Past History Research Articles

A Case Report on Maxillary Ameloblastic Fibroma in a 55-Year-Old Man

Ameloblastic Fibroma (AF) accounts for only 2% of all odontogenic tumors.1 It has been shown to be more common in males than females.2 A malignant transformation of this tumor is known as ameloblastic fibrosarcoma. To the best of our knowledge, there are no published reports on AF in the Philippines, with only one report of its malignant counterpart, ameloblastic fibrosarcoma.3 We present a rare case of AF with an unusual presentation and discuss its rarity, pathogenesis, histologic features and management. CASE REPORTA 55-year-old Filipino man consulted at our tertiary government hospital for a one-year history of a gradually enlarging maxillary alveolar ridge mass extending to the hard palate. Upon first noticing the mass a year prior, he consulted with a local dentist and an intraoral examination revealed a smooth swelling on the right maxillary alveolar ridge between the first and second maxillary premolar, approximately measuring 2 cm x 2 cm x 1 cm. The mass was noted to extend to the hard palate. (Figure 1A) He was advised consultation with an ENT surgeon for further evaluation and management but he did not comply. In the interim, the mass gradually enlarged. Upon first consultation at ITRMC, intraoral examination revealed a 6 cm x 4 cm x 2 cm soft, non-friable, ulcerative mass with irregular borders on the right maxillary alveolar ridge extending to the hard palate. (Figure 1B) The mass was malodorous, easily bled on manipulation and had violaceous areas. A punch biopsy revealed AF. Past medical history was unremarkable. A contrast-enhanced computed tomography (CECT) scan of the paranasal sinuses (PNS) revealed a 6.7 cm x 8.7 cm x 6.7 cm expansile, lobulated, mixed attenuating, heterogeneously enhancing mass in the midface. The bulk of the mass involved the right maxilla but extended to involve the entire hard palate and most of the left maxillary sinus. (Figure 2) The lesion was associated with osteolytic destruction and abutted the floor of the right orbit and bilateral zygomaticomaxillary buttresses. The inferior and posterior portions of the nasal septum were also eroded. (Figure 3) Given the clinical and radiographic features, odontogenic myxoma and ameloblastoma were considered as differential diagnoses as they may present as a painless, slow-growing, multiloculated mass with bony expansions.4,5 Oral cavity squamous cell carcinoma was also considered. The mass was excised via a right subtotal maxillectomy and left inferior maxillectomy using a Weber-Ferguson approach (Figure 4) and a temporary surgical obturator was fitted. Post-operative recovery was unremarkable and the patient was discharged after five days. Once the surgical site healed he was fitted with an acrylic surgical obturator. Final histopathological report was AF, compatible with the pre-operative biopsy result. (Figure 5) On follow up three months post-surgery, the patient was able to eat and speak with ease and no tumor recurrence was observed. One year and three weeks later, there was still no recurrence noted on inspection of the surgical defect, his speech was hypernasal but understandable, and he had no difficulty communicating and eating.

Modern Irredentist Conflicts in the Arab World: Political Science and Socio-Philosophical Aspects (Part 1)

The article is devoted to the study of modern irredentist conflicts in the Arab world, examining cases of irredentist conflicts in countries such as Morocco and Algeria, as well as the situation around the island of Mayotte, which is the subject of claims between the Comoros and France. the article is based on the example of conflicts in West Africa and the Comoros Archipelago. The author emphasizes the growing influence of ethnic and nationalist movements that determine the nature of territorial disputes and pose a threat to political stability in the region. An important aspect of irredentist conflicts is the desire of certain ethnic groups to regain historical territories or to integrate with territories inhabited by ethnically close populations. It is indicated that the source of irredentist conflicts in the Arab world is, firstly, uneven colonization and, accordingly, the ineffectiveness of the application of universal consolidated mechanisms of decolonization; secondly, the differentiated nature of Arab-Muslim imperial colonialism itself in the historical past. The analysis of the political and social sources of conflicts allows us to comprehend their impact on the global political system and outline possible ways of peaceful settlement.

HPB SO55 - Utilisation of Telephone Assessment Clinic for booking Laparoscopic Cholecystectomy: Analysis of outcomes and cancellations

Abstract Background Despite extensive efforts to increase productivity after the Covid pandemic, there still remain areas of limited capacity. Face-to-face outpatient clinic provision is yet to return to normal levels, despite significant increases in referrals. Telephone assessment clinics are attractive solutions as they can be performed outside 'standard' operating hours of the hospital and require fewer support staff, giving increased flexibility to consultant and trainee surgeons who perform them. However, it is unclear whether telephone assessment alone is sufficient to book patients onto operating lists. This study aimed to assess the effectiveness of telephone assessment alone when booking patients for laparoscopic cholecystectomy. Method A standardised telephone assessment process was developed which included mandatory information about symptoms, past medical and surgical history and body weight. All patients referred for consideration of cholecystectomy from January 2023 to January 2024 received either a telephone or face-to-face clinic appointment; those who received a telephone appointment were not routinely offered face-to-face assessment unless clinically indicated. Patients were listed for laparoscopic cholecystectomy from either clinic and all operations took place on pooled operating lists. Operative and clinical outcomes were recorded, including cancellations on the day and unexpected anatomy or procedures. Outcomes between telephone and face-to-face appointments were compared. Results Over the study period, 189 patients had a laparoscopic cholecystectomy from an elective clinic source. Other sources included those patients who had presented acutely and were discharged and those on semi-acute lists. 106 patients had a telephone assessment as their only prior engagement with surgical services prior to surgery. Of these patients, there was one cancellation on the day (due to absence of symptoms between clinic assessment and date of surgery). Nine patients required cholangiography which had not been initially booked. In contrast, three patients who had had face-to-face assessment were cancelled on the day. Conclusion Telephone assessment alone is sufficient to book patients onto an elective theatre list for laparoscopic cholecystectomy, with no adverse impact on cancellations and theatre utilisation. To ensure low cancellation rates and safe surgery, senior decision making is required for telephone assessment clinics (in this study, all appointments were carried out by consultant surgeons) and a standardised proforma to ensure all relevant information is recorded. The low rate of cancellations was maintained even though a 'pooled' operating list is utilised in our hospital. Telephone assessment clinics for first appointments are safe and effective and could help in reducing overall waiting times.

The modality of historical thinking in the latest Greek primary school curriculum and the new challenges in history education

AbstractThis paper refers to the concept of ‘historical thinking’ as it appears in the three versions of the recent Greek History Curriculum for primary school. It is a comparative study of the discourse of the three versions of the recent history curriculum for primary school. The methodological approach of this study was founded on Critical Discourse Analysis. The main purpose of this paper is to explore the meaning and context of this term as presented in the three versions of the history curriculum and to compare the findings of the study with corresponding references in the international literature regarding the terms of ‘historical thinking’. This study demonstrated that this term is not the same in all three versions of the curriculum. In the first version of the curriculum the term ‘historical thinking’ is mentioned autonomously and we also separately identify the term ‘critical thinking’, while in the second and third versions a synthesis of the term is observed, which eventually becomes ‘critical historical thinking’. As a result of this observation, the use of the terms is critically and comparatively studied. The main conclusion is that the term ‘critical historical study’ refers much more to the development of general skills and competences with cognitive characteristics and much less to the critical understanding of the historical past. Furthermore, the conclusions of this study suggest a perspective for historical thinking in contemporary curricula with new challenges such as the relationship of historical education with artificial intelligence and children's representations.

Abstract 4124430: Calcinosis Cutis and Heart Failure---A Rare Manifestation Which Should Never Be Ignored!

Introduction: Heart failure can be a manifestation of underlying immune mediated myopathies like dermatomyositis/polymyositis which can present in broad range of clinical manifestations and sometimes dermatologic lesions can be the only manifestation of these underlying pathologies without typically involving the muscle weakness. Calcinosis cutis is the deposition of calcium salts in the skin and subcutaneous tissue. There are five subtypes of calcinosis cutis, dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis. Case summary: 70-year-old female was evaluated for bilateral lower extremity swelling. Past medical history was significant for Graves’ disease, atrial fibrillation, mechanical aortic valve on warfarin, hypertension, hyperlipidemia, ascending aortic aneurysm. Work up showed BNP of 4700 pg/ml with normal cardiac enzymes. Transthoracic echocardiogram revealed newly reduced ejection fraction of 25—30% with severely dilated left ventricle. Patient refused cardiac catheterization. Nuclear stress test showed no evidence of ischemia. Patient was started on guideline directed medical therapy and biventricular Implantable cardioverter defibrillator device was placed as per cardiology recommendation. Six months later patient developed multiple calcinosis cutis lesions on abdominal wall requiring surgical excisions. Endocrine work up including PTH, serum Ca level was normal, however creatin kinase level was high normal (150 U/L). Serum aldolase was ordered which was found to be elevated(25U/L). Muscle biopsy was performed as per recommendations of rheumatology which was diagnostic of dermatomyositis. Patient was started on high dose steroids and methotrexate and eventually IV immunoglobulins as per rheumatology recommendation. Follow up echocardiogram revealed improved ejection fraction to 40--45% with resolution of any further lesion of calcinosis cutis afterwards. Conclusion: Cardiac involvement such as congestive heart failure can be a part of presentation of underlying untreated myopathies. Calcinosis cutis can be the only clinical manifestation of dermatomyositis affecting heart. Etiology of calcinosis cutis in patients with heart failure should be worked up properly. Dystrophic calcinosis cutis is the subtype associated with underlying autoimmune connective tissue diseases.

Abstract 4144514: Human Immunodeficiency Virus Associated Cardiomyopathy- A Rare Cause of Heart Failure With Reduced Ejection Fraction in Era of Highly Active Antiretroviral Therapy

Introduction: Human Immunodeficiency Virus Associated Cardiomyopathy (HIVAC) is characterized by left ventricular (LV) systolic or diastolic dysfunction with or without LV dilatation and heart failure symptoms. The introduction of antiretroviral therapy (ART) has changed the fulminant systolic heart failure presentation of HIV myocarditis to diastolic heart failure. We present a unique case of dilated cardiomyopathy in a young patient without advanced HIV illness which has rarely been documented in the literature. This is a rare presentation of HIVAC in the post-ART era. Case Report: A 32-year-old male with a past medical history (PMH) of the human immunodeficiency virus (HIV) presented with complaints of new onset worsening shortness of breath and lower extremity edema for four weeks. He was diagnosed with HIV seven years ago and was not compliant with ART. Laboratory testing showed a cluster of differentiation 4 (CD4) 823 and HIV load 2550. Myocarditis was ruled out by normal troponin levels and no new changes on the electrocardiogram (ECG). Transthoracic echocardiogram (TTE) showed dilated left ventricle (LV), LV global hypokinesis, LV ejection fraction (LVEF) 10-15%, dilated right ventricle, biatrial dilation, moderate to severe mitral regurgitation, severe tricuspid regurgitation, pulmonary artery (PA) systolic pressure 73 mmHg and no pericardial effusion. Coronary angiography was negative for coronary artery disease (CAD). The patient was started on carvedilol and outpatient evaluation for a left ventricular assistance device. Discussion: Systolic dysfunction in patients with HIVAC carried a poor prognosis in the pre-ART era and was common in patients with elevated c-reactive protein (CRP), tobacco use, and previous myocardial infarction (MI). After the advent of ART, systolic dysfunction is rare and replaced by diastolic cardiomyopathy in the setting of ART use. Diagnosis is usually by excluding other etiologies and biopsy is not necessarily required. Management is usually guideline-directed medical therapy (i.e. beta blocker, renin-angiotensin-aldosterone antagonists, sodium-glucose cotransporter-2) and device-based therapy but there is still data lacking to assess its benefit.

Unveiling three accessory spleens in one patient: a rare case report and literature review

BackgroundDuring embryogenesis, the spleen undergoes intricate developmental processes, originating from mesenchymal cells in the dorsal mesentery. An accessory spleen, a common anomaly found in autopsies and abdominal CT scans, can often be mistaken for different types of tumors. To the best of our knowledge, this is the first case in Syria documenting the occurrence of 3 accessory spleens in a patient who had previously undergone splenectomy.Case presentationA 33-year-old male presented with right hypochondrium pain, sharp and radiating to the right flank, exacerbated by movement and large meals. Past medical history included mild Irritable Bowel Syndrome (IBS) and splenectomy due to a traumatic accident in childhood. On admission, vital signs were stable, with abdominal tenderness in the right upper quadrant. Laboratory investigations showed normal values. Ultrasound revealed a lobulated mass at the right adrenal gland (4.5 × 5 cm) with an isoechoic to hypoechoic texture. Multi-slice computed tomography (MSCT) Scan showed multiple nodules in the right adrenal gland, regular in shape, exerting a compressive mass effect, and significant lymphadenopathy around the abdominal aorta. Elevated metanephrine levels raised suspicion of an extra-adrenal pheochromocytoma. Laparoscopic surgery was performed, revealing accessory spleens and normal adrenal tissue with no malignancy.ConclusionHealthcare providers should consider accessory spleens as a differential diagnosis for masses near the adrenal glands. Multiple accessory spleens in the adrenal region can complicate cases. Accessory spleens in uncommon locations like the adrenal glands can be challenging to diagnose and manage.

Bilateral Macular Dysplasia in Coffin-Siris Syndrome.

To report a case of bilateral macular dysplasia without pigmentary retinopathy in a patient with genetically confirmed Coffin-Siris syndrome (CSS) and a co-existing, heterozygous CNGB1 variant. Case report. A 7-year-old boy who failed his vision screening was referred for retinal consultation after his eye care provider identified bilateral macular deposits. Past medical history included developmental delay, atypical facial features, uteropelvic junction obstruction, koilonychia, and corpus callosum dysgenesis. The patient underwent whole exome sequencing, which revealed a pathogenic variant in the ARID1A gene consistent with a diagnosis of Coffin-Siris syndrome. Genetic testing also revealed a heterozygous, missense variant in the CNGB1 gene of unknown significance. Fundus examination revealed fine hypopigmented lesions in the macula with surrounding retinal pigment epithelial changes in both eyes. Spectral-domain ocular coherence tomography revealed abnormalities of the ellipsoid and interdigitation zones. The patient's best-corrected visual acuity and clinical examination remained stable for a decade since his initial examination, with persistent macular dysplasia and no pigmentary retinopathy. It is possible that the ocular findings in this case may expand the phenotypes associated with CSS.

Writing Indigenousness

Abstract When Central European Jews underwent massive urbanization during the nineteenth century, their German-language narrative fiction retold this experience in a historical garb. Based on six literary examples, this article argues that during the 1850s, Jewish writing radically changed from an outsider to an insider perspective, while nonetheless emphasizing the precarious position of Jews in the city. The first three examples, The Rabbi of Bacharach (c. 1825) by Heinrich Heine, “Letters and Walks of a Jewish Student” (1850) by Ludwig Philippson, and “Franzefuß” (1855) by Leopold Kompert, retrospectively evoke the anguish of Jewish migrants in the urban labyrinth. Three later novels, The Girls of Khaybar (1859) by Salomon Wassermann, The Y Aguilar Family (1873) by Markus Lehmann, and Jettchen Gebert (1906) by Georg Hermann, imagine Jewish elite families rooted in idyllic cityscapes of the Arabian, Spanish, and German historical pasts, where they must confront the threat of barbarous invaders.

‘[A] very improbable and imaginative fiction’: Fictionalising the French invasion of Fishguard

In the years leading up to the centenary of the last invasion of the British mainland, several historical novels in Welsh and English chronicled the events of the French landing near Fishguard in 1797. These fictional explorations throw Welsh national identity into relief at a time when Britain consolidated its domestic and overseas territories against its main rival, France. While ostensibly set in the historical past, the novels under observation share significant traits with the popular genre of the invasion novel that came to the fore in the second half of the nineteenth century as the British Empire neared its largest extent. Published during a time of cultural and political revivals in late-Victorian Wales, these historical invasion novels offer a different, literary way to examine past discourses around Welsh nationhood and national territory as well as coloniality and sovereignty.

Leaders in the History of Clinical Child and Adolescent Psychology Past Presidents Series: Milton Shore (1974–1975)

Leaders in the History of Clinical Child and Adolescent Psychology Past Presidents Series: Milton Shore (1974–1975)

Clinicopathologic features and outcomes of hepatic inflammatory pseudotumour (IPT) and hepatic IPT-like lesions.

Hepatic inflammatory pseudotumours (IPTs) are nonneoplastic hepatic masses characterized by variably fibroblastic stroma and inflammatory infiltrate, hypothesized to arise as part of a response to infection or prior surgery. The aim of this study was to evaluate the clinicopathologic features and outcomes of biopsy-proven hepatic IPT as well as other cases with IPT-like histologic features. A database search at our institution identified cases with a pathologic diagnosis of hepatic IPT (n = 80) between 2000 and 2023. Histologic features (stromal quality, inflammatory cell components, granulomas, and necrosis) were evaluated. Past medical and surgical history, microbiologic studies, and outcomes were reviewed retrospectively. Patients frequently had a past medical history of malignancy (34%), biliary disease (15%), or prior intraabdominal surgery (24%), and often presented with multifocal hepatic lesions (36%). Variable inflammatory backgrounds were present, including histiocytic (36%), lymphoplasmacytic (34%), or neutrophilic (24%). Specific organisms were identified in 15% of cases, most commonly Klebsiella and Staphylococcus species. Most patients with available clinical follow-up demonstrated radiologic resolution and/or had repeat negative biopsy; a minority of patients (8%) were subsequently diagnosed with neoplastic hepatic lesions. No significant association was seen between histologic features and the subsequent clinical or pathologic diagnosis of hepatic neoplastic lesions. Hepatic IPT is a heterogeneous entity that can present in a variety of clinical scenarios and show a wide morphologic spectrum. These lesions often regress spontaneously or with antibiotics. A subset of cases with hepatic IPT-like histologic features were subsequently diagnosed with malignancy, emphasizing the need for continued follow-up and repeat biopsy depending on clinical and radiologic features.

Accuracy of right atrial pressure estimation by transthoracic echocardiography

Abstract Background/Introduction Transthoracic echocardiography provides an estimate of right atrial pressure (RAP) using the guideline-recommend method of measuring inferior vena cava (IVC) diameter and collapsibility. Despite being ubiquitously reported and necessary for the estimation pulmonary artery systolic pressure, the accuracy of this method for RAP estimation has not been rigorously validated. Purpose To evaluate the accuracy of the guideline-recommended method for the estimation of RAP by TTE. Methods A single center, retrospective chart review of patients who had a TTE and right heart catheterization (RHC) within 48 hours of each other from January 2018 to December 2020. Maximum and minimum IVC diameter were measured by trained study personnel. Accuracy was then stratified by the presence/absence of a history of two variables that could modify IVC diameter independent of RAP—syncope, which is associated with more dilated IVC in some studies and liver disease, which could result in compression (from parenchymal fibrosis surrounding the IVC) or dilation (from diversion of portal blood flow through the IVC among other mechanisms) of the IVC. Results The 117 patients who met inclusion criteria had a median age of 67 years old (interquartile range [IQR] 58 – 75) and median RAP of 13 mmHg (IQR 8 – 18) on RHC. The median time between TTE and RHC was 9.6 hours (IQR 3.8 – 24.5 hours) during which 24 (20.5%) patients received intravenous fluids (median 220 mL administered; IQR 145 – 320). Forty-three (35.9%) received diuretics between the studies with most patients receiving either 1 (26 patients, 61.9% of those who received diuretics) or 2 (13 patients, 31.0%) diuretic doses. In evaluating accuracy, only 26 patient’s (20.5%) RAP by RHC fell within estimated RAP range by TTE (Figure 1). After excluding the 60 patients who received fluids and/or diuretics between the TTE and RHC, the TTE estimate was still only accurate in 13 (22.8%) patients. When analyzing how each subcomponent of the TTE guidelines for RAP estimation correlated with RAP via RHC, maximum IVC diameter and percent collapsibility had Pearson’s correlation coefficients of 0.47 and 0.24 respectfully (Figure 2A and 2B). Past medical history was significant for syncope in 16 patients (13.7%) and liver disease in 8 patients (6.8%). Compared to those without each factor, the absolute accuracy of the TTE estimate was lower when stratified by a history of syncope (12.5% accurate vs 21.8%, p = 0.60) and liver disease (12.5% vs 21.2%, p = 0.90) though neither were statistically significant. Conclusion In this retrospective chart review, RAP estimation by TTE using the guideline-recommended method had limited accuracy. Prospective evaluation with minimal time between RHC and TTE is needed to validate the accuracy of the TTE guidelines.Accuracy of TTE for RAP estimationCorrelation between RAP & TTE Variables

A 25-Year-Old Woman with Continues Unconsciousness For 10 Days; A Case Report and Review of Literature

We reported the case of a 25-year-old woman with antihistamine abuse who presented to our hospital with a GCS of 7 and no significant past medical, psychological, or allergic history. We couldn’t find any evidence of head trauma, seizures, suicide, or any other metabolic, infectious, intoxication, or electrolyte disturbances. During her 10-day admission, the patient developed non-specific manifestations such as fever, hyperthermia, agitation, hypotension, and sinus tachycardia. Physicians should always consider over-the-counter medicines such as antihistamines as a differential diagnosis for loss of consciousness in patients who do not have any footprints of intoxication in primary urine or blood tests.

From Erasure to Restoration: Antisemitism and the Visual Reverberations of a Revolutionary Pedagogy

Abstract A set of rediscovered revolutionary posters by the Reprint Collective (which was presented as part of Documenta fifteen) in Brussels provided an incredibly moving window into times past. Notwithstanding how the events addressed by those political artefacts now lie in the historical past, the revolutionary reverberations of the posters remain something to treasure. They bring to life political causes that underline the importance of radical solidarity and activist alliances. To understand why such artefacts were banned, we need to recognise the role of contemporary racism – the projection of the figure of a Palestine-radical left-Muslim subject that encompasses everything the liberal mainstream supposedly is not. This article argues that the New Anti-Semitism is a merely ideological manifestation that has no contribution to make toward the struggle against antisemitism. The posters remind us that 1) the struggle against antisemitism cannot be separated from the struggle against Islamophobia, but also that 2) the erasure of a particular Jewish and Left revolutionary subjectivity is intrinsic to the workings of hegemonic forces that maintain contemporary politics. Going against the account in which antisemitism has conventionally been framed, this article aims to come to terms with the erasure of a left epistemology that had emerged from the region in the 1970s. Moroccan revolutionary Abraham Serfaty is an example of how the erasure of the radical history of Arab and Jewish progressives was no coincidence. Reversing this erasure not only helps in understanding progressive Jewish interventions in liberation politics but also that the flattening of complex histories and Arab, Left, and Jewish subjectivities is in fact a prerequisite for Zionism. Arab Jews do not fit neatly within a pro-Israel ideological framework that itself systematically feeds off anti-Arab racism. This article furthermore reflects on New Anti-Semitism as a key political instrument and as a powerful moralistic force that muzzles the expression of political context and social ambiguity. The notion ‘Arab Anti-Semitism’ arose against the backdrop of Israeli state terror and regional warfare. This article also provides insights into important intellectual interventions of the left between the 1960s and the 1980s. In combination with the rise of counter-revolutionary forces and major anti-left crackdowns, this emancipatory approach building on a critique of imperialism and capitalism, and solidarity politics based on progressive universal values, was undermined. Finally, coming to terms with the erasure of a left epistemology that had emerged from the region and recovering this very legacy serve as an antidote against historical amnesia. This spirit of a progressive universalism – as, for instance, illustrated in Mahmoud Darwish’s rejection of the opportunistic dictum ‘the enemy of my enemy is my friend’ on the grounds that one can readily speak of a ‘world’s enemy’ – is born from the belief that our ethical and moral constellations carry universal value.

ÜMUMTƏHSİL MƏKTƏBLƏRİNDƏ TƏHSİLİN İDARƏ OLUNMASININ BƏZİ PROBLEMLƏRİ

The article addresses significant issues pertaining to the administration of educational pro¬cess in high schools. Author highlights that, as Azerbaijan prepares to integrate into the global education system, significant challenges have emerged in the administration of the educational process. These issues, though complex, require prompt resolution. Some of these issues have been accumulating since the period of traditional education, while others have emerged as a consequence of the requirements set out in the State Education Reform Programme. The current content of the Azerbaijani education system presents significant obstacles to the develop¬ment of a global perspective among individuals from all professions, effectively limiting their potential for professional growth and development. The forms of education inherited from traditional education, the structure of the educational system, the distinction between theoretical knowledge and practical reality, the significance of certificates and diplomas, and the actual state of knowledge have created a situation of con¬flict. Author believes that it is necessary to ensure a critical examination of our historical past, to investigate the salient aspects of the administration of the existing educational system in developed European countries, and to identify more effective structures in this field for the renewal of our education system. The administration of Azerbaijan's education system should be based on universal and national values, the spiritual and moral qualities of the Turkic world and Islam.

Metastatic Carcinosarcoma with a Sarcomatous Predominance?

Abstract Introduction/Objective Uterine carcinosarcoma (CS), also known as Malignant Mixed Müllerian Tumor, is a malignancy characterized by mixed epithelial and mesenchymal components. It is rare and aggressive, most frequently occurring in elderly, postmenopausal women with a median age of 65 years. CS has a tendency to metastasize with an overall poor prognosis. Fine needle aspiration can be useful in identifying metastatic disease, however, demonstration of both sarcomatous and carcinomatous components can be difficult. Methods/Case Report Our patient is a 68 year old female who was first diagnosed with endometrial carcinosarcoma on an endometrial biopsy in 2022. She subsequently underwent a total abdominal hysterectomy with radical dissection, bilateral salpingo-oophorectomy, upper vaginectomy, sentinel lymph node dissection as well as chemotherapy. Immunohistochemistry for MLH1, MSH2, MSH6 and PMS2 all showed intact nuclear expression. Remission was achieved for about a year, after which she was found to have a moderate right sided pleural effusion with right lower lung infiltrates. Also, a right upper lobe mass was reported on chest CT scan. Paracentesis was performed and cytology was consistent with predominantly atypical spindle cells accompanied by a mixed inflammatory infiltrate. Immunohistochemical stains were performed on the cell block, tumor cells were positive for smooth muscle actin, vimentin and negative for desmin, S-100, SOX-10, CD34, P63, TTF-1 and pancytokeratin. Cytology diagnosis was rendered as malignant cells present, consistent with metastatic CS. A subsequent lung mass core biopsy also confirmed the diagnosis. Results (if a Case Study enter NA) NA Conclusion The cytomorphological features in effusion samples from metastatic CS have the carcinomatous component readily identifiable, and only a minority of effusion samples show additional sarcomatous component. The exact diagnosis of CS may not be possible due to the absence of sarcomatous components. Alternatively, as we present in this rare case of metastatic CS, the sarcomatous component in the form of abundant atypical oval to spindle cells with hyperchromatic nuclei may be the only form of malignant cells present in the specimen. Careful morphological assessment of architectural patterns, a good past medical history, availability of cell blocks and immunohistochemistry are vital in providing an accurate diagnosis in such rare cases of metastatic CS.

Treatment Options in Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP): Case Presentation and Review of the Literature

ABSTRACT Purpose To outline the therapeutic approach for a rare case of Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP) and examine the current management recommendations of this uncommon condition. Methods-Results Literature review on the current treatment options in BDUMP cases. An 82-year-old woman was referred to our clinic due to bilateral visual loss. She was treated elsewhere with anti-vascular endothelial growth factors (anti-VEGF) in both eyes for presumed choroidal neovascularization (CNV) without improvement. Her past medical history (PMH) entailed colon cancer, treated with surgical resection and adjuvant chemotherapy 15 years ago. The patient presented with low visual acuity in both eyes, multiple oval orange patches in the fundus with striking hyperfluorescent pattern in fluorescein angiography (FA), giraffe pattern in fundus autofluorescence (FAF) and rapidly progressive cataracts. Intravitreal dexamethasone implants were administered with mild improvement and subretinal fluid absorption. Conclusions The management strategy in BDUMP should focus on the systemic, often occult malignancy. There is no standard treatment protocol for BDUMP; however, plasmapheresis in combination with primary malignancy treatment seems to yield promising results in current literature reports. Anti-VEGF injections failed to control BDUMP sequelae, however intravitreal dexamethasone implants may offer temporary relief.

Systematic evaluation of multifactorial causal associations for Alzheimer's disease and an interactive platform MRAD developed based on Mendelian randomization analysis.

Alzheimer's disease (AD) is a complex degenerative disease of the central nervous system, and elucidating its pathogenesis remains challenging. In this study, we used the inverse-variance weighted (IVW) model as the major analysis method to perform hypothesis-free Mendelian randomization (MR) analysis on the data from MRC IEU OpenGWAS (18,097 exposure traits and 16 AD outcome traits), and conducted sensitivity analysis with six models, to assess the robustness of the IVW results, to identify various classes of risk or protective factors for AD, early-onset AD, and late-onset AD. We generated 400,274 data entries in total, among which the major analysis method of the IVW model consists of 73,129 records with 4840 exposure traits, which fall into 10 categories: Disease, Medical laboratory science, Imaging, Anthropometric, Treatment, Molecular trait, Gut microbiota, Past history, Family history, and Lifestyle trait. More importantly, a freely accessed online platform called MRAD (https://gwasmrad.com/mrad/) has been developed using the Shiny package with MR analysis results. Additionally, novel potential AD therapeutic targets (CD33, TBCA, VPS29, GNAI3, PSME1) are identified, among which CD33 was positively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. TBCA and VPS29 were negatively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. GNAI3 and PSME1 were negatively associated with the main outcome traits of AD, as well as with LOAD, but had no significant causal association with EOAD. The findings of our research advance our understanding of the etiology of AD.

Systematic evaluation of multifactorial causal associations for Alzheimer’s disease and an interactive platform MRAD developed based on Mendelian randomization analysis

Alzheimer’s disease (AD) is a complex degenerative disease of the central nervous system, and elucidating its pathogenesis remains challenging. In this study, we used the inverse-variance weighted (IVW) model as the major analysis method to perform hypothesis-free Mendelian randomization (MR) analysis on the data from MRC IEU OpenGWAS (18,097 exposure traits and 16 AD outcome traits), and conducted sensitivity analysis with six models, to assess the robustness of the IVW results, to identify various classes of risk or protective factors for AD, early-onset AD, and late-onset AD. We generated 400,274 data entries in total, among which the major analysis method of the IVW model consists of 73,129 records with 4840 exposure traits, which fall into 10 categories: Disease, Medical laboratory science, Imaging, Anthropometric, Treatment, Molecular trait, Gut microbiota, Past history, Family history, and Lifestyle trait. More importantly, a freely accessed online platform called MRAD (https://gwasmrad.com/mrad/) has been developed using the Shiny package with MR analysis results. Additionally, novel potential AD therapeutic targets (CD33, TBCA, VPS29, GNAI3, PSME1) are identified, among which CD33 was positively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. TBCA and VPS29 were negatively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. GNAI3 and PSME1 were negatively associated with the main outcome traits of AD, as well as with LOAD, but had no significant causal association with EOAD. The findings of our research advance our understanding of the etiology of AD.