Female Predominance Research Articles

Analysis of Right Ventricular Strain in Heart Failure with Preserved Ejection Fraction

Introduction: The complexity of the geometry and the unique architecture of the right ventricular (RV) myocardial fibers make the study of its function a significant challenge. However, the advent of new imaging techniques, such as RV strain imaging, has improved our understanding of its function. The aim of our study is to specify the principles of studying right ventricular deformation and its impact on the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a two-year prospective study comparing echocardiographic parameters of right ventricular function in 87 patients followed in our unit for HFpEF at the Cardiology Department of ERRAZI Hospital, CHU Mohammed VI, Marrakech. Results: Over the past two years, our unit has hosted 87 patients diagnosed with HFpEF. The average age was 68 years and 5 months, with a female predominance. The most common cardiovascular risk factors were hypertension and obesity (BMI > 30). Symptomatic presentations were dominated by exertional dyspnea, observed in 84% of cases, with resting dyspnea and cough affecting about half of the patients. Signs of left heart failure, such as crackling rales, were present in 44% of patients, while signs of right heart failure, such as lower limb edema, were noted in 41%, with jugular distension and hepatojugular reflux in 19%. Echocardiography revealed left ventricular hypertrophy in 57% of patients and left atrial dilatation in 65%. Right ventricular function was markedly impaired, with significant abnormalities in TAPSE (Tricuspid Annular Plane Systolic Excursion), S' wave, and Tei index values, highlighting a marked correlation between the Tei index and the deformation of the right ventricular lateral wall. Rehospitalization for heart failure occurred in 40.2% of the cohort, emphasizing the severe clinical implications of right ventricular dysfunction in this patient population. Discussion and Conclusion: RV strain in HFpEF is an analysis that has not yet revealed all its intricacies. This study demonstrates that there is an alteration in RV strain in patients with HFpEF, which has a prognostic impact on mortality and rehospitalization for cardiac decompensation. This suggests that this parameter should be integrated into routine evaluations of RV systolic function.

Fine Needle Aspiration Cytology of Palpable Head and Neck Masses: A Descriptive Cross-sectional Study

Introduction: Fine needle aspiration cytology is a quick and safe technique done for the initial diagnosis of head and neck region masses. This study aims to assess the utility of fine needle aspiration cytology in head and neck palpable masses. Materials & Methods: A descriptive cross-sectional study was done in the Pathology Department of Kathmandu Medical College from 1st February 2023 to 31st December 2023. All the patients with palpable head and neck lumps were included in the study. A convenience sampling method was used. The data was entered and analyzed using the Statistical Package for Social Science (SPSS) version 22.0 Results: Among 650 fine needle aspiration cytology done during the study period, 184 were from head and neck lesions (28.30%). The mean age of the patient was 35.4 years with female predominance. The most common site was lymph node 85 (46.19%) followed by thyroid 39 (21.19%). Reactive lymphadenitis was the most common cause of lymphadenopathy seen in 41(22.2%) patients and colloid goitre was the most common cause of thyroid swelling seen in 26(14.13%) patients. Conclusions: Fine needle aspiration cytology is a useful and reliable technique for the diagnosis of head and neck mass. It helps to avoid unnecessary surgeries and is recommended and guides the clinician in general clinical management.

Renal Disease in Nepal, Under Microscope: One Year Study

Introduction: Renal disease is a significant health problem in Nepal that is creating an increasing health and economic burden. Renal disease usually does not cause symptoms until reaching an advanced stage. Correct diagnosis of renal biopsy requires correlation of clinical, biochemical, and serological parameters and histopathological examination by light microscopy, immunofluorescence, and sometimes electron microscopic examination. The present study was conducted to study the histopathological patterns of all renal biopsy specimens in Nepal with the help of information obtained from Light microscopy and Immunofluorescence examination. Materials and Methods: In this cross-sectional (Prospective study) undertaken at the Pathology Department at Pratham Pathology Laboratory, Lazimpat for 1year duration (January 1ST - December 31ST 2022), all renal biopsy specimens of patients with different glomerular diseases were enrolled. The final diagnosis was made by a pathologist correlating with the histopathological along with immunofluorescence and other clinical and laboratory findings. Results: A total of 195 patient renal biopsy specimens between ages (1-80 years) were enrolled. The majority of patients were in the age group of 21-30 years (23.60%). The study showed slight female predominance with a male-to-female ratio of 1: 1.34. The most common renal disease was Lupus Nephritis with a frequency of 64 with a predominance of Lupus Type IV with a frequency of 34 (17.45. Among all, 21 cases were of Chronic Glomerulonephritis and the most common leading cause for it was IgA Nephropathy with a frequency of 8 (38.10%). Conclusions: The most commonly diagnosed renal disease under a microscope was Lupus Nephritis with a frequency of 34 (17.45%). The leading primary glomerular disease for Chronic glomerulonephritis was IgA Nephropathy with a frequency of 8 (38.10%).

Decoding Age-Related Changes in Emotional Reactivity: The Importance of Distinguishing Positive and Negative Sensations

This study investigated age-related variations in emotional reactivity, focusing on the differentiation between positive and negative emotional sensations. Grounded in Socioemotional Selectivity Theory (SST), we hypothesized that older vs. younger adults would exhibit heightened valence and intensity in their emotional sensations, alongside increased co-occurrence of positive and negative sensations. We presented 100 negative, 100 neutral, and 100 positive images to 67 young adults and 72 older adults. Utilizing unipolar scales enabled a nuanced analysis of emotional reactivity. Our findings revealed that older vs. younger adults overall report: 1) more positive and negative sensations, with a predominance for positive sensations, particularly when faced with positive images; 2) more intense sensations, regardless of the valence of the images; 3) more complex emotional sensations, particularly when faced with negative images. Thus, our findings validated the key principles of SST and can be seen as a manifestation of an adaptive strategy developed in older adults to promote richer, more positive emotional experiences. However, the study’s broader implications are moderated by certain limitations. The experimental sample shows a gender imbalance, with a predominance of females and a lack of racial, ethnic and socio-economic diversity in older adults. In addition, the low- to medium-intensity emotional stimuli reflect only a narrow spectrum of everyday experiences. These constraints underscore the need for future research to encompass greater demographic inclusion and a wider range of emotional stimuli to ensure the applicability of our findings to more complex populations and emotional landscapes.

P82 Are nail, scalp and intergluteal cleft psoriasis really risk factors for psoriatic arthritis or are we just repeating previous studies?

Abstract Psoriasis is a chronic, inflammatory, immune-mediated, systemic disease that primarily affects the skin and joints. In ∼70% of cases, the skin comes before the joints, and it is believed that ∼30% of patients with psoriasis will develop psoriatic arthritis (PsA). There is an ongoing effort to identify screening tools and biomarkers that detect joint disease early. Known risk factors include early onset and severity of disease, nail, scalp and intergluteal cleft involvement, family history of PsA, HLA-B27 positive, obesity, uveitis, biomechanical stress, and trauma. Observational, cross-sectional study with severe plaque psoriasis patients, aged between 18 and 70 years, of both genders. Non-probabilistic convenience sample: All patients were evaluated by the same board-certified dermatologist. Over 3 months, during the weekly shift of the severe psoriasis clinic, PEST was applied. Clinical and epidemiological variables were collected on medical records. PsA was defined by CASPAR criteria. It underwent an ethical assessment and was approved. Hundred and fifty-eight patients were studied: average age of 50.84 years, with a predominance of females (53.2%). The average duration of the disease was 15.89 years. Mean psoriasis area and severity index and body surface area were, respectively, 16.65 and 20.88%. Fifty patients (31.6%) with PsA were identified. Regarding PEST, a sensitivity of 84.61%, a specificity of 75.47%, with a negative predictive value of 90.90% were identified. Having a positive PEST made the presence of PsA almost seven times more frequent [PR: 6.914, P < 0.0001, 95% confidence interval (CI) = 3.486–13.714]. Scalp (80.9%) and intertriginous/intergluteal cleft psoriasis (55.1%) was frequent in the sample, but did not correlate with the presence of PsA (PR: 1.113, P = 0.794, 95% CI = 0.523–2.454; and PR: 0.881, P = 0.612, 95% CI = 0.565–1.375, respectively). However, nail involvement was significantly related to PsA (PR: 1.669, P = 0.026, 95% CI = 1.071–2.601). PEST performance was consistent with the literature and was especially valuable in ruling out PsA due to its high negative predictive value. A classic study that correlates the involvement of specific sites with joint disease may present a selection bias, since it was conducted within the scope of rheumatology, focusing on patients with seronegative chronic inflammatory arthritis, where the diagnosis of psoriasis was not obvious, being sought in ‘hidden’ areas. After all, apart from the involvement of the nail matrix as an extension of distal interphalangeal enthesitis, what would be the biological relationship between the involvement of the scalp or even the intergluteal cleft and the presence of arthritis? Small sample, cross-sectional design and the fact that only 66% of patients with PsA had the opportunity to confirm their diagnosis with a rheumatologist are recognized limitations.

Clinical features and adherence to a gluten-free diet in patients with celiac sprue in the north-west of Algeria

This study aims to identify the predominant form of celiac sprue and the adherence to a gluten-free diet in northwest Algeria. A retrospective analysis was performed on 128 celiac patients at the Department of Gastroenterology and the association of celiac patients. The results show a female predominance with a sex ratio of 0.4. The most affected age group is the young adults (15-29 years). Lean patients represent 42.2%, normal-weight patients represent 51.6% of the study sample, and 6.3% are overweight. 47.7% of cases have a familial form of the disease. 93% underwent a biopsy for diagnosis. 60.9% of patients were not diagnosed in childhood. The main classic gastrointestinal symptoms such as Diarrhea (89.1%) and bloating (56.3%) were detected. Extraintestinal symptoms included weight loss (64.1%), weakness and fatigue (58.6%). Other biological disorders like anemia (71.1%), thyroiditis (15.6%), and type 1 diabetes (14.8%) were observed. Most celiac patients (84.4%) follow the gluten-free diet but find its application difficult. The adherence of GFD does not depend on any parameter of the study (p>0.05). The classic form predominates through a variety of gastrointestinal symptoms and extra-digestive disorders. The unavailability and high cost of imported gluten-free products are the major barriers to gluten-free diet adherence.

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy using Risk Score For Conversion From Laparoscopic To Open Cholecystectomy (RSCLO) in Tertiary Care Centre of Nepal: A Prospective Observational Study

IntroductionLaparoscopic cholecystectomy requires experts for the best result. Occasionally laparoscopic cholecystectomy becomes difficult, requiring conversion to open cholecystectomy and also endangers patients causing potential biliovascular and bowel injury. This study aims to predict difficult laparoscopic cholecystectomy using RSCLO scoring system. MethodsA prospective observational study was conducted including 116 diagnosed case of cholelithiasis undergoing elective laparoscopic cholecystectomy from July 2023 to March 2024. Scores were given on history, physical examination and ultrasonographic findings on admission as per the RSCLO scoring system. Intraoperatively, difficult laparoscopic cholecystectomyn criteria included: Time taken >60 min or bile/stone spillage or injury to bile duct/artery or conversion to open surgery. The end point of study was the end of surgery. Results The mean age was 46.23+15.36 years with female predominance of 69%. Preoperatively, 31.9% patients were predicted to have difficult cholecystectomy and intraoperatively 37.1% had difficulty (pearson chi-square 77.096, p value <0.001). Age > 50 years, male gender and prior history of hospitalization because of gallbladder pathology were significantly associated with difficult laparoscopic cholecystectomy. There was no open conversion, no intraoperative biliovascular or bowel injury. Sensitivity and specificity of RSCLO score with cut off value of >6 was 94.6% and 90%, respectively, with AUROC 0.922. Conclusion RSCLO scoring system is useful for prediction of difficult laparoscopic cholecystectomy and patients with high risk can be counseled preoperatively about intraoperative difficulty.

Prévention du risque thromboembolique de la fibrillation atriale dans le service de cardiologie d'Abidjan

IntroductionAtrial fibrillation is the most common cardiac rhythm disorder whose incidence with age and which is responsible for high morbidity and mortality. ObjectiveEvaluate the thromboembolic risk of patients with atrial fibrillation and analyze the quality of the oral anticoagulation therapy at the Abidjan cardiology institute. MethodsThis was a multicenter, retrospective and prospective cross-sectional study, with descriptive and analytical aims in 332 patients followed for atrial fibrillation diagnosed on the electrocardiogram. ResultsAverage age of 61 years (standard deviation = 16), with a female predominance with a sex ratio (M/F) of 0.93. The circumstances of discovery of atrial fibrillation were mainly palpitations (58.1%). Hypertension (57.8%). was the most frequently encountered comorbidity Underlying heart diseases were dominated by dilated cardiomyopathy (26.8%) and hypertensive heart disease (18.1%). The average CHA2DS2-VASc score was = 3.1 (standard deviation = 1.5) revealing a high level of thromboembolic risk (CHA2DS2-VASc score ≥2) in 76% of cases. The mean HAS-BLED score was =1.9 (SD =1.2).VKA were the main antithrombotic therapy prescribed in our patients and appeared of poor quality with a TTR <65% in the great majority of patients (93,75%) ConclusionAtrial fibrillation is a condition responsible for the occurrence of thromboembolic complications when antithrombotic management is not correct. In this instance good oral anticoagulation is the best treatment to instaure. VKA are the most prescribed OAC in our context.The evaluation of the quality of anticoagulation by vitamin K antagonist is essential by one of its most used indices is the time spent in the therapeutic zone (TTR).

FORENSIC IMPLICATIONS OF CARPAL TUNNEL SYNDROME IN RELATION TO RADIOLOGICAL AND ORHOPEDITION

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy with significant clinical and forensic implications. The condition is characterized by compression of the median nerve within the carpal tunnel, leading to pain, tingling, and functional impairment. Accurate diagnosis is crucial not only for clinical management but also for forensic evaluations, especially in cases of occupational claims and medico-legal disputes. Objective: The purpose of this research is to investigate the forensic consequences of carpal tunnel syndrome regarding radiographic and ophthalmic examinations. Methods: This prospective study included 180 individuals, aged 18 to 65 years, of both genders. This study was conducted at the Department of Forensic Medicine LUMHS from January 2023 to June 2023. Group I comprised 90 patients diagnosed with CTS, while Group II included 90 individuals without CTS, serving as controls. Demographic data, including age, sex, and BMI, were recorded. CTS was confirmed using ultrasonographic and other diagnostic modalities. The cross-sectional area of the carpal tunnel at the pisiform (CSAp) and the carpal tunnel at the hook of the hamate (CSAc) was measured. Delta CSA was calculated as the difference between CSAc and CSAp. Sensitivity and specificity for CTS diagnosis were evaluated. Statistical analysis was performed using SPSS Version 26.0. Results: The study found a predominance of females in both groups, with 63 (70%) females in Group I and 58 (64.4%) in Group II. The mean age in Group I was 47.34 ± 8.58 years with a mean BMI of 25.13 ± 10.49 kg/m², while Group II had a mean age of 49.53 ± 12.74 years and a BMI of 26.34 ± 11.61 kg/m². Group I demonstrated significantly higher CSAc values (18.5 ± 3.35 mm²) compared to Group II (9.8 ± 7.25 mm²; p &lt; 0.004). The delta CSA was also higher in Group I (7.37 ± 8.32 mm²) compared to Group II (1.3 ± 2.13 mm²; p &lt; 0.005). The CSAp values showed no significant differences between groups (Group I: 9.4 ± 3.6 mm²; Group II: 7.12 ± 9.6 mm²). A delta CSA threshold of 2 mm² demonstrated high diagnostic accuracy, yielding a sensitivity of 99.1% and specificity of 100% for Group I wrists. Conclusion: Delta CSA is a highly reliable parameter for diagnosing CTS, surpassing CSAc in accuracy. Advanced ultrasonographic techniques, including high-frequency probes and enhanced power Doppler imaging, represent the gold standard for CTS diagnosis, providing robust evidence for both clinical and forensic applications.

Early hypocalcemia following thyroidectomy in Kurmitola General Hospital, Dhaka, Bangladesh

Background: Hypocalcaemia is a recognized complication after thyroidectomy, which may be transient or permanent due to impairment of blood supply, injury, or inadvertent removal of the parathyroid gland. Parathormone, secreted by parathyroid gland, plays an important role in calcium homeostasis. Purpose of this study was to enable early detection of hypocalcaemia after thyroidectomy, aiding in patient management, early discharge, and reduced hospital stay. Methods: This study was conducted in the otolaryngology and head-neck surgery department of Kurmitola General Hospital over 12 months, from January 2020 to December 2020. Patients with various indications were selected based on eligibility criteria through convenience sampling. Data were collected using a data collection sheet, then cleaned, edited, and tabulated. The results were analyzed using the student’s unpaired t-test (quantitative data) to determine their significance, with a p cut-off set at &lt;0.05. Results: Data analysis of 30 patients (30% male, 70% female) revealed that 13 patients experienced hypocalcaemia, while 17 showed normocalcaemia. Among the 13 hypocalcaemic patients, 10 (76.92%) had asymptomatic (subclinical) hypocalcaemia, and 3 (23.08%) had symptomatic hypocalcaemia. Hypocalcaemia was observed in 46.15% of patients within 24 hours post-surgery, 38.46% within 48 hours, and 15.39% within 72 hours. The results indicated a female predominance in the development of hypocalcaemia. Conclusions: The study suggests that serum calcium levels significantly decrease after total thyroidectomy, with most cases occurring within 48-72 hours post-surgery.

Clinico-epidemiological and treatment factors impact on survival in Egyptian patients with head and neck sarcoma: a retrospective case-series analysis

BackgroundHead and neck sarcomas are very rare accounting for about 1% of head and neck malignancies and 5% of sarcomas. Outcomes have historically been worse in this group compared to other sarcomas, due to anatomical constraints that make complete surgical removal difficult and increased local relapse rate. Surgery remains the main intervention although the data suggest the role of chemotherapy and irradiation as treatment options.Methodologyand Design.Data of patients diagnosed with head and neck sarcoma were retrospectively collected. Clinicopathologic characteristics and patients’ management were reviewed. Time to relapse (TTR) includes both time to local relapse (TTLR) and time to systemic relapse (TTSR). Overall survival (OS), TTLR and TTSR were calculated with Kaplan Mayer analysis using log rank test.ResultsTwenty-four patients were retrospectively identified. Mean age was 37.7 years (range 17–80) with female gender predominance (62.5%). Rhabdomyosarcoma and osteosarcoma were the most common types (16.7%). At presentation, 23 patients showed localized disease (95.8%), while one patient was metastatic to the bone. Surgery was the primary treatment in 83.3% patients with different surgical margin status (R0 in 6/20, R1 in 11/20 and R2 in 3/20 patients), while 4/24 patients were not operated. Radiotherapy was applied as adjuvant treatment in 9 patients, as definitive in 2 and as palliative in one patient. Chemotherapy was administered in neoadjuvant/ adjuvant settings in 8 patients. Median follow-up was 31 months. Mean TTR for all surgically resected population was 39.8 months. Locally relapsed patients were 35% with mean TTLR 43.2 months while 15% of patients developed systemic relapse with mean TTSR 55 months. Mean OS of all studied patients was 48 months.ConclusionHead and neck sarcomas are rare challenging malignancies due to anatomical constrain, with only 20% achieving R0 surgical resection and > 30% suffering of local relapse after complete surgical resection.

Retrospective Study of Fine Needle Aspiration Cytology of Patients with Thyroid Nodule in Benghazi in the Period of (2021-2023)

Background: Thyroid nodules constitute a common endocrine disorder, these nodules could be solitary, multiple, cystic, or solid. Increasing age, female gender, iodine deficiency, and history of thyroid radiation all are high risk for thyroid nodules. FNAC representing the most cost-effective diagnostic tool used in the assessment of nodules of the thyroid. Objective of the study: The aim of this study is to evaluate the result of fine needle aspiration cytology (FNAC) and assess thyroid status using of thyroid hormone obtained from patients with thyroid nodules. Materials and methods: this is a retrospective study, includes collection of data from available cases of thyroid nodules underwent fine needle aspiration between 2021 to 2023, data regarding age, sex, TFT, USS, FNAC was collected from the archive of endocrine out patients clinic of Benghazi Medical Center and from endocrine clinic of Benghazi diabetic center. The analysis was done using the SPSS program. Result: A total of 60 cases were studied, Data was collected from 60 patient’s files for years between 2021 and 2023. The mean age of the patients with FNAC selected for this study was 49.65, and ranged from 21-80 years. The gender distribution shows female predominance in which female cases were 53 (98.33%) while only one case (1.67%) was reported among men. The size of nodules in our cases range from 1cm to 4.5 cm. The mean size of nodules is 1.89cm. In this study the largest group of nodules located in right lobe (21) cases then left lobe (20) cases then both (17) cases and in isthmus only 2 cases. Most of the cases thyroid function test result shows an euthyroid status (38) cases. FNAC of thyroid nodule showed that most of patient’s result diagnosed as benign nodules (47) cases. Conclusion: FNAC is a key tool in diagnosis of thyroid nodule as it has safe, minimally invasive and cost effective diagnostic role.

Pediatric Head and Neck Malignancies in the United States: A 20-Year Population-Based Study.

Epidemiologic data for pediatric head and neck (HN) cancers in the United States (US) have not been reported in many years. An update is essential to highlight trends to guide future treatment. We analyzed the Surveillance Epidemiology and End Results database from 2000 to 2019. We included patients aged <1-21 years with a malignancy in the HN region. We also report trends in incidence rates over time. HN tumors encompassed 16.7% of all pediatric tumors with a mean age of 13.1 years. Females accounted for 59.0% of tumors. The female predominance is largely due to thyroid carcinoma; if thyroid malignancies are excluded male incidence is higher. The overall incidence (0-19 years) was found to be 3.29 malignancies per 100,000 person-years. The incidence from 2000 to 2004 was 2.84 [95% CI, 2.77, 2.91] while from 2015 to 2019 was 3.65 [3.57, 3.73]. This increase of 28.5% was greater than overall pediatric cancer, which increased by 13.7%. Incidence varies significantly by age group with 4.56 [4.35, 4.78] at age <1, 2.45 [2.37, 2.53] from 1 to 4 years, 1.46 [1.40, 1.51] from 5 to 9 years, 2.27 [2.21, 2.34] from 10 to 14 years, 4.81 [4.71, 4.90] from 15 to 19 years, and 7.35 [7.17, 7.40] from 20 to 21 years. Thus, there is a bimodal rise at the extremes of the pediatric age group. Pediatric HN tumors more commonly affect females. These tumors appear in a bimodal distribution; they most commonly present in very young patients and then during late adolescence The incidence has increased since 2000 and faster than overall incidence. Reporting of these data and trends will allow for advancement in treatment.

Incidence and prevalence of prurigo nodularis and associated comorbidities in Denmark from 1995 to 2021.

Prurigo nodularis (PN) is a chronic skin condition characterized by intense itching from nodular skin lesions. Despite its impact on patients' quality of life, limited data exist on its epidemiology. A national register-based study in Denmark was conducted, utilizing data from Danish national health registers to determine the incidence and prevalence of PN diagnosed in hospitals from 1995 to 2021 and to explore the occurrence of comorbidities. We identified a total of 1,209 individuals diagnosed with PN. The mean age of onset was 45 years, with female predominance of 58%. The prevalence of PN increased over the studied period, reaching 14.1 per 100,000 individuals by 2021. Comorbidities such as chronic kidney disease had higher odds ratios preceding the diagnosis of PN, whereas the odds ratios for atopic dermatitis, mood disorders, and depressive disorders increased following the onset of PN. The findings indicate a significant association between PN and various comorbidities, emphasizing the need for multidisciplinary care. The increase in prevalence suggests a growing burden of disease. Although the study may underestimate the true prevalence of PN due to reliance on hospital records, it reveals a rising rate prevalence of PN and associated comorbidities in Denmark. The observed high prevalence of mental health problems in individuals with PN should be a focus of concern for the treating physicians.

Ceus features of liver pecoma: a case report and literature review.

Perivascular epithelioid cell neoplasms (PEComas) and epithelioid angiomyolipomas (EAMLs) are two different denominations for the same "mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells". Hepatic PEComa/EAML is a very rare neoplasm, and only 29 case reports of hepatic PEComa and 25 of hepatic EAML have been reported in the current literature. A clear female predominance with a mean age at diagnosis of 42.5years old can be observed by literature review. Ultrasound (US) examination was the first-line diagnostic technique in most of the cases of hepatic PEComa, but it was documented in very few cases of hepatic EAML. A great variability in the ultrasonographic B-mode, color Doppler and contrast-enhanced ultrasonography (CEUS) features of hepatic PEComa/EAML emerges. Computed tomography and magnetic resonance were the most common used techniques to confirm the nature of the hepatic lesion, even if the anatomo-pathological examination was the only technique to display a certainty diagnosis and to differentiate hepatic PEComa/EAML from benign and malignant hepatic lesions. The great majority of hepatic PEComas/EAMLs are surgically treated without any adjuvant therapy.

Frequency of Different Etiologies in Patients of Upper GI Bleed

Objectives: To find out the frequency of different etiologies of upper GI bleed, based on endoscopic findings. Methodology: It was a retrospective study done over a period of 6 months in gastroenterology department of Federal Government polyclinic (FGPC), hospital from 1st January 2023 to 30th June 2023. Results:A total of 229 patients presented with Upper gastrointestinal bleed.Chronic liver disease manifesting as variceal bleed or portal hypertensive gastropathy was found in significant number of patients as compared to peptic ulcer disease.The predominant age group for most of causes of bleed was 5th decade of life with a significant female predominance. Conclusion:Viral hepatitis along with other causes of portal hypertension seem to be the major predisposing factor as a cause of upper GI bleed. There is an increased need for future awareness campaigns about viral hepatitis in order to reduce the risk of upper GI bleed. It is further suggested to study the impact of such awareness programson incidence of upper GI bleed through future studies.

Incidence and risk factor analysis of moderate-to-severe pain after preoperative CT-guided hook-wire puncture localization of pulmonary nodules

BackgroundPain is a relatively common complication after hook-wire puncture localization. However, the problem of pain occurrence following this localization procedure has not been sufficiently examined. In this prospective study, we aimed to investigate the incidence and risk factors associated with acute pain after preoperative CT-guided hook-wire puncture localization of pulmonary nodules.MethodsClinical data were collected prospectively from patients with small pulmonary nodules who underwent preoperative CT-guided hook-wire puncture localization between May 2022 and May 2023 at the Affiliated Hospital of Xuzhou Medical University. Patients were divided into two groups on the basis of the presence or absence of moderate-to-severe pain following the localization process. Univariate logistic analysis was conducted to analyse the clinical data of the two groups. Subsequently, the significant variables (P < 0.1) from the univariate analysis were subjected to multivariate logistic analysis, followed by the establishment of regression equations to determine the significant risk factors related to moderate-to-severe pain after hook-wire puncture localization.ResultsA total of 281 patients with small pulmonary nodules undergoing preoperative CT-guided hook-wire puncture localization were finally included, with a mean age of 54.86 years (SD = 12.1 years) and female predominance (67.6%). In the resting state, 53% of the patients reported moderate-to-severe pain. Univariate analysis revealed that age (P = 0.085), the depth of localization needle insertion into the lung (P = 0.024) and the location of the chest wall puncture (P = 0.07) were associated with moderate-to-severe pain occurrence after hook-wire puncture localization (P < 0.1). Furthermore, multivariate logistic regression analysis demonstrated that the depth of localization needle insertion into the lung (OR = 0.953, 95% CI: 0.914–0.992, P = 0.02) and the location of the chest wall puncture (lateral chest wall vs. anterior chest wall: OR = 2.101, 95% CI: 1.166–3.784, P = 0.013; posterior chest wall vs. anterior chest wall: OR = 1.163, 95% CI: 0.895–2.971, P = 0.11) were independent predictors of moderate-to-severe pain incidence following CT-guided hook-wire puncture localization (P < 0.05).ConclusionModerate-to-severe pain is prevalent in patients with pulmonary nodules who undergo preoperative CT-guided hook-wire puncture localization. The depth of needle insertion into the lung and the location of the chest wall puncture are significant predictors of moderate-to-severe pain onset.

Two-Year Experience of a Center of Excellence for the Comprehensive Management of Non-Small Cell Lung Cancer at a Fourth-Level Hospital in Bogota, Colombia: Observational Case Series Study and Retrospective Analysis.

Background: This study aimed to provide a comprehensive analysis of 56 patients admitted to the Lung Cancer Clinical Care Center (C3) at Fundación Santa Fe de Bogotá (FSFB) between 2 May 2022 and 22 April 2024. The focus was on demographic characteristics, smoking history, comorbidities, lung cancer types, TNM classification, treatment modalities, and outcomes. Methods: This observational case series study reviewed medical records and included patients over 18 years with a confirmed diagnosis of non-small cell lung cancer (NSCLC). Data were collected and analyzed for demographics, comorbidities, treatment types, biomolecular profiling, and survival rates. Ethical approval was obtained, and data were anonymized. Results: The mean age was 71.8 years with a female predominance (53.6%). A history of smoking was present in 71.4% of patients. Adenocarcinoma was the most common type (75.0%), followed by squamous cell carcinoma (19.6%). At admission, the most frequent TNM stages were IA2 (17.9%) and IVA (16.1%). One-year survival was 68.8%, and 94.3% of stage I-IIIA patients underwent PET scans. Biomolecular profiling revealed 69.2% non-mutated EGFR, 90.4% ALK-negative, and various PDL-1 expression levels. Immunotherapy was received by 91.4% of patients, with Alectinib and Osimertinib being common. Grade III-IV pneumonitis occurred in 5.4% of patients. Conclusions: The study's findings align with existing literature, highlighting significant smoking history, common adenocarcinoma, and substantial use of immunotherapy. Limitations include the observational design, small sample size, and short follow-up period, impacting the generalizability and long-term outcome assessment. Future research should address these limitations and explore longitudinal outcomes and emerging therapies.

Single-port Thoracoscopic Laser Sympathicotomy for Primary Hyperhidrosis: A Safe and Minimally Invasive Approach With Favorable Short-term Outcomes.

Thoracoscopic sympathicotomy is a well-established treatment for severe palmar hyperhidrosis. This study evaluates the safety and efficacy of a novel one-stage, bilateral, single-port laser sympathicotomy with minimal dissection. We retrospectively reviewed 73 patients with severe palmar hyperhidrosis who underwent this novel surgical technique between June 2023 and October 2023. Outcomes included complications, recurrent hyperhidrosis, and compensatory hyperhidrosis (CH). Hyperhidrosis severity was assessed using the hyperhidrosis disease severity score (HDSS). The mean patient age was 21.3 ± 7.7 years, with a female predominance (52.1%). Sympathicotomy was performed at the T3 level only in 46 patients (63%), with the remaining undergoing sympathicotomy at both T3 and T4 levels. Median cauterization and operating times were 78 seconds and 8.7 minutes, respectively. No complications occurred. Two patients experienced recurrent hyperhidrosis during a median follow-up of 9 months, both were mild (HDSS grade 1). CH developed in 41 patients (56.2%), with all occurring within the first month postoperatively. The most common sites for CH were the back (51.2%), chest (43.9%), thigh (41.5%), abdomen (36.6%), and lower leg (36.6%). The majority of patients with CH (95.1%) reported mild (HDSS grade 1) or moderate (HDSS grade 2) hyperhidrosis. A higher body mass index was a significant risk factor for CH (odds ratio: 1.36, 95% CI: 1.12-1.71 for every 1kg/m2 increase). This minimally invasive, single-port thoracoscopic laser sympathicotomy appears to be safe and effective for patients with palmar primary hyperhidrosis. Future studies should investigate long-term outcomes and refine the technique to minimize invasiveness even further.

DISP-20. SEX DIFFERENCES IN MENINGIOMA AGGRESSIVE BEHAVIOR IN RURAL POPULATIONS: A GEO-ECOLOGICAL RISK ASSESSMENT OF MENINGIOMAS IN A SINGLE RURAL HEALTH CARE SYSTEM

Abstract BACKGROUND Cause for health outcome disparities in rural populations is multifactorial. These populations are potentially more vulnerable due to rural area environmental policies and practices. Environmental justice populations (EJP) are designated by the Environmental Protection Agency as at risk for generational exposer to environmental contaminants. We assessed these population for an association between EJP density and aggressiveness of indolent brain tumors. Meningiomas are the most common benign intracranial tumor and have a female predominance. We evaluated meningioma patients in a large rural health system for oncogenic risk associated geo-ecological factors. METHODS A retrospective review of 415 pathology confirmed CNS WHO grades 1-3 meningiomas cases between 2007 – 2017 within the Geisinger Health system in Pennsylvania. Cases were mapped by county for meningioma incidence, tumor grade, and tumor recurrence. Counties were rated for EJP density. We mapped geographic areas with a higher meningioma incidence, grade, and rates of recurrence, and evaluated sex-predilections. RESULTS Seventy-three percent of tumors were WHO grade 1 (n=303), 23.4% (n=97) were grade 2, and 3.6% (n=15) were grade 3. The highest incidence of meningiomas were localized to higher density EJP counties that bordered riverbeds, Lackawanna and Luzerne. Females had a 3.5:1 predominance as compared to males. The grade 1 10-year progression free survival rate was 54.7% in Luzerne, Columbia, and Montour counties (moderate to high density EJP). Males in high EJP counties had a 12% increased risk for developing high grade meningiomas. Males aged 51-60 were more likely to develop a grade 2 or 3 meningioma as compared to males aged 61-70 in these counties. Females aged 50-60 more likely had grade 1 meningiomas but demonstrated consistently increasing risk for recurrence every decile. CONCLUSIONS Pennsylvania high density EJP counties (especially along the Lackawanna River supply) have a disproportionate risk for aggressive meningiomas and lower progression free survival as compared to national averages. A sex-discrepancy exists for males in these areas to have the most aggressive tumors.