Clinical History Research Articles

Prognostic Impacts of Age, Diagnosis Time, and Relapses in Primary CNS Lymphoma.

Background: The incidence of lymphomatous involvement of the central nervous system (CNS) has been increasing in recent years. However, the rarity of the disease has resulted in a scarcity of available data regarding its clinical presentation, natural history, and prognosis. We aimed to investigate the neurological characteristics of uncommon lymphomatous involvements confined to the CNS and to identify key variables that could serve as predictive biomarkers for treatment outcomes. Methods: We identified patients presenting with neurological symptoms and diagnosed with CNS-restricted lymphomatous involvement between 2005 and 2023. Results: We identified 44 cases, 93% of which were diagnosed with primary central nervous system lymphoma (PCNSL) and 7% with intravascular lymphoma. The median time from symptom onset to diagnosis was 47 days (range: 6-573 days), with no statistically significant difference between patients older and younger than 60 years (p = 0.22). The median follow-up time was 1144 days (range: 27-3501 days). Cognitive deterioration was the most common presenting symptom, occurring in 19 out of 44 patients (43%). Brain MRI revealed that lobar lesions were the most frequent location of lesions, found in 24 out of 44 patients (55%). By the end of the study period, 30 patients (68%) had died, with a median survival of 666 days (range: 17-3291 days). Death was significantly more common in patients who experienced relapses (p = 0.04; 95% CI: 0.99-0.03), with these patients having a four times higher chance of death (HR = 4.1; 95% CI: 1.01-16.09). The time to diagnosis significantly correlated with survival (p = 0.02; 95% CI: 0.005-0.54), as did the Eastern Cooperative Oncology Group (ECOG) performance status at the last follow-up (p = 0.006; 95% CI: 0.0012-0.62). Patients aged over 60 years did not exhibit a higher likelihood of death (p = 0.19; HR = 2.3; 95% CI: 0.63-8.61); however, the threshold age at diagnosis for the maximally predicted mortality was 64 years (ROC = 0.73; p = 0.03). Conclusions: Patients had significant delays in diagnosis, affecting patient outcomes. Cognitive deterioration and lobar lesions were prominent clinical and radiological features. Mortality was notably higher in patients with relapses and those who had a longer time to diagnosis.

The Development of Epitope-Based Recombinant Protein Vaccines against SARS-CoV-2.

The COVID-19 pandemic continues to cause infections and deaths, which are attributable to the SARS-CoV-2 Omicron variant of concern (VOC). Moderna's response to the declining protective efficacies of current SARS-CoV-2 vaccines against Omicron was to develop a bivalent booster vaccine based on the Spike (S) protein from the Wuhan and Omicron BA.4/BA.5 strains. This approach, while commendable, is unfeasible in light of rapidly emerging mutated viral strains. PubMed and Google Scholar were systematically reviewed for peer-reviewed papers up to January 2024. Articles included focused on specific themes such as the clinical history of recombinant protein vaccine development against different diseases, including COVID-19, the production of recombinant protein vaccines using different host expression systems, aspects to consider in recombinant protein vaccine development, and overcoming problems associated with large-scale recombinant protein vaccine production. In silico approaches to identify conserved and immunogenic epitopes could provide broad protection against SARS-CoV-2 VOCs but require validation in animal models. The recombinant protein vaccine development platform has shown a successful history in clinical development. Recombinant protein vaccines incorporating conserved epitopes may utilize a number of expression systems, such as yeast (Saccharomyces cerevisiae), baculovirus-insect cells (Sf9 cells), and Escherichia coli (E. coli). Current multi-epitope subunit vaccines against SARS-CoV-2 utilizing synthetic peptides are unfeasible for large-scale immunizations. Recombinant protein vaccines based on conserved and immunogenic proteins produced using E. coli offer high production yields, convenient purification, and cost-effective production of large-scale vaccine quantities capable of protecting against the SARS-CoV-2 D614G strain and its VOCs.

Magnetic resonance imaging and clinical features of Mayer-Rokitansky-Küster-Hauser syndrome: A 10-year review from a dedicated specialist centre.

To correlate the clinical history with imaging findings of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Retrospective cohort study. A UK IOTA and ESGO-certified tertiary referral centre for disorders of reproductive development. All patients with a diagnosis of MRKH and who had undergone an MRI pelvis between 1 January 2011 and 31 April 2021 were included. MRI images were analysed by specialist gynaecological radiologists. Clinical data was extracted from an electronic patient record system. Statistical analysis was computed in R (version 4.1.2), R base stats package and ggstatsplot (v0.5.0). Clinical history and predefined imaging features. One hundred and thirty-four patients were included. Median age at MRI was 18 years (10-64 years). Half (48.2%) of women presenting had a history of pain, most often abdominal (84.6%) or vaginal (9.2%). Remnants were identified in 91.8% of women (n = 123). 4.5% of women had imaging features of endometriosis (n = 6). Women with a functional remnants were significantly more likely to experience pain (p < 0.001). Pain history was not strongly associated with ectopic ovarian position. Common gynaecological pathology such as endometriosis, ovarian cysts and fibroids were also identified. We identify that majority of women with MRKH will have uterine remnants with a connecting fibrous band, and an ectopic ovarian position 44.0% of cases. Abdominal pain was significantly associated with functional remnants on MRI. Further work is required to identify how other gynaecological pathology impacts women with MRKH.

Frequency of Elevated Intraocular Pressure in Patients with Acute and Chronic Anterior Uveitis

Background: Elevated intraocular pressure (IOP) is a frequent and serious complication in patients with uveitis, potentially leading to secondary glaucoma and permanent vision loss. Understanding the frequency and associated risk factors of elevated IOP in patients with acute and chronic anterior uveitis is essential for effective management and prevention of visual morbidity. Objective: This study aimed to determine the frequency of elevated IOP in patients with acute and chronic anterior uveitis and to identify the associated demographic and clinical factors. Methods: This This descriptive, cross-sectional study was conducted over six months at the Outpatient Department of Al-Shifa Trust Eye Hospital, Rawalpindi, involving 160 patients aged 20 to 60 years diagnosed with anterior uveitis. Patients were excluded if they were on anti-glaucoma medications, had specific ocular conditions, or had a pre-existing diagnosis of glaucoma or elevated IOP. Intraocular pressure was measured using Goldmann Applanation Tonometry, with elevated IOP defined as &gt;21 mmHg. Demographic data and clinical history, including the duration and grade of uveitis, were recorded. Data were analyzed using SPSS version 25, with qualitative variables presented as frequencies and percentages, and statistical significance assessed using chi-square tests (p ≤ 0.05). Results: The mean age of the study participants was 33.19 years (SD ± 7.26). Elevated IOP was observed in 38.75% of the patients. A significantly higher frequency of elevated IOP was found in females (61.7% vs. 25% in males, p = 0.000), patients over 30 years of age (46.4% vs. 30.3%, p = 0.026), and those with hypertension (69.8% vs. 23.4% in non-hypertensive patients, p = 0.000). Grade I uveitis had the highest frequency of elevated IOP (100%), followed by grade III (42.9%), grade IV (4.1%), and grade II (0%) (p = 0.000). No significant association was found between elevated IOP and diabetes mellitus or the duration of uveitis. Conclusion: The study found a substantial frequency of elevated IOP in patients with anterior uveitis, particularly among females, older patients, and those with hypertension. These findings highlight the need for regular IOP monitoring and tailored management strategies in high-risk patients to prevent the development of secondary glaucoma and associated vision loss.

Coptis Chinensis Franch: Substance Basis, Mechanism of Action and Quality Control Standard Revealed Based on the Q-marker Concept and New Strategy of Systemic Pharmacology and Biosynthesis Research.

Coptis chinensis Franch. (Ranunculaceae, Coptis), a traditional Chinese medicine (TCM) with thousands of years of clinical use history, also a natural medicine available in many countries, has wide pharmacological mechanisms and significant bioactivity according to its traditional efficacy combined with modern scientific research. The quality marker (Q-marker) of C. chinensis Franch. is predicted in this paper based on the chemical composition and pharmacological effects of the plant, as well as the current system pharmacology, plant relatedness, biosynthetic pathways and quantitative analysis of multi-components (QAMS). Natural medicine has the advantage of being multi-component, multi-pathway and multi-target. However, there are few reports on safety evaluation. This review predicts the Q-marker of C. chinensis, and the safety and efficacy of C. chinensis is provided. Studies from 1975 to 2023 were reviewed from PubMed, Elsevier, ScienceDirect, Web of Science, SpringerLink, and Google Scholar. Alkaloids and organic acids are the two main component categories of Q-Markers. The specific alkaloids identified through predictive results include berberine, coptisine, palmatine, epiberberine, jatrorrhizine, columbamine, and berberrubine. Quinic acid and malic acid, due to their influence on the content of alkaloids and their ability to aid in identifying the active components of C. chinensis, are also considered Q-markers. The research strategy of "exploring chemical components, exploring pharmacological activities, constructing pharmacological mechanism network and locating biosynthetic pathways" was used to accurately screen the quality markers of C. chinensis in this review and summarise the quality evaluation methods and criteria. In addition, we updated the biosynthetic pathway of C. chinensis and refined the specific synthetic pathways of jatrorrhizine (quality markers) and epiberberine (quality markers). Finally, we summarised the quality evaluation methods of C. chinensis, which provide an important reference for resource evaluation and provide a key reference for the discovery of new functional chemical entities for natural medicines.

Prevalence and Patterns of Ocular Comorbidities among Geriatric Population Residents in Rural Eastern India: A Cross-Sectional Study

Background: With the increase in overall life expectancy, the number of people above 60 years old will increase globally from 1 billion in 2020 to 1.4 billion in 2050 and is expected to double by 2.1 billion by 2050 with an increase in age-related comorbidities. Age-related ocular co-morbidities are a major comorbidity. According to India's visual impairment and blindness data, cataracts and severe and moderate visual impairment are the most common cases. Objective: To assess the ocular comorbidities among the geriatric population. Methods: A community-based cross-sectional study was undertaken in the field practice area of the Rural Health Training Center (RHTC), Jamujhari, Khordha, affiliated with the Department of Community Medicine, IMS &amp; SUM Hospital, Bhubaneswar. Stratified random sampling was done, and one stratum constituted three nearby adopted villages. Four strata were included to select the households, and the first household was selected randomly in each village. A socio-demographic profile and detailed clinical history were collected, and the required clinical examinations were conducted after obtaining consent. Results: The prevalence of ocular morbidity (OM) was found to be 96.8%. Refractive error (RE) has the highest prevalence (86.52%), including prescription-corrected glasses users, whereas age-related macular degeneration (ARMD) and ectropion (EC) have the lowest prevalence (3.2%). Conclusions: The study findings show a need for proactive management and earlier screening for better quality of life in the geriatric population.

Temporal Pattern Analysis of Ultrasound Surveillance Data in Vascular Connective Tissue Disorders.

Ehlers-Danlos syndrome (EDS), Marfan syndrome (MFS), and Loeys-Dietz syndrome (LDS) are connective tissue disorders frequently associated with vascular aneurysm formation, dissections, and subsequent major complications. Regular imaging surveillance is recommended for these conditions. However, no guidelines currently exist regarding imaging modality or surveillance intervals. This retrospective single-center observational study analyzed clinical and imaging data of patients attending an outpatient clinic for vascular connective tissue disorders between August 2008 and January 2024. Imaging (1424 data points in total) and clinical data were extracted from electronic health records. Analysis primarily included a comparison of vessel diameter progression across imaging modalities, with an additional review of the clinical history of vascular events. In total, 19 patients with vascular connective tissue disorders (vCTDs) underwent consultations at our outpatient clinic. Nine (47.4%) patients experienced vascular events, while two (10.5%) passed away during the study period. Multimodal imaging surveillance revealed a tendency towards arterial diameter increase. Consistent ultrasound monitoring provided more reliable diameter progression data for the same arterial segment than a combination of imaging modalities. Temporal analysis indicated a tendency for the continuous growth of the abdominal aorta, the common and internal carotid artery, and the common femoral and popliteal artery. The study highlights the importance of standardized, modality-specific imaging protocols in monitoring patients with vCTDs. The variability in disease progression among these patients further complicates surveillance strategies, contemplating the need for individualized approaches. Further research and prospective multicenter studies are required to refine and improve monitoring protocols.

CT-Guided Epidural Contrast Injection for the Identification of Dural Defects.

Post-dural puncture headache (PDPH) is an increasingly recognized cause of chronic headache. Outside of clinical history and myelography that requires an additional dural puncture, there is no reliable diagnostic test to evaluate for persistent dural defects. We describe the injection of iodinated contrast into the dorsal epidural space under CT guidance in five patients as a potential tool to visualize persistent dural defects.ABBREVIATIONS: PDPH = post-dural puncture headache; SIH = spontaneous intracranial hypotension; DSM = digital subtraction myelography; CTM = CT myelography.

The role of serum uric acid in predicting left ventricular function and outcomes in patients with STEMI following PCI

Objectives: Percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI); however, reduced left ventricular ejection fraction (LVEF) remains a critical issue post-PCI. Serum uric acid (SUA) has emerged as a biomarker linked to cardiovascular events and may be associated with LVEF. This study aims to investigate the relationship between SUA levels and LVEF in STEMI patients treated with primary PCI and identify potential biomarkers for predicting patient outcomes. Methods: This prospective study was conducted at Afshar Hospital, Shahid Sadoughi University of Medical Sciences of Yazd, from September 2019 to March 2021. Participants included 254 consecutive ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. Exclusion criteria were contraindications for angiography, history of myocardial infarction, PCI, CABG, NSTEMI, thrombolytic treatment, kidney diseases, gout, or alcoholism. Demographic data, clinical history, SUA levels, and echocardiographic parameters were collected. Statistical analysis was performed using SPSS version 20.0, with significance at p&lt;0.05. Results: 81.49% of patients were male, with a mean age of 57.7±11.47 years. Hypertension was the most prevalent condition (42.9%). SUA levels did not significantly differ between patients with LVEF below and above 40% (p=0.39). However, smoking was significantly associated with reduced LVEF (p&lt;0.001). A weak negative correlation between SUA and LVEF was observed in males (p=0.012) but not in females (p=0.097). Overall, a weak negative correlation between SUA and LVEF was statistically significant (p=0.05). Conclusions: Our findings revealed a weak but statistically significant overall negative correlation between SUA and EF. Further research with larger, more diverse populations is necessary to elucidate the relationship between SUA and cardiac function in STEMI patients.

Characterizing the Links Between Systemic Sclerosis and Breast Cancer.

Systemic sclerosis (SSc) is a complex, autoimmune connective tissue disease that affects multiple organs in the body, culminating in a variance of severity and a reduced quality of life. Breast cancer (BC) also affects patients with SSc, and these two conditions affect a similar demographic. With this systematic review, we aim to characterize the links between SSc and BC. Characterizing possible links between SSc and breast malignancies is important for advancing the understanding of SSc management and comorbidities. In this systematic meta-analysis, a comprehensive literature search was conducted in PubMed using relevant keywords and MeSH terms. The inclusion criteria included an English-language retrospective analysis that characterized patients with SSc with or without BC. Two independent reviewers assessed the study's eligibility based on predetermined criteria. Data extraction included patient antibody measurements, demographics (age and gender), family history, social behaviors (alcohol use and smoking history), concurrent condition treatments, and adverse effects following treatment. Thirteen articles were identified in the literature with relevant data on SSc and BC patients. Studies encompassed research about SSc patients with or without BC and relevant risk factors being measured. SSc was found to have a link to antibodies widely associated with cancer. Adverse treatment outcomes and concurrent conditions of BC were found when patients had a family history of SSc, BC, or an alcohol or smoking history. Our results suggest that the presence of antinuclear antibodies, anti-centromere antibodies, or anti-topoisomerase antibodies in SSc patients is correlated with BC. Out of the three antibodies, ATA seemed to be found more commonly in patients with SSc and malignancy across the studies. This systematic review discusses the link between SSc and BC through patients with relevant clinical markers, medical histories, and treatments. However, further research is necessary to advance the linkage between SSc and BC and determine whether management of one condition may prevent or alleviate the other.

The use of hyperinsulinemia‐euglycaemia therapy in the treatment of amlodipine overdose in a dog

AbstractA 1‐year‐old, female, spayed, mixed breed dog presented for lethargy, ataxia and possible ingestion of amlodipine. Based on clinical signs, history and clinicopathological findings, a diagnosis of amlodipine toxicosis was made. The patient's clinical signs and bloodwork derangements were refractory to traditional medical management for calcium channel blocker toxicosis, but a significant improvement was made after initiation of hyperinsulinemia‐euglycaemia therapy. The dog survived and made a full recovery. The use of hyperinsulinemia‐euglycaemia therapy for amlodipine toxicosis has not previously been reported in dogs. Hyperinsulinemia‐euglycaemia therapy can be used for treatment of hypotension as well as other clinical signs associated with calcium channel blocker toxicosis. The use of hyperinsulinemia‐euglycaemia therapy should be considered for amlodipine toxicosis in dogs.

Risk Factors of Pregnancy Failure in Infertile Patients Undergoing Assisted Reproductive Technology

Background: Assisted Reproductive Technology (ART) represents a critical advancement in the treatment of infertility, providing hope to many couples struggling to conceive naturally. Despite its success, pregnancy failure remains a significant concern, influenced by various factors such as age, BMI, and underlying medical conditions. Objective: The main objective of this study was to identify the risk factors associated with pregnancy failure in infertile patients undergoing ART treatments. Methods: This clinical audit was conducted at Bahria International Hospital, Rawalpindi, from January 2023 to January 2024. Data were collected from 85 patients undergoing ART treatments, including In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). The study included comprehensive demographic information, clinical history, ART cycle details, laboratory results, and lifestyle factors. Pregnancy failure was defined as either biochemical pregnancy loss or clinical pregnancy loss. Ethical approval was obtained, and data were analyzed using SPSS version 25. Descriptive statistics summarized patient characteristics, while comparative analysis and multivariate logistic regression were used to identify significant risk factors. Results: The study included 85 patients with a mean age of 34.5 years. Those experiencing pregnancy failure had a higher mean age of 36.2 years compared to 33.2 years in those without pregnancy failure. The mean BMI was higher in the pregnancy failure group (26.0 kg/m²) versus the no pregnancy failure group (23.8 kg/m²). Significant risk factors for pregnancy failure included older age (OR=1.15, 95% CI 1.05-1.25, p=0.002), higher BMI (&gt;25 kg/m²) (OR=2.45, 95% CI 1.10-5.47, p=0.03), and the presence of underlying medical conditions (OR=1.90, 95% CI 1.02-3.55, p=0.04). Conclusion: Older age, higher BMI, and underlying medical conditions significantly increased the risk of pregnancy failure in infertile patients undergoing ART. Personalized treatment approaches addressing these risk factors could improve ART outcomes and enhance the chances of successful pregnancies.

Frequency of Peptic Ulcer Disease in Patients with Chronic Liver Disease Presenting with Upper Gastrointestinal Bleeding

Background: Peptic ulcer disease (PUD) is a significant cause of morbidity and mortality worldwide, particularly in patients with chronic liver disease (CLD). The occurrence of upper gastrointestinal bleeding (UGIB) in CLD patients presents a serious complication, often requiring urgent medical intervention. Objective: The main objective of this study was to determine the frequency of peptic ulcer disease in patients with chronic liver disease presenting with upper gastrointestinal bleeding. Methods: This retrospective observational study was conducted at Ayub Teaching Hospital, Abbottabad, from 2021 to 2023. Data were collected from 105 patients diagnosed with chronic liver disease who presented with symptoms of upper gastrointestinal bleeding. The diagnosis of CLD was confirmed through clinical evaluation, biochemical tests, imaging studies, and/or liver biopsy. Patients included were aged 18 years and above and presented with UGIB evidenced by hematemesis, melena, or both. Exclusion criteria were individuals with bleeding disorders unrelated to CLD and those who did not undergo endoscopic evaluation. Data collection involved demographic information, clinical history, duration and etiology of CLD, comorbid conditions, and UGIB presentation. Upper gastrointestinal endoscopy was performed on all patients to identify the source of bleeding. Statistical analysis was performed using SPSS version 25, with a p-value of less than 0.05 considered statistically significant. Results: The study included 105 patients, with a mean age of 55.3±3.27 years; 65 (61.9%) were male, and 40 (38.1%) were female. The etiologies of CLD were viral hepatitis (42.9%), alcoholic liver disease (28.6%), non-alcoholic fatty liver disease (19.0%), and other causes (9.5%). Clinical presentations of UGIB included hematemesis (66.7%), melena (23.8%), and both (9.5%). Endoscopic findings revealed that 35 patients (33.3%) had peptic ulcer disease, with 20 (57.1%) having duodenal ulcers and 15 (42.9%) having gastric ulcers. Other sources of UGIB included esophageal varices (38.1%), gastric varices (14.3%), erosive gastritis (9.5%), and malignancies (4.8%). Associated risk factors for PUD included NSAID use (42.9%), smoking (28.6%), and coexisting portal hypertension (71.4%). The mean size of ulcers was 10.2 mm. Endoscopic therapy was utilized in 71.4% of cases, with pharmacological treatment primarily including proton pump inhibitors (85.7%). Complications included rebleeding within 7 days (14.3%) and the need for surgical intervention (5.7%). The mean hospital stay was 7.8 days, and in-hospital mortality was observed in 8.6% of patients. Conclusion: Peptic ulcer disease represents a substantial yet manageable complication in patients with chronic liver disease presenting with upper gastrointestinal bleeding. Prompt recognition and targeted therapeutic interventions are crucial for optimizing outcomes in this high-risk population.

Examining molecular landscape and drug sensitivity profiles of patient-derived xenografts from resected brain metastases.

28 Background: Brain metastases (BrMet) remain an unmet need. Preclinical models of BrMet are rare but can be a valuable tool to interrogate pathology and develop novel therapeutic approaches. We previously published molecular profiles and drug sensitivity screening using novel BrMet patient-derived xenograft (PDX) models established from resected BrMet from patients with breast cancer. We further expanded our study to include BrMet from other solid tumors. Methods: We ascertained the genomic profiles of thirteen novel non-breast BrMet PDX models from patients undergoing clinically indicated surgical resection of BrMet. We then conducted drug sensitivity screening on ex vivo organoids with a panel of over 350 drugs to interrogate drug responses. We also collected information on molecular alterations and clinical treatment history from matched source patient material to correlate molecular alterations between tissue and matched PDXs when available, as well as with drug response in PDXs. Results: The PDXs included tumors that commonly (lung and melanoma) and less commonly (ovarian and sarcoma) metastasize to the brain. We observed potentially targetable DNA alterations in the DNA damaging repair pathway ( ATM, BRCA, CHEK2) and ERBB2. Using the drug sensitivity score 3 (DSS3), we assessed the sensitivity of the drugs tested. While the panel did not include the recently approved anti-HER2 targeted drugs, lapatinib (anti-HER2 TKI), and PARP inhibitors, e.g. olaparib and niraparib, were inactive against these PDXs. The three most active drugs among the BrMet PDXs were romidepsin, bortezomib, and triptolide, similar to what we observed previously for breast BrMet PDXs. When available, we correlated the DSS3 from the PDX testing with the drug exposure history and potentially actionable alterations reported in the matched source patient clinical samples. Interestingly, one case with CDKN2A/1B homozygous deletion had differential sensitivity against CDK inhibitors (highly active to dinaciclib but inactive to abemaciclib and palbociclib). Conclusions: We observed prevalent gene alterations associated with homologous recombination deficiency and HER2 among these non-breast BrMet PDX models, opening an opportunity for novel cross cancer approaches as these alterations are also reportedly linked to BrMet from breast cancer, these mechanisms may contribute to the propensity for BrMet. We also found that there are common drugs that are active across BrMet from different solid tumor types. To further explore the shared molecular features of BrMet across various solid tumors, we have established additional PDX models (near 100) from multiple solid tumors and plan to report on the molecular features.

Pitfalls in Urinary Tract Cytology: Algorithmic Approach and The Paris System

Urine cytology is sensitive for detection of high-grade urothelial carcinoma. However, urine is a hostile medium for the exfoliated cells leading to degenerative changes with various interpretation challenges. Chances of misinterpretation can be avoided if the interpreter is conversant with potential pitfalls during evaluation of urine cytology. The causes may be due to pre-analytic, analytic, or post-analytic factors which include method of collection (voided versus cystoscopic versus bladder washing versus other procedures), use of preservative if any, and availability of relevant clinical history. Most common pitfalls are related to low-grade urothelial neoplasms; however, clinically critical are those which are mimickers of high-grade urothelial carcinoma (HGUC).

Evaluation of thyroid dysfunction in childhood-onset systemic lupus erythematosus: Risk factors for Hashimoto's thyroiditis.

Increased frequency of autoimmune thyroid disease, particularly Hashimoto's thyroiditis (HT) was reported several studies in the literature, in individuals with childhood-onset systemic lupus erythematosus (cSLE). Our study aimed to investigate the prevalence and contributing factors of thyroid dysfunction and HT among cSLE patients. Thyroid function tests were obtained cross-sectionally from cSLE patients. Demographic, clinical, and laboratory characteristics and activity scores were collected from medical records. Patients diagnosed with cSLE were compared to the healthy control group for the frequency of thyroid dysfunction. The Mann-Whitney U, independent samples t test, and the Chi-square or Fisher's exact test were used to compare study groups. A p-value below 0.05 was considered statistically significant. Out of 73 cSLE patients, 14 (19.1%) had subclinical hypothyroidism, 9 (12.3%) had clinical hypothyroidism, 12 (16.4%) were diagnosed with HT, and 12 (16.4%) had a family history of HT. Thyroid USG was performed in 5 euthyroid patients and 1 borderline subclinical hypothyroid patient with positive thyroid autoantibody and reported as diffuse heterogeneous echogenicity enlargement in the thyroid gland. There were no significant differences in clinical and laboratory data or medication used between the groups with and without HT; however, patients with HT had a higher frequency of clinical hypothyroidism and family history of HT. Cumulative prednisolone dose was significantly lower in patients diagnosed with HT. The frequency of HT was considerably higher in patients with cSLE compared to the healthy control group. The results demonstrate an increased incidence of HT in cSLE patients, even if they are euthyroid, and recommend that cSLE patients be screened more frequently.

Levonorgestrel intrauterine system versus dienogest effect on quality of life of women with deep endometriosis: a randomized open-label clinical trial

ABSTRACT Women with deep infiltrating endometriosis (DIE) can benefit from the use of progestins. Our aim is to explore if levonorgestrel-releasing intrauterine system (LNG-IUS) non inferior to dienogest (DNG) in improving deep endometriosis women’s quality of life (QoL). This randomized open-label clinical trial included forty women with DIE assessed using clinical history and physical examination, transvaginal ultrasonography and magnetic resonance of the pelvis without any previous surgical treatment, with two treatments arms. The two groups underwent a 3-month washout of hormonal treatments, and then received either DNG or LNG-IUS for 6 months. QoL was assessed prior to and 6 months after the intervention, using the SF36 and the EHP30. DNG and LNG-IUS showed an increase on all domains of the SF36 (p < .001). There was no difference between treatments on the improvement observed (p > .05 for all domains). DNG and LNG-IUS, also, showed improvement on all domains of EHP30 (p < .001), except “relationship with children” and “feelings about pregnancy.” However, there was no statistical difference between treatments for all sections scores (p > .05). The treatment of deep endometriosis symptoms using either DNG or LNG-IUS in women with no prior surgical treatment is associated with improvement in QoL. Trial Registration Number: This trial is registered on “The Brazilian Registry of Clinical Trials (ReBECID: RBR-8fjx2jp),” that is part of Primary Registries in the WHO Registry Network, under the title: “Dienogest versus Levonorgestrel IUS on deep endometriosis patient´s QoL without surgery” on June 14, 2021; https://ensaiosclinicos.gov.br/rg/RBR-8fjx2jp.

Short-Term Blood Pressure Variability among Young Adults at High or Low Risk for Depression.

Background: Depression has been shown to have adverse effects on blood pressure (BP) and is associated with high blood pressure variability (BPV). In turn, high short-term BPV has been related to eventual cardiovascular risk. But it is not clear how early in adulthood the detrimental effects of depression on BPV may be discerned, if being at high risk for depression also compromises BPV, and whether the clinical features of depression moderate its adverse effects. We investigated these three issues among young adults using an office-like setting. Methods: In total, 218 subjects with a history of childhood-onset major depressive episodes (probands), 206 never-depressed full biological siblings of the probands (high-risk siblings), and 166 emotionally healthy unrelated controls received a psychiatric evaluation and three standardized-sitting BP measurements 5 min apart. Short-term BPV was defined as the maximum difference between measures (range) for each case. The statistical methods included analyses of variance/covariance, chi-square tests, and multiple regression. Results: Systolic and diastolic BP decreased over consecutive measurements (p < 0.001). After controlling for age, the probands, siblings, and controls did not differ significantly in terms of BPV. However, the number of lifetime depressive episodes did predict the diastolic BP range (p = 0.005): probands with the highest number of depressive episodes had the largest short-term diastolic BPV. Conclusions: On a group level, the adverse effects on BPV of having experienced or being at high risk for depression are not yet evident during young adulthood. However, the number of major depressive episodes, which is an index of lifetime depression burden, predicts higher BPV. Thus, BPV monitoring for young adults with clinical depression histories could be part of an early intervention program to reduce the risk of eventual cardiovascular disease.

Prescription of non-steroidal anti-inflammatory and antirheumatic drugs in outpatient hypertensive patients.

It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

Clinical and Radiological Predictors of Positive Microbiological Yield in Vertebral Osteomyelitis: A Retrospective Cohort Study

Objective: To evaluate demographic, laboratory, biopsy, and imaging variables as potential predictors of microbial identification in patients with suspected vertebral osteomyelitis, aiming to enhance diagnostic accuracy and optimize patient care. Methods: This retrospective cohort study analyzed 83 patients who underwent image-guided percutaneous disc-space sampling between June 2020 and December 2023. Inclusion criteria were adults aged ≥18 years with imaging-based evidence of vertebral osteomyelitis and clinical suspicion of infection. Exclusion criteria were presence of known malignancy and non-infective causes. Demographics, clinical history, imaging, biopsy, and microbiology data were collected. Logistic regression analysis was used to identify predictors of positive microbiological yield. Results: Microorganisms were identified in 32 of 83 cases (38.6%), with Mycobacterium tuberculosis being the most common pathogen identified (21.9%). Elevated C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and paravertebral signal changes on MRI were associated with a positive culture yield. Multivariate analysis identified CRP as an independent predictor of positive microbiological results. CT-guided percutaneous biopsy was found to be safe, with no major complications reported. Conclusion: CT-guided percutaneous biopsy is a reliable and safe diagnostic tool for identifying the causative pathogens in vertebral osteomyelitis. Elevated CRP levels were independently associated with positive microbiological yield, highlighting its role as a crucial predictor in clinical practice. These findings underscore the importance of incorporating CRP levels into the diagnostic process, potentially guiding the selection of patients for biopsy to improve the detection of infection.