Department Of Medicine Research Articles

Analysis of interventional treatment options of the common femoral artery - a retrospective single center experience.

Background: Due to the rapid development of treatment techniques of peripheral arterial disease (PAD) treatment is nowadays predominantly interventional. An exception are lesions of the common femoral artery (CFA), which should be treated surgically according to vascular guidelines. However, recent evidence has shown that endovascular techniques, e.g. stenting, have comparable clinical outcomes while causing fewer complications. The aim of the present analysis was to evaluate the therapeutic success of endovascular therapy of CFA lesions in a single center, all - comers registry. Patients and methods: All patients who were treated for a CFA lesion at the Department of Internal Medicine I of the University Hospital Jena in the period from 01/2017 to 12/2020 were included. Treatment success was determined by evaluating the ankle-brachial-index (ABI) pre- and post-interventional as well as after follow-up (FU), measuring walking distance (WD) and by target revascularization rate (TLR) and primary patency rate (PPR). Results: The analysis included 109 patients with a mean age of 73.4 years, with 67% (73) of those being men. 72 patients received interventional treatment, whereas 33 were treated surgically and 4 conservatively. Resting ABI in the overall cohort showed an increase from 0.5 to 0.7 post intervention (p=<0.05; mean FU-time: 6.5 months). In the interventional cohort ABI increases from 0.6 to 0.8 (p=<0.05; mean FU-time: 5,8 months) at FU and from 0.3 to 0.6 (p=<0.05; mean FU-time: 8,8 month) in the surgically treated group. The WD improved in the whole collective from 116.5 meter (m) to 152.5 m (p=<0.05). The TLR showed no significant difference with 8.1% after interventional treatment and 6.1% after vascular surgery in the present analysis (p=0.72) as well as PPR with 89.8% after EVT and 90.9% after surgical approach (p=0.87). The intra-/postinterventional complication rate was 5.5% in the intervention group, compared to postoperative complication rate of 15.2% in the surgically treated group. Conclusions: The present analysis demonstrates that even in a real-world, all-comers collective, interventional therapy for CFA lesions was safe and equally effective as the surgically treated patient cohort. Continuing to generate registry data is important to eventually initiate a paradigm shift.

The use of antibiotics in the early stage of acute exacerbation of chronic obstructive pulmonary disease in patients without obvious signs of infection: a multicenter, randomized, parallel-controlled study

IntroductionChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality. In some acute exacerbations of COPD (AECOPD) in patients with no obvious signs of infection, early antibiotic treatment seems to clinically improve the disease, but more studies are needed to determine the prognostic impact of antibiotic treatment in AECOPD patients with no obvious signs of infection.PurposeTo clarify the impact of antibiotic treatment on the short-term and long-term prognoses of AECOPD patients without obvious signs of infection.MethodsThe impact of the two treatment methods on the prognosis of patients was compared at 30, 90, 180, and 360 days after discharge. A multicenter, randomized, parallel-controlled clinical trial was conducted in a department of respiratory and critical care medicine in Central China. All patients met the inclusion criteria for AECOPD, and the patients were randomly assigned to the antibiotic group or the nonantibiotic group at a 1:1 ratio. Patients in the antibiotic group were given moxifloxacin 400 mg/day intravenously for 7 days. Patients in the nonantibiotic group were intravenously injected with the same amount of normal saline as the amount of moxifloxacin given to those in the antibiotic group for 7 days.ResultsThere were 406 patients in the antibiotic group and 410 patients in the nonantibiotic group. During the short-term and long-term follow-ups, the acute exacerbation frequency, intensive care unit (ICU) treatment rate, mortality, and mMRC and CAT scores were not significantly different between the two groups (p &amp;gt; 0.05). At the 180- and 360-day follow-ups, the forced expiratory volume in 1 s (FEV1%) and peak expiratory flow (PEF) were not significantly different between the two groups (p &amp;gt; 0.05). The 30-day readmission rate was significantly lower in the antibiotic group than in the nonantibiotic group (p &amp;lt; 0.05). The time from discharge to the first acute exacerbation was not significantly different between the two groups (p &amp;gt; 0.05). The length of the first hospital stay after discharge was significantly lower in the antibiotic group (5.84 days) than in the nonantibiotic group (6.75 days) (p &amp;lt; 0.05). At the 30-day follow-up, the acute exacerbation frequency, age, C-reactive protein (CRP) level, and sputum viscosity were significantly greater in the nonantibiotic group than in the antibiotic group (p &amp;lt; 0.05). In addition, according to the receiver operating characteristic (ROC) analysis, the frequency of acute exacerbations at the 30-day follow-up was significantly greater in COPD patients aged &amp;gt;62.5 years, with a CRP level &amp;gt;12.56 mg/L or with a sputum viscosity &amp;gt;III, in the nonantibiotic group than in those in the antibiotic group, suggesting that the short-term prognosis was poor.ConclusionPatients who are &amp;gt;62.5 years of age, have a CRP concentration &amp;gt;12.56 mg/L, or have a sputum viscosity &amp;gt;III without obvious signs of infection should be treated with antibiotics to improve their short-term prognosis.Clinical Trial Registration:(https://www.chictr.org.cn), (ChiCTR1800018921)

Clinical effectiveness of internet-based cognitive behavioral therapy for insomnia in routine secondary care: results of a randomized controlled trial

IntroductionDelivering cognitive behavioral therapy for insomnia over the internet bears the advantage of accessibility and uptake to many patients suffering from chronic insomnia. In the current study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy for insomnia (iCBT-I) in routine care.Materials and methodsWe conducted a two-arm non-blinded randomized controlled trial with care as usual (CAU) as a control condition. Participants were recruited in a specialized outpatient sleep medicine department. Both arms had access to other healthcare resources, and the intervention group had access to the iCBT-I program for 2 months. The primary outcome was insomnia severity, measured by the Insomnia Severity Index (ISI). Secondary outcomes were fatigue severity, daytime sleepiness, affective symptoms, dysfunctional beliefs and attitudes about sleep, sleep locus of control, sleep hygiene, sleep efficiency (SE), sleep onset latency, wake time after sleep onset (WASO), and total sleep time (TST). Linear mixed models for repeated measures were used to analyze the longitudinal data at baseline, post-treatment, and after 3 months of follow-up. The trial was registered at www.clinicaltrials.gov (NCT04300218 21.04.2020).ResultsThe results showed a significant time*group interaction effect (p = 0.001) at post-treatment with between-group effect size (d = 0.51), indicating that the ISI decreased by a score of 3.8-fold in the iCBT-I group than in the CAU group. There was no significant difference in ISI between groups at follow-up. Regarding secondary outcomes, dysfunctional beliefs about sleep, SE, and WASO decreased significantly during treatment in the intervention group with between-group effect sizes d = 0.35, d = −0.51, and d = 0.47, respectively. At the follow-up, between-group effects on DBAS and SE remained significant: d = 0.36 and d = −0.63, respectively. For TST, we observed a significant time*group effect of d = −0.38 only after follow-up.ConclusionOur findings suggest that iCBT-I has a significant effect on insomnia severity at post-treatment compared to CAU. iCBT-I further improved dysfunctional beliefs about sleep and improved subjective sleep characteristics, such as SE, WASO, and TST during 3 months after treatment.Clinical trial registrationwww.clinicaltrials.gov, identifier (NCT04300218).

Risk Assessment Models for Venous Thromboembolism in Medical Inpatients

Thromboprophylaxis is recommended for medical inpatients at risk of venous thromboembolism (VTE). Risk assessment models (RAMs) have been developed to stratify VTE risk, but a prospective head-to-head comparison of validated RAMs is lacking. To prospectively validate an easy-to-use RAM, the simplified Geneva score, and compare its prognostic performance with previously validated RAMs. This prospective cohort study was conducted from June 18, 2020, to January 4, 2022, with a 90-day follow-up. A total of 4205 consecutive adults admitted to the general internal medicine departments of 3 Swiss university hospitals for hospitalization for more than 24 hours due to acute illness were screened for eligibility; 1352 without therapeutic anticoagulation were included. At admission, items of 4 RAMs (ie, the simplified and original Geneva score, the Padua score, and the IMPROVE [International Medical Prevention Registry on Venous Thromboembolism] score) were collected. Patients were stratified into high and low VTE risk groups according to each RAM. Symptomatic VTE within 90 days. Of 1352 medical inpatients (median age, 67 years [IQR, 54-77 years]; 762 men [55.4%]), 28 (2.1%) experienced VTE. Based on the simplified Geneva score, 854 patients (63.2%) were classified as high risk, with a 90-day VTE risk of 2.6% (n = 22; 95% CI, 1.7%-3.9%), and 498 patients (36.8%) were classified as low risk, with a 90-day VTE risk of 1.2% (n = 6; 95% CI, 0.6%-2.6%). Sensitivity of the simplified Geneva score was 78.6% (95% CI, 60.5%-89.8%) and specificity was 37.2% (95% CI, 34.6%-39.8%); the positive likelihood ratio of the simplified Geneva score was 1.25 (95% CI, 1.03-1.52) and the negative likelihood ratio was 0.58 (95% CI, 0.28-1.18). In head-to-head comparisons, sensitivity was highest for the original Geneva score (82.1%; 95% CI, 64.4%-92.1%), while specificity was highest for the IMPROVE score (70.4%; 95% CI, 67.9%-72.8%). After adjusting the VTE risk for thromboprophylaxis use and site, there was no significant difference between the high-risk and low-risk groups based on the simplified Geneva score (subhazard ratio, 2.04 [95% CI, 0.83-5.05]; P = .12) and other RAMs. Discriminative performance was poor for all RAMs, with an area under the receiver operating characteristic curve ranging from 53.8% (95% CI, 51.1%-56.5%) for the original Geneva score to 58.1% (95% CI, 55.4%-60.7%) for the simplified Geneva score. This head-to-head comparison of validated RAMs found suboptimal accuracy and prognostic performance of the simplified Geneva score and other RAMs to predict hospital-acquired VTE in medical inpatients. Clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies.

Retrospective analysis of thyroid incidentalomas detected by [68Ga]Ga-PSMA-11 PET/CT.

Prostate cancer patients, undergo imaging procedures, with [68Ga]Ga-PSMA-11 PET/CT (prostate-specific membrane antigen based positron emission tomography/computed tomography) utilized for primary and secondary staging. PSMA thyroid incidentalomas (PTI) are discovered in the thyroid gland while imaging prostate cancer patients with [68Ga]Ga-PSMA-11 PET/CT. The aim of the study was to determine the clinical significance of PTIs detected on [68Ga]Ga-PSMA-11 PET/CT. Another goal was to identify a possible threshold for the maximum standardized uptake value (SUVmax), above which a malignant growth could be suspected. A retrospective cross-sectional study. 769 patients with prostat cancer who underwent [68Ga]Ga-PSMA-11 PET/CT scans in the nuclear medicine department of a tertiary care hospital between January 2020 and December 2022 were retrospectively screened in this study. We analyzed 67 patients in whom PTI was detected. Patients who exceeded the inclusion criteria had their thyroid ultrasonography and ultrasonography -guided fine needle aspiration findings analyzed. PTI was discovered in 67 patients (8%). 42 patients who met the inclusion and exclusion criteria were included in the study. Of the 4 malignant patients (9.5%) in the study population, 2 were classified as TIRADS 3 and 2 were classified as TIRADS 4. The cut-off SUVmax value was found to be 5.6. With 100% sensitivity and 47.37% specificity, a cutoff SUVmax of 5.3 was determined through receiver-operator characteristic analysis in order to predict malignant cytology. PTI is a significant clinical finding; most of diffuse and focal uptakes are frequently related to benign diseases. Each center should establish its own a possible SUVmax cut-off over which a malignant lesion should be suspected.

Bone turnover markers and muscle decay indicator in patients with proximal femur fracture – a case-control study

IntroductionFracture of the proximal femur is common in elderly patients, in fact threatening their lives. Age-related sarcopenia may be involved in the imbalance resulting in the injury. Handy and readily accessible biochemical tests would be useful to assess the musculoskeletal system condition in daily practice. The aim of the study was to determine whether there is any relation between muscle decay and fracture of the proximal femur and to assess bone quality in elderly patients.Material and methodsIn the study 22 patients who represented the treatment group were hospitalized due to proximal femur fracture. Eighteen patients from the control group with no fracture in their history were admitted to the Internal Medicine Department. Anyone treated for osteoporosis, immune disease affecting protein balance, neoplasm, mental illness, heart failure, or myocardial infarction was excluded from the study. In every case a blood sample from an elbow vein was drawn, collected in EDTA-K2 tubes, and then centrifuged to separate plasma from the whole blood. Subsequently, the concentrations of C-terminal cross-linked telopeptide of type I collagen (CTX-I), sex hormone binding globulin (SHBG) and creatine kinase (CK) in plasma were determined using commercial enzyme-linked immunosorbent assays.ResultsThe CK plasma concentration differed between the patient groups (p = 0.011). The SHBG plasma concentration was significantly higher in the treatment group (p = 0.006), whereas a slight difference in CTX-I plasma concentration between the groups was found (p = 0.038). No significant correlations between plasma CK, SHBG or CTX-I were found (p &gt; 0.05).ConclusionsCreatine kinase is actually not an appropriate marker for the clinical assessment of muscle tissue quality in patients with or at risk of proximal femur fracture. Analyzing the quality of bone tissue, we can conclude it was poorer in patients with proximal femur fracture than in the control group.

Vitamin B12 Deficiency among Cases of Helicobacter Pylori Gastritis: A Cross Sectional Study

Background: Helicobacter pylori (H. pylori) is a gram-negative bacterium associated with various gastrointestinal diseases, including peptic ulcer disease, gastric cancer, and vitamin B12 deficiency. Recent research has highlighted a potential link between chronic H. pylori infection and significant malabsorption of vitamin B12, particularly in populations with high prevalence rates of infection. Objective: This study aims to investigate the frequency of vitamin B12 deficiency among patients with H. pylori gastritis and to explore the association between H. pylori infection and vitamin B12 levels. Methods: A cross-sectional study was conducted from September 2023 to March 2024 at the Department of Medicine, Ayub Teaching Hospital, Abbottabad. A total of 120 patients presenting with symptoms of gastritis were enrolled after obtaining ethical approval from the hospital’s review board. Exclusion criteria included patients already on vitamin B12 supplementation. Diagnostic testing for H. pylori was performed using stool antigen tests, and vitamin B12 levels were assessed through serum measurements. Data analysis was conducted using IBM SPSS Statistics version 23, with the Chi Square test applied to examine the association between H. pylori infection and vitamin B12 deficiency, setting the level of significance at p ≤ 0.05. Results: Out of the 120 patients studied, 49 (40.8%) tested positive for H. pylori. Vitamin B12 deficiency was observed in 35 (29.2%) patients. Among those infected with H. pylori, 51.0% (25 patients) also had vitamin B12 deficiency, compared to 14.1% (10 patients) among those not infected (p = 0.0001). Conclusion: The findings indicate a significant association between H. pylori infection and vitamin B12 deficiency. This study suggests that H. pylori is a potential risk factor for vitamin B12 deficiency, underscoring the need for screening and appropriate management of H. pylori in patients presenting with vitamin B12 deficiency.

Assessment of High Serum Cystatin C as an Early Marker of Renal Impairment in Pre Eclampsia

Introduction: Preeclampsia is the most common medical complication during pregnancy and one of the leading causes of maternal and perinatal morbidity and mortality in Bangladesh. Kidney has role in both adaptive physiology of normal pregnancy and in pathophysiology of preeclampsia. Among the new biomarkers, serum Cystatin C can reliably reflect the GFR in both healthy and hypertensive pregnant women. It is important to evaluate the diagnostic efficiency of Cystatin C as a marker of renal function in preeclampsia. Aim: To assess high serum Cystatin C level as an early marker of renal impairment in pre-eclamptic patients. Materials and Methods: From March, 2021 to February, 2022 (A total of 12 months) a cohort study was conducted among 66 pregnant women, aged 18 to 40 years with pre-eclampsia and normal serum creatinine (0.5-0.8mg/dl) at their 20-28 weeks of gestation attending the antenatal clinic and admitted in the Department of Feto maternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, selected by non random purposive and convenient sampling. Results: Out of 66 respondents, final analysis was done with 62 patients. Among 62 study samples, 76% patients had “High Cystatin C” level that was greater than 0.84 and renal impairment developed in 15% pregnant women. Majority of the participants were in 25-30 age groups (46.8%). The mean serum creatinine level of the pregnant women increased throughout follow up and it was statistically significant (p&lt;0.05) in both cases. No significant difference was found between serum Cystatin C in renal impaired and normal renal function pre eclampsia patients at a cut off value of 0.84. ROC analysis of serum Cystatin C level for detection of renal impairment among Pre eclamptic patients found a cut-off value of ≥1.49 showed the highest Youden index of 0.721. The sensitivity, specificity, PPV, NPV and accuracy of serum Cystatin C were 77.78%, 94.34%, 70.00%, 96.15% and 91.94%. Conclusion: Higher Cystatin C level in pre-eclampsia reflected renal impairment at an early stage even before conventional marker like serum creatinine raise. The diagnostic efficiency of Cystatin C as a marker of renal function in pre eclampsia can be used to reduce maternal morbidity and mortality of Bangladesh. Medicine Today 2023 Vol.36 (1): 12-16

Dentist Involvement in the Treatment of Radiation-Induced Oral Mucositis—A Pilot Cross-Sectional Study

Oral mucositis (OM) occurs in more than 95% of patients irradiated in the head and neck area. This paper aims to determine the occurrence and characteristics of OM in patients with head and neck cancer (HNC), as well as the involvement of dentists/oral medicine specialists in treating such patients. Methods: This study was conducted at the Department of Otorhinolaryngology and Department of Oral Medicine, University Hospital Center Zagreb, from April to August 2022, on patients irradiated in the head and neck area. A unique OM questionnaire was created on the incidence, characteristics, oral care, and involvement of dentists in the overall care. Results: Thirty patients filled out the questionnaire. Of the 22 patients who had developed OM, 14 had grade-three OM. Ten patients were treated for OM in line with the instructions of an oral medicine specialist, eight based on the instructions of a specialist responsible for monitoring of the underlying disease, and four were not treated at all. Sixteen patients had not been referred to a dentist before the start of RT. Conclusions: These results showed insufficient care and treatment of OM, as well as insufficient involvement of dentists in the oncology team.

Pattern of Pesticide and Herbicide Poisoning Among People Admitted to Medicine Wards of a Tertiary Care Hospital

Introduction: Acute poisoning has become a major public health problem accounting for significant morbidity and mortality around the globe2. According to WHO data, an estimated 193,460 people died worldwide in 2012 from unintentional acute poisoning. 84% of these deaths occurred in resource-lacking low- and middle income countries3. The toxicity of accessible poisons and the scarcity of adequate medical facilities for poisoning management is responsible for a such a high mortality rate in this region4. Acute pesticide poisoning usually occurs during agricultural use either by accidental exposure or by suicidal attempt, rarely as homicidal2,5&amp;8. This study is designed to assess the patterns of pesticide &amp; herbicide poisoning among rural &amp; urban peoples admitted to medicine ward of a tertiary level hospital and to find out the sociodemographic characteristics of the respondents. So that the supply of these agents be properly regulated to prevent easy accessibility and misuse. Materials and Methods: It was a hospital based cross-sectional observational study conducted at indoor Department of Medicine, Chittagong Medical College Hospital for six months period from 01/01/2019 to 31/06/2019. Ethical clearance was taken from ethical review committee of Chittagong Medical College and informed consent was obtained from each participants. Hundred patients above 12 years of age with a relevant history and clinical signs and symptoms of any type of pesticides and herbicides poisoning who fulfilled the selection criteria were selected consecutively for the study. Data was collected using a pretested, multi-structured questionnaire which comprised of questions to identify demographic data, type and circumstances of poisoning. Results: Regarding motive of poisoning in our study 81% patient took pesticide &amp; herbicide poisoning for suicide and 19% admitted with accidental case. This result is consistent with the study where most common reason of pesticide &amp; herbicide poisoning was suicide (93.3%) 20. A study performed at Rajshahi Medical College from January 1991 to December 1994 showed that out of those 405 cases of OPC poisoning 310 were suicidal (76.54%) and 95 were homicidal (23.45%) poisoning28. The present study revealed that factors responsible for the suicidal attempt were familial disharmony in 46% of cases, marital problems in 19%, financial problem in 16%, mental disorder in 3% and 11% due to other reasons. Shadequl-Islam et al. reported the motive of pesticide poisoning in their study that 45% of cases were due to familial disharmony, 15% unknown, 13.3% depression, 8.3% marital problems, 5% financial problems and 13.3% due to other reasons26. In most cases, the patient could access to the poison by self-purchasing from poison retailers. Conclusion: This study has indicated that young adults, males and socially underprivileged people are at a higher risk of pesticides and herbicides poisoning. This study showed pesticides &amp; herbicides poisoning is the most common modes of suicidal deaths. Pesticides are mostly misused purposefully as an easy means for committing suicide. Early diagnosis and treatment is mandatory in order to minimize mortality from these potentially lethal compounds. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. Medicine Today 2023 Vol.36 (1): 36-40

The Pattern of Motorcyclists' Death Due to Accidents and a Three-year Forecast in East Azerbaijan Province, Iran: A Time Series Study

Introduction: In low- and middle-income countries, a large proportion of road users include pedestrians, cyclists, and motorcyclists, and nearly half of road traffic fatalities occur among motorcyclists. This study aimed to examine the pattern of motorcyclists' death due to accidents in East Azerbaijan, Iran between 2006 and 2021 and present a forecast. Methods: We used death data due to motorcycle accidents of Legal Medicine Department between 2006 and 2021. For time series analysis, the Box-Jenkins model was used and three stages of identification, estimation, and diagnosis were successively performed and repeated several times to achieve the best prediction model. The Box-cox transformation method was used to stabilize the variance, and the first-order seasonal differential method with a period of 12 was used to control the seasonality. Due to seasonal variations, the Seasonality Auto-Regressive Integrated Moving Average model: SARIMA (p, d, q) (P, D, Q)s was employed and the death trend was predicted for 36 months. The candidate models were compared based on Log-likelihood, AIC, and BIC indices. STATA 17 was used for data analysis. Results: About 18.6% of all accident deaths are attributed to motorcycle accidents. The death rate for all causes of accidents and motorcycle accidents were 23.13 and 4.30 per 100,000 population, respectively. Seven models were considered as candidates. The SARIMA (0, 0, 0) (1, 1, 1)12 model was selected as the best model due to better fit and used to predict the number and trend of motorcycle accident deaths. Motorcycle accident deaths are predicted to decrease gradually in the next 36 months, from June 2021 to May 2024, affected by seasonal changes. Conclusion: The trend of death due to motorcycle accidents from 2006 to 2021 in East Azerbaijan was declining, and it is predicted to decrease slightly in the next three years as well. As this reduction may be attributed to many factors, it is recommended to investigate effective factors in future studies.

Infertility psychological distress in women undergoing assisted reproductive treatment: A grounded theory study.

While there exists an ample body of research in international contexts focused on the characterization and quantification of infertility psychological distress, the level of scholarly scrutiny directed towards this phenomenon within the context of China remains scant. To investigate the formation and developmental processes of psychological distress associated with infertility and infertility treatment among women within the Chinese cultural context and to construct a theoretical framework that elucidates this phenomenon. Qualitative approach with grounded theory methodology. This study was conducted within the reproductive medicine department of a tertiary-level hospital located in central China from May to August 2023. Twenty-seven women who experienced infertility and underwent assisted reproductive treatment (ART) were interviewed. The interview sessions spanned durations ranging from 20 min to 1 h and 35 min. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist. The infertility psychological distress experienced by women undergoing ART is a socially constructed phenomenon influenced by a dynamic interplay of forces that construct and conciliate it. The formation and progression of infertility psychological distress are rooted in the process of self-construction. A Middle-Ranged Theory titled 'self-reconstruction under the dome of infertility and infertility treatment' (SUDIT theory) was developed to explain this phenomenon. Within this framework, infertility psychological distress manifests across three distinct phases under the gambling ofthe constructive force and conciliative force: (1) distress of disrupting the former self; (2) distress linked to the struggling present self; and (3) the renewed-self harmonized with distress. It is imperative for healthcare professionals and policymakers to acknowledge the socially constructed nature of infertility psychological distress, and proactively implement measures aimed at ameliorating it. No patient or public contribution.

Utility of metabolic ratios in the diagnosis of tumor Thrombus on F-18 FDG PET/CT

BackgroundThis study aims to predict quantitative parameter in form of metabolic ratios to diagnose tumor thrombus on F-18 FDG PET/CT.MethodsThis is a retrospective study from Nuclear Medicine department at All India Institute of Medical Sciences, Jodhpur, India. Patients with malignancies who underwent F-18 FDG PET/CT in our department or images sent for review from February 2020 till September 2022 were screened for tumor thrombus that comprised study group. Control group had patients with malignancy and no imaging evidence of tumor thrombus. Metabolic activities (SUVmax) of tumor thrombus, liver and descending aorta in study group, and that of IVC, liver and descending aorta in control group were recorded. Metabolic ratios of tumor thrombus to liver (SUR L) and to aorta (SUR A) in study group, and IVC to liver (SUR* L) and to aorta (SUR*A) in control group were compared using receiver operator curves.ResultsOf 2277 studies screened, 12 had tumor thrombus. The most common primary malignant site and vessel involved were lung and IVC respectively. The median (IQR) SUR L, SUR A, SUR* L and SUR* A were 2.5 (3.25), 2.6 (6), 0.67 (0.18) and 1 (0.17) respectively. Area under ROC for SUR L and SUR A were 0.983 [95% CI: 0.955–1.0] and 0.958 [95% CI: 0.90–1.0] respectively. The ideal cut-off for SUR L was 0.953 (sensitivity 92.3%, specificity 98.0%) and for SUR A was 1.42 (sensitivity 84.6%, specificity 98.0%).ConclusionMetabolic ratios of tumor thrombus to liver (SUR L) and aorta (SUR A) have good diagnostic performance and can be useful in studies with non-iodinated contrast CT.

Analysis of injuries in aircraft accident victims in 2002–2022 based on the resources of the Jagiellonian University Department of Forensic Medicine in Kraków = Analiza obrażeń ofiar katastrof lotniczych w latach 2002–2022 na podstawie danych pochodzących z materiałów Zakładu Medycyny Sądowej Uniwersytetu Jagiellońskiego w Krakowie

Aim: The study aimed to analyse the most common injuries of victims of aviation accidents and compare it with the most recent literature. Methods and materials: Retrospective analysis of autopsy protocols of aircraft crash victims from the Forensic Medicine Department from years 2002–2022. The case selection has been made by two independent researchers. After applying the exclusion criteria 27 cases were obtained. Further searched for features that the bodies of victims had in common. There were analysed sex, age, circumstances of the incident, injuries, presence of psychoactive substances (alcohol, drugs), and blood concentration of carboxyhemoglobin. Results: Among 27 cases we found 19 airplane crashes, 4 glider accidents, 3 motor glider accidents, and one helicopter crash. The 1 case had no information about the type of aircraft. The injuries that emerged in each of the victims were typical results of direct impact forces. The most common were rupture of the lungs 63.0 % (n = 17/27), heart 55.6% (n = 15/27), liver 51.9% (n = 14/27), aorta 40.7% (n = 11/27) and spleen 29.6% (n = 8/27). Common bone traumas included fractures of the ribs 77.8% (n = 21/27) upper limbs 77.8% (n = 21/27), skull 74.1% (n = 20/27), pelvis 59.3% (n = 16/27) and spine 51.9% (n = 14/27). Injuries of the cervical spine occurred in victims who violently tilted their heads back. Conclusions: In most cases, the immediate cause of death was extensive multi-organ injuries, followed by thermal burns or brain injuries. In almost half of the victims, the presence of carboxyhemoglobin in the blood indicates that they were alive during the crashes. Knowledge of injury patterns can improve aviation safety and guide in reconstructing the mechanisms and sequences of the accidents.

Profile of patients coming to the department of physical medicine and rehabilitation for locomotor disability certification: a 5-years observational study

Background: The persons with locomotor disability are eligible for various social welfare benefits from the Government under ‘The persons with disabilities (Equal opportunities, protection of rights and full participation) Act, 1995’ along with other causes of disabilities like blindness, hearing impairment etc. and recent enactment of the Rights of Persons with Disabilities (RPwD) Act, 2016. Understanding the utilization of services is crucial in enhancing assistance for individuals with certifiable disabilities. This study aimed to observe the clinico-demographic profile of patients coming to outpatient Department of Physical Medicine and Rehabilitations for locomotor disabilities certification and 5 years’ trend in the number of patients getting disability certificate. Methods: This retrospective study was based on the data taken at time of disability certification in a multispecialty tertiary care government medical college in Northern India. All persons with locomotor disability who were issued disability certificate between 2014 and 2018 were included in the study. Results: A total of 857 patients were issued disability certificates during the study period of 2014 to 2018. Among the 744 adult patients, only 149 (20%) were female. Most of them were urban residents. In locomotor disability, post-polio residual paralysis was the most common diagnosis encountered, followed by amputations and cerebral palsy. Most of the applicants were having a disability of 40-50%. Conclusions: Awareness has to be generated about the disability benefits and disability certification. Utilisation of services by females should be encouraged. Robust data and literature need to be built up for prevention and management of locomotor disability.

Leptomeningeal carcinomatosis, an emerging disease in internal medicine departments with a generally poor prognosis: two case reports

As a result of improved diagnostic methods and higher cancer patient survival rates, leptomeningeal carcinomatosis is being found in internal medicine departments more frequently. Melanoma, lung cancer, and breast adenocarcinoma are the three cancers that are most commonly associated. When the main tumor diffuses through the bloodstream, cerebrospinal fluid, or direct diffusion and causes multiple focal neurological symptoms, it is known as leptomeningeal involvement; the prognosis is usually not good. Despite multimodal treatment, leptomeningeal carcinomatosis is an advanced form of cancer that frequently results in rapid death. Treatment is typically palliative and consists primarily of intrathecal or systemic radiation and/or chemotherapy. New experimental therapies and immunotherapy are promising means of lowering morbidity and mortality. Clinical cases of leptomeningeal carcinomatosis are reported; both cases were identified at the Ospedale dei Castelli’s Department of Internal Medicine and resulted from primary breast pathology.

DIABETES-RELATED SEXUAL DYSFUNCTION AND ITS ASSOCIATION WITH MICROVASCULAR COMPLICATIONS: A STUDY FROM TERTIARY CARE CENTER IN SOUTH KERALA

Objectives: (1) The objective of this study was to determine the frequency of sexual dysfunction (SD) among patients with Type 2 diabetes mellitus attending the General Medicine and Endocrinology Department at a tertiary care center in south Kerala. (2) To assess the relationship between erectile dysfunction and the microvascular consequences of Type 2 diabetes. (3) To correlate SD with glycemic status. Methods: One hundred and twenty patients with Type 2 diabetes at a tertiary care center in south Kerala participated in the cross-sectional study. A questionnaire was employed to document demographic and glycemic status. The assessment tools utilized included the International Index of Erectile Function for male and the Female Sexual Function Index (FSFI) scoring questionnaire for females. The statistical analysis employed included unpaired t-tests for students and tests assessing the equality of proportions. Results: About 65% of patients with diabetes mellitus had SD. About 46% of female participants and 78.6% of male participants in the study population had SD. Duration of diabetes, poor glycemic status, and microvascular complications correlated with SD. Conclusion: SD is frequent in patients with Type 2 diabetes mellitus. Glycemic control determines the development of SD. It is advisable to screen patients with Type 2 diabetes mellitus for SD as a proactive measure for early intervention and management.

The comparision among euploidy of preimplantation blastocysts in different controlled ovary stimulation (COH) protocols.

To compare differences in euploidy rates for blastocysts in preimplantation genetic testing for aneuploidy (PGT-A) cycles after gonadotropin-releasing hormone agonist (GnRH-a) long and short protocols, GnRH-antagonist (GnRH-ant) protocol, progestin-primed ovarian stimulation and mild stimulation protocols, and other ovary stimulation protocols. This was a retrospective cohort study from the Assisted Reproductive Medicine Department of Shanghai First Maternity and Infant Hospital. A total of 1657 PGT-A cycles with intracytoplasmic sperm injection after different controlled ovary hyperstimulation protocols were analyzed, and a total of 3154 embryos were biopsied. Differences in euploidy rate per embryo biopsied, embryo euploidy rate per oocyte retrieved and cycle cancellation rate were compared. For the PGT-A cycles, the euploidy rate per embryo biopsied was lower in the GnRH-ant protocol than in the GnRH-a long protocol (53.26 vs. 58.68%, respectively). Multiple linear regression showed that the GnRH-ant protocol was associated with a lower euploidy rate per embryo biopsied (β =  -0.079, p = 0.011). The euploidy rate per embryo biopsied was not affected by total gonadotropin dosage, duration of stimulation and number of oocytes retrieved. The embryo euploidy rate per oocyte retrieved was similar in all protocols and was negatively correlated with the total number of oocytes retrieved (β =  -0.003, p = 0.003). Compared with the GnRH-a long protocol, the GnRH-ant protocol was associated with a lower euploidy rate per embryo biopsied. The total gonadotropin dosage, duration of stimulation and number of oocytes retrieved did not appear to significantly influence euploidy rates.

CLINICAL PROFILE AND SPUTUM POSITIVITY RATE OF SUSPECTED PULMONARY TUBERCULOSIS PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL IN SOUTHERN RAJASTHAN

Objective: The purpose of the study is to understand the sputum acid-fast bacilli (AFB) positivity rate among suspected pulmonary tuberculosis (TB) patients presenting to tertiary care hospital in Southern Rajasthan with symptoms of chronic cough for more than 2 weeks. Methods: It is a retrospective observational study. Data from June 2021 to March 2024 were collected from registers maintained by the respiratory medicine department and analyzed. Results: Out of 1720 sputum samples of suspected pulmonary TB patients that were sent for microscopy 344 were AFB positive (20%) and 292 patients (16.97%) were GeneXpert positive. A total of 21 patients (1.22%) were found to have multidrug-resistant (MDR)-TB based on sputum GeneXpert testing. Most of the patients in our study were males and the sputum positivity rate was higher among diabetic and HIV-positive patients. Conclusion: In this study out of 1720 sputum samples analyzed for suspected pulmonary TB patients, 344 were sputum AFB positive (20%) and 21 were MDR-TB (1.22%).

Study of Thyroid Function Tests in Patients with Metabolic Syndrome

Study of Thyroid Function Tests in Patients with Metabolic Syndrome