Pattern Of Disease In Patients Research Articles

Core Promoter and Pre-Core Variants of the Hepatitis B Virus (HBV) Are Frequent in Chronic Hepatitis B HBeAg-Negative Patients Infected by Genotypes A and D.

In Brazil, hepatitis B virus endemicity is low, moderate, or high in some areas, such as Espírito Santo State in the southeast region. In this study, we intend to characterize the basal core promoter (BCP) and pre-core region (PC) variants and their association with clinical/epidemiological disease patterns in patients infected with genotypes A and D. The study included 116 chronic hepatitis B patients from Espírito Santo State, Southeast Brazil, infected with genotypes A and D. Basal core promoter (BCP) and pre-core mutations were analyzed in these patients. The frequency of BCP and PC mutations was compared with age, HBeAg status, HBV genotype and subgenotype, HBV-DNA level, clinical classification, and transmission route. HBeAg-negative status was found in 101 (87.1%) patients: 87 (75.0%) were infected with genotype A (A1 = 85; A2 = 2) and 29 (25.0%) were infected with genotype D (D3 = 24; D4 = 3; D2 = 2). BCP + PC variants altogether were more frequent (48.1%) in genotype D than in genotype A strains (6.0%) (p < 0.001). When this evaluation was performed considering the cases that presented only the A1762T and/or G1764A (BCP) mutations, it was observed that the frequency was higher in genotype A (67.5%) compared to genotype D (7.4%) (p < 0.001). On the other hand, considering the samples with mutations only in positions G1896A and/or G1899A (PC), the frequency was higher in genotype D (75.8%) than in genotype A (6.9%) (p < 0.001). Interestingly, HBV DNA was lower than 2000 IU/mL especially when both BCP/PC mutations were present (p < 0.001) or when only PC mutations were detected (p = 0.047), reinforcing their role in viral replication.

A study comparing the change in drug utilization pattern in medical intensive care unit of a tertiary care hospital in seven years

Background: Medical intensive care unit is a type of intensive care unit that takes care of a range of medical illnesses with patients who are seriously ill and/or suffer from severe chronic illnesses. These patients are usually prescribed multiple drugs. Use of antimicrobial agents and injectable medications in setting of MICU is high as compared with other class of drugs and other hospital settings respectively. Periodic evaluation of drug utilization pattern needs to be done to enable suitable modifications in prescription of drugs to increase the therapeutic benefit and decrease the adverse effects. There could be changes in drug utilization pattern due to changes in disease pattern, development of newer drugs, resistance to antimicrobial agents. Hence comparison of past and present data needs to be done to find out the changes that occurred in drug utilization pattern over the years. Methods: Data was collected from June 2021 to Dec 2021 for prospective arm and June 2014 to December 2014 for retrospective arm was obtained from MICU of tertiary care hospital and Medical Record Department. Drug utilization pattern was analysed and compared with appropriate statistical tests. Results: Most common cause of MICU admission was infective diseases (71% and 67% respectively in retrospective and prospective arm). The drug prescribed frequently was pantoprazole and antimicrobial was ceftriaxone in both the study arms. Half of the drugs were prescribed by generic names in both arms. Conclusions: There was no change observed in drug utilization pattern and disease pattern in patients admitted to medical intensive care unit over the years in our institute.

Whole genome sequencing and disease pattern in patients with juvenile polyposis syndrome: a nationwide study.

Juvenile polyposis syndrome (JPS) is a hereditary hamartomatous polyposis syndrome characterized by gastrointestinal juvenile polyps and increased risk of gastrointestinal cancer. Germline pathogenic variants are detected in SMAD4 or BMPR1A, however in a significant number of patients with JPS, the etiology is unknown. From Danish registers, and genetic department and laboratories, we identified all patients in Denmark with a clinical diagnosis of JPS and/or a pathogenic variant in BMPR1A or SMAD4. In patients where no variant had been detected, we performed genetic analysis, including whole genome sequencing. We collected clinical information on all patients to investigate the phenotypic spectrum. Sixty-six patients (mean age 40years) were included of whom the pathogenic variant was unknown in seven patients. We detected a pathogenic variant in SMAD4 or PTEN in additional three patients and thus ≈95% of patients had a pathogenic germline variant. Endoscopic information was available in fifty-two patients (79%) and of these 31 (60%) fulfilled the clinical criteria of JPS. In 41 patients (79%), other types of polyps than juvenile had been removed. Our results suggest that almost all patients with a clinical diagnosis of JPS has a pathogenic variant in mainly BMPR1A, SMAD4, and more rarely PTEN. However, not all patients with a pathogenic variant fulfil the clinical criteria of JPS. We also demonstrated a wide clinical spectrum, and that the histopathology of removed polyps varied.

Association of Circulating Heme Oxygenase-1, Lipid Profile and Coronary Disease Phenotype in Patients with Chronic Coronary Syndrome.

Background. The NF-E2–related factor 2 (Nrf2)/Heme Oxygenase-1 (HO-1) pathway has an emerging role in atherosclerosis. Activated by oxidative stress, it is deemed to exert athero-protective effects. We aimed at evaluating the relationships between plasma HO-1, clinical/molecular profiles and coronary disease patterns in patients with chronic coronary syndromes (CCS). Methods. HO-1 was measured in 526 patients (60 ± 9 years, 318 males) with CCS. Coronary computed tomography angiography (CTA) and stress imaging were used to assess the disease phenotype (coronary atherosclerosis and myocardial ischemia) in a subgroup of 347 patients. Results. In the overall population, HO-1 median value (25–75 percentile) was 5.195 (1.75–8.25) ng/mL. Patients with higher HO-1 were more frequently male, had a higher BMI and lower LVEF%, but otherwise similar risk factors than the other patients. Their bio-humoral profile was characterized by higher markers of endothelial/myocardial dysfunction, but lower levels of cholesterol lipoproteins. Coronary artery disease was characterized by more diffuse atherosclerosis, with mainly non-obstructive and calcified plaques, and a higher prevalence of functional ischemia. Conclusion: In patients with CCS, higher plasma HO-1 levels are associated with lower cholesterol and a more diffuse but mainly non-obstructive coronary atherosclerosis, confirming a potential role for the Nrf2/HO-1 pathway as a protective feedback.

Morphology of Coronary Artery Disease in a Patient with, Psoriasis Presenting with an Acute Coronary Syndrome

Background: This study was designed to evaluate the patterns of coronary artery disease in patients with Psoriasis presenting with acute coronary syndrome (ACS). Methods: This was a prospective, observational study, conducted on 28 patients with Psoriasis, presenting with acute coronary syndrome undergoing coronary angiogram from September 2017 to March 2021. All patients had undergone coronary angiogram; severity and morphology of coronary lesion were analyzed. Echocardiography was used to analyze LV wall motion and LV function. Results: The study showed that of 28 patients with Psoriasis who presented with ACS, 45.8% of patients were presented with NSTEMI, 39.2% % STEMI, and Unstable angina 15%. The average time of presentation after the onset of the symptom was 14.8 hours. 66 % of patients were a smoker. Coronary involvement 50% had TVD, 40% DVD, and 10% had SVD. In 77.6% culprit vessel was LAD, 10.4% LCX, and 12% RCA. In 75% of patient's coronary lesion was located in the proximal LAD. Chronic total occlusion was found in almost 26% of patients. Extensive LV wall motion abnormality with severe LV systolic dysfunction was noted in Psoriasis patients at the time of presentation (mean LVEF=28%). Conclusions: Psoriasis patients presenting with ACS, associated with increased severity of coronary lesions, multivessel involvement, and depressed LV systolic function.

Patterns of Coronary Artery lesion in a Patient with Chronic Obstructive Pulmonary Disease, Presenting with an Acute Coronary Syndrome

Background: This study was designed to evaluate the patterns of coronary artery disease in patients with chronic obstructive pulmonary disease (COPD) presenting with the acute coronary syndrome (ACS). Methods: This was a prospective, observational study, conducted on 69 patients with chronic obstructive pulmonary disease, presenting with acute coronary syndrome undergoing coronary angiogram from September 2017 to March 2021. All patients had undergone coronary angiogram; severity and morphology of lesion as well as the severity of calcium were analyzed. Results: The study showed that 69 patients with COPD who presented with ACS, 58.8% of patients were presented with NSTEMI, 30.2% STEMI and Unstable angina 11%. The average time of presentation after the onset of the symptom was 17.6 hours. 64% of patients were a smoker. Coronary involvement 10% of patients had LM, 50% TVD, 30% DVD, and 10% had SVD. Type a coronary lesion was seen in 5%, Type B in 20%, and Type C in 75% of patients. Mild Coronary calcium was seen in 25%. Moderate calcium was in 40% and severe calcium in 35%. Conclusions: COPD patients presenting with ACS, associated with increased severity of coronary calcium and coronary lesions.

Retrospective cohort study to investigate the 10-year trajectories of disease patterns in patients with hypertension and/or diabetes mellitus on subsequent cardiovascular outcomes and health service utilisation: a study protocol

IntroductionHypertension (HT) and diabetes mellitus (DM) and are major disease burdens in all healthcare systems. Given their high impact on morbidity, premature death and direct medical costs, we need to...

Analysis of Disease Patterns in Patients with Unilateral Sinonasal Diseases: A Tertiary Care Hospital Experience.

The aim of the present study was to evaluate the clinicopathological profile of sinonasal masses and to identify features suggestive of neoplastic pathology. A retrospective review of all sinonasal masses in patients attending a tertiary care hospital between April 2019 to Feb 2020 presenting at a tertiary care hospital were analysed. The demographic data, presenting symptoms, radiological and histopathological diagnosis were analysed. In the present study total 23 patients with age ranging from 8 to 72years were analysed. The overall M:F ratio was 1.55:1. Most of the patients (56%) belong to 31-60year age group. The main presenting symptoms were nasal obstruction and rhinorrhoea. Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be higher in neoplastic conditions. The number of non-neoplastic lesions were more than neoplastic with 78.2% being reported to be antrochoanal polyp and ethmoidal polyps, 8.69% being inverted papillomas and 13% cases were histopathologically reported to be malignant. Neoplastic conditions were significantly commoner in males and in the age group 40-60years. We concluded that clinical, radiologic, and histopathological evaluation is essential for proper diagnosis and stress the importance of immunohistochemistry which is the ultimate diagnostic technique in certain neoplastic lesions.

Fine-needle aspiration cytology of Bacille Calmette-Guerin adenitis: A perplexing distinct clinical entity.

Bacille Calmette-Guerin (BCG) adenitis is a common complication of post-BCG vaccination. Awareness of this lesser known entity in fine-needle aspiration (FNA) is important to prevent misdiagnosis. This study described the clinical presentation, cytomorphological features and disease pattern in patients with BCG adenitis. We analyzed a series of 15 patients with BCG adenitis seen from July 2017 to July 2019. The detailed clinical and cytomorphology of these cases were studied. Age of presentation ranged from 3 to 12 months. Male to female ratio was 2.75:1. A total of four children were diagnosed with primary immunodeficiency. Three children had acyanotic heart disease. Most of the children had left axillary lymph node enlargement. Cytomorphology showed the presence of polymorphs (66.7%), histiocytic aggregates (80%) and reactive lymphoid population (60%). Epithelioid granulomas (26.7%) and giant cells (6.7%) were present. The necrotic background was present in all but one case. Ziehl-Neelsen stain for acid-fast bacilli was positive in all but two cases. A high index of clinical suspicion for BCG lymphadenitis should be kept in mind for patients who are recently vaccinated. FNA cytology, combined with clinical correlation, is useful for diagnosis and management.

The role of hyperthermic intraperitoneal chemotherapy in the treatment of spontaneously ruptured hepatocellular carcinoma: a pilot study.

BackgroundSpontaneous tumor rupture is a distinctive disease pattern in patients with hepatocellular carcinoma (HCC). The application of hyperthermic intraperitoneal chemotherapy (HIPEC) in spontaneously ruptured hepatocellular carcinoma (srHCC) is debatable. Our study aimed to compare the long-term outcomes of srHCC vs. nrHCC and to test the role of postoperative HIPEC in patients with srHCC after hepatectomy.MethodsFrom 2014 to 2018, PSM was performed to compare 57 patients who performed liver resection for srHCC and met the research criteria with 57 nrHCC patients selected from 446 consecutive patients. Then patients with srHCC were divided into two groups according to whether they underwent HIPEC after hepatectomy.ResultsAfter 1:1 PSM, the clinical characteristics of the patients with srHCC and nrHCC were comparable. In terms of long-term outcomes, the nrHCC group had significantly longer OS (P=0.026) and DFS (P<0.001) than the srHCC group. Of the 57 srHCC patients, the HIPEC group showed added complications compared to the non-HIPEC group, including an increased length of hospital stay and higher in-hospital costs. However, there were no significant differences in the metastatic patterns of these recurrent patients, and there was no statistically significant difference in DFS (P=0.28) or OS (P=0.56) between the two groups.ConclusionsThe prognosis of ruptured HCC patients were worse than those of non-ruptured HCC patients. HIPEC may not be a robust treatment for srHCC now.

Parameters of the Subjective Pattern of Disease in Rheumatoid Patients

Introduction. A patient’s subjective pattern of disease (SPD) is considered both as a result of his/her adjustment to disease and as an instrument of personal self-regulation in disease. Modern clinical psychology actively investigates this psychological construct, which expands available knowledge obtained in the process of determining psychological factors of the treatment process. The present study appears to be the first that examines rheumatoid patients using a SPD multilevel model, which focuses on illness perceptions and coping with it. Methods. The study sample consisted of 80 patients with rheumatic diseases aged 18–52 years, 50 % of whom were patients with rheumatoid arthritis (RA) and 50 % of whom were patients with systemic lupus erythematosus (SLE). The study used the following techniques for assessing the structure and content of various levels of the subjective pattern of disease: (a) the Symptoms Check-List-90-Revised (SCL-90-R), (b) the Brief Inventory of Illness Perceptions, and (c) the technique for psychological assessment of coping with stressful and problematic events. Results. In the comparison groups, significant differences were observed on the scales of illness perceptions (‘illness understanding’, ‘course of illness’, ‘control of illness’, ‘control of treatment’), the scales of coping behavior (‘search for social support’, ‘acceptance of responsibility’), and the scales of ‘somatization’, ‘depression’, and ‘anxiety’. The correlations indicate associations among the parameters of various levels of the subjective pattern of disease in patients in both groups. Discussion. The parameters of the subjective pattern of disease in patients with systemic lupus erythematosus indicate their desire to recognize and overcome uncertainty and unpredictability of their disease. However, this does not reduce their emotional involvement in the problem. The subjective pattern of disease in patients with rheumatoid arthritis is characterized by a worse understanding and control of disease, as well as by emotion-focused coping strategies aimed at distancing from anxiety-related experiences associated with their disease.

Prevalence and patterns of coronary artery disease in patients undergoing cardiac surgery for rheumatic and non- rheumatic valvular heart disease in a tertiary care center of Nepal

Background and Aims: Coronary artery disease (CAD) constitute a major cause of cardiovascular morbidity and mortality worldwide with an enormous burden on healthcare resources. Prevalence and pattern of CAD in patients of rheumatic and non-rhemuatic valvular heart diseases varies widely with limited data on optimal strategies for diagnosis and treatment.Methods: This study includes 97 patients with rheumatic and non-rheumatic valvular heart disease who underwent coronary angiogram (CAG) before cardiac surgery. Patients were divided into two groups based on rheumatic heart disease (RHD) &amp; non-rheumatic disease (Non-RHD) and correlate the patterns of CAD.Results: Out of 97 patients, 22 (22.6%) patients were found to have significant CAD. In patients with non-rheumatic origin CAD was common (15 patients, 68.1%) as compared to rheumatic origin (7 patients, 31. 8%). In rheumatic origin, the prevalence was 7(12.2%) out of 57 patients while in non-rheumatic origin, was 15(37.5%) out of 40 patients. In RHD group, all patients with CAD were found to have single vessel diease (SVD) while, in non-RHD group, 11 patients (73.3%) had SVD, 3 patients (16.7%) had double vessel disease (DVD) and one patient (5.6%) had triple vessel disease (TVD).Conclusions: Prevalence of CAD is higher in patients with non-RHD in comparison to those with RHD. We also found SVD to be the most common pattern of CAD in both rheumatic and non-rheumatic valvular heart disease.

THE STATE OF ANTIOXIDANT SYSTEM OF BLOOD IN PATIENTS SUFFERING FROM PSYCHOSTIMULANTS AND OPIOIDS ADDICTION SYNDROME

Aim. This study was designed to perform the comparative evaluation of functioning of antioxidant system of blood in patients 137 Kubanskij nauchnyj medicinskij vestnik 2018; 25 (5) suffering from psychostimulants and opioids addiction syndrome.Materials and methods. The study was performed using biological material of 52 patients divided into 3 groups. Patients who were considered to be conditionally healthy were included in the 1st (control) group. The 2nd group was presented by the patients suffering from opioids addiction syndrome, the 3rd group included patients suffering from psychostimulants addiction syndrome. Some parameters of the thiol metabolism and general antioxidant activity were identified in the blood plasma of patients as well as the level of products of oxidative modifications of biomolecules and the activity of enzymes of antioxidant protection in the erythrocytes.Results. In the course of the performed studies it was revealed that the decreased antioxidant activity of the blood plasma by 28-40% was characteristic for the examined patients as well as the imbalance of enzymes of the antiradical protection of erythrocytes and the high intensity of oxidative modifications of biomolecules characterized by the increase in the thiobarbituric value by 2,4-3 times. The activity of superoxide dismutase in erythrocytes of patients of both test groups decreased by 35-43%, while the catalase activity increased by 15-21% in comparison with the relevant indices of the control group. The presence of such changes in the functioning of enzymes of the antioxidant protection can indirectly prove the presence of hypoxia in the examined patients. Besides, the increase in the content of easily-accessible thiol groups by 2,6-2,8 times and the decrease in the content of SH-groups difficult for access by 2,5-3,2 times was noted in patients suffering from the drug addiction. The reconstruction of the balance of various types of thiol groups can be associated with the confirmatory reconstruction of protein molecules induced by the oxidative modifications and combining of toxins.Conclusion. The study in prooxidant-antioxidant status revealed the common traits in the disease pattern in patients suffering from various types of drug addiction. The received data allow us to discuss the perspectives of the criteria search for the laboratory biochemical monitoring of the patients with drug addiction and the possibilities of the antioxidant correction of metabolic disorders as a component of the complex therapy for such patients.

VALUE OF FRACTAL ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN VARIOUS STAGES OF DIABETIC RETINOPATHY.

To use fractal dimensional analysis to investigate retinal vascular disease patterns in patients with diabetic retinopathy using spectral domain optical coherence tomography angiography. A retrospective study was conducted which included 49 eyes from 26 control subjects and 58 eyes from 35 patients known to have diabetic retinopathy. Of the 58 eyes with known retinopathy, 31 were categorized as nonproliferative diabetic retinopathy (13 mild, 9 moderate, and 9 severe) and 27 were categorized as proliferative diabetic retinopathy. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti (Optovue, Inc). Automated segmentation was obtained through both the superficial and deep capillary plexuses for each eye. Grayscale optical coherence tomography angiography images were standardized and binarized using ImageJ (National Institutes of Health). Fractal box-counting analyses were conducted using Fractalyse (ThéMA). Fractal dimensions (FDs) and correlation coefficient of the superficial and deep capillary plexuses were compared between control eyes and those in various stages of diabetic retinopathy. The superficial and deep capillary plexuses from diabetic and control eyes were analyzed. The average FD for diabetic eyes was significantly lower than in control eyes in the superficial plexus (P = 2.4 × 10) and in the deep capillary plexus (P = 1.87 × 10 ) with a more statistically significant difference noted in the deep capillary plexus. When analyzing diabetic patients without edema noted on optical coherence tomography, the FD was significantly reduced in the superficial (P = 0.001) and deep (P = 1.49 × 10) plexuses. When analyzing diabetic patients with edema noted on optical coherence tomography, the FD was significantly reduced in the superficial (P = 2.0 × 10) and deep (P = 1.85 × 10) plexuses. The optical coherence tomography angiography FD is significantly lower in both superficial and deep capillary plexuses in eyes with all stages studied of diabetic retinopathy. The results were more often significant for the deep capillary plexus. The use of fractal analysis provides an objective criterion to assess microvascular disease burden in diabetic retinopathy.

23 - A new explanation for rising rates of anal cancer

Background Anal intraepithelial neoplasia (AIN) is associated with high-risk human papillomavirus (hrHPV) infection and is a precursor to anal cancer. Factors other than hrHPV are likely to be involved in causing AIN and further study of cofactors is required. Methods A surgical database of patients having anal warts removed was established at Royal Perth Hospital in 1995 and epidemiological information concerning age, sex, sexual preference, history or clinical evidence of gonorrhoea or chlamydia infection and serological evidence of HIV-1, HSV-2, hepatitis B or C virus infection and syphilis has been prospectively collected since then. Three hundred and fourteen patients underwent 457 operations from June 1995 to November 2016. Histopathology and hrHPV testing using the Digene Hybrid Capture 2 (HC2) method were performed at the time of surgery. Results hrHPV alone was associated with high-grade squamous epithelial lesions (HSIL) (OR=4.65, p Conclusions HrHPV is a sufficient cause of anal HSIL but seropositivity for HIV-1, HSV-2, T. pallidum , HBV, HCV infections and a history of gonorrhoea or chlamydia exert a powerful amplifying factor increasing the risk of HSIL above the risk with hrHPV alone. This pattern of disease in patients with warts is characteristic of a syndemic with potential increased risk of anal carcinoma in men because of rising rates of sexually-transmitted infections.

Changing disease pattern of patients attending a geriatric clinic in India

Background: Psychiatric morbidity is common in geriatric population along with other medical ailments. Increasing longevity contributes to higher prevalence of degenerative diseases in the elderly. In this perspective, the disease patterns may have changed in this age group and more so in the developing countries. Objectives: The current study explores the sociodemographic profile, disease patterns of various psychiatric ICD-10 diagnoses, and medical comorbidities in the elderly outpatients attending geriatric clinic. Materials and Method: The sample consists of 319 elderly outpatients attending geriatric clinic from September 1999 to December 2002 at National Institute of Mental Health and Neuro-Sciences, Bengaluru, India. This institute is one of the 10/66 centers. This sample is a heterogeneous population of both genders and age >60 years. The patients were assessed using a semi-structured interview as well as laboratory and other investigations as required. Results: The common psychiatric morbidity of this population is dementia (42.4%) and affective disorders (27.3%). However, the medical comorbidity of these patients is also high (41.9%). Previous study from the same center in 1996 reported that 4.2% of patients attending psychiatric services were 60 years and above. The most common problems in the previous study included psychoses (66%), of which about two-thirds (43% of the total) were non-organic psychoses. Conclusion: Dementia, a degenerative disease, forms the largest group of mental illness in elderly outpatients attending geriatric clinic. Other organic psychiatric diseases follow this. Medical comorbidity is concurrently seen in patients with the psychiatric morbidity. This extrapolates the requirement of the multidisciplinary approach in managing the patients in geriatric age group.

Syndemic synergy of HPV and other sexually transmitted pathogens in the development of high-grade anal squamous intraepithelial lesions

BackgroundAnal intraepithelial neoplasia is associated with high-risk human papillomavirus (hrHPV) as a precursor to anal cancer. However, factors other than hrHPV are likely to be involved and further study of cofactors is required because of the possibility of syndemic interactions. MethodsThree hundred and fourteen patients underwent 457 operations. Histopathology and hrHPV testing using the Digene Hybrid Capture 2 (HC 2) method were performed. Demographic factors and sexually transmissible infections (STIs) were recorded. ResultsResults showed that hrHPV alone was associated with HSIL (OR = 4.65, p < 0.001). None of the other STIs were alone associated with HSIL but amplification of risk was found when hrHPV infection occurred with HIV (OR = 11.1); syphilis (OR = 5.58); HSV 2 (OR = 7.85); gonorrhoea (OR = 6.45) and some other infections. ConclusionsThese results suggest that hrHPV is a sufficient cause of anal HSIL. Seropositivity for HIV, HSV 2, T. pallidum, HBV and HCV and a history of gonorrhoea or chlamydia exert a powerful amplifying factor increasing the risk of HSIL above the risk with hrHPV alone. Other co-factors which are associated with an increased risk of HSIL are increased age, male gender, MSM behaviour and self-reported history of more than 50 sexual partners. This pattern of disease in patients with warts is characteristic of a syndemic with potential serious increased risk of anal carcinoma.

Histopathologic and molecular approach to staging of multiple lung nodules.

Distinguishing multiple primary lung cancers from intrapulmonary metastases in patients with synchronous multifocal lung adenocarcinomas can be challenging. The most recent 8th edition American Joint Committee on Cancer staging manual (AJCC staging manual) distinguishes four disease patterns in patients with multiple lung nodules: (I) two or more distinct and histologically different masses (considered unrelated and staged as individual cancers); (II) multiple ground-glass or part-solid nodules, histologically of with lepidic growth pattern (considered separate tumors, T staged based on highest T stage lesion); (III) patchy areas of ground-glass and consolidations, histologically often invasive mucinous adenocarcinomas (considered single tumor with diffuse "pneumonic-type" involvement); and (IV) separate nodules with the same histologic features based on comprehensive histologic subtyping (considered intrapulmonary metastases). Histologic and molecular features, in conjunction with clinical and radiological information, can all be tools to assist with staging of multiple nodules. Histologic features of adenocarcinomas are best characterized using comprehensive histologic subtyping (percentage of lepidic, acinar, solid, papillary and micropapillary pattern). Genomic alterations are commonly assessed using fluorescence in-situ hybridization and next generation sequencing (NGS). The AJCC considers exactly matching breakpoints by comparative genomic hybridization (CGH) as the only evidence for intrapulmonary metastases, and clearly different histologic types or subtypes as the only evidence for separate primary tumors. Similar histologic subtypes or the same biomarker pattern are considered merely relative arguments in favor of a single tumor source. When assessing multifocal lung cancer, pathologists should consider, and carefully weigh the importance of, molecular testing results in addition to the tumor's histologic features. For many cases encountered in routine clinical practice, absolute certainty cannot be reached as to whether they represent multiple primary cancers or intrapulmonary metastases. Classification of difficult cases often benefits from multidisciplinary discussion.

Patterns of Disease in Patients with Middle-Lobe Predominant Bronchiectasis

Background: Middle-lobe predominant bronchiectasis affecting the right middle-lobe and/or lingula (RMLP) is classically described in asthenic, elderly females with skeletal abnormalities or associated nontuberculous mycobacterial (NTM) infection. Objectives: We aimed to evaluate the frequency and clinical characteristics of patients with an RMLP phenotype in a cohort of newly diagnosed bronchiectasis patients and determine associations with disease severity. Methods: A retrospective observational cross-sectional cohort study of consecutive bronchiectasis patients in our institution was performed. Data were collected on baseline variables, microbiology status, lung function, and radiology according to the modified Bhalla score. Disease severity was assessed using bronchiectasis severity index (BSI) and FACED severity scores. Results: Of 81 patients (mean age [SD] 62.6 [12.4], females 55 [67.9%], BMI 26.9 [5.7%]), 20 (24.7%) had RMLP disease. These patients were significantly younger, female, and with lower BMIs than patients with the classical bronchiectasis phenotype (p = 0.03, 0.01, and p <0.01, respectively). Fewer symptoms of cough and daily sputum (p = 0.01 and <0.01), prior exacerbation frequency (p = 0.03), and higher baseline forced expiratory volume (p = 0.04) were noted. A higher incidence of NTM at diagnosis was demonstrated (p = 0.01). BSI and FACED severity scores in RMLP patients were significantly lower than their counterparts (both p < 0.001). Conclusions: The RMLP phenotype is associated with younger patients than classically described in the literature. An increased rate of NTM infection in this phenotype was noted, particularly in females, but much lower than previously described. Lung function and disease severity scores in this patient group are relatively normal, suggesting a milder phenotype in patients with this form of the disease.

Patterns of scrotal pain in a hospital setting

Introduction: Scrotal pain is a common urological condition. Common causes of scrotal pain are testicular torsion, epididymitis, epididymo-orchitis and occasionally due to post vasectomy pain, varicocele, testicular trauma etc. The objective of our study is to review the different disease patterns in patients presenting with scrotal pain in a tertiary care hospital.Methods: Patients presenting with scrotal pain to the out-patient clinic and the emergency department were included in the study. All patients were subjected to urinalysis and ultrasound of scrotum with color Doppler study when needed. Descriptive variables were studied and analyzed.Results: Eighty three patients were enrolled in the study during the period of one year. Age ranged from 13 to 72 years; most of the patients were less than 40 years and more than 20 years. Among this age group non-specific orchalgia was very common. Isolated epididymitis was seen in only 4 (4.81%) patients. Epididymo-orchitis was found in 16 (19.27%) patients. Torsion of testis was found in 6 patients (7.22%). The major bulk of the patients presenting with scrotal pain were nonspecific which was found in 39 (46.98%) and exact cause could not be found in them. Total of 15 (18%) patients had acute presentation.Conclusion: Management of Scrotal pain can be simple or at times organ threatening, proper diagnosis and treatment by clinical judgment and necessary investigation is very important.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 31-34