Spectrum Of Complications Research Articles

Post-acute sequelae of COVID-19 in cancer patients: Two cohorts in UK and Hong Kong.

Limited research exists on the risks and spectrum of complications in post-acute phase of COVID-19 in cancer patients. This study aimed to evaluate the post-acute effects of COVID-19 on different types of morbidities among cancer patients across two regions with different healthcare systems and dominant variants of COVID-19. Cancer patients with COVID-19 from the UK Biobank (UKB, n = 2230; March 16, 2020 to May 31, 2021; pre-Omicron-variants dominant) and electronic medical records in Hong Kong (HK cohort, n = 22,335; April 1, 2020 to October 31, 2022; Omicron-variant dominant) were included. Each COVID-19 case was randomly matched with up to 10 non-COVID-19 cancer patients based on age and sex. Follow-up lasted until 31 August 2021 for UKB and 23 January 2023 for HK. Inverse probability treatment weighting balanced cohort characteristics. Cox regression evaluated the association of COVID-19 with morbidities occurred 30 days post-infection. Cancer patients with COVID-19 consistently showed significantly higher risk of major cardiovascular diseases (CVDs) [UKB: hazard ratio [HR] 1.8 (95% CI 1.3, 2.5); HK: HR 1.4 (95% CI 1.1, 1.8)], CVD death [UKB: HR 4.3 (95% CI 2.9, 6.2); HK: HR 1.7 (95% CI 1.3, 2.4)], and all-cause mortality [UKB: HR 4.7 (95% CI 4.0, 5.5); HK: HR 1.6 (95% CI 1.5, 1.7)] in both cohorts despite the difference in dominant variants. Cancer patients at advanced ages or severely infected had higher all-cause mortality risk. However, associations between COVID-19 and CVDs became insignificant for fully vaccinated patients. COVID-19 infection is associated with increased risks of CVDs and mortality in cancer patients. Fully vaccination may reduce the post-acute effects of COVID-19 on CVDs. This information may guide effective pre-emptive measures to reduce COVID-19-related morbidities and mortality in cancer patients.

Post-traumatic intraosseous sheath development of the extensor carpi radials brevis tendon: a case report

BackgroundComplications from closed treatment in children are rare but can include growth disturbances and deformities. This case report presents a unique, post-traumatic growth deformity in the distal radius, where the extensor carpi radialis brevis tendon developed an interosseous course.Case presentationA 49-year-old Caucasian male presented with chronic, dull pain in the radiodorsal aspect of the right wrist, worsened by weightbearing and terminal flexion and extension. The patient had a history of a distal radius fracture from a motor vehicle accident in adolescence, which was treated nonsurgically. Current X-rays showed a lucent process along the distal lateral radius without aggressive features. Magnetic resonance imaging revealed the extensor carpi radialis brevis tendon in an interosseous position within the distal dorsal lateral radius, with a longitudinal tear of the tendon. A noncontrast computed tomography scan confirmed a complete bone bridge along the tendon’s interosseous component, limiting potential surgical access. The patient, found to have a positive Antinuclear Antibody (ANA), was treated with prednisone and later with methotrexate and folic acid, which alleviated symptoms.ConclusionsThis case highlights a rare post-traumatic deformity following a distal radius fracture, where the extensor carpi radialis brevis tendon formed an intraosseous sheath. It underscores the importance of considering unique anatomical changes when planning surgical interventions. This is the first reported case of an interosseous tendon sheath development around a tendon postdistal radius fracture, expanding the spectrum of known complications.

A high-resolution photoelectron spectroscopic and computational study of TaX− (X = C, N, O)

We report on the high-resolution photoelectron spectroscopy of diatomic molecules TaX− (X = C, N, O) anions using a cryogenic ion trap combined with the slow electron velocity imaging (cryo-SEVI) method. We determined the electron affinities of TaC, TaN, and TaO to be 2.098(2), 1.576(2), and 1.069(2) eV, respectively. In addition, the electron affinities of TaX molecules were calculated using the CCSD(T) method with the complete basis sets. To interpret the complicated photoelectron spectra, we predicted the excited states of TaX molecules using the MRCI + Q method, accounting for the spin–orbit coupling effects. Several new excited states of these molecules were observed.

Abstract 4140198: Impact of Non-ST-segment elevation Myocardial Infarction on outcomes of Diabetic Ketoacidosis in Hospitalized Patients: A National Inpatient Sample Analysis

Introduction: Diabetes Mellitus (DM) has a broad spectrum of complications and is one of the leading 5 causes of hospital admissions in the US. Decompensated DM is associated with high mortality in hospitalized patients. Cardiac ischemia and related events are proposed to be increasingly prevalent in hospitalized patients with decompensated diabetes. Numerous studies and reports have suggested that elevation in troponin levels is associated with high mortality in such patients. Notably, there have only been a few studies that assessed the prevalence of NSTEMI (Non-ST segment elevation myocardial infarction) and its effect on outcomes in patients hospitalized with Diabetes ketoacidosis (DKA). Methods: We aimed to compare the outcomes of DKA in hospitalized adults (age >18 years) with NSTMI with those without NSTEMI using the National Inpatient Sample (NIS) database from 2018 to 2020. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays. Results: There were a total of 1113295 hospitalizations identified with a diagnosis of DKA. Of these, 9860 (0.88%) patients had NSTEMI. The mean age of this subpopulation was 38.71 years. Among these patients, 48.59% were female, and 58.40% were male. We attempted to assess the impact of NSTEMI on the occurrence of complications such as cardiac arrest, acute renal failure (ARF), Acute liver failure (ALF), Acute heart failure (Acute HF), and acute respiratory failure in patients admitted with DKA. The results of this analysis are depicted in the table below. The cost of hospitalization for DKA with NSTEMI was $35878 higher and the length of stay was 50% longer compared to the patients with DKA without NSTEMI. The Odds ratio for mortality was 2.84 for patients with NSTEMI. Conclusions: Our analysis suggests that the occurrence of NSTEMI negatively impacts outcomes in DKA patients. The occurrence of primary outcomes assessed in this study (Cardiac arrest, ARF, ALF, Acute HF, and Acute respiratory failure) was significantly higher in DKA patients with concomitant diagnosis of NSTEMI. NSTEMI also increased the cost burden on hospitalizations for DKA.

Temporal Bone Gunshot Wounds: A Multi-institutional Retrospective Study.

To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW). Retrospective chart review. Five participating hospitals. Twenty-two patients met inclusion criteria: experienced a TBGSW, survived ≥30 days following the injury, and were evaluated and managed by a neurotologist between 2019 and 2023. No specific interventions were performed for the purposes of this study. Characteristics, evaluation, management, and outcomes of TBGSW survivors. Patients were found to have a mean age of 33 ± 18 years and were predominantly male (18/22, 81.8%). Majority of patients (17/22, 77.3%) had mastoid injury. Most patients (14/22, 63.6%) had some evidence for vascular injury, most frequently the internal carotid artery (9/22, 40.9%). Almost three-quarters (17/22, 77.3%) of patients had clinical exam findings of facial nerve injury, which was the most common indication for surgery. Otologic surgery was performed in 72.7% (16/22), with delayed adverse events most commonly including cholesteatoma and external auditory canal stenosis. Though evidence for hearing impairment was clinically present in at least 15 of 22 patients (68.2%), hearing rehabilitation was pursued in only two patients. With increasing numbers of TBGSW survivors, there is a growing need for practicing neurotologists to be familiar with the wide spectrum of injury patterns and possible complications to inform clinical management in these patients. Early neurotologic assessment and follow-up beyond the acute period is crucial to minimize morbidity in this high-risk cohort.

Echocardiographic findings after SARS-CoV-2 infection in medical residents without previous cardiopulmonary pathology in a tertiary hospital

SARS-CoV-2 disease is associated with a wide spectrum of cardiovascular, renal, and cognitive complications and effects. The most common cardiovascular findings are pericarditis, myocarditis and arrhythmias described in 5-11% of the general population. Specific information on cardiovascular outcomes in healthcare workers in Mexico is lacking. To determine the echocardiographic findings after SARS-CoV-2 infection in residents at a tertiary care teaching hospital. A prospective, cross-sectional, and selective study was performed. A sample of 62 resident physicians with a diagnosis of COVID-19 was selected from March 2020 to February 2023. Transthoracic echocardiograms were performed, and the findings were described. The main echocardiographic findings were: pericardial refractoriness (90.3%), pericardial effusion (6.5%), abnormal left ventricular mobility (1. 6%), abnormal diastolic function (8.1%), aortic regurgitation (6.5%), mitral regurgitation (19.4%), pulmonary regurgitation (35.5%), tricuspid regurgitation (80.6%), mean LVEF of 65% and PSAP of 23 mmHg. The most relevant echocardiographic findings were refractory pericardium, pericardial effusion, left ventricular diastolic dysfunction, and valvular insufficiency, predominantly in men.

Erythema Infectiosum: A Narrative Review.

Erythema infectiosum occurs worldwide. School-aged children are most often affected. Since the diagnosis is mainly clinical, physicians should be well-versed in the clinical manifestations of erythema infectiosum to avoid misdiagnosis, unnecessary investigations, and mismanagement of the disease. The purpose of this article is to familiarize physicians with the wide spectrum of clinical manifestations and complications of erythema infectiosum associated with parvovirus B19 infection. A search was conducted in July 2022 in PubMed Clinical Queries using the key terms "Erythema infectiosum" OR "Fifth disease" OR "Slapped cheek disease" OR "Parvovirus B19". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Erythema infectiosum is a common exanthematous illness of childhood caused by parvovirus B19. Parvovirus B19 spreads mainly by respiratory tract secretions and, to a lesser extent, the saliva of infected individuals. Children between 4 and 10 years of age are most often affected. The incubation period is usually 4 to 14 days. Prodromal symptoms are usually mild and consist of lowgrade fever, headache, malaise, and myalgia. The rash typically evolves in 3 stages. The initial stage is an erythematous rash on the cheeks, with a characteristic "slapped cheek" appearance. In the second stage, the rash spreads concurrently or quickly to the trunk, extremities, and buttocks as diffuse macular erythema. The rash tends to be more intense on extensor surfaces. The palms and soles are typically spared. Central clearing of the rash results in a characteristic lacy or reticulated appearance. The rash usually resolves spontaneously within three weeks without sequelae. The third stage is characterized by evanescence and recrudescence. In adults, the rash is less pronounced than that in children and is often atypical. Only approximately 20% of affected adults have an erythematous rash on the face. In adults, the rash is more frequently found on the legs, followed by the trunk, and arms. A reticulated or lacy erythema is noted in 80% of cases which helps to distinguish erythema infectiosum from other exanthems. Pruritus is noted in approximately 50% of cases. The diagnosis is mainly clinical. The many manifestations of parvovirus B19 infection can pose a diagnostic challenge even to the best diagnostician. Complications include arthritis, arthralgia, and transient aplastic crisis. In most cases, treatment is symptomatic and supportive. When parvovirus B19 infection occurs in pregnant women, hydrops fetalis becomes a real concern. Erythema infectiosum, the most common clinical manifestation of parvovirus B19 infection, is characterized by a "slapped cheek" appearance on the face and lacy exanthem on the trunk and extremities. Parvovirus B19 infection is associated with a wide spectrum of clinical manifestations. Physicians should be aware of potential complications and conditions associated with parvovirus B19 infection, especially in individuals who are immunocompromised, chronically anemic, or pregnant.

Beyond the gut: Exploring neurological manifestations in inflammatory bowel disease

Neurological manifestations in inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, are increasingly recognized as significant contributors to both disease burden and patient morbidity. This comprehensive review delves into the spectrum of neurological complications linked with IBD, highlighting the involvement of both the central and peripheral nervous systems. The neurological impairments range from more common conditions such as peripheral neuropathy, characterized by nerve damage leading to pain and numbness, and cerebrovascular diseases, which include strokes and transient ischemic attacks, to less frequent but intensely severe conditions such as multiple sclerosis and myasthenia gravis, which involve the immune system attacking components of the nervous system. The complex pathophysiology underlying these manifestations integrates various factors including immune-mediated responses, vascular abnormalities such as thromboembolism, nutritional deficiencies often exacerbated by malabsorption and chronic inflammation, and the adverse effects elicited by IBD medications such as corticosteroids and immunomodulators. This review underscores the importance of adopting a multidisciplinary management approach. By integrating the expertise of gastroenterologists with that of neurologists, rheumatologists, and other specialists, patient outcomes can be significantly optimized. Further emphasis is placed on the necessity for heightened clinical awareness and the implementation of early diagnostic interventions to effectively identify and mitigate the neurological complications associated with IBD. In conclusion, ongoing research aimed at elucidating the underlying mechanisms that connect IBD with neurological disorders is imperative to facilitate the development of more effective preventative and therapeutic strategies for these challenging complications.

Our experience of laproscopic cholecystectomy with associated complications and their treatment: a study of 200 cases

Background: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy along with their treatment. Methods: The study was conducted in a tertiary care government teaching hospital in central Gujarat, India. And conventional laparoscopic cholecystectomy was performed after all relevant investigations. Results: In our analysis of 200 cases of planned laparoscopic cholecystectomy, we have found that the median age of patients undergoing operation was 47 years. In our study, 140 (67%) of the patients were female and 60(33%) male cases. It is noted that there were more complications in male patients (OR=2.95, CI 95%, 1.42-4.23, p<0.001). The total number of complications were 60 (30%) out of which 45 (22%) were found to be intraoperative complications and rest were post operative complications. In our study, most common complication encountered was iatrogenic perforation which caused spillage of stones or bile 35 (17.5%) followed by bleeding from gallbladder fossa 12 (6%). CBD injury which is one of the most dreaded complications of laparoscopic cholecystectomy occurred in only 1 patient (0.5%). Among the post operative complications bleeding from abdominal cavity 12 (6%), bilioma 7 (3.5%) and infection of surgical wounds 4 (1.5%) were common. There was a total rate of 5% conversions to open surgery. Conclusions: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognizing IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention.

Early detection of liver fibrosis in patients with Fontan circulation using multiparametric magnetic resonance imaging

Abstract Introduction Fontan procedure (FP), serving as the palliative intervention for complex congenital heart diseases characterized by single-ventricle physiology, precipitates a spectrum of late-stage complications. Fontan-associated liver disease (FALD) encompassing liver fibrosis (LF) which may progress to liver cirrhosis (LC) and thereby hepatocellular carcinoma (HCC) is among the most serious. Despite its importance, optimal surveillance of FALD remains undefined. Multiparametric Liver Multiscan (LMS) with corrected T1 (cT1) value emerges as a novel magnetic resonance (MRI) based non-invasive quantitative tool for liver inflammation and fibrosis evaluation. Aim of this study was to ascertain prevalence and severity of LF utilizing LMS, alongside identifying contributory risk factors for LF in adults post-FP. Material and methods Our cohort included 29 adult patients after FP who underwent LMS. Median age was 25y (20-43y) 54% were females. Liver morphology was assessed by ultrasound (USG) and MRI-based LMS protocol. Hepatic scoring systems, including the Aspartate Aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) Index, and Model for End-Stage Liver Disease (MELD), were computed. Additionally, presence of fenestrations in the Fontan circulation, hemoglobin levels (Hb), and blood oxygen saturation both at rest and during exercise (SatO2%) were evaluated. Results Median cT1 was 914 (±207) ms, in 87% exceeding normal threshold . In those with elevated cT1, LF was undetected by USG in 38%. LC was identified in 27% of the cohort by USG. LC group exhibited significantly higher cT1 values (P<0.001) compared to non-LC group. cT1 value >933ms was associated with a sensitivity of 89% and a specificity of 80% for diagnosing LC (AUC 0.92). Significant correlation was found between cT1 values and Hb (P=0.01) and desaturation (SatO2 <90%/ interventional closure of fenestration, P=0.004). Conventional liver tests and hepatic scoring systems (APRI/FIB-4/MELD) did not predict cT1 nor LC. Conclusion Our study confirmed that LF is almost widely prevalentamong adult patients with single-chamber circulation. Risk factors for LF are systemic desaturation (SatO2 <90% or interventional closure of fenestration) and polyglobulia. However, reliable FALD surveillance remains challenging. Conventional liver assessments and scoring algorithms fall short in delineating the full scope of LF or LC. Consequently, the integration of non-invasive LMS into routine follow-up regimens is advocated, given its pronounced sensitivity for detecting subclinical FALD manifestations and predicting LC. The LMS-derived cT1 value >933ms is a critical predictor for LC, underscoring its importance in guiding further patient monitoring, treatment, and facilitating early HCC detection.

Osteoporosis and Normocalcemic Primary Hyperparathyroidism (Conservatively or Surgically Managed).

Asymptomatic primary hyperparathyroidism (PHPT) involves 80-90% of the parathyroid tumor-associated cases of PHPT in the modern medical era, while normocalcemic PHPT (NPHPT) has a prevalence of 0.1-11%. We aimed to analyze the bone status and mineral metabolism in NPHPT amid conservative or surgical management. In this narrative review, we searched PubMed (between January 2020 and July 2024) via different keywords. Fourteen studies from the final analysis (388 patients with NPHPT; 1188 with PHPT; and 803 controls) showed that mean serum calcium levels varied between 2.57 and 2.26 mmol/L in NPHPT. Ten studies identified a similar 24 h urinary calcium in NPHPT versus hypercalcemic PHPT (HPHPT). Except for one study, a mandatory vitamin D analysis was performed, but the 25-hydroxyvitamin D cut-offs varied. Osteoporosis (n = 6 studies; N = 172 with NPHPT) was confirmed in 41.7-100% of NPHPT subjects. In surgery candidates, this rate might be overestimated. A DXA analysis was performed in eight studies (235 subjects with NPHPT, and 455 patients with HPHPT); two studies identified a lower BMD in HPHPT < NPHPT, but the results were not homogenous. A single study analyzed the TBS and found similar results in NPHPT. The prevalence of fractures (n = 9) varied between 7.4% and 42.8% in NPHPT. Bone turnover markers (N = 262 patients, n = 8 studies) showed lower bone formation markers in NPHPT versus PHPT (n = 3). Two studies analyzed the BMD and bone turnover markers following parathyroidectomy (161 patients, including 30 patients with NPHPT; mean ages over 60 years). To conclude, given the wide spectrum of complications associated with PHPT, an early diagnosis and proper management is essential. A more extensive screening in patients with osteoporosis and kidney stones might lead to the discovery of NPHPT, a more recently described form of PHPT. While it is still unclear whether NPHPT is an early stage of HPHPT or a separate entity, recent findings show similar osteoporosis and fracture occurrence, and an improvement in bone metabolism, following parathyroidectomy. More extensive prospective studies are crucial to understand the natural course of the disease, to reach a consensus regarding parathyroidectomy indications and surgery candidates' selection, and to ensure proper personalized management for these patients. With the evolving diagnosis methods, PHPT has become a condition with a changing clinical presentation, which now requires modern evaluation and treatment approaches.

Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature.

Over the past decade, the range of surgical options to benign prostatic obstruction (BPO) has expanded significantly with the advent of minimally invasive surgical therapies (MISTs). Nevertheless, the available evidence in the field is heterogeneous. Efficacy and safety thresholds are yet to be determined. To evaluate perioperative and long-term complications after MISTs - including Aquablation, steam injection (Rezūm), Transperineal laser ablation of the prostate (TPLA), implantation of a prostatic urethral lift (PUL) and temporary implantable nitinol device (iTIND) - in patients with lower urinary tract symptoms due to BPO. A systematic literature search was conducted in January 2024 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy used PICO criteria (Patients, Interventions, Comparisons, Outcomes) [1], focusing specifically on patients with BPH-associated LUTS who underwent MIST or other comparative treatments, aiming to assess both perioperative and long-term safety outcomes. Article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. The initial electronic search identified 3660 records, of which 24 ultimately met the inclusion criteria and were included in the analysis. Overall, Aquablation was associated with a higher major complications rate of 14% (IQR 6-22), particularly in the case of patients with prostates <70 ml. PUL showed a higher early postoperative acute urinary retention rate (10.9%, IQR 9.2-12.3%), while 1.4% of patients treated with iTIND experienced major perioperative complications. Urinary tract infections were mostly reported in series assessing TPLA and Rezūm. The adoption of MISTs for LUTS due to BPH is associated with a varied spectrum of perioperative and long-term complications. Our findings showed an acceptable safety profile with specific complications dependent on the type of MIST performed, highlighting the importance of individualized patient selection and procedure-specific considerations.

A Cluster-Based Deep Learning Model Perceiving Series Correlation for Accurate Prediction of Phonon Spectrum.

The spectral properties are the most prevalent continuous representation for characterizing transport phenomena and excitation responses, yet their accurate predictions remain a challenge due to the inability to perceive series correlations by existing machine learning (ML) models. Herein, a ML model named cluster-based series graph networks (CSGN) is developed based on the dynamical theory of crystal lattices to predict phonon density of states (PDOS) spectrum for crystal materials. The multiple atomic cluster representation is constructed to capture the diverse vibration modes, while the mixture Gaussian process and dynamic time warping mechanism are compiled to project from clusters to PDOS spectrum. Accurate predictions of complicated spectra with multiple or overlapping peaks are achieved. The high performance of CSGN model can be attributed to the pertinent feature extraction and the appropriate similarity evaluation, which enable the natural perception of structure-property relation and intrinsic series correlations as confirmed in the predictive results. The transferable and interpretable CSGN model advances ML predictions of spectral properties and reveals the potential of designing ML methods based on physical mechanisms.

Post-Meningitic Syndrome: Pathophysiology and Consequences of Streptococcal Infections on the Central Nervous System.

Streptococcus species represent a significant global cause of meningitis, leading to brain damage through bacterial virulence factors and the host inflammatory response. Upon entering the central nervous system (CNS), excessive inflammation leads to various neurological and psychological complications. This review explores the pathophysiological mechanisms and associated outcomes of streptococcal meningitis, particularly its short- and long-term neurological sequelae. Neurological symptoms, such as cognitive impairment, motor deficits, and sensory loss, are shown to vary in severity, with children being particularly susceptible to lasting complications. Among survivors, hearing loss, cognitive decline, and cranial nerve palsies emerge as the most frequently reported complications. The findings highlight the need for timely intervention, including neurorehabilitation strategies that focus on optimizing recovery and mitigating long-term disabilities. Future recommendations emphasize improving early diagnosis, expanding vaccine access, and personalizing rehabilitation protocols to enhance patient outcomes. As a novel contribution, this review proposes the term "post-meningitic syndrome" to showcase the broad spectrum of CNS complications that persist following streptococcal meningitis, providing a framework for a future clinical and research focus.

Role of Two Dimensional Left and Right Ventricular Speckle Tracking Echocardiography in Early Detection of Chemotherapy Induced Ventricular Systolic Dysfunction

Abstract Background Cancer and cardiovascular diseases are the main causes of mortality worldwide. Although the incidence of cancer is rising, modern comprehensive management including surgery, chemotherapy and radiotherapy led to decreased mortality and prolonged survival, but also a large spectrum of cardiovascular complications. Since mortality from patients who develop heart failure secondary to chemotherapy is as high as 60% by 2 years. Early detection of subclinical Cancer Therapeutic Related Cardiac Dysfunction (CTRCD) is of utmost importance, conventional EF measurement fails to detect subtle changes in LV function, so a more sensitive tool is needed. Objective To detect early subclinical left &amp; right ventricular dysfunction based on measurement of 2D LV &amp; RV speckle tracking derived strain values. Patients and Methods The current study is a prospective study which included 101 asymptomatic female patients with newly diagnosed breast cancer who received anthracycline ± trastuzumab based chemotherapy regimen. A comprehensive echocardiographic examination was performed to all patients prior to receiving the chemotherapy (T0), at 3 months (T1) and at 6 months after (T2). All patients had pre- treatment normal LV EF. We aimed at studying the changes in LV &amp; RV mechanics and detecting whether they can help in early prediction of cardiotoxicity. Cardiotoxicity was defined decrease in EF &amp;gt; 10% from baseline value to EF &amp;lt; 55% in asymptomatic patients or &amp;gt; 5% in symptomatic patients “as defined by the cardiac review and evaluation committee (CREC)”. Results The mean age of the study population was 48.75±10.07 years. CTRCD occurred in 24 patients (25.5%) with mean EF by Simpson`s method 59.29±3.50 % at (T0), 49.54±5.63% at (T1), 45.79±4.49% at (T2). While in non-CTRCD patients the mean EF was 60.21±2.80% at (T0), 59.13±2.53% at (T1), 58.29±2.63% at (T2). RV systolic function impairment (S`&amp;lt;10 cm/s) was more prevalent occurring in 37 patients representing 39.4% of the study population. By univariate and multivariate regression analysis LV GLS at (T1) (cut-off value &amp;lt;-15% with relative 12.5% reduction from the baseline value) was a strong predictor of CTRCD, but combining LV GLS with RV GLS &amp; RV FWLS was the strongest (AUC=0.947, sensitivity=91.67%, specificity=90%). Conclusion Anthracycline ± Trastuzumab treatment leads to changes in LV &amp; RV mechanics with more prevalent deterioration in RV values. Presence of lower LV &amp; RV strain values at the base line together with reduction of these values after chemotherapy treatment both can predict later development of CTRCD. Combining LV GLS with RV GLS &amp; FWLS values at (T1) is the strongest predictor of subsequent CTRCD.

Knee proprioception, muscle strength, and stability in Type 2 Diabetes Mellitus- A cross-sectional study

BackgroundThe burgeoning prevalence of Type 2 Diabetes Mellitus (T2DM) has been linked to a spectrum of health complications, including those affecting the musculoskeletal system. Knee proprioception, muscle strength, and stability are essential for maintaining functional mobility and preventing falls, yet their relationship with T2DM is not fully elucidated. ObjectivesThis study aimed to compare knee proprioception, muscle strength, and limits of stability (LOS) between individuals with T2DM and asymptomatic controls and to examine the moderating role of physical activity on these relationships. MethodsIn a cross-sectional design, 192 participants (96 with T2DM and 96 asymptomatic) underwent assessments for knee proprioception using a digital inclinometer, muscle strength via a handheld dynamometer, and LOS through dynamic posturography, graded as a percentage of maximum lean without losing balance. ResultsOur analysis revealed that individuals with T2DM demonstrated reduced knee muscle strength, with mean differences of 12.90 Nm (right) and 18.80 Nm (left) in 25° of flexion, and 25.78 Nm (right) and 26.36 Nm (left) in 40° of flexion, compared to asymptomatic controls. Proprioception errors were greater in the T2DM group (p < 0.001), with significant deficits noted in both knee 25° of flexion and 40° of flexion. Stability limits were also compromised, with the T2DM group displaying a decreased ability to maintain balance across all tested directions (p < 0.001). Physical activity emerged as a positive moderator, with higher activity levels correlating with improved muscle strength and stability. ConclusionT2DM significantly impairs musculoskeletal function, highlighting the need for integrated management strategies. The study underscores the importance of physical activity in mitigating T2DM-related musculoskeletal deterioration, suggesting that therapeutic interventions should include a focus on enhancing muscle strength and stability to improve the quality of life in this population.

Pulmonary complications of bone marrow transplantation.

Bone marrow transplantation, now often known as haematopoietic stem cell transplantation (HSCT), is a complex choreographed procedure used to treat both acquired and inherited disorders of the bone marrow. It has proven invaluable as therapy for haematological and immunological disorders, and more recently in the treatment of metabolic and enzyme disorders. As the number of performed transplants grows annually, and with patients enjoying improved survival, a knowledge of both early and late complications of HSCT is essential for respiratory trainees and physicians in practice. This article highlights the spectrum of respiratory complications, both infectious and non-infectious, the timeline of their likely occurrence, and the approaches used for diagnosis and treatment, keeping in mind that more than one entity may occur simultaneously. As respiratory issues are often a leading cause of short- and long-term morbidity, consideration of a combined haematology/respiratory clinic may prove useful in this patient population.

Maxillectomy and its ophthalmic implications: A comprehensive analysis over 20 years

PurposeMaxillectomy, a critical surgical intervention for head and neck malignancies, often leads to a comprehensive spectrum of ophthalmic complications due to its impact on orbital structures. This study, conducted over 20 years at a single university hospital, aims to evaluate the extent and severity of these complications, encompassing the entire range of ophthalmological issues encountered in the field. DesignA retrospective, observational cohort study. MethodsAmong the 163 patients who underwent maxillectomy at a single university hospital between January 2003 and December 2022, we analyzed the medical records of 101 patients with over one year of postoperative ophthalmological follow-up. Data on demographics, clinical parameters, surgical details, and ophthalmic complications were collected. Complications were categorized into six groups, with statistical analysis identifying factors influencing these outcomes. ResultsOur findings reveal a predominant occurrence of ophthalmic complications among maxillectomy patients. Only 4.4 % had no complications, while 95.6 % experienced at least one, especially with cornea/conjunctiva (56 %), eyelid (48.4 %), and lacrimal system issues (38.5 %) being the most frequent. Notably, 64.8 % had complications in two or more categories, and 33 % in three or more. Multivariate analysis identified that orbital floor resection was a significant risk factor for complications involving the eyelid and the cornea/conjunctiva (P = 0.008 and P = 0.021, respectively), while radiotherapy specifically emerged as a significant risk factor for cornea/conjunctiva complications (P = 0.009). Surgical management of complications following maxillectomy often involved major tissue transplantation in plastic surgery, particularly for cases of significant tissue contraction or severe orbital dystopia. Common secondary ophthalmic surgeries included dacryocystorhinostomy (DCR) in 14 eyes, tarsorrhaphy in 12 eyes, and lateral tarsal strip procedures in 5 eyes. The study found a high incidence of multiple complications, highlighting the complex nature of postoperative challenges. ConclusionMaxillectomy patients are highly susceptible to a range of ophthalmological complications, primarily influenced by surgical extent and adjuvant therapies. A multidisciplinary approach is essential for comprehensive management and improved quality of life in these patients. The study underscores the need for thorough ophthalmological evaluation and integrated care in treating maxillectomy-related complications.

Prevalence of Early Seizures in Acute Stroke Patients

A stroke is defined as a sudden neurological deficit of cerebrovascular cause that persists beyond 24 hours. Stroke is associated with a whole spectrum of complications, especially post-stroke seizures. These seizures may adversely affect the outcome of stroke in terms of mortality and morbidity. This study was designed to find out the frequency of early post-stroke seizures. Objective: To determine the frequency of early-onset seizures after stroke among patients presenting to tertiary care hospitals. Methods: Two hundred and forty patients, presenting on the Medical floor of Jinnah Hospital Lahore with acute stroke and fulfilling the selection criteria, were approached after informed consent. The patients were followed for 14 days for the development of early seizures after the stroke. Results: Among 240 stroke patients, there were 123 (51.3%) male patients and 117 (48.8%) female patients. The minimum age observed was 30 years and the maximum was noted as 77 years. In 45% of patients, hemorrhagic stroke was detected and 55% of patients had ischemic stroke. From 108 cases of hemorrhagic stroke, there were 10.4% cases in which an episode of seizure occurred within 14 days of stroke. On the other hand, in 132 patients with ischemic stroke, 15.9% of patients developed seizure episodes. Conclusions: It was concluded that ischemic stroke was more common in frequency than hemorrhagic stroke in our population and the occurrence of episode early seizure within 14 days of stroke was more prevalent in ischemic stroke patients.

Dermatological Ultrasound of Less Frequent Dermatological Vascular Anomalies: A Retrospective Study and Literature Review From a Reference Center in Bogotá, Colombia.

Vascular anomalies (VA) are classified as either vascular tumors or vascular malformations. Vascular tumors are characterized by the neoplastic proliferation of endothelial cells, whereas vascular malformations result from defects in the pathways that regulate the development of vascular channels during embryogenesis. Dermatological ultrasound has emerged as a critical diagnostic tool for distinguishing VA from other conditions and differentiating among various types of VA by providing detailed imaging characteristics. In this study, we present cases of less common VA identified and characterized using dermatological ultrasound to illustrate the utility of this modality in clinical practice. Patients were randomly selected from clinical records (February 2021 to February 2024) with dermatological VA confirmed by histology, spanning ages 10 to 72 years. Inclusion required complete clinical records and ultrasound reports. The sample represents six different VA and illustrates a spectrum of complications observed in clinical practice. The selected cases include five vascular tumors: pyogenic granuloma, cutaneous angiosarcoma, extradigital glomus tumors, cherry angiomas, and angiokeratoma, and one vascular malformation: verrucous venous malformation. Despite their varied clinical presentations, dermatological ultrasound demonstrated distinct features for each type of anomaly, proving to be a valuable tool in the multidisciplinary management of cutaneous VA. This imaging modality enables precise evaluation and guides effective treatment strategies.