Clinical Management Of Patients Research Articles

From 2D to 3D: automatic measurement of the Cobb angle in adolescent idiopathic scoliosis with the weight-bearing 3D imaging

Background contextAdolescent idiopathic scoliosis (AIS) necessitates accurate spinal curvature assessment for effective clinical management. Traditional two-dimensional (2D) Cobb angle measurements have been the standard, but the emergence of three-dimensional (3D) automatic measurement techniques, such as those using weight-bearing 3D imaging (WR3D), presents an opportunity to enhance the accuracy and comprehensiveness of AIS evaluation. PurposeThis study aimed to compare traditional 2D Cobb angle measurements with 3D automatic measurements utilizing the WR3D imaging technique in patients with AIS. Study design/settingA cohort of 53 AIS patients was recruited, encompassing 88 spinal curves, for comparative analysis. Patient sampleThe patient sample consisted of 53 individuals diagnosed with AIS. Outcome measuresCobb angles were calculated using the conventional 2D method and three different 3D methods: the Analytical Method (AM), the Plane Intersecting Method (PIM), and the Plane Projection Method (PPM). MethodsThe 2D cobb angle was manually measured by 3 experienced clinicians with 2D frontal whole-spine radiographs. For 3D cobb angle measurements, the spine and femoral heads were segmented from the WR3D images using a 3D-UNet deep-learning model, and the automatic calculations of the angles were performed with the 3D slicer software. ResultsAM and PIM estimates were found to be significantly larger than 2D measurements. Conversely, PPM results showed no statistical difference compared to the 2D method. These findings were consistent in a subgroup analysis based on 2D Cobb angles. ConclusionEach 3D measurement method provides a unique assessment of spinal curvature, with PPM offering values closely resembling 2D measurements, while AM and PIM yield larger estimations. The utilization of WR3D technology alongside deep learning segmentation ensures accuracy and efficiency in comparative analyses. However, additional studies, particularly involving patients with severe curves, are required to validate and expand on these results. This study emphasizes the importance of selecting an appropriate measurement method considering the imaging modality and clinical context when assessing AIS, and it also underlines the need for continuous refinement of these techniques for optimal use in clinical decision-making and patient management.

Artificial neural network-assisted prediction of radiobiological indices in head and neck cancer.

We proposed an artificial neural network model to predict radiobiological parameters for the head and neck squamous cell carcinoma patients treated with radiation therapy. The model uses the tumor specification, demographics, and radiation dose distribution to predict the tumor control probability and the normal tissue complications probability. These indices are crucial for the assessment and clinical management of cancer patients during treatment planning. Two publicly available datasets of 31 and 215 head and neck squamous cell carcinoma patients treated with conformal radiation therapy were selected. The demographics, tumor specifications, and radiation therapy treatment parameters were extracted from the datasets used as inputs for the training of perceptron. Radiobiological indices are calculated by open-source software using dosevolume histograms from radiation therapy treatment plans. Those indices were used as output in the training of a single-layer neural network. The distribution of data used for training, validation, and testing purposes was 70, 15, and 15%, respectively. The best performance of the neural network was noted at epoch number 32 with the mean squared error of 0.0465. The accuracy of the prediction of radiobiological indices by the artificial neural network in training, validation, and test phases were determined to be 0.89, 0.87, and 0.82, respectively. We also found that the percentage volume of parotid inside the planning target volume is the significant parameter for the prediction of normal tissue complications probability. We believe that the model has significant potential to predict radiobiological indices and help clinicians in treatment plan evaluation and treatment management of head and neck squamous cell carcinoma patients.

Deep Learning–Based Automated Imaging Classification of ADPKD

IntroductionThe Mayo imaging classification model (MICM) requires a pre-step qualitative assessment to determine whether a patient is in class 1 (typical) or class 2 (atypical), where patients assigned to class 2 are excluded from the MICM application. MethodsWe developed a deep learning-based method to automatically classify class 1 and 2 from MR images and provide classification confidence utilizing abdominal T2-weighted magnetic resonance images from 486 subjects, where the transfer learning was applied. In addition, the explainable artificial intelligence (XAI) method is illustrated to enhance the explainability of the automated classification results. For performance evaluations, the confusion matrices were generated and receiver operating characteristic curves were drawn to measure the area under the curve. ResultsThe proposed method showed excellent performance for the classification of class 1 (97.7%) and 2 (100%), where the combined test accuracy of 98.01%. The precision and recall for predicting the class 1 were 1.00 and 0.98, respectively, with the F1-score of 0.99, while those for predicting the class 2 were 0.87 and 1.00, respectively, with the F1-score of 0.93. The weighted averages of precision and recall were 0.98 and 0.98, respectively, showing the classification confidence scores while the XAI method well highlighted contributing regions for the classification. ConclusionsThe proposed automated method can classify the class 1 and 2 cases as accurately as the level of a human expert, which may be a useful tool to facilitate clinical trials investigating different types of kidney morphology and clinical management of patients with ADPKD.

A meta-path, attention-based deep learning method to support hepatitis carcinoma predictions for improved cirrhosis patient management

Hepatitis carcinoma (HCC) accounts for the majority of liver cancer–related deaths globally. Cirrhosis often precedes HCC clinically in a strong, temporal relationship. Therefore, identifying cirrhosis patients at higher risk of HCC is crucial to physicians' clinical decision-making and patient management. Effective estimates of at-risk patients can facilitate timely therapeutic interventions and thereby enhance patient outcomes and well-being. We develop a novel, meta-path, attention-based deep learning method to identify at-risk cirrhosis patients. The proposed method integrates complex patient–medication interactions, essential patient–patient and medication–medication links, and the combined effects of medication and comorbidity to support downstream predictions. An empirical test of the proposed method's predictive utilities, relative to nine existing methods, uses a large sample of real-world cirrhosis patient data. The comparative results indicate that the proposed method can identify at-risk patients more effectively than all the benchmarks. The current research has important implications for clinical decision support and patient management, and it can facilitate patient self-management and treatment compliance too.

Identification of Novel Molecular and Clinical Biomarkers of Survival in Glioblastoma Multiforme Patients: A Study Based on The Cancer Genome Atlas Data.

Glioblastoma multiforme (GBM) is the most prevalent type of brain tumour; although advancements in treatment have been made, the median survival time for GBM patients has persisted at 15 months. This study is aimed at investigating the genetic alterations and clinical features of GBM patients to find predictors of survival. GBM patients' methylation and gene expression data along with clinical information from TCGA were retrieved. The most overrepresented pathways were identified independently for each omics dataset. From the genes found in at least 30% of these pathways, one gene that was identified in both sets was further examined using the Kaplan-Meier method for survival analysis. Additionally, three groups of patients who started radio and chemotherapy at different times were identified, and the influence of these variations in treatment modality on patient survival was evaluated. Four pathways that seemed to negatively impact survival and two with the opposite effect were identified. The methylation status of PRKCB was highlighted as a potential novel biomarker for patient survival. The study also found that treatment with chemotherapy prior to radiotherapy can have a significant impact on patient survival, which could lead to improvements in clinical management and therapeutic approaches for GBM patients.

Management Approaches and Patient Outcomes for Giant Pituitary Neuroendocrine Tumors Classified as Knosp Grade 3 and 4.

Background Treatment of patients with a giant pituitary neuroendocrine tumor (GPitNET) is challenging. Here, we present the methods used for the clinical management of patients who underwent GPitNET resection mainly via endoscopic endonasal surgery along with multimodal supportto avoid surgical complications, which can affect the outcomes. Methodology The medical records of 25 patients with a GPitNET who underwent endonasal endoscopic surgery were retrospectively reviewed. Complications were analyzed and factors affecting the extent of resection were evaluated. Results Gross total resection was achieved in six (24%), near-total resection (>90%) in nine (36%), and partial resection in 10 (40%) patients. Multivariate analyses revealed that tumors invading the middle fossa had negative effects on the extent of resection (odds ratio = 0.092, p = 0.047). Postoperative vision improved or normalized in 16 (64%), remained stable in eight (32%), and worsened in one (4%), while a new hormonal deficit was noted in seven (28%) patients. Complications included permanent oculomotor nerve palsy in one (4%) and transient oculomotor palsy in one (4%), apoplexy of the residual tumor resulting in ischemic stroke in one (4%), postoperative cerebrospinal fluid leakage in one (4%), and permanent diabetes insipidus in six (24%) patients. Conclusions For GPitNETs that extend into the middle fossa, our study underscored the difficulties in surgical extraction and the necessity for tailored treatment approaches. To ensure the safest and most complete removal possible, the surgical strategy must be specifically adapted to each case. Additionally, employing a comprehensive support approach is essential to reduce the chance of complications in patients impacted by this condition.

Tuberculosis: Implications for Dentistry

Tuberculosis (TB) is an airborne infection caused by Mycobacterium tuberculosis complex and is highly infectious. Therefore, precautionary measures should be implemented prior to dental treatment to reduce the risk of infection to staff and other patients. Dental history and examination have a role in identification of TB infection. Complex medical history poses a challenge to safe patient management in a dental setting, and close liaison between different disciplines in managing these patients is of paramount importance. This article explores the classical clinical features of pulmonary TB, its oral manifestations and the dental management of patients with active and latent TB. CPD/Clinical Relevance: Clinicians should be aware of the clinical features and dental management of patients with active and latent TB.

Identification and validation of an immune-derived multiple programmed cell death index for predicting clinical outcomes, molecular subtyping, and drug sensitivity in lung adenocarcinoma.

Comprehensive cross-interaction of multiple programmed cell death (PCD) patterns in the patients with lung adenocarcinoma (LUAD) have not yet been thoroughly investigated. Here, we collected 19 different PCD patterns, including 1911 PCD-related genes, and developed an immune-derived multiple programmed cell death index (MPCDI) based on machine learning methods. Using the median MPCDI scores, we categorized the LUAD patients into two groups: low-MPCDI and high-MPCDI. Our analysis of the TCGA-LUAD training cohort and three external GEO cohorts (GSE37745, GSE30219, and GSE68465) revealed that patients with high-MPCDI experienced a more unfavorable prognosis, whereas those with low-MPCDI had a better prognosis. Furthermore, the results of both univariate and multivariate Cox regression analyses further confirmed that MPCDI serves as a novel independent risk factor. By combining clinical characteristics with the MPCDI, we constructed a nomogram that provides an accurate and reliable quantitative tool for personalized clinical management of LUAD patients. The findings obtained from the analysis of C-index and the decision curve revealed that the nomogram outperformed various clinical variables in terms of net clinical benefit. Encouragingly, the low-MPCDI patients are more sensitive to commonly used chemotherapy drugs, which suggests that MPCDI scores have a guiding role in chemotherapy for LUAD patients. Therefore, MPCDI can be used as a novel clinical diagnostic classifier, providing valuable insights into the clinical management and clinical decision-making for LUAD patients.

Factors associated with therapeutic non-adherence inrenal transplant patients: a bicentric study in Algeria

Medication non-adherence is a global concern, particularly in the context of renal transplantation, where it leads to graft failures, increased hospitalizations, diminished quality of life for patients, and higher healthcare costs. The aim of this study was to assess the level of therapeutic adherence among Algerian kidney transplant recipients and identify potential influencing factors. A descriptive, cross-sectional bicenter study was conducted among kidney transplant patients receiving outpatient care at two specialized medical centers in Algeria: the Urology Department of the Hospital Establishment for Urology, Nephrology, and Renal Transplantation in Constantine, and the Nephrology and Renal Transplantation Department of the University Hospital Center (CHU) in Blida, spanning from January to December 2022. Therapeutic adherence was assessed using the 8-item Morisky questionnaire, while the level of knowledge was analyzed through a 12-item questionnaire. Logistic regression was used to identify factors associated with non-adherence to therapy. This study included 130patients with an average age of 47years and a sex ratio of 1.7. The results revealed therapeutic non-adherence in 40.8% of the patients. Multivariate analysis identified several potentially associated factors, including residence, unemployment status, lack of affiliation with a health insurance fund, the use of a therapeutic regimen involving triple therapy, the occurrence of adverse effects, limited education level, and insufficient disease knowledge. Furthermore, non-adherence was associated with an increased risk of graft rejection. The findings of this study highlight concerning therapeutic adherence among kidney transplant recipients, emphasizing the crucial importance of therapeutic education to improve treatment adherence and underscoring the need to integrate these factors into clinical patient management.

Manejo terapéutico, adherencia y resultados clínicos de la insuficiencia cardiaca en Andalucía. Protocolo ANDALIC

Heart failure is a prevalent syndrome with high mortality rates, representing a significant economic burden in terms of healthcare. The lack of systematic information about the treatment and adherence of patients with heart failure limits the understanding of these aspects and potentially the improvement of clinical outcomes. ObjectiveTo describe the clinical characteristics, therapeutic management, adherence, persistence and clinical results, as well as the association between these variables, in a cohort of patients with heart failure in Andalusia. DesignThis study will be an observational, population-based, retrospective cohort study. Data of patients discharged from an Andalusian hospital with a diagnosis of heart failure between 2014 and 2023 will be extracted from the Andalusian population health database. AnalysisThe statistical analysis will incorporate the following strategies: 1) Descriptive analysis of the characteristics of the population cohort, adherence measures, and clinical outcomes. 2) Bivariate analyses to study the association of covariates with adherence, persistence and clinical results. 3) Multivariate logistic regression and Cox regression analysis including relevant covariates. 4) To evaluate changes over time, multivariate Poisson regression models will be used.By conducting this comprehensive study, we aim to gain valuable insights into the clinical characteristics, treatment management, and adherence of heart failure patients in Andalusia, as well as to identify factors that may influence clinical outcomes. These findings could be critical both for the development of optimized strategies that improve medical care and quality of life of patients and for mitigating the health burden of HF in the region.

Racial and ethnic disparities in clinical presentation, management, and outcomes of patients with inflammatory bowel disease: a narrative review.

Inflammatory bowel disease (IBD) is a chronic condition that has been increasing in prevalence and incidence worldwide. Although, most cases are described in Caucasian populations, there has been a rise in IBD diagnosis among other populations. In this article, we will discuss the disparities in the presentation, management, medical and surgical outcomes of IBD patients among different racial and ethnic groups. A literature search was conducted in PubMed, Medline, and Google Scholar. The search strategy included targeted keywords to identify specific studies that provided the current literature on disparities in IBD presentation and management. Articles for presentation were selected by the authors, in accordance with a narrative review format, favoring population-based studies, systematic reviews and meta-analysis over single or multicenter reports. Epidemiological data has shown that there is an increasing incidence in IBD diagnosis among Black, Asian, and Hispanic populations over the past decade. Differences in genetic predispositions have been observed, however it is difficult to ascertain if the minor differences in presentation and medical/surgical management reported are due to innate differences or due to confounding factors such as access to health care. Differences in genetic predisposition, and clinical presentation have been observed to exist among IBD non-Caucasian populations. There were also differences observed in both surgical and medical management, but it is difficult to ascertain if these were innate differences or due to societal factors.

KRAS and BRAF genetic alterations in lung cancer: A case - control study.

Lung cancer (LC) is one of the most critical neoplastic abnormalities, having globally a high mortality rate. Knowledge about its genetic mutations and their association with clinically pathological features of LC is very important. Here, we describe the epidemiological molecular study of genetic mutations in KRAS and BRAF genes and their relationship with the demographic and clinical characteristics of Pakistani patients with lung adenocarcinoma. To analyze the mutations of KRAS and BRAF in LC patients among Pakistani population. The study has been carried out at universities and health institutes of Islamabad, Pakistan. Deoxyribonucleic acid (DNA) was extracted from the patient samples by using the standard protocol and amplified by using the specific primers. Later on, the Polymerase Chain Reaction (PCR) products were examined with the help of single stranded conformational polymorphism (SSCP). Relationship between KRAS, BRAF mutations, and LC risk was accessed by conditional logistic regression using SPSS version 24.0. Results were illustrated by odds ratio (OR), 95% confidence interval (CI), and P value. LC is more common in male population and smoking is one of the leading risk factors for (p < 0.0001) LC. KRAS and BRAF mutations were found to be contributing factors toward LC development and showed statistically significant results along with conformation through computational analysis. It can be concluded that smoking is lethal and cancer causing. The concomitant mutations found in KRAS and BRAF were infrequent, and they probably have a very unusual effect on the clinical management of Pakistani patients with lung adenocarcinoma.

Consensus guidelines for the monitoring and management of metachromatic leukodystrophy in the United States

Metachromatic leukodystrophy (MLD) is a fatal, progressive neurodegenerative disorder caused by biallelic pathogenic mutations in the ARSA (Arylsulfatase A) gene. With the advent of presymptomatic diagnosis and the availability of therapies with a narrow window for intervention, it is critical to define a standardized approach to diagnosis, presymptomatic monitoring, and clinical care. To meet the needs of the MLD community, a panel of MLD experts was established to develop disease-specific guidelines based on healthcare resources in the United States. This group developed a consensus opinion for best-practice recommendations, as follows: (i) Diagnosis should include both genetic and biochemical testing; (ii) Early diagnosis and treatment for MLD is associated with improved clinical outcomes; (iii) The panel supported the development of newborn screening to accelerate the time to diagnosis and treatment; (iv) Clinical management of MLD should include specialists familiar with the disease who are able to follow patients longitudinally; (v) In early onset MLD, including late infantile and early juvenile subtypes, ex vivo gene therapy should be considered for presymptomatic patients where available; (vi) In late-onset MLD, including late juvenile and adult subtypes, hematopoietic cell transplant (HCT) should be considered for patients with no or minimal disease involvement. This document summarizes current guidance on the presymptomatic monitoring of children affected by MLD as well as the clinical management of symptomatic patients. Future data-driven evidence and evolution of these recommendations will be important to stratify clinical treatment options and improve clinical care.

Progress and current perspectives of diagnosis and treatment of hepatoid adenocarcinoma of the stomach

Abstract Hepatoid adenocarcinoma of the stomach (HAS) is a rare malignant gastric tumor exhibiting both hepatocellular and adenocarcinomatous differentiation. Patients are often diagnosed at an advanced stage, and their clinical symptoms closely resemble those of gastric adenocarcinoma. Because of its rarity, misdiagnosis and missed diagnoses are prevalent. Compared with gastric adenocarcinoma, HAS typically exhibits higher invasiveness and a more unfavorable prognosis. This review aimed to elaborate on the pathological features, potential mechanisms, clinical characteristics, diagnosis, and prognosis of HAS. The insights provided aimed to contribute robust guidance for the clinical management of patients with HAS.

Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review.

Obstructive sleep apnea (OSA) syndrome is characterized by repeated airway collapse during sleep. It determines cardiovascular, pulmonary, and neurocognitive consequences and is associated with several daytime and nighttime symptoms that influence the patient's quality of life. The contribution of the dental specialist in the clinical management of OSA patients entails participating in the screening process as diagnostic sentinels and providing adequate treatment using mandibular advancement devices (MADs). Since the treatment of OSA requires a multidisciplinary approach, including different medical specialists, dentists should have a comprehensive understanding of medical and dental factors that influence the strategy and effectiveness of OSA treatment with MAD. Such expertise is crucial in determining the appropriate treatment indications and helps clinicians establish a consolidated position within the multidisciplinary OSA team. In this regard, this review summarizes the evidence of the clinical indications for MAD treatment and provides the dental specialist with helpful information about medical, functional, and other relevant factors that should be considered during diagnosis, treatment plan, and follow-up stages. Information retrieved was organized and discussed, generating specific domains/queries oriented to the clinical management of OSA patients from the clinical perspective of dental specialists.

Междисциплинарный консенсус RE.GA.IN.: что нового? Часть 1: дефиниции, Нelicobacter pylori-ассоциированный и аутоиммунный гастрит

The most relevant topics related to gastritis were addressed in the work of the international group for the study of gastritis in clinical practice – Real-World Gastritis Initiative (RE.GA.IN.), from the revision of the definition of the disease to clinical diagnosis and assessment of prognosis. The RE.GA.IN. interdisciplinary consensus brought together gastritis scholars from five continents. After active debates on the most controversial aspects, the RE.GA.IN. consensus summarised the existing scientific evidence in order to develop patient-centred, evidence-based key messages to assist specialist physicians in their daily clinical practice. The ultimate goal of RE.GA.IN. was and remains to contribute to the further improvement of the clinical management of patients with gastritis. This article presents the RE.GA.IN. consensus statements defining the concepts of normality, current concepts of H. pylori-associated gastritis and autoimmune gastritis.

Association between irritable bowel syndrome and Parkinson’s disease by Cohort study and Mendelian randomization analysis

This study aimed to investigate the association between irritable bowel syndrome (IBS) and Parkinson’s disease (PD) utilizing prospective cohort study and Mendelian randomization. The dataset contained a substantial cohort of 426,911 participants from the UK Biobank, discussing the association between IBS and PD with Cox proportional hazards models and case-control analysis while adjusting for covariates such as age, gender, ethnicity and education level. In univariate Cox regression model, the risk of PD was reduced in IBS patients (HR: 0.774, 95%CI: 0.625–0.956, P = 0.017), but the statistical significance diminished in the three models after adjusting for other variables. In a few subgroup analyses, IBS patients are less likely to develop into PD, and patients diagnosed with IBS after 2000 also had a lower risk (HR: 0.633, 95%CI: 0.403–0.994, P = 0.047) of subsequently developing PD. In addition, we matched five healthy control participants based on gender and age at the end of the study for each IBS patient diagnosed during the follow-up period, and logistic regression results (OR:1.239, 95%CI: 0.896–1.680, P = 0.181) showed that IBS was not associated with the risk of PD. Mendelian randomization did not find significant evidence of the causal relationship between IBS and Parkinson’s disease (OR: 0.801, 95%CI: 0.570–1.278, P = 0.204). Overall, we suggest that IBS status is not associated with the risk of developing PD, and that these findings provide valuable insights into the clinical management and resource allocation of patients with IBS.

Гемифациальный спазм, обусловленный нейроваскулярным конфликтом: клиническая картина, диагностика и лечение пациентов – современное состояние проблемы (часть II)

Гемифациальный спазм (ГФС) – это заболевание, характеризующееся непроизвольными повторяющимися односторонними сокращениями лицевой мускулатуры, не поддающимися самостоятельному купированию и сохраняющимися даже во время сна. Клиническая картина первичного гемифациального спазма чаще всего начинается с подергивания лицевой мускулатуры в параорбитальной области, которая затем распространяется на оставшуюся часть ипсилатеральной лицевой мускулатуры. Диагностика первичного гемифациального спазма основана на проведении высокопольного МРТ по программе Fiesta, которая может дополняться другими методами нейровизуализации с целью уточнения локализации конфликта, анатомии в области нейроваскулярного конфликта и определения дальнейшей тактики лечения. Лечение первичного ГФС включает в себя такие опции, как консервативная терапия, ботулинотерапия и хирургическое лечение в виде микроваскулярной декомпрессии лицевого нерва. Оптимизация диагностических критериев, предопределяющих дифференцированный подход к лечению данной патологии, остается актуальным вопросом современной неврологии и нейрохирургии, требующим дальнейшего детального изучения. Hemifacial spasm (HFS) is a disease characterized by involuntary repeated unilateral contractions of the facial muscles that cannot be relieved on their own and persist even during sleep. The clinical picture of primary hemifacial spasm most often begins with twitching of the facial muscles in the paraorbital region, which then spreads to the rest of the ipsilateral facial muscles. Diagnosis of primary hemifacial spasm is based on high-field MRI using FIESTA MRI sequence, which can be supplemented with other neuroimaging techniques to clarify the conflict localization and the anatomy in the area of neurovascular conflict, and to determine further treatment tactics. The treatment of primary HFS includes such options as conservative therapy, botulinum therapy, and surgical treatment in the form of microvascular decompression of the facial nerve. The optimization of diagnostic criteria predetermining a differentiated approach to the treatment of this pathology remains an urgent issue of modern neurology and neurosurgery requiring further detailed study.

Virus-Induced Epilepsy vs. Epilepsy Patients Acquiring Viral Infection: Unravelling the Complex Relationship for Precision Treatment.

The intricate relationship between viruses and epilepsy involves a bidirectional interaction. Certain viruses can induce epilepsy by infecting the brain, leading to inflammation, damage, or abnormal electrical activity. Conversely, epilepsy patients may be more susceptible to viral infections due to factors, such as compromised immune systems, anticonvulsant drugs, or surgical interventions. Neuroinflammation, a common factor in both scenarios, exhibits onset, duration, intensity, and consequence variations. It can modulate epileptogenesis, increase seizure susceptibility, and impact anticonvulsant drug pharmacokinetics, immune system function, and brain physiology. Viral infections significantly impact the clinical management of epilepsy patients, necessitating a multidisciplinary approach encompassing diagnosis, prevention, and treatment of both conditions. We delved into the dual dynamics of viruses inducing epilepsy and epilepsy patients acquiring viruses, examining the unique features of each case. For virus-induced epilepsy, we specify virus types, elucidate mechanisms of epilepsy induction, emphasize neuroinflammation's impact, and analyze its effects on anticonvulsant drug pharmacokinetics. Conversely, in epilepsy patients acquiring viruses, we detail the acquired virus, its interaction with existing epilepsy, neuroinflammation effects, and changes in anticonvulsant drug pharmacokinetics. Understanding this interplay advances precision therapies for epilepsy during viral infections, providing mechanistic insights, identifying biomarkers and therapeutic targets, and supporting optimized dosing regimens. However, further studies are crucial to validate tools, discover new biomarkers and therapeutic targets, and evaluate targeted therapy safety and efficacy in diverse epilepsy and viral infection scenarios.

Sacrococcygeal teratoma: an experience from a high-volume tertiary institute in North India

Background: Sacrococcygeal teratoma (SCT) is the most common tumour in the newborn. The majority is present in neonates as a sacral mass; however, some may be present late with varied clinical presentation. The study aims to evaluate the clinical presentation and management of patients with SCT in our high-volume tertiary institute in North India. Methods: This is an observational study of infants and children treated between May 2021 to April 2022 in the department of pediatric surgery, SMS Medical College, Jaipur (a high-volume tertiary institute in North India). Data collected included antenatal diagnosis, mode of delivery, age at diagnosis, clinical presentation, Altman classification, surgical approach, histopathology and complications. Functional results were evaluated clinically and radiologically. Results: Twenty-one patients (M: F=1:3.2) with a median age of 40 days (range: 1 day to 5.8 years) with SCT were managed at our centre. Nearly, two-thirds of the tumors were either Altman type 1 or 2. Yolk sac tumour was present in 2 (9.5%) patients, while the rest had either mature or immature teratoma. Tumours were removed through a posterior sagittal approach (chevron incision). In five patients, an abdominoperineal approach was used. Early complications were surgical site infection (n=5; 23.8%), superficial wound dehiscence (n=2; 9.5%), complete wound dehiscence (n=1; 2.4%), and urinary tract infection (n=1; 4.7%). Late complications were urinary dribbling or poor stream (5/21; 23.8%) and faecal soiling (n=3; 14.2%). Conclusions: Most of the sacrococcygeal tumours are benign, and the incidence of malignancy increases with age. Morbidity due to associated malformation and treatment may persist in these patients, especially like urinary complications stream (one-fifth) and faecal incontinence (one-seventh), as seen in our series. A proper long-term follow-up is needed for the management of late complications.