Department Of Clinical Research Articles

Effects of COVID‐19 outbreak on stroke admissions in Brescia, Lombardy, Italy

Italy was the first European country to be affected by the Covid-19 epidemic, with the outbreak estimated to have started in late February, 2020. Currently, Italy has reported more than 228000 Covid-19-positive cases, 14326 of which in the province of Brescia, Lombardy. Although emerging studies have shown a profound hypercoagulable state in Covid-19, it is still highly debated if Covid-19 increases the risk of cerebrovascular disorders. Some reports have shown high frequency of stroke in patients with Covid-191-3 while collaterally there was a decrease of approximately 39% of patients evaluated for stroke in U.S. hospitals,4 possibly due to the fear of seeking care in the midst of the pandemic.

Clinical Utility of 4Kscore ® , ExosomeDx™ and Magnetic Resonance Imaging for the Early Detection of High Grade Prostate Cancer

We aimed to evaluate 4Kscore® and ExosomeDx™ with multiparametric magnetic resonance imaging in the detection of high grade prostate cancer and number of biopsies avoided. Patients had 1 liquid biomarker test with or without multiparametric magnetic resonance imaging. High grade prostate cancer was defined as Gleason grade group 2 or greater. The overall number of avoided biopsies (with Gleason grade 1 or less), and number of missed Gleason grade 2 or greater cancer among the biopsied patients, were determined. Of the 783 patients in the overall cohort 419 (53.5%) underwent biopsy. 4Kscore and ExosomeDx scores higher than the manufacturers' cut point were associated with PI-RADS™ scores 3 to 5 and Gleason grade 2 or greater prostate cancer. Limiting biopsy to the men with liquid biomarker scores above the manufacturers' cut point would have resulted avoiding 29.5% to 39.9% unnecessary biopsies overall, while missing 4.0% to 4.8% Gleason grade 2 or greater prostate cancer in the biopsy group. Screening algorithms with up-front liquid biomarker testing followed by multiparametric magnetic resonance imaging if the biomarker is above the manufacturers' cut point, then followed by biopsy if the multiparametric magnetic resonance imaging is positive or if 4Kscore 20 or greater or ExosomeDx 19 or greater would have missed 4.8% to 5.6% of Gleason grade 2 or greater prostate cancer in the biopsy group while avoiding 39.4% to 43.0% biopsies and 29.5% to 39.9% multiparametric magnetic resonance imaging overall. Similar algorithms with up-front multiparametric magnetic resonance imaging followed by liquid biomarker testing for negative multiparametric magnetic resonance imaging would have missed 2.4% of Gleason grade 2 or greater prostate cancer in the biopsy group but only avoided 17.2% 19.3% biopsies overall. Screening algorithms with up-front liquid biomarker testing followed by multiparametric magnetic resonance imaging and biopsy at certain biomarker thresholds could reduce unnecessary biopsies, multiparametric magnetic resonance imaging and overdetection of Gleason grade 1 prostate cancer.

Первые результаты ведения больных двухсторонней пневмонией, вызванной подтвержденной или вероятной новой коронавирусной инфекцией COVID-19, в перепрофилированном отделении Российского геронтологического научно-клинического центра

Первые результаты ведения больных двухсторонней пневмонией, вызванной подтвержденной или вероятной новой коронавирусной инфекцией COVID-19, в перепрофилированном отделении Российского геронтологического научно-клинического центра

Lactoferrin is an important factor when breastfeeding and COVID-19 are considered.

Acta PaediatricaVolume 109, Issue 10 p. 2139-2140 BRIEF REPORT Lactoferrin is an important factor when breastfeeding and COVID-19 are considered Diego G. Peroni, Corresponding Author Diego G. Peroni [email protected] orcid.org/0000-0002-0234-1373 Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy Correspondence Diego G. Peroni, Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Via Roma 67, 56126, Pisa, Italy. Email: [email protected]Search for more papers by this authorVassilios Fanos, Vassilios Fanos orcid.org/0000-0003-2617-2890 Department of Surgical Sciences, University of Cagliari and Neonatal Intensive Care Unit, AOU Cagliari, Cagliari, ItalySearch for more papers by this author Diego G. Peroni, Corresponding Author Diego G. Peroni [email protected] orcid.org/0000-0002-0234-1373 Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy Correspondence Diego G. Peroni, Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Via Roma 67, 56126, Pisa, Italy. Email: [email protected]Search for more papers by this authorVassilios Fanos, Vassilios Fanos orcid.org/0000-0003-2617-2890 Department of Surgical Sciences, University of Cagliari and Neonatal Intensive Care Unit, AOU Cagliari, Cagliari, ItalySearch for more papers by this author First published: 17 June 2020 https://doi.org/10.1111/apa.15417Citations: 35Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume109, Issue10October 2020Pages 2139-2140 This article also appears in:Covid-19 in Children RelatedInformation

Intoxication with new psychoactive substances in patients diagnosed at the Department of Clinical and Forensic Toxicology, Pomeranian Medical University in Szczecin in 2015–2018

Abstract Introduction: Intoxication with new psychoactive substances (NPSs), colloquially known as designer drugs, has become a significant problem in the last several years. The aim of the study was to conduct a statistical analysis of retrospective data from test records for the presence of NPSs in patients hospitalized in 2015–2018 in the West Pomeranian province. Materials and methods: We analyzed 5,916 results of tests undertaken at the Department of Clinical and Forensic Toxicology at Pomeranian Medical University in Szczecin. Blood samples had been analyzed by liquid chromatography coupled with mass spectrometry (LC/MS) and Headspace gas chromatography (GC/Headspace). Results: Our research was based on 5,916 diagnostic tests for poisoning with volatile and non-volatile organic compounds carried out in 2015–2018 at Pomeranian Medical University in Szczecin. Psychoactive substances used for non-medical purposes were detected in 1,465 patients. In the period under analysis 1,328 of these patients were poisoned with classic psychoactive substances, the poisonings caused by the intentional use NPS were recorded in 137. Conclusions: A retrospective analysis of the above-mentioned data for the period 2015–2018 revealed a gradual increase in the incidence of poisoning with psychoactive substances used for non-medical purposes.

Association Between Walking, Sedentary Behavior, and Weight Changes of Female University Employees Who Were Overweight or Obese

Abstract Objectives Increased physical activity and decreased sedentary time are associated with reduced risk of cardiometabolic disease. The aim of this study was to examine the associations between changes in weight, and walking and sitting time of female employees with overweight or obesity enrolled in a university-based worksite wellness program (WWP). Methods This was a secondary analysis of existing data from the WWP. Descriptive statistics, paired sample t-tests, and the Mann-Whitney U test were used to analyze data from 163 female participants. When comparing participants who lost weight and gained weight, the associations between the changes in walking and sitting times from baseline to 26 weeks post-intervention were analyzed. Results Participants’ mean age was 49.16 ± 10.84 years; 46.60% (n = 76) were white, non-Hispanic (n = 76). Of the 64.40% (n = 105) who lost weight, mean weight loss = 4.11 ± 8.44 pounds after 26 weeks. Those who lost weight increased total walking time by 37.79 minutes/week while the weight gain group (n = 54) decreased total walking time by 52.03 minutes/week (P = 0.01). Those who lost weight decreased sitting time by twice as much (–54.4 vs −23.0 minutes/day, P = 0.11) and increased total moderate-vigorous physical activity time by more than 8 times compared to participants who gained weight (+35.0 vs −4.4 minutes/week, P = 0.07). Conclusions In this sample of female university employees who completed 26 weeks of a WWP, those who lost weight had greater increases in walking time and moderate-vigorous physical activity time and decreases in sitting time compared to those who gained weight. The clinical relevance of the results support the need for prospective research with a larger sample size and objective measures of physical activity is needed to explore the clinical effect of reducing sitting time and engaging in higher intensity physical activity on weight change. Funding Sources Rutgers School of Health Professions Department of Clinical and Preventive Nutrition Sciences.

Ultrasound-Guided Interventions During the COVID-19 Pandemic—A New Challenge

Ultrasound-Guided Interventions During the COVID-19 Pandemic—A New Challenge

Global coronavirus pandemic (2019‐nCOV): implication for an Italian medium size dermatological clinic of a II level hospital

Journal of the European Academy of Dermatology and VenereologyVolume 34, Issue 5 p. e213-e214 Letter to the Editor Global coronavirus pandemic (2019-nCOV): implication for an Italian medium size dermatological clinic of a II level hospital G. Radi, G. Radi orcid.org/0000-0003-3153-1026 Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalyThese two authors contributed equally to the manuscript.Search for more papers by this authorF. Diotallevi, F. Diotallevi orcid.org/0000-0003-2274-1742 Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalyThese two authors contributed equally to the manuscript.Search for more papers by this authorA. Campanati, Corresponding Author A. Campanati anna.campanati@gmail.com a.campanati@univpm.it orcid.org/0000-0002-3740-0839 Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy Correspondence: A. Campanati. E-mails: anna.campanati@gmail.com; a.campanati@univpm.itSearch for more papers by this authorA. Offidani, A. Offidani Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalySearch for more papers by this author G. Radi, G. Radi orcid.org/0000-0003-3153-1026 Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalyThese two authors contributed equally to the manuscript.Search for more papers by this authorF. Diotallevi, F. Diotallevi orcid.org/0000-0003-2274-1742 Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalyThese two authors contributed equally to the manuscript.Search for more papers by this authorA. Campanati, Corresponding Author A. Campanati anna.campanati@gmail.com a.campanati@univpm.it orcid.org/0000-0002-3740-0839 Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy Correspondence: A. Campanati. E-mails: anna.campanati@gmail.com; a.campanati@univpm.itSearch for more papers by this authorA. Offidani, A. Offidani Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalySearch for more papers by this author First published: 22 March 2020 https://doi.org/10.1111/jdv.16386Citations: 36 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume34, Issue5May 2020Pages e213-e214 This article also appears in:JEADV COVID-19 articles RelatedInformation

COVID‐19 and psoriasis: Is it time to limit treatment with immunosuppressants? A call for action

Dermatologic TherapyVolume 33, Issue 4 e13298 Letter to the Editor COVID-19 and psoriasis: Is it time to limit treatment with immunosuppressants? A call for action Claudio Conforti, Claudio Conforti orcid.org/0000-0001-5126-8873 Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorRoberta Giuffrida, Corresponding Author Roberta Giuffrida [email protected] orcid.org/0000-0002-5492-3033 Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy Correspondence Roberta Giuffrida, Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy. Email: [email protected]Search for more papers by this authorCaterina Dianzani, Caterina Dianzani Department of Plastic, Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, ItalySearch for more papers by this authorNicola Di Meo, Nicola Di Meo Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this author Claudio Conforti, Claudio Conforti orcid.org/0000-0001-5126-8873 Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorRoberta Giuffrida, Corresponding Author Roberta Giuffrida [email protected] orcid.org/0000-0002-5492-3033 Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy Correspondence Roberta Giuffrida, Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy. Email: [email protected]Search for more papers by this authorCaterina Dianzani, Caterina Dianzani Department of Plastic, Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, ItalySearch for more papers by this authorNicola Di Meo, Nicola Di Meo Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this author First published: 11 March 2020 https://doi.org/10.1111/dth.13298Citations: 47Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume33, Issue4July/August 2020e13298 This article also appears in:Dermatologic Therapy COVID-19 Articles RelatedInformation

Misperceptions and hallucinatory experiences in ultra-trailer, high-altitude runners.

The Mountain Activities Neuro-behavioural Research Programme is a research project born in the 2 nd Unit of Psychiatry, Department of Clinical and Experimental Medicine at the University of Pisa to investigate the effects of altitude on the mental and neuro-behavioural aspects of people performing activities in mountainous areas. In this study, after elaborating a standardised data collection form, based on traditional psychopathology notions, to classify the misperceptions reported by the athletes taking part, we investigated the various types of these misperceptions in 21 athletes (including only one female), with a mean age of 44.90 ± 8.51 (min 33 and max 58). The athletes reported different kinds of misperceptions. It was possible to highlight three different clusters of athletes, based on the similarities between the kinds of misperceptions reported in each cluster: (a) anomalies in the intrinsic characteristics of perceptions (i.e. depersonalisation and derealisation), (b) illusions and (c) hallucinations. This study supports the concept that anomalous perceptual experiences may occur independently of the context of psychiatric or neurological disorders. The chance of observing hallucinatory phenomena outside the context of psychiatric disorders and in extreme environmental conditions among ultra-trail runners may offer a unique opportunity to those intending to study psychopathological conditions in a 'para-physiological' context.

Clinical case of malaria determining using modern laboratory diagnostics methods

The article describes a clinical case of malaria in patient X., who was admitted to the medical institution of the Ministry of Defense. The patient was diagnosed with acute leukemia based on complaints and the clinical picture, followed by transferring the patient to the hematology centre of the Main Military Clinical Hospital n. a. N. N. Burdenko. In a short time, the patient was diagnosed with laboratory tests of the Department of Clinical and Hematological Research, and the diagnosis was reported to the specialists of the hematological centre. The patient was promptly provided with the necessary medical care. Due to the rare occurrence of this parasitic disease (the last case of malaria we diagnosed 10 years ago), we conducted a comprehensive study using various laboratory methods and modern hematological analyzers. All this made possible to recognize this disease, which is rare in the Moscow region, as well as in other regions of the Russian Federation, in a short period of time.

L-ARGININE SUPPLEMENTATION IMPROVES INSULIN RESISTANCE BY INCREASING THE INSULIN RECEPTOR EXPRESSION IN TYPE II DIABETIC RATS.

12Aug 2019 L-ARGININE SUPPLEMENTATION IMPROVES INSULIN RESISTANCE BY INCREASING THE INSULIN RECEPTOR EXPRESSION IN TYPE II DIABETIC RATS. Nashwa EL-Khazragy and Dalia A. Saad. Department of Clinical Pathology/Hematology, Biomedical Research, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

The influence of varying maxillary central incisor vertical dimension on perceived smile aesthetics.

To evaluate patient perception of the smile focused on analysis of the upper incisors. Cross-sectional study. Department of Clinical and Social Dentistry at Federal University of Paraíba, João Pessoa, Brazil. The sample consisted of 135 individuals (73 women and 62 men). Images with different characteristics associated with the incisal edges were shown at random and analysed using a Likert scale. Data were analysed using the Chi-square test or Fisher's exact test with a statistically significant difference ( P < 0.05). Smile I (difference of 1.5 mm in relation to the central incisor and lateral) was considered the most aesthetic, while Smile III (no difference in height between the central and lateral incisors) was the least aesthetic. A significant difference was found between perception of smile II (difference of 1 mm in relation to the central incisor and lateral) and age groups ( P < 0.005), with 31% (n = 13) of individuals aged 45-64 years considering smile II as not pleasant, 4.4% (n = 2) aged 15-24 years and 8.3% (n=4) aged 25-44 years and 4.4% (n = 2) aged 15-24 years considering the same. A significant difference was also found in relation to educational background of the assessor and smile perception, with smile III ( P = 0.0441) and smile IV ( P = 0.0053) considered the most aesthetic ( P = 0.0116). The smile considered most attractive among the sample was that with 1.5 mm steepness between the central and lateral incisors, while a flat smile arc was considered least attractive.

Editorial introductions

Editorial introductions

Analysis of M1 and M2 tumor associated macrophages in tongue squamous cell carcinomas.

Analysis of M1 and M2 tumor associated macrophages in tongue squamous cell carcinomas.

Analysis of immune-phenotype in squamous cells carcinoma of the tongue

Event Abstract Back to Event Analysis of immune-phenotype in squamous cells carcinoma of the tongue Marco Mascitti1, Giuseppe Troiano2*, Rodolfo Mauceri3, Lorenzo Lo Muzio2, Corrado Rubini1 and Andrea Santarelli1 1 Polytechnical University of Marche, Department of Clinical Specialistic and Dental Sciences, Italy 2 University of Foggia, Department of Clinical and Experimental Medicine, Italy 3 University of Palermo, Department of Surgical, Oncological and Oral Sciences, Italy Aim. The recent success in the treatment of head and neck squamous cell carcinoma with checkpoint inhibitors has stimulated researchers in the understanding of the role that the immune system plays in cancer. The immune system interacts intimately with tumors over the entire process of disease development and progression to metastasis. Recently, Chen and Mellman classified cancer in relation to the immune system, distinguishing three phenotypes: Inflamed, Immune-escaped and Immune-desert. In this paper, we analyzed tongue squamous cell carcinoma (TSCC) samples, according to the aforementioned classification, in order to study the role of the immune system in this subtype of tumors. Materials and Methods. In this study, 82 patients surgically treated for SCCTs at the Department of Maxillofacial Surgery, “Ospedali Riuniti” General Hospital (Ancona, Italy), between 2011 and 2016 were included. Clinical and radiologic data were obtained from each patient’s medical record, and pathologic data were retrieved from the archives of the Sections of Pathology, Marche Polytechnic University, Italy. Tumors were classified on the basis of the immune infiltrated in: Inflamed, Immune-escaped and Immune-desert; and correlated with clinic pathological parameters. Results. Pathological analysis of immune-phenotype of TSCC samples revealed that: 59.8% (49/82) were classified as Inflamed, 30.5% (25/82) as Immune-Excluded and 9.8% (8/82) as Immune-desert. In addition, the ratio carcinoma stroma in TSCC inversely correlated with the size of the tumor at the time of diagnosis. Discussion. The analysis of the immune-phenotype could be used to further stratify patients with TSCC. A possible inclusion of this parameter in the clinical staging needs to be evaluated in further well-standardized studies. References Chen DS, Mellman I. Elements of cancer immunity and the cancer-immune set point. Nature. 2017 Jan 18;541(7637):321-330. Cogdill AP, Andrews MC, Wargo JA. Hallmarks of response to immune checkpoint blockade. Br J Cancer. 2017 Jun 27;117(1):1-7. Chen DS, Mellman I. Oncology meets immunology: the cancer-immunity cycle. Immunity. 2013 Jul 25;39(1):1-10. Keywords: OSCC (oral squamous cell carcinoma), head and neck, Immunity, Immune System, Tongue Conference: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018. Presentation Type: Poster Presentation Topic: Oral Diseases Citation: Mascitti M, Troiano G, Mauceri R, Lo Muzio L, Rubini C and Santarelli A (2019). Analysis of immune-phenotype in squamous cells carcinoma of the tongue. Front. Physiol. Conference Abstract: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine.. doi: 10.3389/conf.fphys.2019.27.00020 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 24 Oct 2018; Published Online: 09 Dec 2019. * Correspondence: Dr. Giuseppe Troiano, University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Apulia, 71122, Italy, giuseppe.troiano@unifg.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Marco Mascitti Giuseppe Troiano Rodolfo Mauceri Lorenzo Lo Muzio Corrado Rubini Andrea Santarelli Google Marco Mascitti Giuseppe Troiano Rodolfo Mauceri Lorenzo Lo Muzio Corrado Rubini Andrea Santarelli Google Scholar Marco Mascitti Giuseppe Troiano Rodolfo Mauceri Lorenzo Lo Muzio Corrado Rubini Andrea Santarelli PubMed Marco Mascitti Giuseppe Troiano Rodolfo Mauceri Lorenzo Lo Muzio Corrado Rubini Andrea Santarelli Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Targeted therapy in head neck tumours

Targeted therapy in head neck tumours

Expression of p53-family members in odontogenic cysts

Expression of p53-family members in odontogenic cysts

An unusual case of recurrent oral cancer in a young woman HPV-negative, non-smoker and non-drinker

An unusual case of recurrent oral cancer in a young woman HPV-negative, non-smoker and non-drinker

Osteonecrosis of the jaws caused by myelodysplasia: a case report

Osteonecrosis of the jaws caused by myelodysplasia: a case report