Basis Of Clinical Examination Research Articles

Neonatal Herpes Zoster Ophthalmicus: Two Rare Cases

Two neonates one at age of 15 days and another at age of 20 days were presented with redness, watering, periocular and lid swelling, photophobia and vesicular lesions over forehead on right side of face. Ocular examination revealed ciliary and conjunctival congestion, chemosis, and hazy cornea due to stromal edema. Though herpes zoster is very rare in neonates, the diagnosis of herpes zoster ophthalmicus was made on basis of clinical examination and treated with systemic and topical anti-viral, topical antibiotic and corticosteroid. Both neonates showed dramatic response in seven days treatment and completely cured within four weeks. High clinical suspicion in vesiculo-papular lesion of child of any age can help in early diagnose and early treatment can prevent sequelae of HZO.

Repair of long bone fractures in dogs using locking compression plates

Seven dogs of different breeds, age, sex and body weight (19–30 kg) were treated for unstable long bone fractures (tibia- 2, radius-ulna- 3, humerus- 1 and femur- 1) using locking compression plates (LCP). The efficacy of treatment was evaluated on the basis of clinical examination, haemato-biochemical evaluation and radiographic findings. The mean±SE values of swelling, lameness and pain score were minimum on 15th, 45th and 30th postoperative day, respectively; while the mean value of weight bearing score was highest on 60th postoperative day. The serum alkaline phosphatase showed irregular variation during the study period, while the mean±SE value of serum calcium was above the normal value till 15th postoperative day. Radiographic study revealed primary healing in three cases, secondary healing in two cases and remaining two cases were subjected to revised surgery due to dislodgement of fixation device. The radiographic union was achieved on an average of 54 days. Fixation failure in two cases and wound dehiscence followed by osteomyelitis in one case were the complications observed. On the basis of the findings of the study, it can be concluded LCP provides rigid fixation of long bone fractures in majority of cases.

Neonatal Herpes Zoster Ophthalmicus: Two Rare Cases

Two neonates one at age of 15 days and another at age of 20 days were presented with redness, watering, periocular and lid swelling, photophobia and vesicular lesions over forehead on right side of face. Ocular examination revealed ciliary and conjunctival congestion, chemosis, and hazy cornea due to stromal edema. Though herpes zoster is very rare in neonates, the diagnosis of herpes zoster ophthalmicus was made on basis of clinical examination and treated with systemic and topical anti-viral, topical antibiotic and corticosteroid. Both neonates showed dramatic response in seven days treatment and completely cured within four weeks. High clinical suspicion in vesiculo-papular lesion of child of any age can help in early diagnose and early treatment can prevent sequelae of HZO.

Role of Infrared Imaging for Detection of Subclinical Inflammation of Joints: A Prospective Cohort Study

Introduction: The detection of inflammation is important for diagnosis of inflammatory joint diseases and its severity. There are clinically doubtful cases of inflammation of joints. Advanced thermal cameras are able to detect the presence of inflammation. Hence, thermal imaging technology has been used for detection of this type of subclinical inflammation of joints. Aim: To study the efficacy of infrared imaging to detect the subclinical inflammation of joints in doubtful cases of arthritis. Materials and Methods: A prospective cohort study was conducted for a period of one year from January 2016 to June 2017. The study comprised of 60 patients of all age groups. Patients with joint pain attending Out Patient Department (OPD) of Physical Medicine and Rehabilitation Department (PMR), Agartala Government Medical College (AGMC) and Govind Ballav Pant Hospital (GBPH), Agartala, India, irrespective of the duration of illness and diseases were selected considering inclusion and exclusion criteria. They were evaluated clinically (swelling, tenderness, redness, increased temperature and the presence of restriction of movement) for presence of inflammation in the joint. Blood tests were done for Acute Phase Reactant (APR) namely Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) and infrared imaging of the respective joints were taken. On the basis of clinical examination all these patients were divided in three groups: (i) patients with inflamed joint; (ii) non inflamed joint; and (iii) doubtful inflammation of joints. Infrared imaging of all the respective joints of all the patients were compared with the respective results of APR for presence of inflammation. Values more than the normal range of APR were considered as positive marker for inflammation. The data was analysed statistically by calculating sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) using MATLAB 2013b software. Results: Out of 60 cases, 37 (61.66%) patients showed clinically inflamed joints, 10 (16.66%) showed no inflammation and there were 13 (21.66%) clinically doubtful cases of inflammation. The results were statistically analysed and the sensitivity, specificity, PPV and NPV of infrared imaging for detection of joint inflammation were 91%, 80%, 94% and 72%, respectively. Conclusion: Infrared imaging is a very sensitive tool for the detection of inflammation of joints and is very useful for detection of subclinical inflammation of joint.

Utility of Mini-Clinical Evaluation Exercise in the Assessment of Medical Interns in Simulation based Medical Education: A Pilot Study

Introduction: Medical graduates skill assessment in simulation is underdeveloped and needs due attention in making them proficient. The mini-Clinical Evaluation Exercise (mini-CEX) could be an important tool in assessing and making them perfect through Competency-Based Medical Education (CBME). Aim: To determine utility of mini-CEX as a definitive and reliable assessment tool in high fidelity medical simulation. Materials and Methods: This pilot study was conducted at School of Virtual Learning (SVL) affiliated with JNMC, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (M), Wardha, Maharashtra, India between 1st November 2021- 31st December 2021, on 50 medical interns. The learners were taught of basic clinical examination on SimMan simulator along with training in MiniCEX exercise. The case scenarios on Hypertensive, Valvular, Acute Coronary artery disorders and dysrhythmias cardiac medical emergencies were allotted and the performance of administrators and learners were assessed by mini-CEX. The mini-CEX rating form was used to evaluate the competence and student satisfaction score form was sent to learners for their feedback. The data was collected on online Google form and was tabulated and analysed, descriptive statistics, mean with standard deviation was calculated. Results: The mean age of participants was 22.5±0.53 years. There were 15 males (30%) and 35 females (70%). Average satisfaction score for the assessors was 7.4±1.2 and for the interns was 8.2±0.2. Conclusion: Excellent level of satisfaction was observed in the learners as well as the administrators by use of Mini-CEX format. Hence this exercise can be applied in accessing high fidelity simulation.

Cardiovascular Risk in Patients with COPD: Cardiovascular Comorbidities in Patients with COPD Increase CAT and mMRC Dyspnea Scores

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a number of different comorbidities. Cardiovascular diseases (CVD) are the most frequent comorbidities in COPD. The economic burden associated with cardiovascular comorbidity (CVC) in this population of patients is considerable. The COPD patients are related to the increased systemic inflammation, reduced capacity for physical activity, and airflow obstruction. AIM: The aim of our investigation was to evaluate the dyspnea as a disabling symptom in COPD patients with cardiovascular comorbidity (CVC) especially heart failure. The main aim of this study is to evaluate its intensity in patients with COPD in stages II according to GOLD. METHODS: The investigation was conducted from December 2019 to January 2020, on pulmonology and allergology clinic and cardiology clinic of medical faculty in Skopje. We investigated 65 outpatients with COPD, 44 with different type of CVD, Group I, and 21 without CVD, Group II. All patients were with partial chronic respiratory failure (In type 1 respiratory failure hypoxemic). Patients, according GOLD initiative, were in COPD stadium II, 70% < forced expiratory volume in 1 s (FEV1)>50%. Heart condition was diagnosed on the basis of clinical examination, electrocardiography, and echocardiography of the heart. Included patients with CVD were with ejection fraction (EF) <65%. Dyspnea was measured with modified MRC (mMRC) dyspnea scale. RESULTS: The forced vital capacity and forced expiratory volume in 1 s were statically significantly higher in Group II with CVD. Dyspnea measured with Modified Medical Research Council (MRC) dyspnea scale showed statistically significantly higher values in Group I COPD patients with CVC (2.9 ± 1.4) versus Group II without CVC (1.7 ± 1.4), (p < 0.05). The perception of the higher dyspnea in Group I was associated with increased COPD assessment test-scores, in Group I: Group I (19.8 ± 9.1) versus Group II: (9.8 ± 9.1), (p < 0.001). The number of exacerbations and what is more important the number of severe exacerbation leading to hospitalizations was statistically higher in patients of Group I with CVC than in Group II without CVC (3.0 ± 1.1 vs. 1.0 ± 2.1), (p < 0.001) and the number of hospitalizations (1.0 ± 1.1 vs. 0.3 ± 2.1) (p < 0.001). CONCLUSION: We can conclude that patients with COPD who have CVC have an increased risk of high symptoms, which mean poor quality of life and increased morbidity.

Evaluation of trichoscopic features in female pattern hair loss

Female pattern hair loss (FPHL) is explained by decrease in hair fiber production and their eventual miniaturization. It is considered a counterpart of male androgenetic alopecia but the role of androgens in its pathogenesis is yet to be proven. To evaluate the trichoscopic features in females with patterned hair loss. Inclusion and exclusion criteria were applied and 37 cases were enrolled in our study. Detailed history and clinical examination were done to establish the diagnosis. Trichoscopic examination was done after taking consent in diagnosed cases. On trichoscopy, hair diameter variability, peri pilar sign, white dots, scalp pigmentation and focal atrichia was observed in 62.2%, 62.2%, 40.5%, 45.9% and 40.5% respectively. Most common trichoscopy finding observed was peri pilar sign and hair diameter variability in 23/37 females. Definitive diagnosis of FPHL is difficult to be established solely on the basis of clinical examination. Thus, trichoscopy serves as a non-invasive tool to ascertain the diagnosis in these patients.

Age and clinical signs as predictors of COVID-19 symptoms and cycle threshold value

ABSTRACT Many COVID-19 infected people remain asymptomatic, and hence the diagnosis at first presentation remains a challenge. Assessment at a presentation in primary care settings is usually done by visual triaging and basic clinical examination. This retrospective study involved investigating the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar for July 2020. The presence (symptomatic group) or the absence (asymptomatic group) of symptoms along with objective vital examination ( ie ; heart-rate (HR), temperature, haemoglobin saturation (SpO2)) were analysed and linked to the viral load ( ie ; cycle threshold (Ct)) of COVID-19 positive patients. Four hundred eighty-one symptomatic (230 males) and 216 asymptomatic (101 males) patients were included. Compared to the asymptomatic male group, the symptomatic male group was older, had lower Ct value and SpO2, and higher temperature and HR. Compared to the females asymptomatic group, the symptomatic females group had lower Ct value, and higher temperature. Compared to the asymptomatic group, the symptomatic group had lower Ct value and SpO2, and higher temperature and HR. Compared to the asymptomatic group, the symptomatic group had lower Ct values (age groups [21–30], [31–40], [41–50] and [51–60]), higher temperature (age groups [21–30] and [31–40], Ct ranges [20.01–25.00] and [25.01–30.00]), higher HR (age groups [21–30] and [31–40], Ct range [15.01–20.00]); and lower SpO2 (age groups [41–50] and [51–60], Ct ranges [15.01–20.00] and [35.01–40.00]). Compared with asymptomatic patients, symptomatic patients with COVID-19 are most likely to be febrile, tachycardic, hypoxic and having higher viral load. Higher viral load was associated with higher HR, higher temperature, lower SpO2, but there was no relation between viral load and age.

JUVENILE NASOPHARYNGEALANGIOFIBROMA: OUR EXPERIENCE AND LITERATURE REVIEW

ABSTRACT
 Introduction: Juvenile nasopharyngeal angiofibroma is a benign vasculartumor.It is commonly found in teen age males. Its site of origin is sphenopalatine foramen. Exact pathogenesis of angiofibroma is not known. It has predictable natural history and growth pattern. This tumor most often involves nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa and infratemporal fossa. It can also involve orbit and can spread intracranially. Its very important to diagnose this tumor very early on the basis of clinical examination and imaging. As early tumor confined to nose and sinuses can be removed exclusively with endoscope. It is very helpful to do angiography before surgery to ascertain itsblood supply and then embolization can be done to reduce intraoperative bleeding. Objective: To describe our experience of Juvenile Nasopharyngeal Angiofibroma cases in ENT Unit-I of Lahore General Hospital. Study Design: Descriptive Study with retrospective analysis after approval from Institutional Review Board (IRB) of LGH/PGMI/AMC Lahore. Methods: We studied 20 patients who underwent surgery in our department from October 2019 to October 2020. We analyzed following factors: age, gender, symptoms, staging, mode of surgery and need for intraoperative blood transfusion, hospital stay, complications and recurrences. Results: Range of patient’s age was 12 to 25 years. Eight patients underwent surgery with endoscope. Mean blood loss was about 400 ml and mean operating time was 140 minutes. All the cases were embolized preoperatively. Conclusion: Endoscopic surgery is a safe and effective method in early stage JNA patients. While patients with advance stage tumors should be managed with combined endoscopic and conventional open approaches.
 KEYWORDS: juvenile nasopharyngeal angiofibroma, JNA, endoscopic surgery

Multinucleate Cell Angiohistiocytoma: A Case Report and Unique Treatment Consideration

Introduction: Multinucleate cell angiohistiocytoma (MCAH) is a benign, yet exceedingly rare vascular and firbiohistiocytic proliferation. The lesions are typically asymptomatic and are commonly cosmetically displeasing to patients. 1 Previous reports have demonstrated success in treating MCAH with fractional ablative CO2 laser, argon laser, pulsed dye laser, and KTP lasers. 3 The scarcity of reported cases may suggest that the lesion is commonly misdiagnosed, and we report this case to highlight the characteristic features of MCAH with successful treatment with Neodymium YAG laser.
 Case Presentation: A 64-year- old female presented to our clinic with a 1- month history of multiple erythematous to violaceous lesions on her bilateral hands. The lesions were asymptomatic, but cosmetically displeasing for the patient. Past medical history and family history was noncontributory. Examination revealed several 2-6 mm well- circumscribed, erythematous, indurated smooth papules on the bilateral dorsal and in the second web space of the left hand. Shave biopsy of the lesions were consistent with MCAH. She was initially treated with topical steroids twice daily for 2 weeks, with no improvement. The patient received 3 treatments with Neodymium YAG, 4 weeks apart. This treatment was discontinued after 3 sessions due to the dramatic visible improvements in regards to induration and discoloration of the lesions.
 Discussion: MCAH is an extremely uncommon lesion, diagnosis is made on the basis of clinical examination, histopathologic and immunohistochemical analysis of the lesions. This case illustrates diagnosis and successful treatment of MCAH with Neodymium YAG and offers a unique treatment consideration for patients.

ORTHOPEDIC MANIFESTATIONS OF CONGENITAL VASCULAR MALFORMATIONS OF THE LOWER EXTREMITIES

The spectrum of orthopedic manifestations of congenital vascular malformations of lower limbs remains insufficiently studied. Objective. To analyze the results of examination of patients with orthopedic manifestations of congenital vascular malformations. Methods. 24 patients with various forms of congenital vascular malformations of the lower extremities were examined. Distribution of patients according to the Hamburg classification of vascular malformations: arteriovenous type — 14 patients; venous — 6; capillary — 2; capillaryvenous — 1; lymphatic — 1 patient. The diagnosis of orthopedicpathology was performed on the basis of clinical examination, X-ray, ultrasound, X-ray densitometry. Results. All patients with congenital vascular malformations were diagnosed with orthopedic pathology: leg length discrepancy (75 %), secondary scoliotic deformity (16 %), knee flexion contracture 40° (8 %), flatfoot (12 %), equinus deformity of the foot (8 %), osteoporosis of the affected limb (16 %), areas of pathological reconstruction of the affected bone (lytic areas) (4 %), hip osteoarthritis of the affected limb (grade 2) (4 %). Leg length discrepancy was observed due to the elongation of the affectedlimb — in 16 patients (67 %), shortening — in 2 (8 %). Leg length discrepancy was in the range of 0.5–6 cm. Elongation of the affected limb < 2 cm was noted in 5 patients (21 %), > 2 cm — in 11 patients (46 %); shortening of the affected limb < 2 cm was observed in one patient (4 %), > 2 cm — in one patient (4 %). Among the patients with leg length discrepancy, 61 % had combinations of several orthopedic manifestations of the disease. Conclusions. Patients with congenital vascular malformations have a wide range of orthopedic pathology, among them the leading is leg length discrepancy (75 %) due to elongation(67 %) or shortening of the affected limb (8 %). Leg length discrepancy is most often observed in patients with arteriovenous type of vascular malformation (67 %), elongation of the lower limb > 2 cm (75 %) significantly predominating in this category. Among patients with a difference in the length of the lower limbs in 61 % of cases, there is a combination with other orthopedic manifestations of the disease. Systematization of orthopedic pathology and development lesions’ classification of the musculoskeletal system taking into account the forms of vascular malformation will improve the diagnosisof the disease and improve the tactics of its orthopedic treatment.

An exploratory study into the teaching of clinical examination skills in advanced practice.

Clinical examination skills are vital for the accurate assessment and diagnosis of patients. These skills also allow clinicians to differentiate between pathology requiring investigation or treatment and normal anatomy or physiology. This allows clinicians to avoid unnecessary tests and to be able to reassure a patient that their symptoms do not require treatment. However, an incomplete or faulty clinical examination can lead to missed diagnoses and patient harm. Although comprehensive clinical examination skills training is provided in the undergraduate curriculum of medical schools in the UK, little is known in relation to the teaching provided for nurses and allied health professions working in advanced practice roles. This survey sought to explore this phenomenon and uncover clinicians' experiences with regard to being taught a selection of specific clinical examination skills in theory and in practice, those skills being the core system examinations (respiratory, cardiovascular and peripheral vascular, abdominal, central and peripheral nervous systems) and a number of focused examinations (digital rectal and examination, thyroid, breast and genital examination for males and females). The findings demonstrate a concerning variability of educational experiences and a lack of educational coverage of some of the basic clinical examination skills in both theoretical and practical terms. These findings provide an insight into areas of future higher education curricula development as well as workplace mentoring and learning.

Value of nitroglycerin test in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea.

BackgroundRapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians.HypothesisCardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea.Materials and MethodsA prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro‐brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve.ResultsThis study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non‐HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636–0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11–0.29); p < .001].ConclusionsOur study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea.

Sternal closure in patients with the high risk of sternal dehiscence

The objective was to evaluate the efficacy of sternal closure using the «double twist» technique.Methods and materials. The study included 37 patients with risk factors for sternal dehiscence (obesity, diabetes, chronic obstructive pulmonary disease). The patients were divided into 2 groups. In the first group (n=12), «double twist» technique was used. In patients of the second group (n=25), osteosynthesis was performed using standard technique (single wire ligatures). The efficacy of the «double twist» sternal closure was evaluated on the basis of clinical examination and multispiral computed tomography of the chest.Results. In the early postoperative period, the sternal dehiscence, which required re-operation was detected in 12 % after standard sternal closure. Sternum was stable in all of the patients of «double twist» group (p=0.211). No deep sternal infection was observed in both groups. In the follow-up (up to 6 months), there were no clinical and tomographic sings of delayed sternal dehiscence or infection in «double twist» group.Conclusions. Sternal closure using the «double twist» technique provides reliable fixation of the sternum in patients with the risk of its dehiscence.

Respiratory health of workers exposed to polyacrylate dust.

Background:Polyacrylate (PA) powder dust formed in PA manufacturing units is fine sized, i.e., in nanosize. Although several previous studies reported possible significant adverse effects of nanomaterials, studies on the harmful effect of small-sized PA particles on the respiratory health of the workers are scarce. The present study was carried out to assess the effect of PA on respiratory health and lung volumes/rates among the workers of PA manufacturing unit.Materials and Methods:The present cross-sectional study included 84 workers of PA manufacturing unit. Using interview technique as a tool for data collection, demographic, occupational, and clinical details of the workers were recorded on the predesigned pro forma. This was followed by detailed clinical examination, spirometry, chest X-ray (posteroanterior [PA] view), and high-resolution computed tomography (HRCT) examination of each worker.Results:On the basis of clinical examination, chest radiography, and HRCT, 17.9% of the workers were found to have fibrotic and cavitarychanges in lung parenchyma. The production department workers had a higher proportion of respiratory morbidities as compared to supervisory or office staff. Age, gender, smoking habit, and duration of exposure were nonsignificant risk factors for respiratory morbidity. The overall mean forced vital capacity, forced expiratory volume in 1sts, Peak Expiratory Flow Rate (PEFR), (Maximal Mid Expiratory Flow Rate) MMEFR0.2–1.2, and MMEFR25%–75% were 3.19 ± 0.77 L, 2.72 ± 0.67 L, 6.82 ± 1.86 L/s, 5.79 ± 2.03 L/s, and 3.16 ± 1.19 L/s, respectively. Females and those having respiratory morbidity had significantly lower values of all spirometric parameters as compared to their counterparts.Conclusions:The workers exposed to engineered fine dust of PA may be at risk of respiratory ill-health.

Захворюваність населення України запальними захворюваннями пародонта, прогнозування та профілактика патологій в сучасних умовах

The purpose of the study. The article reflects the issues of the incidence of inflammatory periodontal diseases in the population of Ukraine, methods for predicting exacerbations of diseases for the timely conduct of secondary prevention. It has been established that the high prevalence of periodontal diseases among different groups of the population makes this problem one of the most important problems of modern dentistry. According to WHO experts, 80% of schoolchildren in different countries have periodontal pathology, and among adults it occurs in almost 100% of cases. Modern periodontal prophylaxis should be carried out on the basis of clinical examination of patients. Periodontal prophylaxis should be based on taking into account the identified etiological factors of the disease. Predicting the incidence of periodontitis and predicting the course of the disease is one of the most important problems of periodontology today. Solving forecasting problems in clinical, experimental and preventive medicine is one of the most difficult areas of the activity of doctors of various profiles. Materials and methods. In order to form a risk group, the occurrence of an exacerbation of inflammatory periodontal diseases for the timely implementation of secondary prevention of pathology, an algorithm for the probability of diseases and a mathematical model for predicting the course of the disease were developed. The use of this method made it possible to select 9 signs out of 42 that most significantly affect the prognosis of exacerbation in inflammatory periodontal diseases. Results and discussion. Based on the curves of the dependence of the frequency of the occurrence of exacerbation of inflammatory periodontal diseases on the magnitude of the risk of exacerbation of this pathology, 3 degrees of prognosis probability were determined: low, medium, high. The use of the method of stepwise discriminant analysis made it possible to develop a system for predicting the possibility of an exacerbation of inflammatory periodontal disease and to scientifically substantiate the principles of identifying risk groups for the possibility of exacerbation of inflammatory periodontal diseases in this group of examination. For patients with a risk of exacerbation, dynamic observation was established for one year, before the beginning of which they were divided into 2 groups – the study and control. Patients in the study group underwent preventive treatment, which included the appointment of an appropriate diet, work and rest regimen, correction of the state of the immune system using immunomodulatory drugs, treatment of concomitant diseases and local treatment of inflammatory periodontal diseases. Patients in the control group underwent conventional prophylaxis, which included adherence to general rules: a rational regimen, a balanced diet, rational oral hygiene, and basic sanitary and educational work. Conclusion. As shown by the results of dynamic observation, among patients of the study group, exacerbation of the disease was observed in 14.3% of cases, in patients of the control group – in 42.5%, which corresponded to the likelihood of an exacerbation of the disease by 94.5%

Adrenalectomies for adrenal gland tumours-a retrospective study of 15 cases at a single center

We present our experience of 15 cases of adrenal tumours who underwent adrenalectomy procedure in last 5 years at our institute and analysed retrospectively clinical outcome. Pre-operative, intra-operative and post-operative data from 15 patients who underwent adrenalectomy between August2015 and July 2020 at our institution were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Prazosin was preoperatively administered in case of pheochromocytoma. All adrenalectomies were performed by team of urologists. A multidisciplinary management involving endocrinologists, urologists, oncologists, onco-surgeons and anaesthesiologists was carried at our institute. Fifteen patients were evaluated retrospectively in our study. Functioning tumours were diagnosed in 08(53.3%) patients, 06 patients were affected by pheochromocytomas, 2 cases by adrenal cortical carcinoma (ACC). 3 (20%) patients had incidentalomas. 11 (73.3%) patients underwent open adrenalectomy and in 04 (26.6%) patients, laparoscopic adrenalectomy (LA) was performed. An accurate preoperative examination (radiological and biochemical evaluation) is mandatory to select eligible patients to LA or open adrenalectomy (OA). LA is safe and feasible for benign lesions up to 6 cm. A skilled operative team, composed by surgeons experienced in LA after adequate learning curve, is required. Preoperative alfa blockade does not prevent PCC hypertensive crises but, facilitating their pharmacological control, must be recommended.

Serum Thioredoxin as a Diagnostic Marker for Hepatocellular Carcinoma in Cirrhotic Hepatitis C Patients

Background: Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy. Early detection of HCC is extremely important in improving the survival of patients. Alpha-fetoprotein (AFP) was commonly used as a predictor for HCC, but it was associated with low sensitivity and specificity. Thioredoxin (TRX) is a ubiquitous protein that was suggested to be elevated in cases with HCC. Objective: To evaluate the value of serum thioredoxin as a diagnostic marker of HCC versus alpha-fetoprotein in cirrhotic HCV patients. Materials and methods: This study included 96 patients divided into; groups I included, patients with liver cirrhosis, and group II included, patients with HCC on top of a cirrhotic liver. Both groups were successfully undergoing treatment of HCV with direct-acting antiviral (DAAs). Basic data, clinical examination, and laboratory analysis were obtained from all the cases. Human thioredoxin detection was done using Human TRX kits. Results: There is statistically significant increased TRX, AFP, APRI, and FIB4 among hepatocellular carcinoma group versus cirrhotic group. The ROC curve analysis demonstrated that TRX at a cut-off value of 198.19 (IU/ml) has 85.4% sensitivity and 89.6% specificity for differentiating HCC cases from cirrhotic cases with 89.1% PPV, 86% NPV, and AUC equal to 0.841. Both, AFP at a cut-off of 24 (ng/ml)and combined AFP and TRX had 93.8% sensitivity and 97.9% specificity with AUC equal to 0.99 for differentiating HCC cases from cirrhotic cases. Conclusion: Thioredoxin is a novel biomarker that revealed good sensitivity in the prediction of HCC on top of liver cirrhosis especially if combined with AFP.

Ovotesticular Disorder of Sex Development in Korean Children: A Single-Center Analysis over a 30-Year Period.

To present clinical features that characterize ovotesticular disorder of sex development (OT-DSD) in the Korean population. Among the patient cohort who were initially suspected to have OT-DSD, the actual OT-DSD patients and those of other disorder of sex development were compared. Retrospective medical chart review of patients who were initially suspected to have OT-DSD from 1984 to 2018 on the basis of clinical examination. Tertiary care university hospital. Of 26 patients with initial diagnosis of OT-DSD, 3 were excluded because of incomplete records, and finally, 23 patients were subjected to analysis. Various examinations were performed before the surgical confirmation of gonad histopathology. Medical records were reviewed for clinical, anatomical, biochemical, and cytogenic characteristics, gender assignment, medical treatment, and histopathologic diagnosis. Characteristics of OT-DSD in a Korean population. Among 23 patients suspected to have OT-DSD, 13/23 (56.5%) were diagnosed as OT-DSD after histopathologic confirmation. Of the remaining 10 patients, 5/23 (21.7%) were diagnosed with mixed gonadal dysgenesis, 3 with Turner variant, 1 with 46,XX disorder of sex development, and 1 with Mayer-Rokitansky-Küster-Hauser syndrome. Among the 13 OT-DSD cases, 9 patients presented with the 46,XX karyotype, 1 with the 46,XY, and 3 with the 46,XX/XY karyotype. Nine patients were assigned as male and 4 as female at birth. The most common gonad histology was ovotestis 10/26 (38%), followed by ovary and testis. OT-DSD is one of the rarest disorders with various clinical presentations. A patient with ambiguous genitalia must be examined with a multidisciplinary approach with clinical suspicion for OT-DSD. Standardized procedure of evaluation and treatment is crucial.

Differences in the degree of nutrition and body composition of boys and girls of pubertal age

Background and Study Aim. The nutritional status of children can be assessed on the basis of clinical examination, laboratory procedures and anthropometric measurements. Height and body weight are most often used to determine nutrition. Children and adolescents who are at risk of being overweight often also become obese adults.&#x0D; Material and Methods. The research was conducted on a sample of 136 students (67 boys and 69 girls), with an average age of 11.56 years. The aim of the study was to determine the degree and differences in the degree of nutrition and body composition in boys and girls of pubertal age.&#x0D; Results. Based on the obtained results, T-test for small independent samples, it was determined that there are no statistically significant differences between boys and girls, both in the degree of nutrition and body composition, estimated by 10 variables using bioelectric impedance InBody 720. Also, it was found that 19.70% of boys are obese, as well as 17.40% of girls. Cumulatively with the percentage of malnourished respondents, a total of 61.50% of boys were not normally fed, as were 37.70% of girls. The obtained results indicate the need for a more extensive review of the analysed segments and a significantly larger sample of respondents, in order to act preventively in the fight against obesity, as the leading epidemiological health problem of today.&#x0D; Conclusion. It is obvious that physical activity based on physical education classes is not sufficient or is not sufficiently represented to meet the challenges of the modern way of life of children.