) in Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. Methods: This is a retrospective review of patients with JIA seen over a five-year period at the rheumatology clinic and children ward of LASUTH. We reviewed the folders of 28 patients from our unit records. The demographics, baseline clinical and laboratory characteristics, treatment given and patient outcomes were extracted and analyzed. Results: A total of 28 patients with JIA were managed over the study period. Twenty one (75%) patients among our JIA cases were female and the mean age at presentation was 9.8±3.9 years. The mean duration of symptoms before diagnosis was 21.8±5.7 months. Polyarticular JIA (PJIA) constituted 14 (50%) cases, while oligoarticular and systemic-onset JIA (SoJIA) constituted 9 (39.3%) and 5 (17.9%) of the JIA cases respectively. Anaemia was present in 20 (71.4%) patients, leucocytosis in 16 (57.1%) and thrombocytosis in 11 (39.2%). Twenty five (89.2%) patients had elevated erythrocyte sedimentation rates (ESRs), 21 (75%) had elevated C-reactive protein levels and 23 (82.1%) patients had hyperferritinaemia. Positive antinuclear antibody (ANA) was found in 5 (17.8%) patients. Mortality was documented in 2 (7.1%) patients both of whom were SoJIA cases. Eleven (39.3%) patients were lost to follow up. Conclusion: Unlike the common report of oligoarticular JIA (OJIA) being the most frequent subtype of JIA in various series from North America and Europe, PJIA was the most frequent subtype seen among our patients and this variant accounted for half of all JIA cases seen. There were no cases of psoriatic, enthesitis-related or undifferentiated JIA and most patients had haematological abnormalities and high levels of inflammatory markers at presentation.
Aug 2017 DOI 10.14302/issn.2379-8572.joa-17-1602
Background: Dental infections, salivary gland lesions, neoplasms and developmental abnormalities can cause oral cutaneous fistulae, fistulae of the neck and intraoral fistulae. Published case reports deliver the same message; that these lesions are misdiagnosed and treated late and ineffectively and this remains a significant on-going problem. Aim: It is important to reiterate the management and diagnosis of this condition, despite the fact that it is already well documented in the current literature as patients are still being subjected to unnecessary treatment. Design and Setting: We performed a retrospective review of 5 consecutive dental sinus infections between June 2013 and January 2014 that were misdiagnosed initially. Information was extracted from the medical case notes of 2 male and 3 female patients with an age range from 12-87 years. Method: The medical records of all 5 patients were analyzed, medical photography was taken and the patients were followed up regularly in our clinic. Results: Each patient presented with a non-healing lesion and all were treated with either oral or topical antibiotics. Patients were eventually referred to the craniofacial department where they all received an orthopantomogram and underwent dental extraction, which led to complete healing. Conclusion: Cutaneous facial sinus tracts of odontogenic origin are often initially misdiagnosed which leads to prolonged and inappropriate treatment. Correct diagnosis and treatment will result in predictable and rapid healing and thus it is essential to record these case series, to ensure that medical professionals are aware of the presenting symptoms, which can often be very subtle.
Aug 2017 DOI 10.14302/issn.2470-0436.jos-17-1666
Purpose: To evaluate early versus late immunomodulatory therapy (IMT) for patients following initial diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Methods: Retrospective review including all VKH patients seen 5/1/2014 to 4/1/2016 at LAC+USC. Early IMT was defined as starting an immunomodulatory agent within 3 months of corticosteroid initiation. Results: Twenty-seven patients were included, of whom 15 received early IMT and 8 received late IMT. Early IMT patients trended toward greater improvement in vision compared to late IMT (logMAR 0.59 vs. 0.11; p=0.14) with no differences in ocular complications including ocular hypertension (p=0.53) and cataract (p=1.0). Patients receiving early IMT averaged 0.93 recurrences versus 2.13 recurrences for late IMT (p=0.092). Of patients successfully taper off oral corticosteroids, the early IMT group was tapered in an average of 8.3 months versus 19.8 months for late IMT (p=0.0019). Conclusions: Early IMT in VKH may allow for shorter duration of corticosteroids with similar visual outcomes, ocular complications, and disease recurrences.
Jul 2017 DOI 10.14302/issn.2474-7785.jarh-16-1067
Aim Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospital with orthopaedic surgery already an established risk factor. This study aims to establish the length of time that a patient is at risk of sustaining a VTE post orthopaedic surgery. Method A retrospective case series of all patients who underwent orthopaedic surgery between 2010 and 2014 whom re-presented with a VTE within one year of their initial operation. Demographic, operative and clinical information was obtained in order to identify potential risk factors. Results 53 patients were identified as having a VTE within one year of discharge. The majority (63.4%) underwent lower limb arthroplasty. 29% of the cohort had either a family or personal history of VTE, 79% had ischaemic heart disease (IHD), hypertension or both. The average body mass index (BMI) of the cohort was 31.4; above the UK national average. 56.6% of the cohort developed a pulmonary embolism (PE) and 49% developed a deep vein thrombosis (DVT). Co-occurring DVT and PE was diagnosed in 5.6% of patients. The average length of time for readmission for patients to re-present at hospital with a PE was 122 days (range 4-361) and 107 days (range 7 – 360) with a DVT. Conclusion This study confirms the existence of pre-established risk factors for developing VTE including obesity, personal and family history of DVT, cardiovascular disease and lower limb arthroplasty. These risk factors are recognised despite patients receiving post-operative thromboprophylaxis. The findings of this study extend the current research by suggesting that patients presenting with known risk factors of developing VTE may be at risk for longer than the current guidelines cover for the administration of thromboprophylaxis. We propose further studies are needed to identify any potential requirements for more extensive VTE prophylaxis in this population.
Jul 2017 DOI 10.14302/issn.2474-3585.jpmc-17-1579
Objectives: Vitamin D (25(OH)D) status has been extensively evaluated in different populations and care settings. A negative relationship between glycated hemoglobin (HbA1c) and serum 25(OH)D levels in outpatients with diabetes has been reported, while data about 25(OH)D status in inpatients with diabetes are inconsistent. The aim of the study was to evaluate 25(OH)D levels in a large series of inpatients with type 1 and type 2 diabetes and in an age-, sex-, serum creatinine-, and HbA1c-matched group of outpatients with diabetes. Design: After the preliminary exclusion of patients with confounding factors, 540 subjects with diabetes were retrospectively evaluated in a 1:1 matched case-control study between inpatients and outpatients. Results: 25(OH)D levels resulted significantly lower in inpatients versus outpatients with diabetes (37.9 nmol/L, median, 25.3 interquartile range, vs 44.9, 31.8 nmol/L, respectively), regardless of season. 25(OH)D levels were inversely correlated with HbA1c levels and BMI in outpatients, and with fibrinogen and erythrocyte sedimentation rate in inpatients. Conclusions: Vitamin D deficiency is common in diabetic inpatients and more frequent than in diabetic outpatients. 25(OH)D status in diabetic inpatients is not related to glycemic control but is likely influenced by acute inflammatory condition.
Jun 2017 DOI 10.14302/issn.2329-9487.jhc-17-1493
Objective: Studies suggest that cardiovascular risk of patients with congenital heart disease (CHD) is increased. This study aims on the predictive value of a single daily activity and exercise capacity assessments on the change of body-mass-index (BMI) and blood pressure in the future. Patients and Methods: We retrospectively analyzed all patients with CHD who underwent a daily activity assessment by triaxial accelerometry and accompanied cardiopulmonary exercise testing. From 276 patients 16 years or older (120 female, 28.6 ± 8.5 years) current BMI and blood pressure could be abstracted from their last outpatient visit. Results: After a mean follow-up of 5.5 ± 1.5 years, the BMI of the patients has increased from 23.0 ± 3.4 to 23.7 ± 3.5 kg/m2 (p<.001) corresponding to an annual increase of 0.14 ± 0.40 kg/m2 respectively. The systolic blood pressure decreased by -0.37 ± 3.14 mmHg (p=.049). The multivariable regression analysis corrected for confounders showed no association to annual BMI change according to baseline daily activity levels (p=.891) or peak oxygen uptake (p=.596). Only in patients with higher BMI at baseline (Beta= -.275; p<.001) and females (Beta= -.177; p=.009) increase in BMI was less. Also the blood pressure change was not associated with daily activity levels (p=.420) and peak oxygen uptake (p=.732) at baseline. Conclusions: Single daily activity or exercise capacity measures do not predict future BMI or blood pressure changes. Regular evaluation of functional status including exercise testing, activity assessment and tailored counseling are therefore recommended in patients with CHD.
Apr 2017 DOI 10.14302/issn.2691-5014.jphn-17-1424
Objective: To assess the effect of different treatment approaches on the course of anorexia nervosa (AN) over time. Methods: The subjects were 27 hospitalized AN patients. In our retrospective analysis we compared weight gain in two groups. While one group was treated with a standard oral refeeding protocol (historical control) through January 2013 (N=16), the second group (highly standardized refeeding protocol) received a high energy liquid nutrition and nutritional supplements including omega-3 fatty acids (N=11). Results: On admission, the two groups were comparable in terms of height, weight, age and heart rate. At the end of our monitoring time frame of 25 days, weight gain was 121.4% higher in the highly standardized refeeding protocol group than in the historical control group (66.5 ±52.4 vs 147.3 ±55.7 grams/day; t-Test p=0.004; CI95%: 29.3-132.2). A carbohydrate rich diet clearly improved weight gain if high energy liquid nutrition was replaced by the diet according the patient’s own wishes. About 45% of our patients stated they were vegetarians at admission. However, we could not identify a vegetarian diet as a statistically significant negative prognostic factor for weight gain. Conclusion: The highly standardized refeeding protocol seems to be helpful in malnourished AN patients to improve weight gain without enhancing the risk of a refeeding syndrome. However, further studies with greater number of patients are needed to confirm the effectiveness of our standardized treatment protocol.
Feb 2017 DOI 10.14302/issn.2372-6601.jhor-17-1423
Background: The diagnosis and treatment outcomes of Non- Hodgkin Lymphoma’s (NHL) in resource poor countries in the absence of routine molecular studies and immunohistochemistry is challenging. Methods: A retrospective review of case folders of NHL patients aged13 years and above. Information obtained from the case folders included age, sex, histological subtype, subtypes using the Working Formulation and WHO classifications. Treatment given and follow up information were also evaluated. Results: A total of 279 cases of NHL were identified within the study period. The mean age of the patients was 48.8 ± 17.0 years. The male to female ratio was approximately 1.5:1. The majority of cases seen (53%) were diffuse large B- cell lymphoma. Chronic lymphocytic leukaemia/ small lymphocytic lymphoma (22.2%) was the next most common subtype. Other sub types seen, in order of frequency, included diffuse mixed cell lymphoma (6.4%), gastric lymphomas (3.9%), mediastinal B- cell lymphoma (2.9%), Burkitt’s lymphoma (1.8%), splenic marginal zone B-cell lymphoma (1.1%), lymphoblastic lymphoma (1.1%), mucosa- associated lymphoid tissue (MALT) type B- cell lymphoma (0.7%) and follicular lymphoma (0.7%). Conclusion: This study provides an overview of the distribution of NHL subtypes and their outcomes in a resource constrained setting. Immunohistochemistry, cytogenetics and specific molecular studies which are important in characterization of NHLs, should be made affordable and accessible in low income countries.
Jan 2017 DOI 10.14302/issn.2470-5020.jnrt-16-1415
Objectives: Computed tomography angiography (CTA) provides early assessment of cerebral vasculature in ED patients presenting with Acute Ischemic Stroke (AIS). Prior studies using 4 row detector CT scanners have suggested that results may be used to determine who receives thrombolytics (tPA). We sought to evaluate the rate of normal CTA and the use of tPA in AIS patients with and without blockages using modern CT technology. Patients and Methods: We conducted a retrospective cohort study of all code stroke patients presenting to our ED over a 3 year period. Inclusion criteria included an ED and neurology diagnosis of AIS with a CTA performed at presentation. All patients had a NIHSS score recorded at presentation and underwent imaging using a 64 row detector scanner with 50cc of non-ionic contrast. Demographic, imaging, and clinical data were collected. Modified Rankin Scores (mRS) were assigned at hospital discharge. Good clinical outcome was defined as a mRS of 0-2. Data are reported as frequencies and medians with interquartile ranges (IQR) as appropriate. Rates of tPA use were evaluated using χ2 testing. Rates of good outcomes were evaluated using odds ratios. Results: A total of 205 subjects met inclusion for analysis of which 103 (50%) were male and 109 (54%) had no blockage on CTA. The median NIHSS score and mortality rates were 14 (IQR 8-19), 14 (14%) with CTA blockage, and 4 (IQR 2-7), 2 (2%) for those without. Of those AIS with a blockage on CTA 46 (48%) were treated with tPA including 29 who were treated with intra-arterial therapy as well while only 13 (13%) of patients without a blockage were treated with tPA. Post tPA bleeding occurred in 12 (13%) patients with blockage on CTA and in 0 patients without blockage. Use of tPA was significantly more frequent in patients with a blockage on CTA, P <0.001. Conclusion: More than half of our AIS patients presenting through our ED have no blockage on CTA. Inter-rater reliability among neuroradiologists evaluating for large vessel occlusion appears to be very good. Patients with AIS and no blockage on CTA have less severe strokes and are less likely to receive tPA. Given the new guidelines recommending endovascular treatment for AIS we expect more emergency departments to begin performing CTA.
Jan 2017 DOI 10.14302/issn.2379-8572.joa-16-1399
Aim: The relation between inflammation and cancer has been known since the 19th century. However, investigations on the pathogenesis and pathophysiology of this relation have begun recently. It was demonstrated that increased neutrophil/lymphocyte ratio is a poor prognostic factor in some malignancies. The present study aimed to determine whether preoperative neutrophil/lymphocyte ratio has a prognostic value in larynx cancer. Method: Preoperative blood analyses of 139 patients, who underwent subtotal or total laryngectomy for larynx cancer between 2003 and 2013 at Marmara University School of Medicine, Department of ENT, were retrospectively evaluated. Neutrophil/lymphocyte ratio (NLR) was calculated dividing absolute neutrophil count by absolute lymphocyte count. Optimal cut-off value for NLR was determined by receiver operating characteristics (ROC) curve analysis. Statistical analyses were done using IBM SPSS statistic 22.0 (IBM SPSS, Turkey) and Med Calc 12.3.0 package programs. Results: The sensitivity of NLR in predicting advanced-stage (Stage 3 and 4) squamous-cell carcinoma of the larynx (LSSC), T4 LSSC and lymph node metastasis at different cut-off values were 66.2%, 83.9% and 73.8%, respectively and the specificity was 76.7%, 66.2% and 65.2%, respectively. Staging according to T classification revealed that NLR significantly increases with tumor stage (p<0.001). Statistically significant relation was determined between lymph node metastasis of tumor and neutrophil/lymphocyte ratio (p=0.003). Comparing overall survival (OS) and disease-free survival (DFS) between the cases with NLR <3.02 and the cases with NLR >3.02, it was demonstrated that OS and DFS are significantly lower in the cases with NLR<3.02 (p: 0.001 vs. p<0.05 for OS and p: 0.013 vs. p<0.05 for DFS) Conclusion: NLR increases with the stage of disease in LSSC. NLR is a simple, cheap, repeatable and valuable parameter that can be obtained from routine analyses, gives information about poor prognosis and survival, and is able to predict T4 LSSC, advanced-stage LSSC (stage 3-4) and lymph node metastasis.
Dec 2016 DOI 10.14302/issn.2372-6601.jhor-16-1070
Introduction: Post-transplant lymphoproliferative disease (PTLD) is a collection of conditions associated with abnormal proliferation of lymphoid tissues in patients after solid organ transplants (SOT). Its clinical presentations are quite variable and non-specific. Otolaryngological signs and symptoms, manifested as adenotonsillar hypertrophy or cervical lymphadenopathy, may guide to early detection and treatment. Methods: We conducted a retrospective review of all pediatric SOT recipients with the diagnosis of PTLD, age 0-18, between 2005 and 2014 at the Loma Linda University Children’s Hospital. The patient’s age, type of organ transplant, immunosuppression, head and neck signs and symptoms, imaging modality, EBV status, histology as well as treatment regimen information were recorded. Results: A total of 21 pediatric patients were included in this retrospective review with a history of solid organ transplant and a diagnosis of PTLD. The most commonly associated type of transplanted organ is heart (57.1%), followed by kidneys (33.3%) and liver (9.5%). Neck swelling (28.6%) was the main head and neck complaint while one patient developed upper airway obstruction with respiratory distress. Cervical lymphadenopathy was found in 66.7% and tonsillar hypertrophy in 9.5% of the patients. Monomorphic PTLD (46.2%) was the most common pathological diagnosis, followed by reactive hyperplasia (30.8%), Hodgkin lymphoma (15.4%) and polymorphic PTLD (7.7%). Majority of the PTLD patients were treated with rituximab and cyclophosphamide combination therapy with and without prednisone. Conclusion: Adenotonsillectomy and cervical lymph node biopsies are easy to perform with low complication rates. They serve an important role in the armamentarium in the early detection of PTLD in its early stage, allowing prompt treatment and prevention of further progression.
Dec 2016 DOI 10.14302/issn.2379-7835.ijn-16-1390
Objectives: To evaluate the efficacy of a weight loss programme and the factors that predict successful adherence of the treatment. Methodology: A retrospective chart review of 500 overweight outpatients (427 women, 73 men), mean age 41.7 years (range: 18–81) and mean BMI of 31.44 kg/m2 (range: 25.09–51.33), treated at an obesity specific clinic. A programme involving a hypocaloric Mediterranean diet was prescribed, along with suggestions for leisure exercise and daily activity. The weekly follow-up continued until the weight loss goal was reached (‘completion’ group) or the patient discontinued the programme (‘dropout’ group). Key Results: Those that completed the programme achieved a mean weight loss of 10.6 kg (12.9% percentage loss of initial body weight) and a mean body fat mass loss of 26.8%. Factors predictive of completion were: gender (males higher completion), previous dietary programmes (predictive of dropout), initial percentage of fat mass (higher percentage, lower completion), age (younger age, lower completion) and hypothyroid disease (predictive of dropout). Conclusions: A hypocaloric Mediterranean diet and moderate exercise could help to reduce body weight and body fat in overweight patients. Treatment completion of self-selected and self-paying patients is low, and appear to be more effective for men, persons with a low percentage of fat mass, older age groups and those who have not made other previous diets.
Dec 2016 DOI 10.14302/issn.2381-862X.jwrh-15-846
Sexual assault is a serious problem in the United States. It is crucial that the medical management of these patients is adequate. The Centers for Disease Control and Prevention (CDC) provides guidelines for appropriate management of these patients. The purpose of this study is to evaluate medical management of survivors of sexual assault at an academic medical center and identify opportunities for improvements in care. We conducted a retrospective, chart review study of patients aged 12 years and older presenting at an academic medical center following sexual assault or rape between 2009 and 2013. Descriptive statistical tests were used to analyze the data. A total of 29 females and 5 males were identified. The majority of patients presented to the medical center within 24 hours of sexual assault or rape and typically presented to the emergency department. Empiric treatment for infections were 8.8% for Hepatitis B, 29.4% for human immunodeficiency virus, 20.6% for gonorrhea, 17.6% for chlamydia, and 8.8% for trichomonas. Among women of reproductive age, 28.0% were provided with emergency contraception. This study found inconsistency in the medical management of sexual assault survivors. Among this small sample size, many patients were not provided with recommended medical treatments. With this knowledge, the medical center plans to implement institutional guidelines and a corresponding order set in the computerized prescriber order entry system to standardize the medical management of sexual assault survivors and educate healthcare professionals. Future studies are warranted to evaluate the impact of standardized guidelines and order set implementation.
Dec 2016 DOI 10.14302/issn.2379-8572.joa-16-1366
Idiopathic sudden sensorineural hearing loss (ISSHL) is a commonly seen otorhinolaryngology emergency, and its etiology is still a mystery. In this retrospective clinical study, we aimed to investigate the possible relationship of inflammatory markers derived from CBC such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Red cell distribution width-to-platelet ratio (RPR), lymphocyte-to-monocyte ratio (LMR), mean platelet volume (MPV) and platelet distribution width (PDW) in ISSHL . A total of 50 idiopathic sudden hearing loss patients were included in the study. They were grouped according to their hearing healing levels as recovered, partially recovered and unrecovered. Also 47 age- and sex- matched healthy individuals created the control group. Their complete blood count parameters of NLR, LMR, PLR, RPR, PDW and MPV were recorded. The results were statistically compared to bring out a significant difference between the groups. There was no significant demographic difference between the groups. The comparison of patient group with control group reveal a significant difference in the NLR, LMR and PDW values (p<0.05). The remaining values were not statistically significant. The analysis of these values according to the recovery level of the ISSHL, there was no statistical difference between the groups (p>0.05). We demonstrated for the first time that LMR value was significantly elevated in ISSHL patients. NLR, LMR, and PDW might be indicative for diagnosis of ISSHL. However, we believe that using these parameters for the screening of the prognosis is a clinically useless exercise.
Oct 2016 DOI 10.14302/issn.2576-182X.jbsc-16-1261
Background: Spontaneous primary intracranial hemorrhage or known as intracerebral hypertensive hemorrhage consist of 15 to 20% of all stroke, is one of the major health problems among healthy and productive workforce in any countries. Methods: A retrospective study was conducted in a dedicated Neurosurgical Centre at the Hospital Sungai Buloh, Malaysia. The study was conducted for admission within a year period, in the year 2013 with 6 months follow-up. A total of 35 patients were studied. Results: The mean age was 52.8 years old (31-77 years old). A total of 29 patients (82.9%) were presented with basal ganglia hemorrhage, 4 with cerebral lobar hemorrhage (11.4%) and 2 with cerebellar hemorrhage (5.7%). The surgical mortality rate was 40%. For the 6 months follow-up, 31.4% patients improved to Glasgow Outcome score (GOS) of 4, while 22.9% and 5.7% patients improved to only GOS of 3 and 2 respectively. There were several factors identified in the study to be important predictors of survival. There were statistically significance of higher mortality rate among patients with pre-operative GCS of 5 and below (p=0.015), pre-operative CT scan brain showing acute hydrocephalus (p=0.046) and residual post-operative hematoma above 5% of pre-operative clots volume (p=0.006). Other factors such as age, sex, size of pre-operative hematomas, presence of intraventricular hemorrhage, underlying medical illness were not statistically significant in predicting the surgical outcome of those patients. Conclusions: Outcome predictors such as pre-operative GCS and CT scan brain findings helps treating neurosurgeons to determine the prognosis of patients presented with spontaneous intracranial hemorrhage.
Oct 2016 DOI 10.14302/issn.2574-450X.jom-16-1003
Introduction: The Roux-en-Y Gastric Bypass (RYGB) has been one of the most popular surgeries in the USA for years. While many models have been made to investigate the factors that affect weight loss, these factors are still highly debated. Objective: To create a model that predict performance of RYGB patients. Methods: 110 out of 344 patients who received a RYGB at a single institution between Jan 2010 and April 2014 were included in this study. Data was collected retrospectively. Patients were included if they had greater than 1 year follow up with at least three follow up points and could be modeled with r2>0.95. All patients were one year beyond surgery, while 40 were completely lost to follow up, 104 at 1 month, 138 at 3 months, 188 at 6 months, and 225 at one year. 9 patients were not included because they did not meet the criteria of the study. Patients were divided into quartiles based on percentage excess weight loss (%EWL) at one year. Multivariate analysis was performed to determine the significant factors that influence patients being in the first quartile of weight loss (17-60% %EWL). Results: Only males with a Body Mass Index (BMI) above 44 and females with a BMI above 64 were found to be predictive of patients being in the first quartile. Our model has Positive and Negative predictor values of 66% and 80% respectively with sensitivity and specificity of 29% and 95% respectively. Conclusions: An model to predict %EWL was created, only gender and pre-operative BMI were found to be significant factors. In general females have better outcomes with higher BMI’s than do males. This information should be discussed with patients when deciding a procedure. However, more studies are needed for validation of these results.
Aug 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1115
Purpose: To determine an appropriate time interval for conducting mass screening for glaucoma, it is important to gather information on the annual incidence rate. Thus, a retrospective cohort study was conducted to determine the annual incidence rate of visual field abnormalities (VFA) among a workplace cohort. Methods: In an initial visual field test using frequency doubling technology (FDT) perimetry conducted on 3443 employees (mean age 47.4 ± 8.9, men/women = 2967/476), no abnormalities were observed. Subjects were followed-up with annual perimetric testing for seven years, with VFA being determined using FDT test (FDT-VFA). Results: Using theKaplan–Meier method (log rank test, p < 0.001), cumulative FDT-VFA rates (SE) at seven years for subjects in their 30s, 40s, 50s, and 60s or older were found to be 3.0% (0.6), 4.2 % (0.6), 4.8 (0.8), and 11.3% (0.2), respectively. A linear fit to the Kaplan–Meier results yielded an annual incidence rate of 0.42%, 0.60%, 0.77%, and 1.60% for the 30s, 40s, 50s, and ≥60s age groups, respectively. Conclusion: Our data suggest that the annual incidence rate of VFA is <0.7% per year in subjects younger than 60 years of age; however, it increases to 1.6% per year in older subjects, thus suggesting that the monitoring frequency of glaucoma patients may need to be adjusted as a function of their age and be performed more frequently after the age of 60 years
Aug 2016 DOI 10.14302/issn.2470-5020.jnrt-16-1200
Objective: To assess mortality, medical complications, and care indicators among stroke patients admitted to general medical units at King Abdulaziz Medical City-Jeddah-Saudi Arabia. Methods: This retrospective cohort study included all adult patients (>16 years) admitted to KAMC-Jeddah between January 1, 2014, and June 30, 2015, with acute stroke. Data regarding in-hospital stroke mortality and medical complications (pressure ulcer, pneumonia, venous thromboembolism dysphagia, and wheelchair dependency) and stroke care indicators (time-to-CT, carotid imaging, lipid profile, physical therapy, swallowing assessment, nutritional assessment, and length of stay) were collected. Results: Patients included were 208. Acute stroke mortality was 19%, while wheelchair dependency, and dysphagia on discharge were 39% and 56% respectively in general medical units. The incidence of pressure ulcers, pneumonia, and venous thromboembolism was 17%, 14%, and 3%, respectively. Pneumonia (odds ratio OR, 5.5; P = 0.002; 95% confidence interval CI, 1.9–16), abnormal troponin level (OR, 4.4; P = 0.002; 95% CI, 1.7–11),hemorrhagic stroke (OR, 3.9; P = 0.015; 95% CI, 1.3–12), and pressure ulcers (OR, 3.0; P = 0.036; 95% CI, 1.1–8.0) were significantly associated with increased mortality. Median time to CT scan was 117 minutes. Carotid imaging was performed for 67% of ischemic stroke patients, and 65% underwent fasting lipid profile assessment. Assessment by nutritionist, physiotherapist, and swallowing therapist was done for 90%, 76%, and 53% of stroke patients respectively. The median length of stay was 12 days. Conclusion: Acute stroke mortality was 19 %, while wheelchair dependency, and dysphagia on discharge were 39% and 56% respectively in general medical units at KAMC Jeddah. Pneumonia, abnormal troponin, hemorrhagic stroke, and pressure ulcers are associated with increased mortality. Future research is needed to compare outcomes of stroke care between general units and specialized stroke units nationally.
Jul 2016 DOI 10.14302/issn.2574-4526.jddd-16-1203
Background: Iron deficiency is a common reason for referral to a gastroenterologist. Objective: To identify predictors of colorectal cancer in patients referred to a gastroenterologist for iron deficiency. Methods: This was a retrospective review of consecutive patients referred to one of two gastroenterologists for assessment of iron deficiency. The office files and electronic health records were reviewed for all patients. Clinical data, such as hemoglobin level, and clinical symptoms were recorded. The final diagnosis was that of the attending gastroenterologist. Variables associated with a diagnosis of colorectal cancer by univariate analysis were entered into a multivariate logistic regression model to identify variables independently associated with the diagnosis of colorectal cancer. Results: Two hundred and seventy eight patients were included in this study. One hundred and fifty-eight (56.8%) were female. Mean age was 60.7 years (± 16.7 years). The most common causes of iron deficiency were: menorrhagia 16.2%, colorectal cancer 14%, use of aspirin or non-steroidal agents 11.2% and regular blood donation 7.2%. In 11.5% of patients, no cause was found. In univariate analysis, lower hemoglobin, greater age, shorter duration of iron deficiency, weight loss, symptoms from anemia and NSAID use were associated with colorectal cancer. In multivariate analysis, only older age (OR=1.06; 95% CI 1.04-1.09) and symptoms from anemia (OR=2.19; 95% CI 1.20-4.0) were independently associated with colorectal cancer. Conclusions: Colorectal cancer was found in 14% of patients referred to a gastroenterologist because of iron deficiency. Older age, and symptomatic anemia may help predict a diagnosis of colorectal cancer.
Jul 2016 DOI 10.14302/issn.2471-7061.jcrc-14-575
Aim: To analyze the factors involved in and the results of stoma reversal after an emergency Hartmann's operation. Methods: A multicenter retrospective study from the Valencian Society of Surgery of patients who had undergone an emergent Hartmann’s operation from 2004 to 2008. An analysis of the reversal rate and related factors, delay, and morbidity of reconstruction was performed. Results: Three hundred sixty-two patients were studied. The most frequent initial diagnosis was colorectal cancer, followed by complicated acute diverticulitis; the primary surgical indication was acute peritonitis. After a median follow-up of 52 months, 151 patients (41.7%) underwent surgery to reverse the stoma at a median of 10 months after initial surgery. Diagnosis of diverticulitis or trauma, peritonitis as the surgical indication, and non-advanced tumors were associated with reversal. Multivariate analysis showed that only age and tumor stage were predictive of reversal. Postoperative complications occurred in 44% of the cases, and wound infection was the most common. There were 9 (6%) anastomotic leaks. Thirteen patients (8.6%) retained a permanent or temporary stoma after the attempted reconstruction. Conclusion: Hartmann’s reversal after emergency surgery is performed in less than half of all such patients and has significant morbidity.
Jul 2016 DOI 10.14302/issn.2381-862X.jwrh-15-806
Background and Objectives: The prevalence of abnormal cervical cytology in morbidly obese women using ThinPrep® liquid-based Pap Test™ and HPV DNA Test™ is unknown. We aimed to investigate whether women with morbid obesity have a higher frequency of abnormal Pap smears compared with nonobese women, and to explore the rate of Pap smear screening in morbidly obese women. Design and Setting: We conducted a retrospective study over five years in two general government hospitals in Dubai. Patients and Methods: We screened ThinPrep slides and HPV DNA of morbidly obese women and nonobese women. The age, ethnicity, demographic and socioeconomic backgrounds of the two groups were matched. We studied hypertension (HTN), diabetes (DM), infertility, sexually transmitted diseases (STD), connective tissue disease (CTD), immunosuppression and oral contraceptive pills (OCP) as potential risk cofactors. Results: Only 90 (29%) out of 310 morbidly obese women had had Pap tests. They showed more prevalence (P<0.05) of ASC-US, high-risk HPV DNA and LSIL 16 positive (18%) (95% CI: 7.0, and of endometrial AGCs {4 positive (4.5%) (95% CI: 0.3-13.5)} than the nonobese women (n=8175), {279 positive (3%) (95% CI: 3.0-3.8} , and {2 positive (0.024%) (CI:0.01-0.09)}. There were no endocervical AGCs, HSIL or squamous cancer in morbidly obese women. DM, HTN, OCPs, CTD and STD were more common in morbidly obese women having abnormal Pap smears. Conclusions: Low-grade squamous abnormalities, high-risk HPV, and endometrial AGCs are more frequent in morbidly obese women than in nonobese women. Women with morbid obesity have a low rate of cervical screening. This, among other factors, could increase the risk of these women to abnormal cervical cytology. This vulnerable group should benefit from more frequent cervical cytology screening. Appropriate clinical and educational measures should be implemented to encourage compliance to Pap smears. Weight reduction might help.
Jun 2016 DOI 10.14302/issn.2574-4488.jna-16-1008
Background: It is unclear whether patients who present with elevated blood urea nitrogen (BUN), but are normal for other markers of kidney damage, are prone to develop chronic kidney disease (CKD). This study therefore investigated estimated glomerular filtration rate (eGFR), a marker of CKD, in these patients. Methods: Patients with elevated BUN but normal for other markers of kidney damage who were followed-up for ≥48 months in our outpatient clinics were retrospectively evaluated. BUN, eGFR, and serum creatinine concentrations in the patient group were compared with findings in an age- and sex-matched control group. Results: At baseline, BUN concentration was significantly higher in the patient than that in the control group (8.30±1.10 vs 5.05±0.91 mmol/L; p <0.01), but eGFR (111.94±18.62 vs 111.25±14.63 ml/min/1.73m2) and serum creatinine concentrations (87.23±8.59 vs 72.39±10.06 µmol/L) were similar. At 1 year, however, eGFR in the patient group was significantly lower than in the control group (95.39±18.52 vs 108.17±16.99 ml/min/1.73m2; p < 0.01), and was significantly lower than in the patient group at baseline (95.39±18.52 vs 111.94±18.62 ml/min/ 1.73 m2, p < 0.01), with these differences becoming more pronounced over time. Conclusions: Patients with elevated BUN but normal for other markers of kidney damage show significantly lower eGFR over time than matched controls.
Jun 2016 DOI 10.14302/issn.2471-2175.jdrt-15-836
Cellulitis is an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, usually complicating a wound, ulcer, or dermatosis. Inappropriate diagnosis of cellulitis is a problem and would need prospective rather than retrospective studies to quantify the extent. There is one national guideline for the management of patients with cellulitis. The aim of this study is to determine the validity of Crest guideline in the patients with non-facial cellulitis. This prospective cohort study was conducted on all Adult patients with cellulites who were admitted at Resole-Akram and Sina emergency department between November 2013 and January 2014. Based on admission duration, the patients were randomly divided into two groups including primary and secondary outcome, <24-hours or >24-hours admission, respectively. Out of 89 admitted patients, 55% were hospitalized over 24 hours and 20% of them had significant systemic symptoms. The most patients (n= 42) had either systemically ill or systemically well or class II followed by classes I (n=28), III (n=18), and IV (n=1). There was significant relevancy between age, fever, PR, infected organ, leukocytosis, diabetes mellitus, IUDA, human bite, and primary outcome. In conclusion, factors associated with admission were age, presence of multiple comorbid conditions, diabetes mellitus, human bite, IUDA, infected organ, leukocytosis and fever. These results showed that the decision in the emergency department was mostly the same as Crest guideline and the prospection of admission and discharge of these patients was almost according to the educations of Crest guideline.
Dec 2015 DOI 10.14302/issn.2372-6601.jhor-15-799
Objective: Hospital construction work, among other environmental factors, is a risk factor for invasive aspergillosis (IA). Methods: We retrospectively surveyed the incidence of IA in hematology-oncology patients before and during hospital construction and studied the effectiveness of prophylactic oral itraconazole (ITCZ) treatment. We compared the rates of galactomannan (GM)-positive cases and probable IA cases among 224 patients discharged before the start of construction work and among 67 patients hospitalized within two months after the start of the construction work. Results: Our results showed that, during the 12 months before the construction work was started, only four patients were GM-positive, and one had a probable diagnosis; in contrast, among patients hospitalized within two months from the start of the construction work, seven patients were GM-positive, and four had a probable diagnosis. Therefore, we started to administer oral ITCZ to 40 patients with hematological diseases. Although the construction work continued, after the ITCZ prophylaxis, no new probable cases of IA were detected. Conclusion: From our experience, GM surveillance among hematological patients is necessary during hospital construction work, and the administration of ITCZ to prophylactically prevent IA is suggested upon detection of an increase in GM-positive patients.
Dec 2015 DOI 10.14302/issn.2471-7061.jcrc-15-661
Following multivisceral pelvic resections, the pelvis and perineum are often reconstructed using myocutaneous flaps. Abdominal wall defects after harvesting rectus abdominis flaps can be reinforced with mesh. Primary reconstruction using synthetic mesh was presently evaluated. Fifty-eight patients who underwent multivisceral pelvic resection and perineal reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap, January 2004 to February 2014, were retrospectively reviewed. The abdominal wall was reinforced in 26. Demographics, treatment procedures, surgical procedures, length of hospital and ICU stay, early and late morbidity at the recipient and donor sites were recorded. Patients with mesh reinforcement were significantly younger than those without. There were no further significant differences in patient demographics or treatment procedures between the two groups. In 31% of the patients with mesh, surgery was performed on two consecutive days, although total operating time did not differ significantly. Patients without mesh bled more. Surgery was associated with considerable morbidity, without significant differences in overall complication rate between the two groups. At the recipient site, wound infection/dehiscence was the most common early complication. The group with mesh had higher rate of total flap necrosis necessitating re-operation. At the donor site, wound infection /dehiscence, hernia, or bulge were recorded. Patients with mesh had lower rates of donor site morbidity. Perineal reconstruction with VRAM flap and primary abdominal wall reinforcement with mesh is feasible after multivisceral resection. Our study indicates that primary use of mesh can be applied in potentially contaminated surgical fields in oncologic patients without increasing morbidity and with improved long-term cosmetic results.
Oct 2015
The mitotic count is the most frequent reason for discordance between pathologists in modified Bloom and Richardson (mBR) scoring. Recently, the phosphohistone H3 (PHH3) immunohistochemical stain has been proposed as a potential surrogate marker for mitotic figures. This study examines the differences between H&E mitotic count, PHH3 mitotic count, and Ki-67 index in invasive breast carcinoma. A retrospective review of invasive breast carcinoma cases from 2013- 2014 was performed. H&E and PHH3 mitotic counts were assigned a mitotic score of 1 to 3 using mBR criteria. Ki-67 index was categorized into a three-grade system: <10% (low), 10 - <20% (intermediate), and >20% (high). A total of 451 cases were evaluated. PHH3 versus H&E mitotic count changed mBR scores in 24% of cases, upgrading in 23% and downgrading in 1%. A total of 431 cases had both Ki-67 and PHH3 available for comparison. Both H&E and PHH3 mitotic scores correlated with Ki-67 in 51% of cases; however, PHH3 had better correlation. We conclude that PHH3 in breast carcinoma allows for a more sensitive and practical approach in the identification of mitotic figures. PHH3 IHC is useful as a confirmatory tool in assessing the final mitotic score for more accurate mBR scoring and grading. In this study, 48 out of 451 (10.6%) of patients had a significant upgrade that may change the patient's treatment plans, including the addition of chemotherapy
Oct 2015 DOI 10.14302/issn.2470-5020.jnrt-15-726
Background: A higher incidence of symptomatic lacunar infarction (LI) was confirmed in metropolitan areas. The aim of this study was to determinethe prevalence characteristics and early predictors of LI in a population of elderly outpatients in northern China. Methods: From February 2011 to March 2012, a retrospective cohort of new patients was selected for study, all registered neurologic outpatients of the tertiary teaching hospital in northern China. A total of 453 outpatients, clinically only having had an initial visit and a magnetic resonance imaging study of the brain, were enrolled. The prevalence characteristics and vascular risk factors of LI were assessed. Results: Of 453 symptomatic outpatients, 258(57.0%) patients had symptomatic LI. We found that the main types of symptomatic LI were nonfocal symptoms, such as dizziness and headache, dizziness/vertigo, and migraine/headache. Age, BMI, smoking, history of hypertension, duration of hypertension, existing hypertension, headache and dizziness, pure motor hemiparesis, blood glucose, hypercholesterolemia, systolic blood pressure, and ABCD2 score, were significantly higher in patients with LI than in those without LI (P<0.05). Multivariate logistic regression confirmed that hypertension ≥3years in duration (odds ratio=1.092; 95% CI, 1.019 -1.170) and a median mABCD2 score ≥4 (odds ratio=3.912; 95% CI, 2.955- 5.180) were independent, early predictors of symptomatic LI. Conclusions: The incidence of LI in Northern China was located at the higher end of range in northern China, and common type of symptomatic LI was nonfocal symptoms. Hypertension of long duration and high-risk ABCD2 scores are early predictors of symptomatic LI.
Oct 2015 DOI 10.14302/issn.2379-8572.joa-15-691
Background. Nasopharyngeal carcinoma (NPC) is a rare disease in the pediatric age group; it represents 1% of all pediatrics malignancies, however, it is the predominant malignancy arising in the nasopharynx in this age group. Although NPC is a chemo-radiosensitive disease yet, the optimal dose of radiotherapy and optimal timing of chemotherapy is still not standardized. Methods. This is a retrospective study including all the newly diagnosed pediatric NPC who were diagnosed and treated at the Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to December 2012. All imaging studies (e.g., CT or MRI scans) were reviewed by a senior head and neck radiologist for proper staging and assessment of tumor response. Patients were staged according to AJCC staging system. Modified version of the Response Evaluation Criteria in Solid Tumor (RECIST) was used to assess response. Results. Twenty-six patients were diagnosed and received treatment as NPC in CCHE. Median age was 12 years (range 7.8-17 years). There was a male predominance. Eleven patients (42.3%) were stratified as stage 4, and 11 (42.3%) as stage 3. All patients received 3 cycles of neo-adjuvant chemotherapy followed by concurrent chemo-radiotherapy. IMRT was used to deliver radiotherapy in all patients. The overall response rate (CR and PR) to induction therapy was 73%, 19.3% had SD, while 7.7% had PD. By the end of the study, 18 patients (69.2%) were alive in CR, 5 patients (19.2%) had PD, and 3 patients (10%) lost for follow up. The Mean duration of follow up was 35 months, range 5-66 months. The 3 year OS and EFS and rates were 84.6% and 69.3 % respectively. OS for M0 was 91.3% and for M1 33.3% with statistical significance (p =0.032). Conclusion. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy using IMRT lead to good clinical end results with limited toxicity. Metastatic disease at presentation was identified as the adverse prognostic factor.
Jun 2015 DOI 10.14302/issn.2374-9431.jbd-12-164
Objective: To identify the efficacy of focal photocoagulation to maintain or achieve best corrected visual acuity (BCVA) ≥20/40 in eyes with clinically significant macular edema (CSME) that had a focal angiographic pattern. Material and Methods: Non-experimental, retrospective, longitudinal, descriptive study in type 2 diabetic patients of any gender, who had CSME with focal angiographic pattern, who received focal photocoagulation from January to October 2012, with a register of BCVA before and 3 weeks after photocoagulation. 101 eyes from patients aged 35-74 years (mean 60.1±8.15) were assigned to one of two groups: 1, with BCVA before treatment <20/40 (n=60), and 2, with BCVA ≥20/40 (n=41). The proportion of eyes with BCVA≥20/40 after treatment was identified, in the sample and within each group. Results: In group 1 BCVA improved in 34 eyes (56.7%), did not change in 15 (25%), and worsened in 11 (18.3%); in group 2 BCVA improved in 10 eyes (24.4%), did not change in 18 (43.9%) and worsened in 13 (31.7%). Post treatment BCVA was ≥20/40 in 57 eyes (56.4%, 95% confidence intervals 46.8-66.1%), 21 of them from group 1 (36.8%) and 36 from group 2 (63.2%). Conclusion: Treating CSME with focal photocoagulation was efficacious to maintain BCVA ≥20/40 in 87.8% of eyes with that rank of vision preoperatively, and to achieve BCVA ≥20/40 in 35% of eyes without it. Early detection and treatment of CSME is required to increase the proportion of eyes with BVCA that provides visual independence, preferably when visual function is still good.
May 2015 DOI 10.14302/issn.2372-6601.jhor-14-382
Background/Aims: Thyroid disorders are a common, worldwide clinical problem in general practice.It presents predominantly as a thyroid nodule. Each thyroid nodule has a risk of cancer. The incidence of thyroid cancer is much more common in Saudi Arabia in comparison to the West. There is a worldwide increase in the incidence of thyroid cancer. The objective of this study is to highlight in details the wide spectrum of histopathologic diagnosis encountered in patient undergoing thyroid surgery in the population of Riyadh region of Saudi Arabia. Patients and Methods: Retrospective review of all thyroid samples for 256 patients whom underwent thyroid surgery at King Khalid University Hospital, King Saud University, Riyadh, during the period between 2000 and 2009. Of those, 171 cases were non neoplastic and 85 neoplastic lesions. Females constitute 80% of non neoplastic lesions and 79% of all thyroid malignancies. The peak incidence of thyroid cancer was in the third decade. Papillary thyroid carcinoma was the most common cancer (71%). Conclusion: Thyroid cancer is a common cancer in Saudi Arabia; it is the second most common cancer in females. The increasing rates of thyroid cancer occur predominantly in women. Papillary thyroid carcinoma accounted for the bulk of this increase. Additional studies are needed to explain the rise in papillary thyroid carcinoma incidence in Saudi Arab as well as throughout the world and to search potential risk factors that are currently unrecognized.
May 2015 DOI 10.14302/issn.2574-4496.jtc-14-395
Background: Medullary Thyroid Cancer (MTC) is a rare malignancy, accounting for less than 3% of all thyroid cancers and causes significant morbidity and mortality. MTC is often due to an underlying mutation of the RET proto-oncogene, which can result in additional endocrinopathies that must be screened for pre-operatively. The project aim was to determine if surgical training background influenced patient pre-operative evaluation for MTC. Methods: A retrospective review was performed of patients undergoing thyroidectomy for MTC at a single academic institution. Patients were analyzed based on who performed the initial operative procedure, a surgeon with specific endocrine surgery training or a surgeon without. Results: From 1994 to 2011, 37 patients with MTC were identified. Thirty percent were managed by an endocrine surgeon and 70% by a non-endocrine surgeon. A complete thyroid work-up was done for all the patients managed by an endocrine surgeon vs. 38.5% of the non-endocrine surgeon patients (p<0.01). Appropriate preoperative endocrine screening was performed in 91% of the endocrine surgeon patients vs. 50% of the non-endocrine surgeon patients (p= 0.03). RET mutation genetic testing was done for all endocrine surgeon patients vs. 85% of non-endocrine surgeon patients (p= 0.30). Conclusion: Endocrine trained surgeons recognize and appropriately manage the complexity of MTC and associated endocrinopathies, more often than surgeons without an endocrine surgery background. This may result in optimized management of these patients.
May 2015 DOI 10.14302/issn.2372-6601.jhor-14-493
In autologous hematopoietic stem cell transplantation patients for whom granulocyte-colony stimulating factor fails to mobilize a sufficient number of peripheral blood stem cells, plerixafor proposes an option for successful rescue mobilization. This paper evaluates the efficacy of plerixafor to mobilize peripheral blood stem cells (PBSCs) in patients who failed previous mobilization with G-CSF alone, by retrospectively analysing the PBSC results from lymphoma and myeloma (MM) patients between 2006 and 2011. Patients were classified according to the CD34+ cells/kg yield collected by apheresis: < 2 x 106 CD34+ cells/kg was considered collection failure, whereas ≥ 5 x 106 CD34+ cells/kg was considered good mobilization. 797 patients underwent one or more apheresis. The first mobilization success rate was 82%; 140 patients proved to be poor mobilizers. Suboptimal first mobilization was significantly associated with age >50 years (p=0.005) and the absence of chemotherapy in prior PBSCs stimulation (p=0.04). 149 rescue protocols were used in the 140 poor mobilizers, and 71 patients received plerixafor. In univariate analysis the remobilization rate without plerixafor was 42% and increased to 65% when plerixafor was added. In multivariate analysis, plerixafor administration reduced the PBSC remobilization failure risk by a half (OR=0.47). The median value of CD34+ cells/kg in transplants increased from 1.43 (range, 014.03) without plerixafor to 3.85 (range, 0–18.25; p=1 x 10-4) with plerixafor. There were more good mobilizers after plerixafor use (35% with plerixafor versus 15% without plerixafor; p=0.005). Plerixafor efficacy was similar for lymphoma (60% remobilization) and MM (80%; p=0.12). These data show that plerixafor was effective in poor mobilizers and that it synergized with G-CSF to improve the quantity of collected PBSCs. Plerixafor also increased transplant feasibility by 23%. While the clinical results of this study are promising, economic data were not taken into account and there is a need for real work concerning the cost-effectiveness of this treatment. We propose a subsequent study in which the economic efficacy of plerixafor’s use is evaluated based on the financial aspects of the treatments received by the cohort evaluated in this paper.
Aug 2014 DOI 10.14302/issn.2329-9487.jhc-13-313
Objective: Ablation of foci within the atria has been shown to resolve symptoms of atrial fibrillation and atrial flutter. However, no standard has been established for anticoagulation after the procedure. Enoxaparin has been well described in the literature as a means to provide anticoagulation after ablation procedures. The only enoxaparin doses previously studied were 0.5 mg/kg and 1 mg/kg, both given every 12 hours. The purpose of the study was to compare the incidence of a major bleed or vascular complication in patients who received enoxaparin doses between 0.5 mg/kg and 1 mg/kg every 12 hours with patients who received either 0.5 mg/kg or 1 mg/kg every 12 hours. Methods: This IRB-approved, single-center, retrospective, cohort study included subjects greater than 18 years of age who received an atrial fibrillation or atrial flutter ablation procedure and at least one dose of enoxaparin post-ablation. Results: There were 119 subjects who satisfied the inclusion criteria. The primary outcome, incidence of major bleeding or vascular complication, did not demonstrate a statistically significant difference between groups (p = 0.92). The incidences were 4.8% with enoxaparin ≥ 1 mg/kg, 3% with enoxaparin between 0.5 mg/kg and 1 mg/kg, and 3.2% with enoxaparin ≤ 0.5 mg/kg. No subject experienced an ischemic stroke or transient ischemic attack within 28 days of a cardiac ablation procedure. Conclusion: Significant increases in major bleeding or vascular complications may not exist with an intermediate dose of enoxaparin provided after a cardiac ablation procedure.
Feb 2014 DOI 10.14302/ISSN.2372-6601.JHOR-13-344
Context: Fine needle aspiration cytology (FNA) is increasingly replacing excisional lymph node biopsy in the assessment of various lymphoid lesions. Recent changes in the classification of non-Hodgkin’s lymphoma, namely the WHO (World Health Organization) Classification of Tumors of Haematopoietic and Lymphoid Tissues has considerably expanded its classification of lymphomas based on the molecular and cytogenetic profiling and immunophenotyping. FNA diagnosis includes varied cytomorphologic diagnostic categories; one of them is the atypical/suspicious. Objective: The atypical/suspicious category constitutes about 20 % of all cases studied by FNA cytology. The objective of this study is to determine the definition and the outcome of this unique category. Design: A retrospective analysis of 34 fine needle aspirations with the diagnosis of atypical/suspicious cases were obtained during the period between 1995 –2000, and the histological and/or clinical follow-up was performed. Results: Flow cytometry was performed on all of the atypical/suspicious lesions. It was positive/diagnostic in 16 (47%) and negative in 18(53%) cases. Excisional follow-up biopsy was obtained in 30 cases. Of these 7(21%) confirmed to be negative, 17(50%) Non-Hodgkin’s lymphoma and 6 (18%) Hodgkin’s Lymphoma. Conclusion: The atypical/suspicious category by fine needle aspiration is a crucial diagnosis as it has proved to represent some type of lymphoma in about two third (68%) of cases.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-211
Recruitment of couples is important for study success. The multi-centered HPTN 052 clinical trial was designed to evaluate whether immediate versus delayed use of ART by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners. The objective of this study was to retrospectively compare several approaches for community recruitment at our site in Kisumu, Kenya based on a) feedback from recruitment staff, b) associated cost, and c) number of eligible couples enrolled. A secondary objective was to assess the discordant couples’ acceptability of the community recruitment approaches relative to the a) main recruitment venues, b) educational materials, and c) local language best suited for explaining the trial. 241 couples were screened for eligibility using nine recruitment approaches. We compared the approaches used for the 60 couples found to be eligible to those used for the 56 ineligible couples for whom that information was available. Analyses for association were carried out. In-depth interviews were conducted with 20 staff and 29 discordant couples. Records were kept of the costs associated with each approach. Overall, staff interviews revealed that acceptability of the approaches was high. Challenges were present with all approaches ranging from one member of the couple not wanting to reveal their positive HIV status to their partner (Patient Support Center or PSC approach), to not finding people at home (home based counseling and testing or HBCT approach). The PSC and the HBCT recruitment approaches were the most effective in terms of recruiting eligible participants. There was an overall significant difference between the proportion of eligible and ineligible participants among the 9 approaches (χ2 (8) =33.5; p<0.0001). Analyses for association showed that the PSC approach resulted in attracting a greater proportion of couples who were eligible than ineligible (χ2 (1) =6.6; p=0.016). The cost for the PSC approach was less than one-third that of the HBCT approach. All discordant couples interviewed found the two main recruitment venues (PSC and their home) acceptable. Among couples who saw the educational materials, the majority found them useful (poster 72.7%; pamphlet 90.9%; flyer 88.9%). All couples found the language they were told about the study acceptable. The evaluation of recruitment approaches indicated that working with local partners, specifically the PSC staff and HBCT staff, was the most effective way to recruit eligible discordant couples. A focus on collaborations and partnerships between research and clinical organizations will help study recruitment efforts. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of their respective institutions. Funding for this substudy was provided by the Kenya Medical Research Institute (KEMRI) through a cooperative agreement with the U.S. Centers for Disease Control and Prevention.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-137
Background: HAART has resulted in significant decline in morbidity and mortality from HIV. However, it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care and resource allocation. We examined the diagnoses for hospitalizations of patients with HIV and their clinical and demographic profile years after the introduction of HAART. Methods: A retrospective audit of the HIV admissions from July 2009 through June 2010. The case notes of all the adult admissions where one of the discharge diagnoses was HIV infection was reviewed. Data including the demographics, date of diagnosis, treatment and the follow up details, admission outcome and the final diagnosis were extracted from the case notes. Results: Over the 12 months period there were 154 admissions where one of the discharge diagnosis was HIV infection, and this accounted for 2.9% of all medical admissions in adults. 103(67%) admissions were in persons who were known to be HIV infected prior to the current admission. HIV infection was diagnosed for the first time during the current admission in 51(33%) cases. Nearly two-thirds of those hospitalized, had a CD 4 cell counts of < 200/µL and 63 (66%) had a viral load greater than 50,000 copies/ml. Over all, opportunistic infection was the commonest (47%) discharge diagnosis, followed by serious bacterial infections and HIV nephropathy. The median duration of hospitalization was 6 days (Range 2 to 71 days). There were 49 (32%) deaths. Conclusions: A significant proportion of patients admitted with HIV infection were still diagnosed on admission and were found to be severely immunosuppressed. An opportunistic infection continues to be the commonest discharge diagnosis in HIV infected patients.
Distant metastases generally indicate disseminated disease and the standard treatment for these patients is palliative chemotherapy. Retrospective series showed that selected patients with metastatic lung cancer and a solitary extrathoracic disease could be effectively treated with curative intention by resection of both primary tumor and the single site of metastatic disease. According to current data, adrenalectomy might be considered as an alternative option for patients with isolated adrenal metastases. Significant morbidity and mortality may be happened by these procedures, and a cautious analysis of pros and cons should be discussed with the patient. We present a review of the literature and updated recommendations focusing lung cancer with solitary adrenal metastasis.