Female Patients Research Articles

The relationship between anxiety and postoperative pain after Laparoscopic Sleeve Gastrectomy; A prospective cohort study

Background: Anxiety is an emotional situation marked by apprehension, agitation, tachypnea, tachycardia and hypertension. There has been a recent rise in the amount of patients who have undergone surgery for morbid obesity. The STAI anxiety scale was the primary tool for measuring anxiety levels. Aim: The purpose of this research was to evaluate the levels of anxiety in patients with morbid obesity both before and after surgery and to identify the factors that contribute to this anxiety. Methods: This is a prospective cohort study that uses quantitive descriptive methodology. The study included 129 patients planned for laparoscopic sleeve gastrectomy. The STAI anxiety scale was used to assess anxiety levels both before and after surgery. The patients' pain levels were assessed using VAS during the postoperative period. Results: In comparison of genders, female patients' pre-op anxiety levels were statistically significantly higher (p= 0.001). The anxiety levels differed significantly between preoperative and postoperative patients. Even it has not reached a significant level, the elderly group had lower pre-op anxiety scores than the others, but higher post-op anxiety scores. Educational level didn’t effect anxiety scores. The correlation between patients' anxiety levels and VAS pain levels was found to be statistically significant (p=0.001). Conclusions: Anxiety plays a significant role in influencing postoperative pain and the subsequent analgesic needs after sleeve gastrectomy procedures. Postoperative pain is the primary cause of perioperative anxiety. Females exhibit higher preoperative anxiety levels than males.

The seroprevalence of COVID-19 among people living with HIV in Morocco

The association of COVID-19 and HIV infection would seem deadly in terms of prognosis and the possibilities of viral clearance given the immunodeficiency. However, a lower seroprevalence has been reported in some studies compared to that found in the non-HIV population. The objective of this study is to determine the seroprevalence of COVID-19 among people living with HIV (PLHIV) in Morocco. This is a prospective study carried out in the infectious diseases department of the Ibn Rochd University Hospital in Casablanca. We included PLHIV who consulted the Infectious Diseases Day-Hospital service between January 18, 2021 and March 10, 2021. After informed consent, patients completed a survey and had blood drawn for SARS-CoV-2 antibody testing. The determination of IgG antibodies against SARS-CoV-2 in blood was carried out using chemiluminescence microparticle immunoassay technology. We included 418 PLHIV in the study, most patients were male (50.24%), the average age was 40 years, 90.2% of patients were on antiretroviral treatment, 56.7% had a viral load <20 copies/ml, and 47.37% had a CD4 count greater than 500 cells/μL. The IgG test was positive in 53 patients, representing a seroprevalence of 12.68%. None of the patients had clinical signs. Seroprevalence was higher in female patients (58.49%), aged between 30 and 40 years (41.51%), in patients with a negative viral load (64.15%) and a CD4 count greater than 500 cells/mm3 (49.6%). Our study showed that the seroprevalence of COVID-19 was higher among PLHIV compared to people without HIV infection. All the patients had asymptomatic forms which pushes us to evoke a theory, to demonstrate, of the action of antiretrovirals against SARS-CoV-2.

The Benefits of Breast Massage: A Qualitative Study

Massage therapy has grown as a profession, and its use in the traditional medical setting is rapidly increasing. Massage therapy has been shown to have positive physical, psychological, and biochemical effects. The aim of this study is to review the reasons patients choose breast massage therapy and the benefits of breast massage therapy. Ten female patients of 18 years and older participated and completed the survey. Of the ten patients, the average age was 37.5 years. Most common reasons for choosing breast massage include: improve overall health (90%) and overall well-being (80%), relieve muscle tension (80%), reduce stress (70%), and increase size/firmness/elasticity (70%). Almost all patients reported an improvement in quality of life. Bust size increased for nine patients. Most patients reported a reduction in breast pain, reduction in breast swelling, increase in breast size, increase in breast firmness, improved skin elasticity, improved physical health, improved psychological health, and improved overall health and well-being. Breast massage has positive effects on physical and psychological health and well-being. Its use is increasingly sought after to improve breast health and overall health and wellness. Physicians, healthcare providers, and patients should consider breast massage therapy as complementary and alternative medicine.

A case report of Steven Johnson’s Syndrome (SJS) /Toxic Epidermal Necrolysis(TEN) overlap caused by Nimesulide

Introduction: Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, acute and life-threatening mucocutaneous diseases that are nearly always drug-related. Incidence of SJS and TEN is 0.05 to 2 persons per million populations per year. In India, Nimesulide is easily available as an over the counter drug (OTC), different cutaneous reactions associated with, Nimesulide including angioedema, maculo-papular rash, severe urticaria, pityriasis rosea and worsening of preexisting psoriasis. Patient concern (Case summary): A 17 years old female patient complained about fever and she was prescribed with Tab.Nimesulide twice daily by private practitioner. On the 3rd day of intake of oral Nimesulide, patient developed skin lesions over face, trunk, back and all four limbs. This reaction was diagnosed as Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) overlap by Nimesulide based on clinical picture and drug history. Interventions: Tab. Nimesulide was stopped and patient was admitted in dermatology ward. Patient was treated with Inj.Hydrocortisone sodium succinate 100mg iv twice daily, Inj.Cefotaxime 1gm iv thrice a daily, Inj. Metronidazole 500mg once a day and Liquid Cyclosporine 50mg twice a day for 10days. Other treatments included Inj. Albumin 100ml i.v slowly for 3 days given. Patient recovered and was discharged after 10 days. Conclusion: We are presenting a case of SJS-TEN overlap caused by Nimesulide, which is commonly used as an over the counter drug (OTC). Our aims to minimize this type of serious ADR by making alert to physicians and other healthcare professionals, we can avoid hospital admissions because of ADR, reduce economic burden of the patients and health related quality of life of the patient can be improved.

Addressing olanzapine-induced diabetic ketoacidosis in a major depressive disorder case

This case study highlights a critical incidence of olanzapine-induced diabetic ketoacidosis (DKA) in a 36-year-old female patient treated for major depressive disorder with psychotic features. The patient developed severe DKA after the initiation of olanzapine, despite initially normal metabolic parameters and a low starting dose. This report underscores the acute metabolic derangement facilitated by olanza- pine, necessitating a comprehensive and urgent medical approach. The clinical intervention involved discontinuing olanzapine and initiating a multidisciplinary treatment strategy, which included medical management of DKA and psychiatric adjustments using alternatives with a lower metabolic risk. This case emphasizes the necessity for regular metabolic monitoring and the potential need for tailored psychiatric medication strategies to prevent severe side effects, highlighting the unpredictability of antipsychotic- induced metabolic disturbances and advocating for a holistic, patient-centered approach in psychiatric care.

Research progress of acupuncture regulating ERK signaling pathway in the treatment of depression.

Acupuncture treatment for depression has definite therapeutic efficacy, and its mechanism has been extensively studied. The extracellular regulatory protein kinase(ERK) signaling pathway is involved in the development and progression of depression. This article reviewed and summarized the research progress on the regulation of the ERK signaling pathway by acupuncture in the treatment of depression in recent years, focusing on the physiological activation and regulatory mechanism of the ERK signaling pathway, its association with the occurrence of depression, and the mechanisms through which acupuncture activates the ERK signaling pathway to treat depression (including enhancing neuronal synaptic plasticity, promoting the release of neurotrophic factors, and inhibiting neuronal apoptosis). Future research could explore the relationship between the ERK pathway and other pathways, investigate other brain regions besides the prefrontal cortex and hippocampus, examine differences in regulatory mechanisms between male and female patients, assess the effects of different acupuncture techniques on the ERK pathway, and increase efforts to explore mechanism of synaptic plasticity regulation, so as to provide reference for the clinical application and mechanism sludy of acupuncture in depression treatment.

Correlation Between Serum microRNA-18a Level and Endothelial Function and Prognosis in Female Coronary Heart Disease Patients.

The aim was to analyze the correlation between serum microRNA (miR)-18a level, endothelial function, and prognosis in female coronary heart disease (CHD) patients. One hundred sixtyfemale patients admitted to our hospital for the first occurrences of chest pain and tightness were divided into CHD and non-CHD groups based on the coronary angiography results. Clinical data, laboratory indexes, serum miR-18a level, and endothelial function [flow-mediated dilation (FMD) function, endothelin 1 (ET-1), and nitric oxide (NO)] were compared. There were no significant differences in clinical data (except CHD family history) between 2 groups. Coronary heart disease group had significantly lower levels of NO and FMD, while significantly higher levels of miR-18a and ET-1 than non-CHD group (P <.05). Pearson correlation showed that serum miR-18a level was positively correlated with ET-1 (r = 0.492, P <.001), and negatively correlated with NO and FMD (r = -0.504, -0.307, P <.001). The receiver operating characteristic) curve showed that the area under the curve of serum miR-18a level in predicting the occurrence of CHD in women was 0.878 (95% CI: 0.828-0.928). Compared with good prognosis group, poor prognosis group had signifi-cantly lower NO, and FMD levels, while higher proportions of acute coronary syndrome, multivessel disease, miR-18a, and ET-1 levels (P <.05). The expression of serum miR-18a in female CHD patients was high, which was related to endothelial function. The increase in serum miR-18a level was a risk factor for the occurrence of MACE in female CHD patients during follow-up, and the serum miR-18a level could effectively predict the occurrence of CHD in female patients.

Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023.

The COVID-19 pandemic has exerted a significant toll on individual health and the efficacy of health care systems. However, the influence of COVID-19 on the frequency and outcomes of out-of-hospital cardiac arrest (OHCA) within the Chinese population, both before and throughout the entire pandemic period, remains to be clarified. This study aimed to fill the gaps by investigating the prevalence and outcomes of OHCA in Hong Kong (HK) both before and during the whole pandemic period. This is a retrospective regional registry study. The researchers matched OHCA data with COVID-19-confirmed case records between December 2017 and May 2023. The data included information on response times, location of OHCA, witness presence, initial rhythm, bystander cardiopulmonary resuscitation (CPR), use of public-access defibrillation, resuscitation in the accident and emergency department, and survival to admission. Descriptive analyses were conducted, and statistical tests such as analysis of variance and χ2 were used to examine differences between variables. The incidence of OHCA and survival rates were calculated, and logistic regression analysis was performed to assess associations. The prevalence of OHCA and COVID-19 during the peak of the pandemic was also described. A total of 43,882 cases of OHCA were reported in HK and included in our analysis. Around 13,946 cases were recorded during the prepandemic period (2017-2019), and the remaining 29,936 cases were reported during the pandemic period (2020-2023). During the pandemic period, the proportion of female patients increased to 44.1% (13,215/29,936), and the average age increased slightly to 76.5 (SD 18.5) years. The majority of OHCAs (n=18,143, 61.1% cases) occurred at home. A witness was present in 45.9% (n=10,723) of the cases, and bystander CPR was initiated in 44.6% (n=13,318) of the cases. There was a significant increase in OHCA incidence, with a corresponding decrease in survival rates compared to the prepandemic period. The location of OHCA shifted, with a decrease in incidents in public places and a potential increase in incidents at home. We found that CPR (odds ratio 1.48, 95% CI 1.17-1.86) and public-access defibrillation (odds ratio 1.16, 95% CI 1.05-1.28) were significantly associated with a high survival to admission rate during the pandemic period. There was a correlation between the development of OHCA and the prevalence of COVID-19 in HK. The COVID-19 pandemic has had a significant impact on OHCA in HK, resulting in increased incidence and decreased survival rates. The findings highlight the importance of addressing the indirect effects of the pandemic, such as increased stress levels and strain on health care systems, on OHCA outcomes. Strategies should be developed to improve OHCA prevention, emergency response systems, and health care services during public health emergencies to mitigate the impact on population health.

Application of Endoscopic Submucosal Dissection (ESD) in Treatment of Gastrointestinal Lesions-Single Center Experience.

Background and Objectives: Endoscopic resection of gastrointestinal (GI) tract lesions, originating from Japan, is becoming more frequently used in European countries. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) ensure minimally invasive removal of benign, premalignant, and early neoplastic tumors of esophagus, stomach, and intestine in selected group of patients. Aim of this study was to determine the outcomes, radical resection rate (R0), and complication rate of ESD procedures performed in our department. Methods: The data from 100 ESD procedures of esophageal, gastric, duodenal, and colorectal lesions performed in out unit between 02.01.2020 and 30.06.2023 were collected and analyzed retrospectively. Results: A total of 42 male and 58 female patients in the median age of 64 years (range, 31-89 years) underwent ESD. Mean duration of the procedure was 66 minutes (ranging 25-185 minutes). Tumors were located in the esophagus in 8 cases (8%), stomach in 25 cases (25%), duodenum in 1 case (1%), and colon in 66 cases (66%). Radical resection was achieved in 98 cases (98%); 2 patients were qualified for surgical treatment. Average size of dissection lesions was 26 × 19 mm. The biggest one was 60 × 60 mm (sigmoid adenoma), and the smallest one was 5 × 5 mm (gastrointestinal neuroectodermal tumors). Complication occurred in 10 patients (10%)-9 perforations of the wall of intestine (9%) and 1 hemorrhage, which required endoscopic intervention (1%). Conclusions: Implementation of ESD to clinical practice gives the opportunity for minimally invasive, radical treatment of benign, premalignant, and early neoplastic lesions of gastrointestinal tract in selected group of patients. Experienced endoscopists, following current guidelines and standardized process of qualification, are crucial to minimize the risk of severe complications.

Relationship between nutrition indicators and pneumonia risk among stable schizophrenia patients: a retrospective study.

It is reported that reduced physical activity and malnutrition may trigger pneumonia, and the utilisation of the geriatric nutritional risk index (GNRI) upon admission to long-term nursing care can enable the implementation of accurate and timely rehabilitation and nutritional support, which may, in turn, minimise pneumonia incidence. However, to date, there is no reported association between GNRI and pneumonia among stable schizophrenic patients. This is a retrospective investigation. We enrolled 434 hospitalised subjects aged ≥50 years, who were diagnosed with stable schizophrenia between January 2017 and June 2022. Baseline nutritional status information during the stable stage of schizophrenia was evaluated using body mass index, serum albumin, and GNRI. In addition, pneumonia-based information, including diagnosis and treatment, was retrospectively obtained within 1 year. To examine the potential association between nutrition indicators and pneumonia risk among stable schizophrenia patients, we employed a logistic regression analysis. The pneumonia incidence among all stable schizophrenia patients was 10.14%, and there were no statistically significant difference between sexes (male vs. female, 10.63% vs. 9.44%, P = 0.687). Based on the univariate analysis of nutrition indicators and pneumonia, female patients exhibited a strong correlation between serum albumin and pneumonia (P = 0.022). Furthermore, we adjusted for potential influencing factors of pneumonia infection, and confirmed that only serum albumin was linked to pneumonia risk in female stable schizophrenia patients (odds ratio = 0.854, 95% CI: 0.749-0.975, P = 0.02). Based on our analysis, serum albumin was strongly correlated with pneumonia risk in female stable schizophrenia patients.

A compressive assessment of patient satisfaction with ophthalmology with ophthalmology clinic services: A study at a tertiary care academic institution amidst and after the COVID-19 pandemic.

The study aims to systematically assess patient satisfaction concerning eye care services provided during and after the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care academic institution. This work seeks to analyze the various dimensions influencing the holistic measure of overall patient contentment. A cohort of 2485 patients seeking physical consultation for ocular conditions at a tertiary care academic institution between April 2020 and December 2022 were recruited in a cross-sectional study. They were divided into two groups, viz. during the COVID period and post-COVID period. The primary focus was on evaluating overall satisfaction, measured through a validated patient satisfaction questionnaire (PSQ-18). The study encompassed a total of 2485 participants, with 1242 individuals in the cohort during the COVID period and 1243 in the post-COVID phase. Within the COVID period subgroup, the mean age of male and female patients was 39.46 ± 19.31 and 39.58 ± 19.07 years, respectively. In the post-COVID subgroup, the mean age of male and female patients was 45.26 ± 19.38 and 45.36 ± 19.22 years, respectively. Examining the COVID subgroup, the highest satisfaction scores were observed in the domain of time spent with the doctor (3.3453 ± 0.59), followed by financial aspects (3.0816 ± 0.47), interpersonal manner (3.0589 ± 0.37), and accessibility and convenience (3.0585 ± 0.37). Notably, technical quality received the lowest satisfaction score (2.4763 ± 0.42). A statistically significant difference (P < 0.0001) was noted in the PSQ-18 scores between the two groups. In the post-COVID subgroup, patients expressed higher satisfaction with the technical quality of treatment, irrespective of the mode of management. However, financial satisfaction was better in the COVID group. Our study using the PSQ-18 questionnaire highlights significant variations in patient satisfaction with ophthalmology clinic services during and after the COVID era. Notably, time spent with the doctor scored the highest, emphasizing its positive impact. However, addressing concerns related to technical quality is crucial for overall improvement.

Sex Difference in Characteristics and Predictors of In-Hospital Mortality Among Patients with COVID-19.

With the surge in the prevalence of coronavirus disease (COVID-19) in Beijing starting in October 2022, hospitalisations have increased markedly. The present study aimed to evaluate factors associated with in-hospital mortality in patients with COVID-19. Using data from hospitalised patients, sex differences in clinical characteristics, in-hospital management, and in-hospital mortality among patients diagnosed with COVID-19 were evaluated. Additionally, predictive factors associated with mortality in 1091 patients, who were admitted to the Beijing Anzhen Hospital (Beijing, China) for COVID-19 between October 2022 and January 2023, were also evaluated. Data from 1091 patients hospitalised with COVID-19 were included in the analysis. The in-hospital mortality rates were 14.9% and 10.4% for males and females, respectively. Multifactorial logistic analysis revealed that lymphocyte percentage (LYM%) (odds ratio [OR] 0.863 [95% confidence interval (CI) 0.805-0.925]; P&lt;0.001), uric acid (OR 1.004 [95% CI 1.002-1.006]; P=0.001), and high-sensitivity C-reactive protein (hs-CRP) (OR 1.094 [95% CI 1.012-1.183]; P=0.024) were independently associated with in-hospital mortality from COVID-19. Among female patients, multifactorial analysis revealed that LYM% (OR 0.856 [95% CI 0.796-0.920]; P&lt;0.001), older age (OR 1.061 [95% CI 1.020-1.103]; P=0.003), obesity (OR 2.590 [95% CI 1.131-5.931]; P=0.024), and high high-sensitivity troponin I level (OR 2.602 [95% CI 1.157-5.853]; P=0.021) were risk factors for in-hospital mortality. Receiver operating characteristic (ROC) curve analysis revealed that the efficacy of LYM% in predicting in-hospital death and its area under the ROC curve (AUC) for predicting in-hospital death in males was 0.800, with a sensitivity of 63.2% and specificity of 83.2%. The AUC for predicting hospital death in females was 0.815, with a sensitivity of 87.5% and specificity of 64.4%. LYM% was a consistent predictor of in-hospital mortality in both sexes. Older age and markers of systemic inflammation, myocardial injury, and metabolic dysregulation were also associated with higher mortality risk. These findings may help identify patients who require closer monitoring and tailored interventions to improve outcomes.

A Biomimetic Osteochondral Scaffold Augmented With Filtered Bone Marrow Aspirate for the Treatment of Joint Surface Lesions in the Knee.

Multilayered osteochondral scaffolds are becoming increasingly utilized for the repair of knee joint surface lesions (KJSLs). However, the literature on predictive factors is rather limited. To (1) evaluate the clinical outcomes and safety of a combined single-step approach using a biomimetic collagen-hydroxyapatite scaffold (CHAS) and filtered bone marrow aspirate (fBMA) for the treatment of KJSLs and (2) identify significant predictors of the treatment outcomes. Case series; Level of evidence, 4. All patients who underwent surgery because of a KJSL (size ≥1.5 cm2; International Cartilage Regeneration & Joint Preservation Society grades 3-4) using the combination above were selected from a hospital registry database (100 patients; minimum 2-year follow-up). Patient characteristics, medical history, knee joint and lesion status, intraoperative details, and cellular parameters of the injected fBMA were collected. The arthroscopic evaluation of chondral and meniscal tissue quality in all knee compartments was performed using the Chondropenia Severity Score. Treatment outcomes were determined clinically using patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, EuroQol-5 Dimensions-3 Levels, EuroQol-Visual Analog Scale, and Tegner Activity Scale) and by assessing the occurrence of serious adverse events and graft failure. Multivariable regression analysis was performed to identify significant predictors of the treatment outcomes. At a mean follow-up of 54.2 ± 19.4 months, 78 (87%) patients completed the questionnaires with significant improvements toward the baseline (P < .00625): KOOS Pain subscale from 62 ± 17 to 79 ± 18, KOOS Total score from 57 ± 16 to 70 ± 20, EuroQol-Visual Analog Scale from 61 ± 21 to 76 ± 16, EuroQol-5 Dimensions-3 Levels from 0.57 ± 0.20 to 0.80 ± 0.21, and Tegner Activity Scale from 2.8 ± 1.5 to 3.9 ± 1.9. The graft failure rate was 4%. A longer duration of preoperative symptoms, previous surgery, larger lesions, older age, and female sex were the main negative predictors for the treatment outcomes. The Chondropenia Severity Score and the number of fibroblast colony-forming units in fBMA positively influenced some of the clinical results and safety. A CHAS augmented with fBMA proved to be an adequate and safe approach for the treatment of KJSLs up to midterm follow-up. Based on the subanalysis of predictive factors, the surgical intervention should be performed in a timely and precise manner to prevent lesion enlargement, deterioration of the general knee cartilage status, and recurrent surgical procedures, especially in older and female patients. When a CHAS is used, the quantity of MSCs seems to play a role in augmentation. NCT06078072 (ClinicalTrials.gov identifier).

Leading with dysphagia… An unusual view of a common symptom.

Plummer-Vinson syndrome (PVS) is characterized by the classic triad of post-cricoid dysphagia, iron-deficiency anemia and esophageal webs. PVS is commonly found in women of middle age especially in the fourth and fifth decade of life. The prevalence of PVS has decreased due to early detection of iron deficiency and repletion of iron stores. We report a case of a 81-year-old female patient who had a classic presentation of PVS, treated successfully with endoscopic procedure. To our knowledge, the current case is the fourth case of dysphagia related to Plummer-Vinson syndrome reported in an octogenarian in the literature so far. Iron supplementation can resolve dysphagia in many patients, but dilation of esophageal webs may sometimes be required. PVS should be part of the differential diagnosis of sideropenic dysphagia, especially due the risk of pharyngeal and esophageal epidermoid neoplasia.

Pediatric renal transplantation: a single center experience.

The rising prevalence of global end-stage renal disease (ESRD) is a significant health concern, especially among children. Although renal replacement therapy is available, children with ESRD are at an increased risk of mortality. Kidney transplantation is the preferred modality of treatment and surpasses renal replacement therapy in terms of survival. However, pediatric renal transplantation could prove difficult due to factors like smaller recipients and donor-recipient mismatches leading to higher complications. A retrospective single-group case series study was conducted on children with ESRD who were planned to undergo kidney transplantation from living donors between 2015 and 2021. The data was collected from two centers in the city of Sulaymaniyah. The study comprised a predominantly male patient population, with a total of 39 individuals (n = 39) and 13 female patients. The donors were mostly males between 25-40 years old. The majority of participants were 15-18 years old. In majority of the patients Thymoglobulin was the immunosuppressive agent used in induction. The most common etiology for renal failure was reflux nephropathy and artery anastomosis was performed to the external iliac artery in the majority of patients. Only 9 patients had complications following the transplantation and 3 patients had an episode of acute rejection. Renal transplantation is the preferred treatment of renal failure in pediatric patients in the city of Sulaymaniyah. The most common etiology for pediatric renal failure was reflux nephropathy which was different from the findings of North American Pediatric Renal Trials and Collaborative Studies.

Demographic and Clinical Characteristics of Females with Breast Cancer in Iraq with Respect to Age: A Single-Center Study

Abstract Background Breast cancer is a growing concern in Iraq, posing significant health challenges for Iraqi women. The objective of this study was to describe the demographic and clinical characteristics associated with breast cancer among Iraqi women, with a specific focus on age-related differences. Materials and Methods Medical records of 500 female patients diagnosed with breast cancer between 2017 and 2022 were retrospectively analyzed. Demographic information, clinical history, presentation details, treatment modalities, and outcomes were collected and analyzed. Results Among the studied cohort, 62.4% of breast cancer cases were diagnosed in women aged 50 and older. Marital status correlated significantly with age, with 89.9% of those diagnosed before 50 being married compared to 74.7% of those diagnosed after 50. Notably, 48% of patients diagnosed before 50 had breastfeeding duration of 1–3 months, contrasting with 28.5% of those diagnosed after 50. Diabetes mellitus, hypertension, hypercholesterolemia, heart disease, and vitamin D deficiency were significantly more prevalent among patients diagnosed after 50. Clinical presentation revealed 67.8% with tumor stage II. Metastasis to lymph nodes occurred in approximately 50% of patients. Among patients who were diagnosed after 50 years of age, 34% had metastasis, compared to 22.9% of those diagnosed before the age of 50. Mortality rates were higher in patients diagnosed after 50 (23%) compared to those under 50 (12.8%). Conclusion The findings emphasize the need for targeted public health campaigns, early detection initiatives, and treatment optimization to improve patient outcomes and mitigate the burden of breast cancer.

Assurance versus frustration: a retrospective single-center analysis of female patients with acute telogen effluvium

Assurance versus frustration: a retrospective single-center analysis of female patients with acute telogen effluvium

A perplexing case report of concomitant multiple sclerosis and myasthenia gravis

Introduction &amp; Importance: The co-occurrence of multiple sclerosis (MS) and myasthenia gravis (MG) within the Middle East and North African Region (MENA) has been scarcely reported in current literature. This rare case report explores the pathophysiological mechanisms and potential avenues of treatment modalities. Such insights can potentially facilitate the development of more efficacious and targeted treatment modalities and perhaps pave the way for disease prevention. Case Description: 29-year-old female patient presented with diplopia of two weeks duration associated with occasional blurred vision in the left eye. On physical examination, she was discovered to have marked left eye ptosis. A visual evoked potential (VEP) test was performed, which revealed asymmetrical delay. MRI imaging revealed a few white matter hyperintense foci noted at both periventricular regions and the corpus callosum with the characteristic appearance of Dawson’s fingers and thus MS was diagnosed. An anti-acetylcholine receptor antibody test returned positive, confirming the diagnosis of concurrent MG. Clinical Discussion: Proposed pathophysiological mechanisms underlying the concurrent manifestation of both diseases include, among others, the involvement of HLA haplotype and non-HLA genotypes, as well as the immunogenetic influence of specific transcription factors. Notable HLA haplotype genes include DRB1 and HLA-DQ5 genes. In contrast, non-HLA genes include the interleukin-4 receptor (IL4RA) and factor forkhead box P3 (FOXP3). Conclusion: Considering the similar immunological background of the two diseases, ideally, a single therapeutic modality could be used for management. This will hopefully simplify the patient’s treatment regimen and may ultimately reduce the treatment cost and patient burden.

Pelvic vein thrombosis in patients with pelvic venous disorders.

To assess the incidence of pelvic vein thrombosis (PVT) and outcomes of anticoagulant therapy for PVT in patients with pelvic venous disorders (PeVDs). This prospective cohort study included 588 female patients with PeVDs underwent clinical examination followed by duplex ultrasound of the pelvic veins in 2021-2023. Patients with PVT were administered with anticoagulant therapy in an outpatient setting using low molecular weight heparins at a therapeutic dose. PVT was detected in 7.6% of patients with PeVDs and was symptomatic in 28.8% of them. The majority of asymptomatic patients had thrombosis in only one of the parametrial veins (90.6%). Anticoagulant therapy resulted in the PVT symptoms relief in all patients within 10 days and recanalization of the pelvic veins in 1-3 months. In our study, PVT was diagnosed in 7.6% of patients with PeVDs. Anticoagulant therapy is effective and safe in resolving PVT symptoms.

The Neutrophil to Lymphocyte Ratio Modifies Lipoprotein (a)-Related Poor Prognosis in Patients After Percutaneous Coronary Intervention.

Lipoprotein (a) [Lp(a)] could contribute to coronary artery disease (CAD) through proinflammatory effects. The neutrophil to lymphocyte ratio (NLR) is an inflammatory biomarker. We consecutively enrolled 7,922 CAD patients to investigate the synergistic association of Lp(a) and NLR with prognosis in patients undergoing percutaneous coronary intervention (PCI). NLR was calculated as the neutrophil count divided by the lymphocyte count. Cutoff for NLR was a median of 2.07. The threshold value was set at 30mg/dL for Lp(a). The primary endpoint was major adverse cardiac events (MACEs), including all-cause mortality and myocardial infarction. During 2 years follow-up, 111 (1.40%) MACEs occurred. Lp(a) > 30mg/dL was associated with an increased MACE risk in participants with NLR ≥2.07 [adjusted hazard ratio (HR), 1.84; 95% CI, 1.12-3.03], but not in participants with NLR <2.07 (adjusted HR, 0.74; 95% CI, 0.38-1.45) (Pinteraction = 0.021). Subgroup analysis demonstrated that the synergistic association of Lp(a) and NLR with prognosis was more pronounced in female patients (Pinteraction = 0.028). This study suggested that combining Lp(a) and NLR may be useful for risk stratification in CAD population.