Adult Cases Research Articles

Evaluation of Four Adult Visceral Leishmaniasis Cases.

Leishmania infantum is the species responsible for visceral leishmaniasis [(VL), kala-azar], which is observed sporadically mainly in pediatric age groups in the Aegean, Mediterranean and Central Anatolian regions of Türkiye. The aim of this study is to evaluate the diagnosis, clinic, laboratory results and treatments of four adult patients with VL who applied to our hospital. The patients were referred to our hospital to investigate hematological malignancy. In the study, the data of four patients (three men, one woman; age range: 30-40 years) who were diagnosed with VL and treated in the infectious diseases clinic of our hospital between January 2022 and April 2022 were evaluated retrospectively. The diagnosis of VL was made according to appropriate clinical and physical examination findings, biochemical and serological tests (indirect fluorescent antibody test and rK39 rapid antigen test) and polymerase chain reaction (PCR) results, as well as the presence of amastigote forms of the parasite in bone marrow samples. Serology positivity was found in all patients, and bone marrow positivity was found in two patients. According to the results of RT-PCR in all patients, it was determined that the species causing the disease was L. infantum/L. donovani. Initially, the most common symptoms were fever, fatigue, and abdominal distension. None of the patients had an immunosuppressive condition. It was understood that all the patients lived in the rural area of Syria's Idlib province. Hepatosplenomegaly, increased erythrocyte sedimentation rate, anemia, leukopenia and thrombocytopenia were found in all patients. The patients were treated with liposomal amphotericin-B (L-AMB). One patient did not come for follow-ups, the other three patients were found to have completely recovered in their follow-up. No recurrence was observed in any of the patients. In conclusion, VL should be considered in patients who apply to health institutions with complaints of fever, hepatosplenomegaly, increased erythrocyte sedimentation rate, anemia, leukopenia and thrombocytopenia.

Eosinophilic oesophagitis: a common cause of food bolus obstruction.

Eosinophilic oesophagitis (EOE) is a known cause of food bolus obstruction (FBO) with rising incidence and prevalence. To assess the rates of EOE in adult cases presenting with an FBO via prospective biopsy collection during index endoscopy. Oesophageal FBO cases requiring gastroscopy between February 2014 and January 2021 at a single institution with a unified policy to perform biopsies on FBO cases were analysed using medical records, endoscopy and histology. Statistical analysis was undertaken to compare those with and without EOE as their final diagnosis, including the timing of oesophageal biopsy and the season that cases presented. One hundred ninety FBO presentations were analysed, 15 patients presented twice and one patient presented four times within the 7-year study period. Men represented 72% of cases. A total of 78% of cases had biopsies collected at an index or scheduled follow-up endoscopy. EOE was the cause of the FBO in 28% (53/190) of presentations. FBO secondary to EOE was more likely to occur in the spring and summer months (Australian September to March), with 39% (19 of 49) of cases presenting in spring attributable to EOE. EOE affects a significant proportion of patients presenting with FBO (28%); a high biopsy rate of 78% in FBO cases provides an opportunity for prompt diagnosis and treatment.

Idiopathic isolated adrenocorticotropic hormone deficiency: a systematic review of a heterogeneous and underreported disease.

Isolated adrenocorticotropic hormone deficiency (IAD) is considered to be a rare disease. Due to the nonspecific clinical presentation, precise data on the prevalence and incidence are lacking. In this systematic review, we aimed to analyse the clinical characteristics, association with autoimmune diseases, and management of acquired idiopathic IAD cases.A structured search was conducted after developing a search strategy combining terms for acquired (idiopathic) IAD. Articles describing an adult case with a diagnosis of ACTH deficiency using dynamic testing, no deficiency of other pituitary axes, and MRI of the brain/pituitary protocolled as normal, were included. Exclusion criteria were cases describing congenital IAD, cases with another aetiology for IAD, and articles where full text was not available.In total 42 articles were included, consisting of 85 cases of acquired idiopathic IAD. Distribution by sex was approximately equal (F:M; 47:38). Lethargy was the most common presenting symptom (38%), followed by weight loss (25%), anorexia (22%), and myalgia/arthralgia (12%). Eight cases (9.5%) presented with an Addison crisis. 31% of cases had an autoimmune disease at diagnosis of which Hashimoto hypothyroidism was the most frequent. Data about follow-up was scarce; dynamic testing was repeated in 4 cases of which 2 showed recovery of the adrenal axis.We report the largest case series of acquired idiopathic IAD to date. Our systematic review highlights the lack of a clear definition and diagnostic work-up. Based on the findings in this review a proposition is made for a flowchart to diagnose acquired idiopathic IAD.

RADIOTHERAPY NEEDS BY PORTUGUESE OLDER ADULTS IN 2040—A GLOBOCAN ANALYSIS

Abstract In Portugal, cancer is the second leading cause of death, accounting 28,544 deaths in 2018 (around 25% of all deaths). Radiotherapy (RT) is an effective cancer treatment. Around half of all cancer patients will require RT as part of their treatment. The European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project data states that Portuguese actual utilisation of RT relative to the evidence-based optimal use is between 50-60%. The aim of this study was to project RT use and resources to maintain RT accessibility for Portuguese older adults in 2040 for the most common types of cancers. The authors examined GLOBOCAN data to determine expected incidence of prostate, colon, rectum, lung, breast, and stomach cancers for those aged 70 and over. Results show that in 2040, new cancer cases in older adults are expected to account for around 60% of total cancer cases. Cancer incidence is estimated to increase between 30 to 40% in this population. In accordance with this projection, the authors used the optimal utilisation percentage of RT to calculate the number of RT courses anticipated to be needed for each cancer type and an increase of around 38% (8878 to 12729) is expected by 2040 to address the needs of this population. The ESTRO-HERO guidelines state that each RT machine should treat 400 to 450 patients per year. So, to cover the older patients’ demand, we estimate the need to install 8 to 10 additional RT machines by 2040.

COMMUNITY ENGAGEMENT IN OLDER ADULTS WITH COGNITIVE DECLINE: THE USAGE OF INFORMATION COMMUNICATION TECHNOLOGY

Abstract Background Cognitive decline is typical among older adults, affecting their activities of daily living and community participation. However, the advent of cognitive function support information technologies may improve their community engagement, perhaps more than memory training alone. This study examined information communication technology usage as a mediator of associations of cognitive decline and community engagement in older adults. Methods We sampled older adult cases from Round 11 of the National Health and Aging Trends Study data set (N=3817) with cognitive decline in community dwelling (mean age =81.38, SD=6.266), male (n= 1313) and female (n=1771). We utilized multi-level Structural Equation Model (SEM) to examine the mediation of cognitive decline and community connection through the ICTs, as well as direct relationships among memory, orientation, and executive function. Results From SEM analysis, an increase of ICTs usage has statistically significantly effects on older adults’ cognitive ability overall (Estimate = 0.103, S.E. = 0.023, C.R. = 4.438, p < 0.001). Cognitive function has a direct impact on the activity orientation function (Estimate=1, p < 0.0011.000). The greater usage of ICTs by older adults is associated with higher levels of community engagement (Estimate = 1.230, S.E. = 0.284, C.R. = 4.338, P < 0.001). Conclusion This finding highlights the potential role of ICTs in fostering older adults’ cognitive function for their social interactions and community involvement. Digital age older adults may have greater cognitive function than previous cohort, reducing demand for care services their community participation.

Expert recommendations on hepatitis A vaccination for adults

Hepatitis A is a significant global public health concern, with severe clinical symptoms in adult cases that can progress to acute hepatic failure. With the implementation of comprehensive prevention and control measures based on vaccination, the reported incidence of hepatitis A in children has notably decreased in China, while the incidence of hepatitis A in adults has gradually increased. Vaccination against hepatitis A in adults remains a crucial preventive measure. This recommendation is formulated based on the World Health Organization's position paper on hepatitis A vaccines (2022), incorporating the latest domestic and international research advancements and opinions from domestic experts. Its aim is to provide recommendations for hepatitis A vaccination among Chinese adults, offering evidence for public health and vaccination professionals to scientifically use hepatitis A vaccines and maximize their preventive efficacy, thereby enhancing hepatitis A prevention and control efforts.

Indication as a predictor for outcomes in anterior cervical discectomy and fusion: The impact of myelopathy on disposition

BackgroundWhile the indication for Anterior Cervical Discectomy and Fusion (ACDF) may influence the expected postoperative course, there is limited data comparing how length of stay (LOS) and disposition for patients with myelopathy differ from those with radiculopathy. This study aimed to compare LOS and discharge disposition, in patients undergoing ACDF for cervical radiculopathy versus those for myelopathy. MethodsA retrospective review of all adult ACDF cases between 2013 and 2019 was conducted analyzing sex, age, race, comorbidities, level of surgery, myelopathy measures when applicable, complications, dysphagia, hospital LOS, and discharge disposition. ResultsA total of 157 patients were included in the study with 73 patients undergoing an ACDF for radiculopathy and 84 for myelopathy. Univariate analysis determined older age (p < 0.01), male sex (p = 0.03), presence of CKD (p < 0.01) or COPD (p = 0.01), surgery at C3/4 level (p = 0.01), and indication (p < 0.01) as predictors for a discharge to either acute rehabilitation or a skilled nursing facility rather than to home. Multivariate logistic regression demonstrated age and indication as the only independent predictors of disposition, with home disposition being more likely with decreased age (OR 0.92, 95 % CI 0.86–0.98) and radiculopathy as the diagnosis (OR 6.72, 95 % CI 1.22- 37.02). ConclusionsMyelopathic patients, as compared to those with radiculopathy at presentation, had significantly longer LOS, increased dysphagia, and were more often discharged to a facility. Understanding these two distinct populations as separate entities will streamline the pre and post-surgical care as the current DRG codes and ICD 10 PCS do not differentiate the expected post-operative course in patients undergoing ACDF for myelopathy versus radiculopathy.

The most common founder pathogenic variant c.868G > A (p.Val290Met) in the NPHS2 gene in a representative adult Czech cohort with focal segmental glomerulosclerosis is associated with a milder disease and its underdiagnosis in childhood.

Genetic focal segmental glomerulosclerosis (FSGS) is caused by pathogenic variants in a broad spectrum of genes that have a variable representation based on subjects' ethnicity and/or age. The most frequently mutated autosomal recessive gene in FSGS is NPHS2. In this study, we analyzed the spectrum of NPHS2 variants and their associated phenotype in Czech adult FSGS patients. A representative cohort of 234 adult patients with FSGS, derived from 225 families originating from all regions of Czechia, was analyzed by massively parallel sequencing. In this study, we focused on the comprehensive analysis of the NPHS2 gene. The histological classification of FSGS followed the Columbia classification. We detected seven (3%) cases bearing homozygous or compound heterozygous pathogenic NPHS2 variants. A single pathogenic variant c.868G > A (p.Val290Met) was found in the majority of NPHS2-positive cases (86%; 6 out of 7) in histologically confirmed instances of FSGS. Its allele frequency among unrelated NPHS2-associated FSGS patients was 50% (6/12), and Haplotype analysis predicted its origin to be a result of a founder effect. There is an identical V290M-related haplotype on all V290M alleles spanning a 0,7 Mb region flanking NPHS2 in Central European FSGS populations. The phenotype of the p.Val290Met NPHS2-associated FSGS demonstrated a later onset and a much milder course of the disease compared to other NPHS2 pathogenic variants associated with FSGS. The mean age of the FSGS diagnosis based on kidney biopsy evaluation was 31.2 ± 7.46 years. In 50% of all cases, the initial disease manifestation of proteinuria occurred only in adulthood, with 83% of these cases not presenting with edemas. One-third (33%) of the studied subjects progressed to ESRD (2 out of 6) at the mean age of 35.0 ± 2.82 years. We identified the most prevalent pathogenic variant, p.Val290Met, in the NPHS2 gene among Czech adult FSGS patients, which has arisen due to a founder effect in Central Europe. The documented milder course of the disease associated with this variant leads to the underdiagnosis in childhood. We established the histopathological features of the NPHS2-associated adult FSGS cases based on the Columbia classification. This might improve patient stratification and optimize their treatment.

Immunohistochemistry in an Adult Case of Bitot's Spots Caused by Vitamin A Deficiency.

Bitot's spots (BS) are the buildup of superficially located keratin in the conjunctiva and are early indicators of vitamin A deficiency (VAD), primarily due to malnutrition and malabsorption, thus leading to xerophthalmia. BS are particularly prevalent in developing countries, and their presence necessitates prompt vitamin A supplementation to avert blindness, with the immunohistochemical characteristics of BS aiding in understanding the extent of epithelial abnormalities and the efficacy of vitamin A supplementation. We describe the case of a 34-year-old male with persistent BS despite extensive vitamin A supplementation and topical treatments who underwent surgical excision of the BS followed by amniotic membrane transplantation, thus resulting in symptom relief and epithelialization, with no recurrence observed during follow-up. Histopathologic and immunohistochemical evaluations revealed expression of keratinization-related proteins, along with an absence of mucin-5AC-positive cells, suggesting impaired differentiation into goblet cells due to VAD. This case highlights the potential age-related disparity in the efficacy of vitamin A supplementation, emphasizing the need for early detection and a multidisciplinary approach in the management of VAD, especially in young adults. The favorable outcome of surgical intervention highlights its viability in the management of persistent BS and encourages further investigation to optimize therapeutic strategies for VAD-related ocular manifestations.

Echocardiographic Assessment of Cardiomyopathy in Pediatric Oncology Associated with Increased Cardiac Output Due to the Influence of the Tumor Process: Pheochromocytoma/Paraganglioma, Neuroblastoma (Literature Review with Clinical Observations)

The condition of increased cardiac output is a state in which, in response to various pathological causes, there is a pathological activation of the renin-angiotensin-aldosterone and sympathetic-adrenal systems, which overall creates a multifaceted, increased load on the heart, ultimately leading to heart failure. The cause of this condition may be arteriovenous pathological shunts, among which arteriovenous dural fistulas in glomus tumors (intracranial paragangliomas) occupy a special place. An arteriovenous fistula is a direct connection between an artery and a vein bypassing the capillary bed, creating a massive shunt from the high-pressure system to the low-pressure system, triggering a pathophysiological chain. In addition, activation of the renin-angiotensin-aldosterone and sympathetic-adrenal systems and direct myocardial damage can be caused by elevated levels of catecholamines in the blood in cases of adrenal paraganglioma (pheochromocytoma) and neuroblastoma. The condition of increased cardiac output is more often described in the literature using examples of clinical cases in adults, with significantly less literature data available in pediatric practice.

Phenotype-Genotype Correlations in Three Different Cases of Adult-Onset Genetic Focal Segmental Glomerulosclerosis.

This study highlights the importance of a combined diagnostic approach in the diagnosis of rare diseases, such as adult-onset genetic FSGS. We present three adult patient cases evaluated with kidney biopsy for proteinuria, chronic kidney disease, and hypertension, which were suggestive of adult-onset genetic FSGS. Renal biopsy samples and formalin-fixed, paraffin-embedded fetal kidneys were evaluated using standard light microscopical stainings, direct immunofluorescence on cryostat sections, and electron microscopy. Clinical exome sequencing was performed for each case, and 45 FSGS-related genes were analyzed. Identifying mutations in the PAX2, ACTN4, and COL4A5 genes have prompted a re-evaluation of the previous histopathological examinations. The PAX2 mutation led to a thinner nephrogenic zone and decreased number of glomeruli, resulting in oligohydramnios during fetal development and oligomeganephronia and adaptive focal-segmental glomerulosclerosis in adulthood. The ACTN4 mutation caused distinct electron-dense aggregates in podocyte cell bodies, while the COL4A5 mutation led to segmental sclerosis of glomeruli with marked interstitial fibrosis and tubular atrophy. The identification of specific mutations and their histopathological consequences can lead to a better understanding of the disease and its progression, as well as potential treatment options.

Temporal changes to adult case fatality risk of COVID-19 after vaccination in England between May 2020 and February 2022: a national surveillance study.

Risk of death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has fallen during the pandemic, largely due to immunity from vaccination. In England, the timing and extent of this reduction varied due to staggered eligibility during the primary vaccination campaign, based on age and clinical risk group. Duration of protection is less well understood. Our objective was to estimate the case fatality risk (CFR) by vaccination status and time since last dose during a period of widespread community testing, to better understand the impact of coronavirus disease 2019 (COVID-19) vaccination and duration of protection. SARS-CoV-2 cases diagnosed between May 2020 and February 2022 were linked to vaccine records from the National Immunisation Management System. CFR was calculated as the proportion of cases that died of COVID-19 per the death certificate, aggregated by week of specimen and stratified by 10-year age band and vaccination status. England, UK. A total of 10,616,148 SARS-CoV-2 cases, aged ≥18 years, recorded by England's laboratory reporting system. Case fatality risk of COVID-19, stratified by age band and vaccination status. Overall, a reduction in CFR was observed for all age bands, with a clear temporal link to when the age group became eligible for primary vaccination and then the first booster. CFR increased with age (0.3% 50-59 years; 1.2% 60-69; 4.7% 70-79; 16.3% 80+) and was highest in the unvaccinated - albeit a reduction was observed over time. The highest CFR was seen in the unvaccinated 80+ group prior to vaccination rollout (30.6%). CFR was consistently lowest in vaccinated populations within 6 months of last dose, yet increased after over 6 months elapsed since last dose, across all age bands. COVID-19 CFR reduced after vaccination, with the lowest CFR seen across all age bands when vaccinated up to 6 months prior to specimen date. This provides some evidence for continued booster doses in older age groups.

10025-MPC-3 DIFFERENCE AMONG GENERATIONS IN PATIENTS WITH HISTONE H3-MUTATED GLIOMAS

Abstract OBJECT This study investigates clinical and molecular features, including the survival outcomes, of patients with histone H3-mutant gliomas and the differences among generations: children (-13 years), adolescence and young adult (AYA) (14-39 years), and older adult (40- years) patients. Particularly, we focused on the older adult cases. METHODS We collected pediatric and adult glioma cases harboring histone H3 mutations (K27M and G34R/G34V) enrolled in Kansai Network (118 cases) and retrospectively analyzed clinical characteristics and genetic status, including overall survival times (OS). Additionally, the differences between the older adult (40- years) and the younger generations (-39 years) were evaluated. RESULTS The older adult patients were not infrequently enrolled in the H3 K27-mutant glioma group (n = 47) (40-79 years old)), although H3 G34-mutant glioma cases belonged to around AYA generation (11-45 years old). Most popular location was brainstem in children (8/15, 53%) and thalamus in AYA (29/56, 52%), while cerebrum as well as brainstem and thalamus were common in the older adults (15/47, 32%; 15/47, 32%; 11/47, 24%). Histologically, diagnosis of non-GBM was not uncommon (63/105, 60%). There were no significant age-specific differences in genetic status (IDH1/2, TERT promoter, MGMT promoter, TP53, BRAF, FGFR1, EGFR). In general, tumor biopsy followed by radiation and chemotherapy was the main treatment regimen regardless of patient age (92/115, 80%). Particularly in the H3 K27-mutant gliomas, there was no statistically significant difference in OS among generations (median OS of children/AYA/older adult, 16.6/18.4/15.9 months). CONCLUSIONS We report clinicopathological features and survival outcomes of histone H3-mutated glioma patients in Kansai Network cohort. Histone H3 mutation could exist in the older adult cases with diffuse gliomas at cerebral location. There was a little difference in clinical and pathological features among generations. The prognosis of the older adults was as poor as those of children and AYA.

10114-GMC-10 EXPERIENCE WITH DIFFERENTIAL NTRK2 FUSION GENE DETECTION IN CANCER MULTI-GENE PANEL TESTING

Abstract INTRODUCTION NTRK fusion gene-positive CNS tumours are rare and there are only two reports in Japan of the use of entrectinib, both in children; This is third case and the first adult case was experienced; the patient was treated by taking entrectinib. The diagnosis and treatment course are reported here and the problems with current oncopanel testings are discussed. CASE Female in her 60s. She came to the hospital on her own with a chief complaint of unstable walk. A mass with a maximum diameter of 8 cm was found in the right temporal occipital lobe. She underwent craniotomy followed by radiotherapy, and in-house panel testing (PleSSision Rapid Neo) detected two BCR-NTRK2 fusion genes. Subsequently, no NTRK gene abnormalities were detected in the foundation-one. Sanger sequencing was performed by ourselves, which could still detect gene mutations, and the patient was submitted to the NCC Onco-Panel at his own expense, where NTRK fusion gene abnormalities could be detected, and after review by the in-house ethics committee, he was started on entrectinib. The tumor showed a shrinking effect and has been stable for eight months. RESULT In the in-house panel test, NTRK2 covered Intron8,9,10,11,12 and two BCR-NTRK2 fusion genes were detected, (Exon1-Exon13) and (Exon1-Exon12). Foundation one covered Intron12 and no genetic variants were detected this time. Subsequently, the NCC OncoPanel test covered Intron 9, 10, 12, 13 and 14 and was able to detect fusion gene mutations. Different results were obtained for NTRK2 fusion gene mutations in each panel test, with different detection coverage. The differences in NTRK fusion gene mutations between tests indicate that it is important to reconfirm which panel test to choose. CONCLUSION Third case in Japan and first adult case of NTRK fusion gene mutation-positive brain tumor; may need to be addressed in NTRK fusion gene detection, recognizing differences in cancer multi-gene panel testing.

Exploring the rate and reasons for same-day cancellation of cardiac surgery after implementing joint commission international standards: a retrospective cross-sectional study

BackgroundSame-day cancellation of cardiac surgery significantly impacts operating room management efficiency, which can be mitigated by taking preventive measures. This study aimed to explore the same-day cancellation rate of elective adult cardiac surgery, as well as the reasons for those cancellations. A retrospective cross-sectional study reviewed the records of 581 scheduled elective adult cardiac surgical cases at a single cardiac center from June 2017 to May 2018. The same-day cancellation reasons were grouped into four broad categories: nonclinical cancellations, clinical cancellations, patient-related cancellations, and 'other reason' cancellations. A case was considered canceled when it was not performed on the same day as the planned surgery.ResultsA total of 581 elective adult cardiac surgeries were scheduled during the study period, and 56 (9.63%) of these were canceled. The highest cancellation rate was due to nonclinical cancellations, with 39% of scheduled cases, followed by clinical cancellations, with a 34% cancellation rate. Patient-related cancellations accounted for 23% of cancellations, while the lowest rate was due to ‘other reasons,’ which accounted for 4% of total cancellations. The most common reason for nonclinical cancellations was the inclusion of emergency cases (n = 8; 14%). The most common reason for clinical cancellations was changes in the patient’s medical condition (n = 8, 14%). The common reason for patient-related cancellations was the refusal of surgery (n = 9; 16%). The lowest rate was for menstruating female patients (n = 2; 4%).ConclusionsThe same-day cancellation rate was 9.36%, and most of the cancellation reasons could be mitigated by implementing preventive strategies to improve the efficiency of the operating room. Preoperative preparation clinics and paying particular attention to female patients scheduled for surgery might reduce the rate of elective cardiac surgery cancellation.

The burden of fracture in China from 1990 to 2019.

Osteoporosis is one of the most common clinical problems among the elderly population. China is one of the countries most threatened by osteoporosis and fragility fracture, because of its large population and aging population trends during recent decades. We aimed to estimate the disease burden of fracture from 1990 to 2019 in China. We performed a secondary analysis of fractures using detailed information for China from the Global Burden of Disease Study 2019. Fracture incidence and prevalence, rate of years lost to disability from fractures, and term secular trends in China from 1990 to 2019 were compared by sex, age, cause, and nature of fracture. The numbers for incidence and prevalence of fracture and years lived with disability (YLDs) from fractures in China increased from 12.54 million, 28.35 million, and 1.71 million in 1990 to 21.27 million, 67.85 million, and 3.79 million in 2019, respectively, increases of 70%, 139%, and 122%, respectively. In 2019, falls was the leading cause of fractures, with an age-standardized incidence rate (ASIR) of 762 per 100 000 (95% uncertainty interval [UI] 629-906), an age-standardized prevalence rate (ASPR) of 1863 per 100 000 (95% UI 1663-2094), and an age-standardized YLD rate (ASYR) of 103 per 100 000 (95% UI 69-147). Fall-associated deaths and disability-adjusted life-years (DALYs) from low bone mineral density increased greatly during the most recent three decades. Fracture of patella, tibia or fibula, and ankle were the most frequent fracture types, with an ASYR of 116 per 100 000 (95% UI 75-169). Hip fracture had more incident cases in adults ≥ 60years old, and was more frequent for females. The burden from fractures has increased significantly since 1990 in China. Falls and road injuries are the main causes of the increase. The fall-associated health burden from osteoporosis needs to be prioritized, with longer-term commitment to its reduction required.

Analysis of Ischemic stroke risk factors in young Adults

Background and objectives: Keeping in mind stroke is the leading cause of disability globally, with increasing incidence of Ischemic stroke in young age reaching approximately more than 5-10 % according to multiple studies worldwide especially in developing countries. Methods: This observational cross-sectional study was conducted at the Neurology Department of the Rizgary Hospital, Erbil, Iraq over 12 months from July 2020 until July 2021. We included consecutive patients whom their age was between 18-45 years with first-ever ischemic stroke fulfilling the definition of The American Stroke Association. All patients underwent thorough history and clinical examination. Each patient underwent routine stroke assessment, including full blood workup and vascular imaging. Results: Out of 70 patients, 41 (58.8%) were males and 29 (41.4%) were females. There is a male predominance over females, which is comparable with other studies. Our present study showed that the most obvious risk factor for stroke in young people was hypertension, which was present in (38.6%) of cases followed by diabetes mellitus (20 %.), obesity (17.1%), smoking (17%), alcohol consumption (11.4%). Regarding stroke subtypes; small vessel disease was the commonest, subtype, it was present in 25.7% of cases. A stroke from a cardiac source is the second most common (24.3%). About (17.1%) of cases were in the large vessel category. The cause of the stroke was undetermined in (14.5 %) percent of cases (cryptogenic). Conclusion: Our study demonstrated that traditional atherosclerotic risk factors such as hypertension, diabetes, dyslipidemia, and smoking are responsible for most cases in young adults.

Clinicopathologic Characteristics of Renal Cell Carcinoma in Prof. dr. I.G.N.G. Ngoerah General Hospital 2018 – 2022

RCC is a tumor that manifests in proximal tubule epithelial cells and accounts for 3% of total adult neoplastic cases. In Indonesia, RCC cases are still deemed low, but show a tendency to increase annually. This study’s objective is to provide a description on the clinicopathologic features of RCC patients in Prof. dr. I.G.N.G. Ngoerah General Hospital in the province of Bali from 2018 to 2022. This is a cross-sectional study which implemented total sampling in collecting secondary data from the laboratory of anatomical pathology in Prof. dr. I.G.N.G. Ngoerah General Hospital. There were 38 cases of RCC from a total of 108 kidney cases which underwent histopathologic examinations. Descriptive analysis showed that the majority of RCC cases were found in the age range of 51 – 60 years old (36.8%), males (76,3%), left tumor laterality (57,9%), operative procedures for specimen collection (94,7%), ccRCC subtype (63,2%), tumor size of &gt;10 cm (50,0%), grade III – IV (57,9%), and pT3a stage (47,4%). The combination of these clinicopathologic findings suggested that the RCC patients in Bali were shown to be associated with worse prognosis and should consider further analytical studies.

The rise of the throat distemper.

Diphtheria vaccination in the EPI program has controlled much of the childhood infection. Nevertheless, sporadic adult cases of Diphtheria come up every now and then in Pakistan and other South-Asian countries. This is, most likely, due to the lack of booster dosing of Diphtheria vaccine in adulthood. In an effort to suppress the spread of this infection, adult vaccinations need to be mandated.

You do not suddenly become safe on your 18th birthday: managing safeguarding cases involving adult athletes in the United Kingdom

ABSTRACT Despite publicised cases of abuse impacting those above the age of 18, little research attention has been paid to the safeguarding of adults. The present study is informed by the recommendations of the Duty of Care in Sport Review, aiming to inform the development of a case data collection tool. Semi-structured online interviews were conducted with 11 key stakeholders. Inductive thematic analysis of the interview transcripts revealed several challenges to collecting adult safeguarding case data in sport which were categorised into three domains: conceptualising cases, managing cases, and recording cases. Developing an effective case management process for adults will require a broader, and shared, understanding of the conceptualisation of adult safeguarding cases, including that vulnerability is not solely determined by personal characteristics, but is affected by the behaviour of perpetrators and fluctuates as circumstances change. Top-down support is necessary to ensure greater consistency in the reporting of valuable adult case data. With clear expectations, regarding what an adult safeguarding case is, what data should be collected, how it should be collected and why, as well as adequate resources, sports of all levels will be in a better position to protect adults from abuse or harm. A clearer roadmap for the management of adult safeguarding concerns in sport is offered.