Clinical Awareness Research Articles

Comparative analysis of croup severity and treatment in pediatric patient: a study of COVID-19 positive vs. negative cases during peak Omicron

BackgroundThe Omicron variant of SARS-CoV-2 has been associated with unique clinical presentations in children, including croup-like symptoms such as barking cough, hoarseness, and respiratory distress. This study aimed to compare the clinical, laboratory, and treatment characteristics of hospitalized pediatric patients with croup who tested positive or negative for COVID-19 during the Omicron wave.MethodsA retrospective, descriptive-analytical study was conducted on 111 pediatric patients hospitalized with croup at Bahrami Children’s Hospital and the Children’s Medical Center in Iran from January 21 to March 20, 2022. Patients were categorized into two groups: PCR-positive (Omicron group, n = 30) and PCR-negative (non-Omicron group, n = 81). Data on demographics, clinical severity, laboratory indices, treatments, and outcomes were extracted and analyzed using SPSS version 20.ResultsThe mean age of the Omicron group was significantly younger (16.93 ± 24.80 months) compared to the non-Omicron group (32.58 ± 37.26 months; p = 0.049). Symptom severity was higher in the Omicron group, with moderate to severe symptoms observed in 73.4% of patients, compared to 32.1% in the non-Omicron group (p = 0.001). The Omicron group had longer hospital stays (2.59 ± 3.93 vs. 2.11 ± 2.75 days; p = 0.016) and required more nebulized epinephrine (2.47 ± 1.27 vs. 1.77 ± 1.003 days; p = 0.003) and repeat corticosteroid doses (83.3% vs. 38.3%; p = 0.0001). Laboratory findings showed no significant differences between the groups (all p > 0.05).ConclusionChildren with croup during the Omicron surge exhibited increased symptom severity, required more intensive treatment, and experienced longer hospital stays compared to those without COVID-19. These findings emphasize the need for heightened clinical awareness and tailored management strategies for Omicron-related croup in pediatric populations.

High prevalence of facioscapulohumeral muscular dystrophy (FSHD) and inflammatory myopathies association: Is there an interplay?

Certain types of muscular dystrophy (MD), notably facioscapulohumeral muscular dystrophy (FSHD), exhibit muscle fiber necrosis with regeneration and a nonspecific inflammatory process. Although rare, the coexistence of MDs and autoimmune myositis has been observed. We hypothesized that, in some circumstances, FSHD may predispose individuals to myositis through muscle damage-induced autoantigen overexpression, contributing to an autoimmune response. We conducted a retrospective analysis of patient data from neuromuscular disease centers in France and Italy between September 2012 and May 2024. Clinical, immunological, and myopathological features of 1750 myositis patients were comprehensively reviewed. Five patients were identified with both FSHD and IIM. Two patients were first diagnosed with FSHD and later developed IIM, while two others initially had IIM followed by an FSHD diagnosis. The fifth patient received simultaneous diagnoses of both conditions. The prevalence of FSHD in the IIM cohort was 1/350, and the prevalence of IIM in the FSHD cohort was 1/40 (p<0.0001). Our study showed a high prevalence of FSHD and IIM association compared to the general population, with underlying mechanisms that remain unclear. This association might be more frequent than previously reported, indicating a need for increased clinical awareness. Understanding the interplay between FSHD and autoimmune myositis could reveal insights into the immunopathological processes of these diseases and improve diagnostic and therapeutic approaches.

Genetic variants in NHEJ1 and related DNA repair disorders: insights into phenotypic heterogeneity and links to hypoplastic myelodysplastic syndromes and familial hematological malignancies susceptibility.

This study investigates the burden, phenotypes, progression, and outcomes of familial hematological malignancies (FHM) through clinical evaluation, gene panel testing, and whole exome sequencing, highlighting the significance of identifying genetic causes for personalized treatment. Over six years, 357 patients initially diagnosed with bone marrow failure (BMF) were evaluated, with 152 patients lacking identifiable causes undergoing further analysis. Among these, 53 (34.9%) exhibited features of inherited BMF syndromes, and 13 (24.5%) developed FHM. In a separate cohort of 27 patients with inherited immunodeficiency disorders, 8 (29.6%) developed FHM associated with NHEJ1 or LYST variants, underscoring the familial clustering of hematologic disorders. Notably, 6 of 7 patients from the same family (family-1) with homozygous NHEJ1 variants progressed to secondary myelodysplastic syndrome (sMDS), acute myeloid leukemia (AML), or lymphoma. Among 780 patients diagnosed with hematological malignancies during the study period, 45 (5.8%) were confirmed to have FHM, with 33 patients enrolled for detailed analysis. Of these, 16 (48.5%) had DNA-repair deficiencies (DNA-RD), including eight with Fanconi anemia, six with NHEJ1 variants, and two with BRCA2 mutations. The remaining 17 patients presented conditions such as familial myeloproliferative neoplasms, dyskeratosis congenita (DC) [TERT, DKC1 variants], and Chediak-Higashi syndrome. Two siblings (family-3) with a rare TERT variant and a unique DC phenotype developed sMDS after prolonged BMF. Patients with DNA-RD were younger and exhibited higher rates of growth failure, recurrent infections, and endocrinopathies. These cases frequently progressed to sMDS or AML. A comparative analysis of 319 individuals with DNA double-strand break repair deficiencies revealed a 45% frequency of hematological malignancies. Lymphoma was most common in Nijmegen breakage syndrome (79.4%) while MDS/AML was prevalent in Cernunnos deficiency (66.6%). The findings emphasize the importance of early diagnosis, genetic testing, and personalized management, including timely transplantation, to improve outcomes in FHM. This research underscores the need for clinical awareness and surveillance to facilitate timely interventions and mitigate disease progression.

Race, Genetics, and Social Determinants of Health in Transthyretin Cardiac Amyloidosis: A Literature Review and Call to Action.

Recent evidence suggests that transthyretin cardiac amyloidosis (ATTR-CM) is significantly more common than once believed, yet it remains frequently under- and mis-diagnosed. With effective treatments now available, early and accurate diagnosis has become critical for better patient outcomes. Understanding the interplay between genetics, race, and social determinants of health (SDOH) in influencing both ATTR-CM diagnosis and management is essential for bridging the current gaps. Our analysis reveals multiple barriers affecting ATTR-CM care. Specifically, we discuss how clinician awareness, regional differences in clinical practice, and limited access to health care and specialty centers contribute to diagnostic delays. Additionally, we identify several management obstacles, such as inadequate diversity in clinical trials, high cost of available treatments, and limited ancillary resources. We examine these challenges in detail and provide practical solutions to address them. While disparities in heart failure outcomes have been well-documented, those specific to ATTR-CM remain underrepresented in the literature. This review establishes a structured approach to understanding how biological, structural and SDOH-related disparities impact ATTR-CM diagnosis and management while offering concrete strategies to overcome these challenges. We emphasize the need for enhanced SDOH identification and advocate for coordinated, multidisciplinary efforts to improve ATTR-CM patient outcomes.

IgA Nephropathy and the Risk of Primary Infections: A Swedish population-based cohort study.

IgA nephropathy is the most common primary kidney disease in the world and has a highly variable clinical presentation. While studies have indicated a link between glomerular disease and infections, large-scale studies on IgA nephropathy are missing. In our study, IgA nephropathy was defined as having a kidney biopsy record 1997-2011 in Sweden. Each IgA nephropathy patient was matched with five reference individuals based on age, sex, calendar year, and county of residence. We excluded individuals with earlier organ transplants, HIV, immunodeficiency, or end-stage kidney disease. Linear and Cox regressions, adjusted for age, sex, education and diabetes, were performed to analyze total infections and antimicrobial treatments in both patients and reference individuals. Sibling analyses were also performed. The linear regression analysis revealed a significant association between IgA nephropathy and the overall frequency of infections compared to the general population (β=0.44; 95%CI: 0.35-0.53) and siblings (β=0.36; 95%CI:0.23-0.49). Similarly, antimicrobial prescriptions, especially antibiotics, were more common in IgA nephropathy compared to the general population and to siblings. Cox regression showed an elevated risk of any infection (adjusted hazard ratio (HR)=2.00; 95%CI 1.84-2.18) and sepsis (aHR=3.18; 95%CI 2.17-4.65) corresponding to one extra case of sepsis per 63 patients followed for 10 years. The strongest associations were seen for urinary tract infections; ear, nose, and throat infections; musculoskeletal and gastrointestinal infections. Conclusively, our study demonstrates an increased prevalence of infections and antibiotic prescriptions in IgA nephropathy patients. The increased risk of sepsis warrants clinical awareness and prevention.

Migratory Flows and Endomyocardial Fibrosis: A Mysterious Disease in Western Countries

Background—Endomyocardial fibrosis (EMF) is a chronic restrictive cardiomyopathy endemic to tropical and subtropical regions, characterized by fibrotic thickening of the endocardium, predominantly affecting the ventricular chambers. As global migration increases, cases of EMF may emerge in non-endemic areas, posing a diagnostic challenge for healthcare professionals unfamiliar with this condition. Methods—We report the case of a 21-year-old man of African origin who experienced sudden collapse while residing in a reception center for asylum seekers in Apulia, Southeastern Italy. His medical history revealed that one week prior, he had been presented with high fever, chest pain, and asthenia, symptoms initially misinterpreted as influenza by a local physician, leading to antibiotic therapy. Results—The definitive diagnosis of EMF was established post-mortem through histological examination, which identified characteristic endocardial fibrosis. This case exemplifies the re-emergence of neglected tropical cardiac diseases in Western countries due to increased migration from endemic regions. Conclusions—This case highlights the need for heightened clinical awareness among healthcare professionals, particularly in cardiology and primary care, to recognize and manage geographically displaced diseases such as EMF. Implementing enhanced medical education and diagnostic protocols is essential to address the evolving epidemiological landscape and improve early identification of rare but significant cardiac pathologies in migrant populations.

Increasing provider awareness of Lp(a) testing for patients at risk for cardiovascular disease: a comparative study.

Increasing provider awareness of Lp(a) testing for patients at risk for cardiovascular disease: a comparative study.

Pathogenesis of Melasma Explained.

This review provides an in-depth analysis of the pathophysiology of melasma and highlights recent studies that elucidate its underlying mechanisms. Given the prevalence of melasma, a thorough understanding of its pathogenesis is critical for the development of effective treatment strategies. We analyzed the current literature to identify findings related to epidermal changes, basement membrane (BM) alterations, and various dermal modifications, including solar elastosis, mast cell activity, and vascular changes. We also examined the influence of visible light (VL) and hormonal fluctuations on melasma. This review intertwines these insights with an overview of contemporary treatment approaches. Our findings indicate advancements in understanding melasma's pathophysiology, highlighting significant changes in the epidermis and BM, along with dermal factors, such as vascular alterations, mast cell involvement, and senescent fibroblasts. We review the established mechanisms in the pathogenesis of melasma while incorporating recent scientific updates. Additionally, a survey of the available treatments targeting these novel mechanisms revealed promising therapeutic modalities currently under investigation. In conclusion, understanding the latest pathophysiological insights is crucial for enhancing clinician awareness and patient reassurance, as well as improving therapeutic strategies. Nevertheless, ongoing research remains essential to elucidate the complexities of melasma further and optimize clinical outcomes.

Psychosocial Burden and Suicidality in Epilepsy: A Public Health Concern.

The increased risk for psychosocial burden and suicidality in people with epilepsy compared to the general population is a well-established global public health concern. Suicidality risk is also increased in patients with functional seizures. The timely identification of patients at highest risk for psychosocial burden and self-harm is vital. This can pose a significant challenge for multidisciplinary clinicians caring for people with epilepsy. Early identification of social stressors and comorbid psychiatric contributors via screening are required to assist with the development of predictive models for self-harm in epilepsy; and subsequent options for treatment and the provision of adjunct supports in the community may help lead to evidence-based suicide prevention strategies for people with epilepsy. Too often, pervasive and common social stressors leading to self-harm go unrecognized and undertreated. Elevating clinician awareness of patient subpopulations at highest risk for suicide, and informing on the advent of evidence-based self-management programs targeting depression and self-harm presents an opportunity to increase suicide prevention in epilepsy.

USTEKINUMAB-INDUCED ANCA-VASCULITIS IN A PATIENT WITH CROHN’S DISEASE: A CASE REPORT

Abstract INTRODUCTION Ustekinumab is a monoclonal antibody commonly used in the management of Crohn’s disease (CD). ANCA-associated vasculitis (AAV), a type of vasculitis characterized by the presence of anti-neutrophil cytoplasmic antibodies, can arise from various etiologies, including drug-induced mechanisms. However, reports of ustekinumab-associated AAV are rare, with only one other documented case.We present a case of possible ustekinumab-induced AAV in a patient receiving treatment for CD, contributing to the growing understanding of biologic-induced vascular inflammation. CASE REPORT A 65-year-old male with a history of penetrating ileocolonic and perianal CD and chronic eczematous dermatitis presented with a two-week history of fatigue, night sweats, and high-grade fevers. Following multiple treatment failures, the patient started ustekinumab therapy in 2017. This led to clinical remission and endoscopic improvement for four years prior to presentation, with only mild inflammation on the latest colonoscopy. Upon presentation, the patient was febrile (39.3°C) with otherwise normal vital signs. Initial laboratory investigations revealed elevated serum creatinine (1.40 mg/dL), AST (88 U/L), ALT (152 U/L), alkaline phosphatase (251 U/L), and WBC count (17.52 thousand/uL). An extensive infectious workup, including a CT scan and a nuclear medicine white blood cell scan, was unrevealing.Rheumatology consultation found low suspicion for an autoimmune etiology following a positive antinuclear antibody (ANA) test (1:640) and a negative smooth muscle antibody test. A liver biopsy suggested possible drug-induced injury. A bone marrow biopsy and flow cytometry did not reveal evidence of malignancy. After these evaluations, no clear etiology was found, and the patient was ultimately discharged on antipyretics. Following persistent fevers after discharge, an outpatient ANCA panel returned positive for P-ANCA with an MPO &amp;gt; 8. A subsequent kidney biopsy confirmed MPO-ANCA-associated glomerulonephritis, revealing focal necrotizing glomerulonephritis with 17% crescents. The patient was started on rituximab and prednisone, and ustekinumab, thought by rheumatology consultants to be an inciting factor, was discontinued. Prednisone was tapered off, and rituximab was continued for 2 years before the patient experienced a flare of his CD. This led to the discontinuation of rituximab and initiation of upadacitinib for CD, chronic eczematous dermatitis, and vasculitis. DISCUSSION This case highlights the rare occurrence of potentially ustekinumab-induced AAV in patients treated for CD, underscoring the need for a high index of suspicion for uncommon adverse events. Understanding these potential risks can pave the way for future pathophysiological insights and improved clinical awareness.

SWEET AND SALTY: SWEET SYNDROME AS THE INITIAL PRESENTATION OF NEWLY DIAGNOSED ULCERATIVE COLITIS

Abstract INTRODUCTION Sweet syndrome is a rare cutaneous disorder that arises secondary to various inciting factors, including certain medications, bacterial or viral infections, autoimmune or autoinflammatory conditions, and malignancies. It is classified into three subtypes, with classical Sweet syndrome being the most common. CASE PRESENTATION A 60-year-old male with no significant medical history presented with multiple painful erythematous and pustular skin lesions persisting for two weeks, following a trip to Aruba. His symptoms began with a painful lesion on his posterior scapular region attributed to an insect bite. He sought local care where the lesion was drained and packed. Upon returning home, his PCP initiated fluoroquinolone therapy. Subsequently, the patient developed daily fevers, experienced a 5-pound weight loss, began passing bloody stools, complained of bilateral shoulder pain, and noticed the appearance of additional similar lesions across his torso and groin. CT scan revealed colitis, and the patient met SIRS criteria, prompting the initiation of IV antibiotics. Initially suspected to have a MRSA-related abscess, he was maintained on vancomycin, although uncertainty remained regarding a unifying diagnosis. Flexible sigmoidoscopy was performed, revealing severe Mayo 3 colitis and deep ulcerations in the rectum with a continuous, circumferential pattern and no sparing areas. Inflammation worsened proximally, with narrowing of the lumen observed in the upper rectum. Skin lesion biopsy revealed intraepidermal neutrophils with associated spongiosis, a dense neutrophilic infiltrate in the dermis with apoptotic debris consistent with Sweet syndrome. Given these biopsy results, antibiotics were discontinued, and the patient was started on steroids, leading to symptom improvement. The cold forceps biopsy from the colon showed severe active proctitis with ulceration, crypt disarray, and plasmacytosis, consistent with ulcerative colitis. The patient was transitioned to oral steroids and discharged with outpatient GI follow-up for the consideration of biologic therapy. DISCUSSION Current literature reports SS predominantly in middle-aged white women with colonic involvement and other EIMs, though its association with either ulcerative colitis (UC) or Crohn’s disease remains uncertain. While the temporal relationship between SS and IBD activity is not well established, it is most frequently seen during active phases of IBD. This case highlights SS as the initial presentation of IBD in an older male, manifesting prior to any gastrointestinal symptoms or other EIMs. CONCLUSION Skin lesions, though rare, can be an early sign of IBD, making prompt recognition vital for proper treatment. A biopsy is the diagnostic gold standard and should be done immediately. Heightened clinical awareness is key, as SS may appear before any GI symptoms in IBD cases. Cutaneous lesion on the back Histology Findings in Sweet Syndrome

Alternatives to hormonal therapies in the prevention and correction of dishormonal disorders in women (Part I)

Alternatives to hormonal therapies in the prevention and correction of dishormonal disorders in women (Part I)

Management of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: consensus statement.

Buruli ulcer, caused by Mycobacterium ulcerans, is increasing in incidence and spreading to new areas in southeast Australia. With increasing experience and emerging evidence, this consensus statement considers contemporary data to provide up-to-date recommendations to clinicians who may encounter this disease. The emergence of Buruli ulcer in previously non-endemic areas highlights the importance of increasing clinician and community awareness of this disease. Main recommendations and changes in management as a result of this consensus statement: Buruli ulcer is a notifiable disease in Victoria, the Northern Territory and Queensland. Cases identified in other states or territories should be discussed with relevant health authorities. We call for Buruli ulcer to be made nationally notifiable to monitor for its potential emergence in non-endemic regions. Diagnosis using polymerase chain reaction is sensitive and specific if performed correctly; a dry swab under the undermined edge of ulcers or a tissue sample via punch biopsy if the lesion is not ulcerated is recommended. If swabs are incorrectly performed or performed on non-ulcerated skin, they can give a false negative result. There is high quality evidence to support treatment of eight weeks' duration using rifampicin-based dual oral antibiotic therapy, in combination with clarithromycin or afluoroquinolone; relapse is very rare but can occur in people with risk factors. There is emerging evidence for shorter durations of treatment (six weeks) in individuals with small lesions who are at low risk of relapse and in thosewho have undergone surgical excision of the lesion (four weeks). Patients should be warned that ulcers typically enlarge with antibiotic treatment, will not have healed by completion ofantibiotics, and take a median of four to five months to heal. Surgical management is usually not required, but may be beneficial to reduce healing times, avoid or reduce the duration of antibiotics, and manage paradoxical reactions. Early identification and treatment of paradoxical reactions is important, as they are associated with increased tissue necrosis and delayed wound healing. Good wound care is critical in successful treatment of Buruli ulcer, as it enhances healing and prevents secondary bacterial infection. Compared with adults, children have a higher proportion of non-ulcerative and severe lesions, are less likely to experience adverse antibiotic effects, but have higher rates of paradoxical reactions; specialist referral is recommended.

Isolated Pulmonary Valve Endocarditis Caused by Enterococcus faecalis—Facing the Unpredictable

Background: Infective endocarditis is a severe, life-threatening condition which affects the endocardial lining of the heart. Right-sided IE typically affects the tricuspid valve and, less commonly, the pulmonary valve, often in association with intravenous drug use and intracardiac devices. Enterococcus faecalis, a significant pathogen in healthcare settings, is frequently resistant to several antibiotics, complicating treatment. Results: We present the case of a 69-year-old man diagnosed with isolated pulmonary valve endocarditis, with no identifiable risk factors, good oral hygiene, and no recent dental procedures. In our case, the E. faecalis strain, initially susceptible to ampicillin, acquired resistance during high-dose ampicillin and gentamicin therapy, leading to cardiac surgery and prolonged antibiotic treatment. Conclusions: IPE is rare, emphasizing the need for heightened clinical awareness and thorough diagnostic evaluation, especially in patients with endocarditis symptoms and known risk factors. Although ampicillin resistance in E. faecalis is uncommon, its emergence during treatment presents a challenge, necessitating careful antibiotic stewardship to improve outcomes.

Menopause and mental health.

This review discusses mental health changes commonly experienced by individuals during the menopause transition (MT). The pathophysiology of the MT, the chronology and type of mental health symptoms arising from this pathophysiology, and evidence-based options for treating midlife patients are discussed. This review concludes with treatment options to enable clinicians to more effectively counsel, recognize and treat symptoms during the MT. The MT begins earlier than previously understood with mood and cognitive issues as common initial mental health symptoms significantly impacting quality of life. These symptoms are due to profound changes in the brain's structure, connectivity, energy metabolism, and inflammation linked to perimenopausal hormone shifts. Hormone therapy, psychiatric medication, psychotherapy, and lifestyle adjustments all play a role in the management of mental health symptoms arising during the MT. Lack of both obstetrician and gynecologist and mental health clinician awareness can leave patients undertreated and vulnerable to nonevidence-based approaches. Patients in the MT are at increased risk for mental health issues, both preexisting and new onset. The OB/GYN clinician plays a key role in recognizing and addressing these conditions to improve health outcomes in midlife women.

A Review of Exocrine Pancreatic Insufficiency in Children beyond Cystic Fibrosis and the Role of Endoscopic Direct Pancreatic Function Testing.

Common indications to evaluate exocrine pancreatic function in children include chronic diarrhea, steatorrhea, failure to thrive, cystic fibrosis and those with chronic abdominal pain due to chronic pancreatitis where imaging studies are normal [1]. Exocrine Pancreatic Insufficiency (EPI) has a spectrum of severity. In children often remains an underdiagnosed condition, particularly in its mild, partial, and isolated enzyme deficiency forms. The purpose of this review is to help understand the different varieties of EPI including isolated pancreatic enzyme deficiencies as possible causes of malnutrition and growth failure in pediatric patients. Among the indirect diagnostic methods, the fecal elastase-1 (FE-1) testing is the most widely used one. While it has good sensitivity and specificity in severe pancreatic damage, like cystic fibrosis in children, its performance in the diagnosis of mild, partial, and isolated enzyme deficiencies is poor. Direct pancreatic function testing performed during endoscopy (ePFT), has emerged as a more sensitive and specific method for assessing all forms of exocrine pancreatic function. Notably, recent guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) emphasize the importance of ePFT in pediatric patients. Most of the pediatric practitioners taught that the pancreas has only two diseases, cystic fibrosis and pancreatitis. They are missing the fact that pancreas, like other digestive organs, can have different, many times secondary, dysfunctions that influence the growth of children. Most pediatric gastroenterologists still use the fecal elastase-1 (FE-1) test, however, this lacks sufficient specificity and sensitivity [2-5] especially in patients with mild or early pancreatic disease or those with isolated enzyme deficiencies [5]. The most accurate diagnostic modality to explore these conditions is ePFT. In this review we highlighted the critical importance of direct pancreatic function testing. Enhancing clinical awareness and incorporating direct testing methods can ultimately improve outcomes for affected children.

Detections of rare enterovirus C105 linked to an emerging novel clade, Spain, 2019 to 2024.

Enterovirus (EV)-C105 is a rare genotype not previously detected in Spain. Between 2019 and 2024, we detected EV-C105 in respiratory samples of five patients, through routine EV surveillance. Three cases had respiratory illness and two were hospitalised for neurological illness. Four of the five sequenced strains belonged to an emerging clade (C1), defined by four novel nonsynonymous mutations in key antigenic epitopes. We recommend reinforced clinical awareness and EV genomic surveillance, including respiratory samples, even when symptoms are neurological.

Exploring clinical trials awareness, information access and participation amongst Australians with ovarian cancer: a qualitative study

PurposeOvarian cancer is associated with advanced stage diagnosis and poor survival rates. Clinical trials are critical for improving both clinical and quality of life outcomes. Challenges exist to clinical trials awareness, information access and participation, but perspectives of Australians with ovarian cancer have not been previously investigated. We aimed to explore clinical trials awareness, information access and participation amongst Australians with ovarian cancer.MethodsUtilising an exploratory qualitative approach, women with ovarian cancer participated in online focus groups and interviews between December 2023 and February 2024. Transcripts underwent inductive content analysis.ResultsFive themes and five subthemes emerged. In theme 1, participants identified “Barriers exist that affect clinical trial awareness and participation” and were explored through their experience of ovarian cancer. In theme 2, participants shared that “Instigating the conversation and doing my own research” was necessary to access clinical trials. Theme 3 describes ideas on “Finding solutions to improve clinical trial awareness and information access” through subthemes: “we need a centralised, credible source”; “communicate clinical trials in various ways from trusted contacts”; and “I want tailored, relevant information”. Theme 4 explained that “Altruism is a motivator” in willingness to participate in trials. Finally, in theme 5, participants explained that “Emotions regarding clinical trials are varied” illustrated in subthemes: “feeling left behind” and “feeling fortunate”.ConclusionsThese qualitative insights will inform development of a cross-sectional survey for national distribution amongst Australians with ovarian cancer. Results will assist in developing solutions to improve clinical trials awareness and information access.

Cutting-Edge Diagnostic Tools for Cardiac Amyloidosis Detection

The prevalence of cardiac amyloidosis (CA), especially as a cause of heart failure, has significantly increased in recent years. Early detection and accurate assessment of the disease burden are crucial for initiating timely treatment and ensuring precise prognosis. CA primarily results from the infiltration of the myocardium by either immunoglobulin light chain fibrils (AL) or transthyretin fibrils (ATTR), leading to restrictive cardiomyopathy and eventual death if untreated. Over the past decade, advancements in diagnostic imaging and heightened clinical awareness have revealed a substantial presence of CA, particularly ATTR, among the elderly. These diagnostic improvements encompass echocardiography, cardiac computerized tomography scans, magnetic resonance imaging, and radionuclide scintigraphy with bone-avid tracers. Concurrently, significant progress has been made in therapeutic options, with new disease-modifying treatments now available that can dramatically alter the disease trajectory and improve survival rates when administered early. However, despite these advancements, there remains an urgent need for the early and accurate detection of CA to ensure that patients can fully benefit from these emerging therapies.

Collision tumor consisting of primary mucoepidermoid carcinoma and adenocarcinoma in the lung: a case report and literature review.

Mucoepidermoid carcinoma in the lung is uncommon, while the occurrence of a collision tumor consisting of primary mucoepidermoid carcinoma (MEC) and typical adenocarcinoma is extremely rare. We report a case of a 70-year-old female with the presence of a nodule in her right lung. The pathological examination revealed a primary collision tumor consisting of invasive adenocarcinoma and mucoepidermoid carcinoma. Manual microdissection was performed to selectively isolate the MEC and adenocarcinoma components, followed by exome sequencing which unveiled identical mutations in both components, suggesting their monoclonal origins with divergent differentiation. Clinical awareness and recognition of such collision tumors are crucial, as they will determine appropriate treatment strategies based on the individual biological aggressiveness of each tumor component.