Clinical Aspects Research Articles

Charting the Course: Insights into Neuroendocrine Tumor Dynamics in the United States.

To explore changing trends and characteristics in neuroendocrine tumors (NETs) epidemiology, focusing on demographics, clinical aspects, and survival, including the impact of social determinants of health (SDOH) on outcomes. The escalating incidence and prevalence of NETs underscore the pressing need for updated epidemiologic data to reveal the evolving landscape of this condition. Access to current information is imperative for informing clinical strategies and public health initiatives targeting NETs. A retrospective, population-based study analyzed NET patient data from 1975 to 2020, using the Surveillance, Epidemiology, and End Results (SEER 8, 12, 18) program. We calculated annual age-adjusted incidence, prevalence, and 5-year overall survival (OS) rates. Survival trends from 2000 to 2019 were examined, employing the Fine-Gray model to evaluate cancer-specific mortality. NETs' age-adjusted incidence rate quadrupled from 1.5 per 100,000 in 1975 to 6.0 per 100,000 in 2020. A decline in incidence occurred from 6.8 per 100,000 in 2019 to 6.0 per 100,000 in 2020. All-cause survival multivariable analysis demonstrated high grade (HR: 2.95, 95% CI: 2.63-3.09, P<0.001), single patients (HR: 1.49, 95% CI: 1.45-1.54, P<0.001), and Black patients (HR: 1.17, 95% CI:1.13-1.22, P<0.001) all had worse survival than their controls. In conclusion, our study shows a steady increase in NETs incidence until 2019, with a decline in 2020. Understanding the reasons behind this trend is vital for improved management and public health planning. Further research should focus on the factors driving these changes to enhance our understanding of NET epidemiology.

Frontal Sinus Displacement of Silicone Implant After Previous Rhinoplasty.

Rhinoplasty, a historic surgical procedure for facial esthetics, has been actively performed in Asia. The use of autologous tissues or artificial materials, such as silicone, Gore-Tex, and Medpore, is common in achieving cosmetic improvements. However, artificial material poses risks of inflammation and foreign body reactions, leading to complications like infection and necessitating material removal and antibiotic treatment. According to previous reports, various clinical aspects appear across inflammation, skin necrosis, and, in severe cases, systemic symptoms caused by implants. In this case study, the goal is to share a rare case of silicone implant migration into the frontal sinus after augmentation rhinoplasty. A 38-year-old female patient who had previously undergone rhinoplasty surgery visited the outpatient clinic complaining of headaches and a deviated nose. On computed tomography, the silicone implant moved upward, penetrating the nasoethmoid bone and invading the frontal sinus. Fortunately, there was no intracranial invasion. The authors planned the implant removal and performed the complete implant removal with capsulectomy. The patient has been undergoing follow-up without any complications after surgery. Augmentation rhinoplasty with implants, while common, carries long-term risks. This case highlights the severity of complications, emphasizing infection and migration into the frontal sinus and, in extreme cases, the brain cavity. Therefore, surgeons must continually refine operation techniques to minimize iatrogenic causes and consider modifying surgical procedures to prevent potential complications.

Invasive meningococcal disease in older adults: current perspectives and call for action.

Invasive meningococcal disease (IMD) is a devastating condition. While most attention is directed towards disease in children and adolescents, IMD poses an important cause of morbidity and mortality in adults ≥60years. While immunization is a critical component of healthy ageing strategies, meningococcal immunization is not routinely offered to older adults. The aim of this review was to summarize clinical and epidemiological aspects of IMD and available immunization strategies, with a particular focus on disease in older individuals, to emphasize the importance of this rather neglected area. An expert working group was established to evaluate clinical and epidemiological data toraise awareness of IMD in older individuals, and develop suggestions to improve the existing burden. Routine child and adolescent meningococcal immunization has substantially reduced IMD in these targeted populations. Consequently, prevalence and proportion of IMD among those ≥60years, mostly unvaccinated, is increasing in developed countries (accounting for up to 25% of cases). IMD-related mortality is highest in this age-group, with substantial sequelae in survivors. IMD due to serogroups W and Y is more prevalent among older adults, often with atypical clinical features (pneumonia, gastrointestinal presentations) which may delay timely treatment. IMD in older adults remains overlooked and greater awareness is required at clinical and societal levels. We encourage clinicians and immunization policy makers to reconsider IMD, with a call for action to remedy existing inequity in older adult access to protective meningococcal immunization.

Surgical Management and Short-Term Outcome of Patients with Posterior Fossa Tumor in All Age Groups: Our Perspective

Background: Different types of brain tumor can occur in the region of posterior fossa. Ependymoma, medulloblastoma and pilocytic astrocytoma occur mostly in children and rarely in adults. Brain metastases in adults are the most common malignancies at this site. Other tumors that occur in the posterior fossa are meningioma, schwannoma, hemangioblastoma, brain stem glioma and epidermoid tumors. Posterior fossa tumor has different treatment approaches and prognosis. So, an accurate diagnosis, surgical approaches, complication analysis and outcome assessment are mandatory. Objective: To evaluate the clinical aspects, surgical approach, role of preoperative shunt, post-operative complications, and short-term outcome of patients with posterior fossa tumor in different age groups. Methods: This cross-sectional observational study included 36 patients with posterior fossa tumors that were admitted and operated in the Neurosurgery Department of Rangpur Medical College Hospital between the period of November 2018 and June 2022. In each patient clinically diagnosis was confirmed by MRI of Brain with contrast followed by histopathology. Results: Out of 36 patients, 23(63.9%) patients were male and 13(36.1%) were female. Mean age was 18.01±13.95 SD years (minimum 6 months and maximum 45 years), more common in pediatric age group (36.1% &lt;10 years and 25% between 11-20 years). Common presentations were headache (91.6%), vomiting (83.3%) and ataxia (72.2%). Medulloblastoma (27.8%) and ependymoma (25%) were common histological types. Surgical outcome was excellent in 17 cases (47.2%), while poor in 5.6% and 19.4% patients died. There was no statistically significant association of surgical outcome with age (p=0.148) and sex (p=0.170). Suboccipital craniotomy was superior to other surgical procedures in terms of patient’s outcome (p=0.031). Ependymomas and Astrocytomas had better outcome (p=0.014). Conclusions: Surgical outcome is related to the operative approach and histology of the tumor in this study, but no significant association of patient’s outcome with age, sex and preoperative procedure. J Rang Med Col. March 2024; Vol. 9, No. 1: 3-9

Early goal-directed management after out-of-hospital cardiac arrest: lessons from a certified cardiac Arrest centre.

Despite continuous advances in post-resuscitation management, outcome after out-of-hospital cardiac arrest (OHCA) is limited. To improve the outcome, interdisciplinary Cardiac Arrest Centers (CACs) have been established in recent years, but survival remains low and treatment strategies vary considerably in clinical and geographical aspects. Here we analyzed a strategy of in-hospital post-resuscitation management while evaluating the outcome. A broad spectrum of pre- and in-hospital parameters of 545 resuscitated patients, admitted to the Cardiac Arrest Center of the University Hospital of Marburg (MCAC) between 01/2018 and 12/2022 were retrospectively analyzed. Inclusion criteria were≥18 years, resuscitation by emergency medical services, and non-traumatic cause of OHCA. In the overall patient cohort, the survival rate to hospital discharge was 39.8% (n=217/545), which is 50.7% higher than in the EuReCa-TWO registry. 77.2% of the survivors had CPC status 1 or 2 (favorable neurological outcome) before and after therapy. A standardized 'therapy bundle' for in-hospital post-resuscitation management was applied to 445 patients who survived the initial treatment in the emergency department. In addition to basic care (standardized antimicrobial therapy, adequate anticoagulation, targeted sedation, early enteral and parenteral nutrition), it includes early whole-body CT (n=391; 87.9%), invasive coronary diagnostics (n=322; 72.4%), targeted temperature management (n=293; 65.8%) and if indicated, mechanical circulatory support (n=145; 32.6%) and appropriate neurological diagnostics. Early goal-directed post-resuscitation management in a well-established and highly frequented CAC leads to significantly higher survival rates. However, our results underline the need for a broader standardization in post-resuscitation management to ultimately improve the outcome.

Abstract PO4-16-12: Patient initiated centricity towards improved communication, side effect management and follow-up care by Real World Evidence Survey from patients for patients – Preview of the Breast BRIDGister Platform

Abstract Background Treatment adherence is crucial for outcome improvement. Still up to 50% of patients interrupt e.g. endocrine treatment or other effective treatment choices due to side effects or miscommunication. Reasons may include limited time spent for patient information in daily routine and the intrinsic barriers to frankly tell the truth to the attending physicians. Therefore, a patient initiated survey has been compiled to comprehensively address all clinical, diagnostic and critical aspects of importance for patients by decentral data capture from patients at home via smart devices in a pseudonymized &amp; interactive fashion to refocus on challenges regarding patients needs, fears and wishes to support evidence based statistical analysis of Real World Data. Materials and Methods Establishing a cloud-based IT Platform enabling nationwide, decentral data entry using Climedo clinical trial software tools without the need of any commercial app utilities and therefore obeying GDPR conform standards to create an interconnected online platform integrating 36 interconnected surveys comprising &amp;gt;1.200 singular questions has been set up between 2020 and 2022 based on patients content elaboration &amp; wishes. The questionnaires address all Real World experiences e.g. at initial diagnosis, during primary treatment and all subsequent lines as well as side effect management with complementary medicine and follow up care realities. After 100 patients a preplanned statistical analysis has been performed to evaluate the feasibility of the patient oriented ePRO approach and demonstrate relevance of proof-of-concept results before entering international trial expansion. Descriptive analysis by Excel as well as Correlation analysis; Chi square and Partitioning tests using the SAS JMP® 9.0.0 software were performed. Results Despite in depth complexity &amp;gt; 85% of patients completed the whole survey. Age distribution of the pilot cohort revealed comparably younger patient age (28% between 30-39 years, 40% between 40-49 years, 24% between 50-59 and 10% being above 60 years) and dominance of Triple Negative Patients (~39%) participating the online survey in the pilot cohort. 97% of patients were treated in certified breast centers (50% in larger centers of bigger towns,15% in central clinics, 23% in university sites, 5% in local hospitals and 7% at office based doctors). Interestingly, 25% of patients did not or only partially understand their diagnosis and upcoming treatment. Time spent for communicating initial breast cancer diagnosis was less than 10 minutes for 25% of patients, while 13% did not remember. Exclusively one treatment option was discussed with 86% of patients. 78% have been informed about their initial breast cancer diagnosis in personal meetings, while 21% were informed by phone calls. 37% of patients had been informed about their patient rights. At preplanned interim analysis 38% of patients were lymphnode positive and 6% metastasized at initial diagnosis. 56% of patients were satisfied with their guideline conform follow-up-care, while 42% did pay for additional follow up care on their own. 85% of patients wished to have a risk-adopted, more individualized follow-up care. Conclusion Despite complexity and lengthiness &amp;gt; 85% of patients did complete the survey. There is an apparent need to have more time for initial confrontation with diagnosis and treatment options. Patients are frequently not informed about alternative treatment options as well as patient rights. Patients frequently feel under pressure in their life threatening situation and suffer substantial lack of information as well as appropriate personal communication. Patient centricity should focus on elaborated communication and information systems that support treatment decision acceptance and adherence. Further details analysis will become available in upcoming subanalysis of the Breast BRIDGister platform survey. Citation Format: Cornelia Stuewe, Ralph Wirtz, Christa Gress, Lena Schmidt, Veronika Schweighart, Sebastian Eidt, Claudia Schumacher, Julia Habraschka, Heidi Lehmann, Katrin Schuere. Patient initiated centricity towards improved communication, side effect management and follow-up care by Real World Evidence Survey from patients for patients – Preview of the Breast BRIDGister Platform [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-16-12.

Abstract PO5-26-11: The Breast Cancer Research Foundation Drug Research Collaborative – A unique and innovative model for industry-funded, academically driven research to advance the field of breast cancer

Abstract The Breast Cancer Research Foundation (BCRF) is committed to preventing and curing breast cancer through groundbreaking research. In pursuit of this mission, the BCRF launched the Drug Research Collaborative (DRC) in 2016—a pioneering program designed to bridge the gap between academic investigators and access to investigational therapies, thereby fostering greater academic-driven research in breast cancer. The DRC's primary objective is to fund independent, innovative, and high-quality investigator-initiated trials (IITs) and pre-clinical/translational research projects. In conventional drug development, industry-sponsored registration trials play a crucial role, leaving limited resources and scope for exploratory and translational IITs that fall outside the industry's drug approval strategy. Additionally, industry-funded IIT research faces challenges such as reputational risks, perceived influence during internal review processes, intellectual property (IP) concerns, and logistics/program management burdens. The BCRF-DRC program addresses these challenges by issuing requests for proposals to generate creative and unbiased ideas, which are then vetted through an academic review process involving leading breast cancer experts. The most promising research projects are selected for further advancement. The BCRF-DRC program is facilitated by the BCRF research staff, providing project management, while the Translational Breast Cancer Research Consortium (TBCRC), founded by the BCRF and also supported by Susan G. Komen, supports the clinical trial aspects of the program. Since its inception, the BCRF-DRC has expanded from one to three industry partners, securing a total funding of $25 million for 15 projects, including seven clinical trials and eight pre-clinical projects. This abstract reports on the ongoing progress and outcomes achieved by these three programs. The BCRF-DRC represents a revolutionary paradigm in research funding and collaboration by harnessing the collective power of industry partners, philanthropic organizations, and academic institutions. Through this collaborative effort, the BCRF-DRC provides a unique platform for researchers to accelerate the translation of scientific discoveries into effective clinical interventions, thus making significant strides in the field of breast cancer in the coming decades. By empowering academic investigators, fostering unbiased research, and addressing the limitations of industry-funded IITs, the BCRF-DRC is revolutionizing breast cancer research and driving the development of novel interventions. This abstract highlights the transformative potential of the BCRF-DRC program and its contribution to advancing breast cancer treatments and ultimately improving patient outcomes. The success of this collaborative model serves as a testament to the power of multi-sector partnerships and the pivotal role they play in shaping the future of breast cancer research. Citation Format: Unnati Jariwala, Dorraya El-Ashry, Judy Garber, Larry Norton. The Breast Cancer Research Foundation Drug Research Collaborative – A unique and innovative model for industry-funded, academically driven research to advance the field of breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-11.

Abstract PO1-22-10: Long term outcomes of breast cancer patients with local recurrence after mastectomy undergoing immediate breast reconstruction: A retrospective multi-institutional study of 4153 cases

Abstract Background: The number of breast cancer patients in Japan undergoing immediate breast reconstruction (IBR) has increased and the postoperative follow-up period has been extended. This study was conducted to clarify the clinical aspects of and factors associated with local recurrence (LR) after IBR. Methods: This was a multicenter study which included 4153 early breast cancer patients who underwent IBR. Clinicopathological characteristics were examined and factors potentially contributing to LR were analyzed. Risk factors for LR were examined separately for non-invasive and invasive breast cancers. Results: The median follow-up period was 75 months. The 7-year LR rates were 2.1% and 4.3% for non-invasive and invasive cancers, respectively (p &amp;lt; 0.001). The proportions of LR detected by palpation, subjective symptoms, and ultrasonography were 40.0%, 27.3%, and 25.9%, respectively. Overall, 75.7% of LR were solitary, and 92.7% of these cases had no further recurrences during the observational period. Multivariate analysis of LR for invasive cancer showed that skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM), the presence of lymphovascular invasion, cancer at the surgical margin, and not receiving radiation therapy were factors related to LR. The 7-year overall survival rates of the patients with LR and non-LR of invasive cancers were 92.5% and 97.3%, respectively, (p=0.002). Conclusions: The rate of LR after IBR was acceptably low and IBR can thus be performed safely for early breast cancer patients. Invasive cancer, SSM/NSM, lymphovascular invasion, and/or cancer at the surgical margin should prompt awareness of the possibility of LR. Citation Format: Akiko Ogiya, Naomi Nagura, Ayaka Shimo, Hiroko Nogi, Kazutaka Narui, Hirohito Seki, Hiroki Mori, Shinsuke Sasada, Makoto Ishitobi, Naoto Kondo, Chikako Yamauchi, Kohei Akazawa, Tadahiko Shien. Long term outcomes of breast cancer patients with local recurrence after mastectomy undergoing immediate breast reconstruction: A retrospective multi-institutional study of 4153 cases [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-22-10.

Epidemiological, clinical and paraclinical aspects of Pott's disease at Brazzaville University Hospital

Objective: Describe the epidemiological, clinical and paraclinical aspects of Pott's disease at the University Hospital Center of Brazzaville. Patients and methods: This was a descriptive, cross-sectional study with retrospective collection carried out in the Rheumatology department of Brazzaville University Hospital from January 1, 2013 to June 31, 2017, i.e. 4 years and 6 months. The diagnosis of Pott's disease was based on anamnestic, clinical and paraclinical arguments. Results: The hospital frequency of Pott's disease was 6.4%. Men predominated (56.4%) with a sex ratio of 1.3. The average age was 46 +/- 16 years (range: 20-80 years). The average time to diagnosis was 6.6 ± 5 months (range: 1-26 months). Alcoholism was the most common cause in 56 cases (50.9%). Spinal syndrome was present in 109 cases (99.1%). All patients had a standard spine x-ray performed. Computed tomography was performed in 28 patients (25.5%), magnetic resonance imaging in 23 patients (20.9%). The most common morphological aspect was spondylodiscitis in 76 cases (69.1%) associating disc pinching (60%), erosion (40%), and demineralization (19.1%). Atypical forms were found in 34 cases (30.9%), dominated by the appearance of spondylitis in 21 cases (61.8%). Conclusion: Pott's disease is a common pathology in developing countries, spondylodiscitis remains the most common morphological form.

Moral harassment in university hospital of Marrakesh: Epidemiological investigation

Introduction: moral harassment in the workplace is a growing phenomenon worldwide. Leymann defined it as a form of psychological terrorism that manifests itself over a relatively long period of hostile words or actions expressed or manifested by one or more people towards a third person (target) at work. It causes damaging consequences on the mental and physical workers health, with negative economic impacts on the company. Objectives: our objective was to study the epidemiological characteristics, the clinical aspects, and the consequences of moral harassment among the medical and paramedical staff of the Mohammed VI university hospital in Marrakech. Methods: We carried out a descriptive transversal study over six months covering 329 caregivers working at the Mohammed VI university hospital in Marrakech. The support of the investigation was an individual, and a strictly anonymous questionnaire containing the French version validated by the questionnaire of Leymann entitled Leymann Inventory of Psychological Terror; sociodemographic, mental health, and professional data were also collected. Results: In our study, the prevalence of moral harassment was 27.5%, according to Leymann's criteria (exposure to at least one situation, at least once a week for at least six months). Moral violence targets were between 25 to 35 years old (76%) and less than five years seniority (55%). The victims were represented mainly by residents (65.5%) and interns (33%). There was no correlation between sex and exposure to psychological violence (p=0,36). The supervisor was the main harasser (80%). Anxiety, depression, and symptoms of post-traumatic stress disorder had been the most observed consequences on the mental health of victims. Conclusion: Moral harassment at work seems, by its prevalence, to invade the hospital environment, and young doctors constitute a particular target. Exposure to this phenomenon has a negative impact on an individual's mental health. Our results are alarming enough to prompt us to continue investigating and put in place recommendations to limit and prevent the consequences.

Place of Delayed Primary Closure in Ballistic Wounds and by Explosive Devices at the Somine Dolo Hospital in Mopti

Objectives: To study delayed primary closure in ballistic and explosive device injuries by describing the clinical, therapeutic and evolutionary aspects. Methodology: This was a prospective study running from August 1, 2022 to May 31, 2023 including all patients of all ages presenting a ballistic or explosive device injury. Results: In 10 months, we collected 190 cases of ballistic and explosive device trauma, or 35.9%. The average age was 31.89 ± 14.026 years with a sex ratio of 12. Intercommunity conflicts were the most frequent causes (61.1%). Limb injuries represented 78.9 %, of which isolated wounds without fracture were the most frequent (59.5%). Standard radiography was ’the most used medical imaging (94%). DPC (Deferred Primary Closure) was performed in 71.2% followed by DPC + external fixator in 19%. We recorded 2 cases of death. Conclusion: Well-conducted delayed primary closure helps reduce the risk of complications, give the patient every chance of survival and shorten the hospital stay.

Epidemioclinical and Histological Profile of Malignant Ocular Tumors at University Hospital Center of Bouake

Objective: To describe the epidemiological, clinical and histopathological aspects of malignant tumors in the Gbêkê region. Materials and methods: Retrospective cross-sectional descriptive study conducted in the ophthalmology department of the Bouake University Hospital over a 5-year period [January 1, 2018, to December 31, 2022]. It involved patients seen in consultation for malignant ocular tumors confirmed after clinical and paraclinical examination. Results: Prevalence was 0.19%. The mean age was 31.52 years, with extremes of 4 months and 72 years. Reasons for consultation were dominated by exophthalmos (41.67%). Most patients (77.08%) had a consultation delay of over 12 months. The conjunctiva was the preferred site of ocular malignancies (41.67%). Squamous cell carcinoma was the most common tumour of all ages, accounting for 41.66%. Squamous cell carcinoma was the most common malignancy in adults, with 55.56%. In children, retinoblastoma remains the most common tumor (58.33%).

INTERRELATION BETWEENCARDIAC CONDUCTION ANOMALIES AND RADIOLOGICALFEATURES OF FAHRS SYNDROME: AFACT OR COINCIDENCE? CASE REPORT AND REVIEW OF THE LITTERATURE

Introduction:Fahrs syndrome is a rare, slowly progressive, neurodegenerativedisorder, characterized by extensive, bilateral, and symmetrical basal ganglia calcification. It isassociatedwithneuropsychiatric manifestations and gradually progressive cognitive impairment. Fahrs syndrome is the secondaryform of brain calcification thatiscaused by variousmetabolic, infectious, or degenerativediseases. Case report:An old manwasadmittedto ourdepartmentwithrecurrentepisodes of syncope. An electrocardiogramrevealedcomplete AV block.Laboratoryresultsdisclosedhypocalcemia, pseudo hypoparathyroidism, and hyperphosphatemia. Computedtomographyrevealedintracranial calcifications suggestiveofFahrs syndrome. Conclusion:Fahrs syndrome is a rare anatomo-clinical and radiologicalentity, with multiple clinical and etiological aspects. The pathophysiologicalmechanism of the lesionsremainspoorlyunderstood, even more cardiacfeaturesthatmaycause, but is set to benefitfromadvances in functionalneuroimaging.

Acute Surgical Abdomens at the Dioila Reference Health Center

Objectives: To study acute surgical abdomens by describing the clinical, paraclinical and therapeutic aspects. Methodology: This was a retrospective descriptive study from July 2019 to June 2021 including all patients taken in the surgical unit for acute surgical abdomens. Results: In 24 months, we collected 117 cases of acute surgical abdomens, or 19.1% of surgical interventions. The mean age was 30.6 ± 16.95 years. The sex ratio was 1.78. The reason for consultation was abdominal pain (100% of cases). The stopping of materials and gases represented 10.3% of cases. Intraperitoneal collection was the most common ultrasound sign found in 47.1% of cases. Acute appendicitis was the most frequent intraoperative diagnosis in 60.7% of cases. The surgical procedure performed was appendectomy (71.8%). The average length of hospitalization was four days. Morbidity was 6.8%. We recorded two deaths. Conclusion: Acute surgical abdomens occupy an important place in surgery due to their high frequency. The care is multidisciplinary.

ContourTL-Net: Contour-Based Transfer Learning Algorithm for Early-Stage Brain Tumor Detection

Brain tumors are critical neurological ailments caused by uncontrolled cell growth in the brain or skull, often leading to death. An increasing patient longevity rate requires prompt detection; however, the complexities of brain tissue make early diagnosis challenging. Hence, automated tools are necessary to aid healthcare professionals. This study is particularly aimed at improving the efficacy of computerized brain tumor detection in a clinical setting through a deep learning model. Hence, a novel thresholding-based MRI image segmentation approach with a transfer learning model based on contour (ContourTL-Net) is suggested to facilitate the clinical detection of brain malignancies at an initial phase. The model utilizes contour-based analysis, which is critical for object detection, precise segmentation, and capturing subtle variations in tumor morphology. The model employs a VGG-16 architecture priorly trained on the “ImageNet” collection for feature extraction and categorization. The model is designed to utilize its ten nontrainable and three trainable convolutional layers and three dropout layers. The proposed ContourTL-Net model is evaluated on two benchmark datasets in four ways, among which an unseen case is considered as the clinical aspect. Validating a deep learning model on unseen data is crucial to determine the model’s generalization capability, domain adaptation, robustness, and real-world applicability. Here, the presented model’s outcomes demonstrate a highly accurate classification of the unseen data, achieving a perfect sensitivity and negative predictive value (NPV) of 100%, 98.60% specificity, 99.12% precision, 99.56% F1-score, and 99.46% accuracy. Additionally, the outcomes of the suggested model are compared with state-of-the-art methodologies to further enhance its effectiveness. The proposed solution outperforms the existing solutions in both seen and unseen data, with the potential to significantly improve brain tumor detection efficiency and accuracy, leading to earlier diagnoses and improved patient outcomes.

Bakterijske infekcije urinarnog trakta u veterinarskim ordinacijama za male životinje

The urinary tract infection (UTI) is a common disease in dogs and cats, and it can occur as isolated infections or recurrently. Recurrent cases are particularly common in cases with underlying health conditions. The diagnosis of UTIs in dogs and cats generally involves an integrated interpretation of clinical signs, urinalysis, and bacterial cultures. Diagnostic imaging can also help assessing or discarding anatomical lesions. One of the many microorganisms that can cause UTIs is Escherichia coli. Females, geriatric patients, and animals with comorbidities usually have an increased risk of UTI. Antimicrobial prescription is common for the treatment of UTIs in companion animals. However, nowadays, there is a growing concern about antimicrobial resistance due to over-prescription driving selection for resistance. Therefore, correct prescription and appropriate patient management are essential. This review aims to provide a summary of the clinical and epidemiological aspects of UTIs, contributing to improving veterinary practices and antibiotic prescription in the context of UTIs in companion animals.

From hallucinations to delusions: A narrative review of psychotic-like experiences and their implications.

Psychotic-like experiences (PLEs) refer to sub-threshold hallucinations and delusions observed in both clinical samples and the general population. Psychotic-like experiences have far-reaching implications for an individual's coping strategies and daily functioning. They are associated with both psychotic and non-psychotic disorders. This article presents a comprehensive review of the current literature on PLEs, incorporating a detailed exploration of the definition, prevalence, risk factors, functional impairments, and comorbid psychiatric disorders. Medline/PubMed and Embase were searched to establish and identify the literature. A total of 108 studies met our inclusion criteria. The genetic and biochemical backgrounds of PLEs are discussed, focusing on gene polymorphisms, changes in brain gyrification and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Psychological factors, such as trauma exposure, emotion regulation difficulties, cognitive biases, and attachment issues, were thoroughly examined, especially in terms of their impact on the emergence of PLEs. Here, we show how important the clinical aspects of developmental PLEs are, underlining the significance of an increased risk of self-harm and suicidal behaviors in those individuals and the comorbidity of psychiatric disorders in enabling clinicians to discern specific areas to observe. Although there is limited evidence on effective protocols for PLE management, various treatment approaches are explained. Despite increased research on PLEs in recent years, further investigation is needed to fully understand the nature of PLEs and to optimize therapeutic strategies. This article consolidates the current knowledge by synthesizing information on PLEs, including risk factors, comorbidities, treatments, and their impact on individual's lives.

Post-traumatic Fat Embolism in Intensive Care

Fat embolism syndrome (FES) is a group of clinical, biological and radiological symptoms resulting from obstruction of the microcirculatory network by microdroplets of insoluble fat. It is a complication most often observed in the aftermath of a polytrauma involving several long bone fractures, but it can also occur outside the traumatic context. The aim of this study was to examine the epidemiological, pathogenic, clinical, paraclinical, therapeutic and evolutionary aspects of fat embolism syndrome. This was a retrospective study including all cases of post-traumatic fat embolism collected in the surgical intensive care unit of the Chu Ibn Rochd in Casablanca over a period of 5 years. 24 cases of post-traumatic fat embolism were collected. Male sex, age less than 40 years and the presence of a femur fracture were the dominant characteristics of the epidemiological profile of the trauma patient presenting with this syndrome occurring mainly within 72 hours of the trauma. The clinico-biological presentation was dominated by respiratory distress, consciousness disorders, anaemia, thrombocytopenia and hypocholesterolaemia. The management of FES was symptomatic, combining early immobilisation of fracture sites, optimal analgesia and maintenance of an effective blood volume. 41.66% of patients required mechanical ventilation and 75% underwent osteosynthesis of their fracture sites. 25% developed ARDS and the mortality rate was 26.08%.

Immunological Aspects of Kabuki Syndrome: A Retrospective Multicenter Study of the Italian Primary Immunodeficiency Network (IPINet).

Kabuki Syndrome (KS) is a multisystemic genetic disorder. A portion of patients has immunological manifestations characterized by increased susceptibility to infections and autoimmunity. Aiming to describe the clinical and laboratory immunological aspects of KS, we conducted a retrospective multicenter observational study on patients with KS treated in centers affiliated to the Italian Primary Immunodeficiency Network.Thirty-nine patients were enrolled, with a median age at evaluation of 10 years (range: 3m-21y). All individuals had organ malformations of variable severity. Congenital heart defect (CHD) was present in 19/39 patients (49%) and required surgical correction in 9/39 (23%), with associated thymectomy in 7/39 (18%). Autoimmune cytopenia occurred in 6/39 patients (15%) and was significantly correlated with thymectomy (p < 0.002), but not CHD. Individuals with cytopenia treated with mycophenolate as long-term immunomodulatory treatment (n = 4) showed complete response. Increased susceptibility to infections was observed in 22/32 patients (69%). IgG, IgA, and IgM were low in 13/29 (45%), 13/30 (43%) and 4/29 (14%) patients, respectively. Immunoglobulin substitution was required in three patients. Lymphocyte subsets were normal in all patients except for reduced naïve T-cells in 3/15 patients (20%) and reduced memory switched B-cells in 3/17 patients(18%). Elevated CD3 + TCRαβ + CD4-CD8-T-cells were present in 5/17 individuals (23%) and were correlated with hematological and overall autoimmunity (p < 0.05).In conclusion, immunological manifestations of KS in our cohort include susceptibility to infections, antibody deficiency, and autoimmunity. Autoimmune cytopenia is correlated with thymectomy and elevated CD3 + TCRαβ + CD4-CD8-T-cells, and benefits from treatment with mycophenolate.

Spectrum of COVID-19 induced liver injury: A review report.

The coronavirus disease 2019 (COVID-19) pandemic has caused changes in the global health system, causing significant setbacks in healthcare systems worldwide. This pandemic has also shown resilience, flexibility, and creativity in reacting to the tragedy. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection targets most of the respiratory tract, resulting in a severe sickness called acute respiratory distress syndrome that may be fatal in some individuals. Although the lung is the primary organ targeted by COVID-19 viruses, the clinical aspect of the disease is varied and ranges from asymptomatic to respiratory failure. However, due to an unorganized immune response and several affected mechanisms, the liver may also experience liver cell injury, ischemic liver dysfunction, and drug-induced liver injury, which can result in respiratory failure because of the immune system's disordered response and other compromised processes that can end in multisystem organ failure. Patients with liver cirrhosis or those who have impaired immune systems may be more likely than other groups to experience worse results from the SARS-CoV-2 infection. We thus intend to examine the pathogenesis, current therapy, and consequences of liver damage concerning COVID-19.