Grave Outcome Research Articles

False-positive fentanyl screening kit results during treatment with long term injectable risperidone (Risperdal-Consta)

Fentanyl, a highly potent synthetic opioid, is a major cause of overdose deaths in the United States and worldwide. Urine drug immunoassay tests that include fentanyl in their drug panel are the common screening tool. However, false positive results may compromise test accuracy and cause grave clinical outcomes. In this preliminary report we describe 3 cases of patients with schizophrenia, who are treated with long-term injectable risperidone (Risperdal Consta) and were false positively screened for fentanyl by a rapid commercial screening kit. This finding warrants clinical attention to the possibility of inaccurate results regarding fentanyl misuse in multiple clinical settings.

Gastric mucormycosis in an immunocompetent patient with fatal outcome

Mucormycosis is being reported as a serious fungal infection with grave outcomes among patients recovering from corona virus disease 2019 (COVID-19). This condition is a new challenge for the physicians in this pandemic situation. Mucormycosis predominantly occurs among patients with immunosuppression but immunocompetent patients are not immune. Here, we report a case of gastric mucormycosis occurring in an immunocompetent patient during the pre-COVID era. Patient presented with fever and upper gastro-intestinal bleeding. Diagnostic work-up confirmed gastric mucormycosis. His response to medical management was unsatisfactory and he died while awaiting a gastric resection.
 BIRDEM Med J 2021; 11(3): 223-226

Acute motor-sensory axonal polyneuropathy variant of Guillain\u2013Barre syndrome complicating the recovery phase of coronavirus disease 2019 infection: a case report

IntroductionThe novel coronavirus, since its first identification in China, in December 2019, has shown remarkable heterogeneity in its clinical behavior. It has affected humans on every continent. Clinically, it has affected every organ system. The outcome has also been variable, with most of the older patients showing grave outcomes as compared with the younger individuals. Here we present a rare and severe variant of Guillain–Barre syndrome that complicated the disease in recovery phase.Case presentationA 60-year-old Afghan man, who had been recovering from symptoms related to novel coronavirus associated disease, presented with sudden onset of progressive muscle weakness and oxygen desaturation. Electrophysiological workup confirmed the diagnosis of Guillain–Barre syndrome, and early institution of intravenous immunoglobulin resulted in complete resolution.ConclusionGuillain–Barre syndrome has recently been reported in many patients diagnosed with novel coronavirus associated disease. While clinical suspicion is mandatory to guide towards an effective diagnostic workup, early diagnosis of this complication and timely institution of therapeutic interventions are indispensable and lifesaving.

Immunity to hepatitis A virus in liver transplant recipients: A population-based study in Iran

BackgroundAcute hepatitis A is usually a self-limited viral disease but can be severe and even fatal in special groups of patients including those with chronic liver disease and recipients of liver transplantation. To take appropriate preventive measures, it is important to determine the immune status against the hepatitis A virus in patients at risk of grave clinical outcomes following infection. To assess the need for immunization against hepatitis A, we aimed to determine the immune status against hepatitis A in a population of liver transplant recipients. We also investigated the association between hepatitis A immune status and demographic factors such as age and sex, underlying liver disease, source of drinking water, geographical area of residence and socioeconomic status. MethodsThis cross-sectional study was performed on 242 recipients of allogenic liver transplants at Abu Ali Sina Organ Transplant Hospital in Shiraz, Iran, between January 2017 and April 2017. The level of immunity was assessed using hepatitis A antibody detection kits. ResultsThe rate of immunity against hepatitis A was detected as 88.8% in our study population. In the multivariable logistic regression model, younger age (OR=1.175, P<0.001) and higher education level (OR=2.142, P=0.040) were the main determinants of non-immune status. However, hepatitis A immunity was independent of gender, monthly family income, water supply source, residential area and underlying liver disorder. ConclusionAlthough a significant proportion of liver transplant recipients in this study showed evidence of natural immunity to hepatitis A, a considerable proportion of younger patients and those with a higher level of education were non-immune. The results of this study signify the importance of screening for hepatitis A immunity in this at-risk population of patients and the need for vaccinating non-immune patients.

Long-term outcomes of Graves’ disease in children and adolescents receiving antithyroid drugs

PurposeAntithyroid drugs (ATDs) are primarily used as an initial treatment in pediatric patients with Graves’ disease (GD). We aimed to investigate the long-term outcomes in pediatric GD patients receiving ATDs.MethodsRetrospective data from a single center were collected from April 2003 to July 2020. A total of 98 children and adolescents aged 2–16 years diagnosed with GD and receiving ATDs was enrolled. We investigated the factors correlated with remission by comparing children who achieved remission after 5 years and those with persistent disease.ResultsThe study included 76 girls (77.6%) and 22 boys (22.4%). During the 5-year follow-up period, 18 children (18.3%) maintained remission, ATDs could not be discontinued in 74 patients (75.5%), and relapse occurred in 6 patients (6.2%). The remission group had significantly lower thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) level at diagnosis (P=0.002) and 3 months (P=0.002), 1 year (P=0.002), 2 years (P≤0.001), 3 years (P≤0.001), 4 years (P≤0.001), and 5 years (P≤0.001) after ATD treatment than did the nonremission group. The remission group also had a shorter time for TBII normalization after ATD treatment (P≤0.001). Multiple logistic regression analysis showed that the time to TBII normalization (cutoff time=2.35 years) was related to GD remission (odds ratio, 0.596; 95% confidence interval, 0.374–0.951).ConclusionsTBII level and time to TBII normalization after ATD treatment can be used to predict remission in pediatric GD patients.

Presentation and Outcome of Severe Graves’ Disease

Introduction: Subjects with “severe” Graves’ disease (GD) are known to have adverse outcomes. They have multisystem involvement (orbitopathy, dermopathy), more severe clinical features, large goitres and a higher relapse rate. Also, their response to thionamides is slower. There is a developing consensus that early definitive treatment improves prognosis in them. Methods: We retrospectively analysed the electronic case records and biochemistry databases of all subjects seen in our University Health Board between January 2017 and October 2019 with GD. Severe GD was defined by (1) a thyrotropin receptor antibody (TRAb) value greater than 10U/l (normal range: less than 0.9), (2) with any one of the following - (a) free thyroxine (T4) above 50pmol/l (reference range 9-19.1), (b) a combination of T4 more than 40 pmol/l with triiodothyronine (T3) above the detection range of the assay (46.1 pmol/l), (c) the presence of a large goitre, (d) active Graves’ orbitopathy (GO) or (e) dermopathy. We compared subjects with severe GD to those who did not fulfil the above criteria i.e. non-severe GD. Results: 176 GD subjects were seen during this period - 52 (29.5%) with severe and 124 (70.5%) with non-severe GD. However, 19 severe and 26 non-severe GD subjects were on active thionamide treatment at the time of analysis, and complete details were unavailable in 41 subjects. There was a significant difference in the following features between the severe and non-severe GD groups respectively (1) their median age (39 vs.52 years), (2) median TRAb levels (25.5 vs.18.5 U/l) (3) higher prevalence of GO (38.5 vs.13.3%) and active GO (15.4 vs.0%), (4) the presence of moderate/large goitre (51.3 vs.3.3%), (5) higher number failing to normalize biochemically within the first 6 months after treatment initiation (53.9 vs.39%), (6) the presence of a family history, and (8) a higher number requiring definitive treatment within 12 months of starting treatment (9.6vs.0.81%)(p=0.001-0.026 for the above). There was no difference between the two groups in gender, treatment regime i.e. dose titration regime or block and replacement regime, number biochemically normalizing within 12 months, and those who had more than 18 months of treatment and their relapse rates (55 vs. 59.1%, p=0.84). Conclusions: We have shown that those with severe GD were younger, have higher TRAb concentrations with multisystem involvement, and delayed initial normalization of thyroid hormones. A greater number of them require definitive treatment within 12 months of treatment initiation. However, the majority in both groups normalize thyroid hormones within 12 months irrespective of the treatment regime used. Early definitive treatment is required in a significantly higher percentage of subjects with severe GD and needs to be considered in them.

English

BACKGROUND Tumours of central nervous system (CNS) are reported to be less than 2 % of all malignancies. In India, CNS tumours constitute about 1.9 % of all tumours. The CNS space occupying lesions cause grave life-threatening outcomes irrespective of their nature as they grow in a confined space and are present close to vital structures. Hence, it is of great importance to establish the accurate diagnosis for proper and timely neurosurgical intervention. METHODS This was a retrospective study carried out in a tertiary care teaching hospital which caters as a referral unit for neurosurgical cases in Eastern India, for a duration of one and half year (January 2018 - July 2020) among 185 cases of CNS lesions collected from archives of Department of Pathology. The tumours were reclassified and graded according to the most recent World health organisation (WHO) classification of CNS tumours (2016). RESULTS Neoplastic lesions (168 cases, 91.35 %) were commoner than non-neoplastic entities and amongst the neoplastic lesions, meningioma was the commonest entity followed by diffuse astrocytic and oligodendroglial tumours while least incidence was noted for neuronal and mixed neuronal glial tumours. Out of all the tumours for which World Health Organization (WHO) grading was done, highest was WHO grade I (80 cases, 54.8 %) and least was grade III tumours (10 cases, 6.8 %). Male predominance was seen overall except in meningioma. Some rare and interesting cases like solitary fibrous tumour / hemangiopericytoma (anaplastic type), primary CNS diffuse large B cell lymphoma (DLBCL), CNS plasmacytoma which we came across are also highlighted. CONCLUSIONS The present study helps to provide information regarding the disease burden in our area. This study attempts to categorise various CNS neoplasms as per recent WHO classification (2016) which has not only diagnostic implication but also has significant prognosis and predictive value. KEYWORDS Central Nervous System, Immunohistochemistry, Eastern India, Meningioma, Solitary Fibrous Tumour / Hemangiopericytoma, Diffuse Large B Cell Lymphoma

Effect of Preeclampsia on Ultrastructure of Thyroid Gland, Hepatic Type 1 Iodothyronine Deiodinase, and Thyroid Hormone Levels in Rats.

Background Although hypothyroidism during pregnancy may develop grave outcomes for both mothers and offspring, management of which is still a challenge due to the insufficient understanding of this disease. The close correlation between hypothyroidism and preeclampsia is well documented, suggesting that preeclampsia is a potential risk factor for the development of maternal hypothyroidism. However, the exact role of preeclampsia in gestational hypothyroidism is still obscure. Objective In this study, we explored the possible mechanisms of the effect of preeclampsia on thyroid function of maternal rats. Methods Thirty pregnant rats were randomly divided into normal pregnancy control (NOP), preeclampsia (PE), and preeclampsia supplemented with amlodipine besylate (PEAml). NG-Nitro-L-arginine-methyl ester was used to induce preeclamptic symptoms. On gestational day 21, rats were sacrificed, and then, the ultrastructure of the thyroid gland, type 1 iodothyronine deiodinase (Dio1) expression, and serum-free thyroxine (FT4), free triiodothyronine (FT3), and thyroid stimulation hormones (TSH) were assessed. Results Compared to NOP rats, results of PE rats showed that thyroid follicular cells' ultrastructure was damaged; both hepatic Dio1 mRNA and protein levels were decreased. Interestingly, these changes were ameliorated in PEAml rats. Additionally, FT4, FT3, and TSH levels have no significant differences among groups. Conclusion These findings indicated that preeclampsia could disrupt synthesis, secretion, and metabolism function of thyroid hormones by damaging thyroid follicular cells and interfering Dio1 expression.

Can artificial intelligence reduce the interval cancer rate in mammography screening?

ObjectivesTo investigate whether artificial intelligence (AI) can reduce interval cancer in mammography screening.Materials and methodsPreceding screening mammograms of 429 consecutive women diagnosed with interval cancer in Southern Sweden between 2013 and 2017 were analysed with a deep learning–based AI system. The system assigns a risk score from 1 to 10. Two experienced breast radiologists reviewed and classified the cases in consensus as true negative, minimal signs or false negative and assessed whether the AI system correctly localised the cancer. The potential reduction of interval cancer was calculated at different risk score thresholds corresponding to approximately 10%, 4% and 1% recall rates.ResultsA statistically significant correlation between interval cancer classification groups and AI risk score was observed (p < .0001). AI scored one in three (143/429) interval cancer with risk score 10, of which 67% (96/143) were either classified as minimal signs or false negative. Of these, 58% (83/143) were correctly located by AI, and could therefore potentially be detected at screening with the aid of AI, resulting in a 19.3% (95% CI 15.9–23.4) reduction of interval cancer. At 4% and 1% recall thresholds, the reduction of interval cancer was 11.2% (95% CI 8.5–14.5) and 4.7% (95% CI 3.0–7.1). The corresponding reduction of interval cancer with grave outcome (women who died or with stage IV disease) at risk score 10 was 23% (8/35; 95% CI 12–39).ConclusionThe use of AI in screen reading has the potential to reduce the rate of interval cancer without supplementary screening modalities.Key Points• Retrospective study showed that AI detected 19% of interval cancer at the preceding screening exam that in addition showed at least minimal signs of malignancy. Importantly, these were correctly localised by AI, thus obviating supplementary screening modalities.• AI could potentially reduce a proportion of particularly aggressive interval cancers.• There was a correlation between AI risk score and interval cancer classified as true negative, minimal signs or false negative.

Diabetes and rhino-orbito-cerebral mucormycosis - A deadly duo.

Rhino-orbito-cerebral mucormycosis(ROCM) is an uncommon yet potentially fatal fungal infection predominantly seen in immunocompromised individuals. However, there is very limited data available from India regarding outcome of patients with ROCM and diabetes mellitus. To ascertain clinical parameters and factors in the final outcome of patients with diabetes mellitus and ROCM. This series included retrospective analysis of medical records of 91 patients with diabetes mellitus who were diagnosed with ROCM from january 2007 to june 2019at a tertiary care hospital in Punjab. The mean age of patients was 52.6years (range 18-82years), with men constituting the majority (71.4 %). Ophthalmoplegia was the most frequent presenting feature seen in 77 % of patients followed by proptosis (71 %). Intracranial involvement was seen in 20 % of the patients and cavernous sinus thrombosis was diagnosed in 9(10 %) patients. Out of 91 patients, 81 patients were subjected to appropriate surgical procedure depending upon site and extent of involvement by mucorales. A total of 53 (58.2 %) patients survived while 38(41.8 %) patients succumbed. Delay in presentation to hospital, intracranial extension and loss of vision at presentation adversely affected the outcome (p < 0.05). Aggressive surgical management in the form of multiple debridements was superior to single debridement (p < 0.05). Diabetic ketoacidosis did not significantly affect the outcome (p = 0.359). ROCM in patients with diabetes mellitus, is a rapidly progressive disease with a high fatality rate and grave outcome unless diagnosed early and managed aggressively.

A multi-centre, cross-sectional study on coronavirus disease 2019 in Bangladesh: clinical epidemiology and short-term outcomes in recovered individuals

Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic. This study aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -associated epidemiology and clinical outcomes in Bangladesh in order to understand the future course of the COVID-19 pandemic and develop approaches to prevention. A cross-sectional study based on retrospective interviews was conducted on 1021 individuals with RT-PCR-confirmed COVID-19 admitted in six different hospitals in Bangladesh and who recovered 4 weeks before the interview date. Of the 1021 patients, 111 (10.9%) were asymptomatic and the other 910 (89.1%) were symptomatic. Higher prevalence of COVID-19 was found in the male population (75%), in cohorts with B-positive blood group (36.3%) and in the 31–40 years age group. Common symptoms observed in our study participants were fever (72.4%), cough (55.9%), loss of taste (40.7%) and body ache (40%); whereas among the biochemical parameters, neutrophil count (46.4%), D-dimer (46.1%) and ferritin (37.9%) levels were elevated. Among the recovered individuals, short-term outcomes including pains and aches (31.8%), weakened attention span (24.4%) and anxiety or depression (23.1%) were also significantly prevalent in the symptomatic cases with comorbidities. Our study showed that in Bangladesh, adult males aged between 31 and 40 years were more vulnerable to developing COVID-19. It also indicated a rising trend of asymptomatic cases as the pandemic progressed. As a consequence, deployment of interventions to curb further spread of community infection is necessary to avoid grave outcomes of COVID-19 in Bangladesh.

Influence of Dental Treatment on Outcome of Graves’ Disease Treated with Anti-Thyroid Drug

Purpose: The relations between Time Courses (TCs) of anti-TSH receptor auto-antibodies (TRAb) during Anti-Thyroid Drug (ATD) treatment and the outcome of Graves’ Disease (GD) were sought in relation to dental treatment.

Magnetic resonance imaging findings in a rare case of left ventricular noncompaction

Left ventricular noncompaction (LVNC) is a relatively rare clinical entity with a grave outcome. Various morphological findings, both on two-dimensional echocardiography and cardiac magnetic resonance imaging (MRI), have been depicted in the literature, helping in establishing the correct diagnosis of this condition. We describe a rare case of LVNC and its MRI features.

Vitamin D levels in women of reproductive age group- where do we stand?

Vitamin D is a steroid hormone which is fat soluble and activated in kidneys. It plays multiple roles including regulation of cellular growth and differentiation, metabolic modifications, immunity, insulin resistance, cardiovascular disease, malignancies and also various reproduction related states like preeclampsia, preterm birth and gestational diabetes, along with calcium and phosphorous regulation in the body. In present study, we analyzed serum vitamin D levels in 100 women of reproductive age group (15-45 years). Surprisingly, only 7% of the women were found to have sufficient vitamin D level while 19% had insufficient level and 74 % were deficient. Such alarming community wide deficiency raises concern. Especially in this reproductive age group the women are liable to have rickets, osteoporosis, osteomalacia, low fertility and increased risk for adverse pregnancy outcomes. Pre-conception vitamin D supplementation is simple, easy, and inexpensive method which can prevent such grave outcomes. Keywords: Vitamin D, Women, Reproductive age group, Deficiency.

Predictors and prognoses of Willisian collateral failure during mechanical thrombectomy

During mechanical thrombectomy in the anterior cerebral circulation, thrombus embolization resulting in Willisian collateral failure may lead to critical stroke outcomes due to a shutdown of leptomeningeal collaterals. We hypothesized that the outcomes of dynamic Willisian collateral failure (DWF), induced during mechanical thrombectomy, would be associated with grave outcomes. We evaluated this hypothesis in consecutive patients, between January 2011 and May 2016, who underwent mechanical thrombectomy for anterior circulation occlusions, with an onset-to-puncture of 24 h. Patients with initial Willisian collateral failure (IWF) were identified first, with remaining patients classified into the DWF and Willisian collateral sparing (WCS) groups. Comparative and multivariable analyses were performed to predict grave outcomes (3-month modified Rankin Scale score of 5–6). Among 567 patients, 37 were in the IWF group, 38 in the DWF group, and 492 in the WCS group. Compared to the WCS and DWF groups, the IWF group had a higher baseline National Institute of Health Stroke Scale score and lower Alberta Stroke Program Early CT Score. The prevalence of grave outcomes was similarly high in the IWF (48.6%) and DWF (47.4%) groups, but lower in the WCS group (22.0%; p < 0.001). IWF and DWF were independent risk factors for a grave outcome.

Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable?

IntroductionVery few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspectives from a spine surgeon’s point of view in this seriously affected patient group.Materials and methodsA retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylodiscitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis.ResultsAll 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied.ConclusionsDestructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.

The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa.

Cervical cancer is one of the most common causes of morbidity and mortality among women in developing countries including Ethiopia. Unlike other types of cancers, the grave outcomes of cervical cancer could be prevented if detected at its early stage. However, in Ethiopia, awareness about the disease and the availability of screening and treatment services is limited. This study aims to determine the role of health education on cervical cancer screening uptake in selected health facilities in Addis Ababa. Two-pronged clustered randomized controlled trial was conducted in 2018 at eight public health centers that provide cervical cancer screening services using visual inspection with acetic acid (VIA) in Addis Ababa, Ethiopia. Each of the eight health centers were randomly assigned to serve as either an intervention or a control center. A two-pronged clustered randomized controlled trial was conducted in eight public health care centers. All the selected facilities provided cervical cancer screening services using visual inspection with acetic acid (VIA). Four health centers were randomly assigned to the intervention and control arms. The study participants were women aged 30-49 years who sought care at maternal and child health clinics but who had never been screened for cervical cancer. In the intervention health centers, all eligible women received one-to-one health education and educational brochures about cervical cancer and cervical cancer screening. In the control health centers, participants received standard care. Baseline data were collected at recruitment and follow-up data were collected two months after the baseline. For the follow-up data collection, participants (both in the intervention and control arms) were interviewed over the phone to check whether they were screened for cervical cancer. From the 2,140 women who participated in the study, 215 (10%) screened for cervical cancer, where 152(71%) were from the intervention health centers. Seventy-four percent of these participants reported that they learned about the benefits of screening from the one-to-one health education or the brochure. Women from the intervention health centers had higher odds of getting screened (AOR = 2.43,95%CI;1.58-2.90) than the controls. Women with the educational status of the first degree and those who have a history of sexually transmitted infections (STIs) had higher odds of getting screened (AOR = 2.03,95%CI;(1.15-2.58) and (AOR = 1.55,95%CI;1.01-2.36), respectively. Providing focused health education supported by printed educational materials increased the uptake of cervical cancer screening services. Integrating one-to-one health education and providing a take-home educational material into the existing maternal and child health services can help increase cervical cancer screening uptake.

THINK OUTSIDE THE BOX

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: In the world of oncology, superior vena cava (SVC) syndrome and cardiac tamponade occurring together are infrequent. Although it's rare, clinicians should be looking for all life-threatening oncological emergencies and manage them emergently. CASE PRESENTATION: A 62-year-old male with recently diagnosed metastatic small cell lung cancer complicated with SVC syndrome treated with four cycles of cisplatin and etoposide with good response presented with acute dyspnea. He was hemodynamically stable but tachypneic and maintaining good oxygen saturations. A computerized tomography (CT) scan of the chest showed an increase in the size of the right lung mass compressing SVC, right main pulmonary artery, and proximal right upper lobe bronchus along with severe pericardial effusion. An emergent echocardiogram revealed tamponade physiology. He underwent emergent pericardiocentesis and drained 470 cc of fluid which was positive for malignant cells. He was scheduled for radiation and second-line chemotherapy but developed pneumonia and septic shock. The family opted for comfort care and he expired soon thereafter. DISCUSSION: Malignancy related pericardial effusions are due to secondary metastases to the pericardium, direct invasion of the pericardium, previous radiation or concurrent infection. Diagnosis is by echocardiogram as the clinical picture is not classical most of the time [1]. Irrespective of the mechanism, emergent pericardiocentesis should be performed. Pericardial drain placement, systemic chemotherapy, and radiation can be tried to prevent reaccumulation [2]. External compression of SVC leading to SVC syndrome can be suspected clinically but CT scan with contrast confirms it. Emergent treatment with an endovascular stent is indicated for hemodynamic instability, airway compromise, and elevated intracranial pressure. Radiation therapy is effective but symptom relief is delayed [3]. CONCLUSIONS: This case alerts fellow physicians regarding two major oncological emergencies where accurate diagnosis and urgent intervention is mandated. Also, in the absence of a clinical suspicion identification of one can lead to an overlooked diagnosis of the other. It is always a good approach to keep the differentials broad and failure to recognize and treat either of the two may result in a grave outcome. Reference #1: Asif S, Mahmood M, Pauly RR. Concurrent Cardiac Tamponade and Superior Vena Cava Syndrome: A Concerning Situation. Cureus. 2019 Mar;11(3). Reference #2: Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G. Management of pericardial effusion. Heart. 2001 Aug 1;86(2):235-40. Reference #3: Halfdanarson TR, Hogan WJ, Madsen BE. Emergencies in hematology and oncology. InMayo Clinic Proceedings 2017 Apr 1 (Vol. 92, No. 4, pp. 609-641). Elsevier. DISCLOSURES: No relevant relationships by Ammar Ali Ashfaq, source=Web Response No relevant relationships by Neelima Manda, source=Web Response No relevant relationships by Nishanth Thalambedu, source=Web Response

MicroRNA-1271-5p/TIAM1 suppresses the progression of ovarian cancer through inactivating Notch signaling pathway

ObjectiveOvarian cancer (OC) has been regarded as the most malignant gynecological neoplasm and often confers grave outcomes owing to the frequent metastasis and high recurrence. A previous study has demonstrated that miR-1271-5p is implicated in OC progression, however, the possible mechanism of it remains unknown. The purpose of this investigation was to explore how miR-1271-5p regulates the progression of OC.MethodsGene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases were employed to analyze the differentially expressed miRNAs or genes as well as their corresponding prognostic values. miR-1271-5p expression in OC cells was examined by qRT-PCR. Cell counting kit 8 (CCK-8), colony formation, and transwell tests were conducted to evaluate the proliferation, migration and invasion potentials. Bioinformatics prediction and luciferase activity analysis were utilized to predict and verify the target gene of miR-1271-5p. Western blot assay was carried out to measure protein expression.ResultsmiR-1271-5p was significantly decreased in OC and its down-regulation was associated with the grave outcome of OC patients. Upregulation of miR-1271-5p inhibited cell viability, but miR-1271-5p knockdown promoted the proliferation of OC cells. TIAM1 was a direct target gene of miR-1271-5p and expressed in OC tissues at higher level. High expression of TIAM1 induced the poorer prognosis of patients with OC. Further functional analyses showed that the suppressive role of miR-1271-5p on OC cell malignant behaviors was overturned by the upregulation of TIAM1. The protein levels of Cyclin D1, HES1, NOTCH and NUMB were remarkably changed due to the abnormal expression of miR-1271-5p and TIAM1.ConclusionTo sum up, miR-1271-5p inhibits proliferation, invasion and migration of OC cells by directly repressing TIAM1 to inactivate the Notch signaling pathway, which provides an alternative therapeutic candidate for the advancement of OC treatment.

A country report: impact of COVID-19 and inequity of health on South Korea’s disabled community during a pandemic

The South Korean media boasts of its leading success–during the escalation of the coronavirus outbreak–in flattening of the curve thereby mitigating the grave outcomes of the public health crisis. Much of the success is reportedly attributed to the rapid and advanced development of test kits, essential equipment and implementation of protocols in precautionary measures. However, it has been an arduous task to stay afloat for one particular vulnerable community. The disabled citizens of Korea were confronted by the realities of health inequity during this disastrous period. Pre-existing the pandemic onset, the disabled community have faced stigmatization and under many circumstances de-prioritization by their own society. Through the lense of a visiting physician, my hope is to poignantly and respectfully share personal experiences and thoughts on these realties impacted by the COVID-19 pandemic in South Korea.