Late Diagnosis Research Articles

AUTISM IN ADULTS: Feelings and changes after a late diagnosis

Previously considered a rare childhood disorder, autism today is a frequent diagnosis with increasing demand in all age groups, including people who were not diagnosed in childhood, but who perceive characteristics of this condition. This study, which is part of a broader research on the experience of Brazilian adults who were diagnosed with autism spectrum disorder (ASD) after 18 years, aims to explore the feelings and life changes of this group of people after the diagnosis. To this end, a qualitative research was carried out in which 12 participants were interviewed and the data were analyzed using the content analysis method, in its categorical aspect. Considering the objective of this work, in the analysis of the interviews, these categories emerged: alexithymia, relif, revisiting the past, self-compassion and acquired rights. As a result, relief was observed as a feeling of great relevance and predominance, accompanied by a process of understanding the past and self-compassion and self-respect. It was concluded that the late receipt of the diagnosis of autism by this group of participants allowed a better understanding of their characteristics and behaviors, reducing the pressure they exerted on themselves, in addition to enabling access to rights guaranteed by law.

A clinical case report of aberrant pancreas in the practice of a general practitioner

An aberrant pancreas is a fairly rare developmental anomaly, which, de spite its congenital genesis, is most often found in people of the middle age group. The article presents a clinical case of an aberrant pancreas with localization in the antrum of the stomach in a 52-year-old patient. Congenital pathology has an asymptomatic course for a long time, which is subsequently associated with late diagnosis and the need for a comprehensive examination of the patient. Despite the long-term symptomless course of the pathology, the secretory activity of the ab errant pancreas contributes to persistent inflammation of the gastric and duodenal mucosa, potentiates irreversible pathological changes, and increases the risk of complications, including gastric intestinal metaplasia. The patient under consider ation was diagnosed with a multimorbid chronic pathology of the gastrointestinal tract, which, despite ongoing therapy, was characterized by frequent exacerbations. Due to the established diagnosis, it was possible to prescribe successful conser vative treatment and avoid surgical intervention in this patient. According to the literature, differential diagnosis with malignant neoplasms is necessary. The choice of surgical treatment tactics is determined by the development of complications, among which both obstructive complications (dysphagia, pyloric stenosis, intus susception, intestinal obstruction, obstructive jaundice) and complications specific only to pancreatic tissue, such as pancreatitis, cysts and pseudocysts, ulcerative defects with perforation of the hollow organ, benign and malignant neoplasms, are described. The question of the expediency of surgical treatment of patients in the absence of complications remains debatable to the present day, which causes diffi culties in the management of these patients.

Transmitted Antiretroviral Drug Resistance to Integrase Strand Transfer Inhibitors Class in São Paulo Metropolitan Area, Brazil.

A newer integrase strand transfer inhibitor (INSTI) cabotegravir was recently approved for both therapy and prophylaxis and can play an essential role in the fight against AIDS. It shares similar resistance profile to dolutegravir, the cornerstone of Brazilian antiretroviral (ARV) treatment, with about 600 thousand people living with HIV in Brazil currently on regimens that contain this INSTI. Health services in the São Paulo metropolitan area are responsible for a large proportion of ARV dispensation in the country. Estimating transmitted drug resistance mutation (TDRM) in the area before cabotegravir introduction may provide a useful baseline information. Partial HIV-1 pol gene was sequenced (Sanger) from 192 newly diagnosed individuals from São Paulo and nearby cities (2020 to March 2023) at integrase, with 85 also at protease/reverse transcriptase regions. Retrotranscribed plasma RNA, amplified with nested PCR, was edited (Recall or Sequencher) and analyzed at Rega and Stanford db. Surveillance drug resistance mutations (SDRM) to INSTI class was detected in three cases (1.6%; 95% CI: 0.5%-5%), two E138K and one R263K, with 7.8% (95% CI: 5%-13%) with resistance mutations (major or accessory). SDRM for nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and PI classes were identified in 7 (8.2% CI: 95% 4%-16%) cases. Subtype B predominated (69%), followed by subtype C (16%), now the second most prevalent infection in this area. Among 131 patients treated for over 6 months, 92% were virally suppressed below 200 copies/mL, with low TCD4 counts independently associated to failure. SDRM to INSTI class is rare in the area. Intermediate rates of transmitted resistance to other ARV classes are comparable to previous estimates. Viral suppression rates may depend on TCD4 counts, another negative impact of late diagnosis in care that deserves more attention.

Detection of Tumor-Associated Autoantibodies in the Sera of Pancreatic Cancer Patients Using Engineered MUC1 Glycopeptide Nanoparticle Probes.

Pancreatic cancer is one of the deadliest cancers worldwide, mainly due to late diagnosis. Therefore, there is an urgent need for novel diagnostic approaches to identify the disease as early as possible. We have developed a diagnostic assay for pancreatic cancer based on the detection of naturally occurring tumor associated autoantibodies against Mucin-1 (MUC1) using engineered glycopeptides on nanoparticle probes. We used a structure-guided approach to develop unnatural glycopeptides as model antigens for tumor-associated MUC1. We designed a collection of 13 glycopeptides to bind either SM3 or 5E5, two monoclonal antibodies with distinct epitopes known to recognize tumor associated MUC1. Glycopeptide binding to SM3 or 5E5 was confirmed by surface plasmon resonance and rationalized by molecular dynamics simulations. These model antigens were conjugated to gold nanoparticles and used in a dot-blot assay to detect autoantibodies in serum samples from pancreatic cancer patients and healthy volunteers. Nanoparticle probes with glycopeptides displaying the SM3 epitope did not have diagnostic potential. Instead, nanoparticle probes displaying glycopeptides with high affinity for 5E5 could discriminate between cancer patients and healthy controls. Remarkably, the best-discriminating probes show significantly better true and false positive rates than the current clinical biomarkers CA19-9 and carcinoembryonic antigen (CEA).

Detection of Tumor‐Associated Autoantibodies in the Sera of Pancreatic Cancer Patients Using Engineered MUC1 Glycopeptide Nanoparticle Probes

AbstractPancreatic cancer is one of the deadliest cancers worldwide, mainly due to late diagnosis. Therefore, there is an urgent need for novel diagnostic approaches to identify the disease as early as possible. We have developed a diagnostic assay for pancreatic cancer based on the detection of naturally occurring tumor associated autoantibodies against Mucin‐1 (MUC1) using engineered glycopeptides on nanoparticle probes. We used a structure‐guided approach to develop unnatural glycopeptides as model antigens for tumor‐associated MUC1. We designed a collection of 13 glycopeptides to bind either SM3 or 5E5, two monoclonal antibodies with distinct epitopes known to recognize tumor associated MUC1. Glycopeptide binding to SM3 or 5E5 was confirmed by surface plasmon resonance and rationalized by molecular dynamics simulations. These model antigens were conjugated to gold nanoparticles and used in a dot‐blot assay to detect autoantibodies in serum samples from pancreatic cancer patients and healthy volunteers. Nanoparticle probes with glycopeptides displaying the SM3 epitope did not have diagnostic potential. Instead, nanoparticle probes displaying glycopeptides with high affinity for 5E5 could discriminate between cancer patients and healthy controls. Remarkably, the best‐discriminating probes show significantly better true and false positive rates than the current clinical biomarkers CA19‐9 and carcinoembryonic antigen (CEA).

Two-Step Conservative Surgery for Complicated Forms of Diabetes-Related Foot Osteomyelitis.

Diabetes-related foot osteomyelitis (DFO) is a common yet complex condition, often complicated by concurrent soft tissue infections (STIs). This study evaluates the efficacy of a two-step conservative surgical approach, hypothesizing that it offers comparable outcomes to a one-step procedure. Conducted on a cohort of 93 patients with DFO, the study categorized cases into two types: OM1 (osteomyelitis without STI) and OM2 (osteomyelitis with STI). OM2 was further subdivided into OM2a (early diagnosis) and OM2b (late diagnosis), with OM2 patients undergoing initial soft tissue debridement followed by elective bone surgery. The results indicated no significant differences in infection recurrence or amputation rates between the two surgical approaches, with recurrence observed in 20.7% of cases and amputations in 10.8%. The two-step procedure was associated with higher inflammatory responses and greater need for antibiotics and hospital admissions. However, these factors did not translate into increased recurrence or amputation compared to the one-step procedure. The study supports the two-step approach as a safe and effective method for managing complicated DFO cases, providing a viable alternative to immediate amputation or single-stage surgery. Despite some limitations, including regional specificity and potential underdiagnosis in late-diagnosed cases, the findings offer valuable insights for clinical management and suggest further research to refine treatment protocols. The study's strengths include confirmed histopathological diagnoses and consistent follow-up, reinforcing the validity of the two-step surgical approach for complex DFO treatment.

The role of physical therapists in the early detection of skin melanoma: insights from an anonymous survey.

Skin melanoma is the most severe form of skin cancer. Recent years have seen an increase in melanoma incidence. Melanomas often appear on the back, a hidden area, leading to late diagnoses. Physical therapists, who frequently treat patients with lower back pain, could play a crucial role in early melanoma detection. An anonymous online survey was conducted among 254 Israeli physical therapists to assess their perspectives on melanoma detection, their knowledge in identifying suspicious lesions, and their referral patterns. The survey included sections on demographics, professional perspectives, melanoma knowledge, personal or family experiences with melanoma, and referral frequency for dermatological evaluation. The survey revealed that 75.2% of physical therapists viewed melanoma detection as part of their professional duties, yet 59.1% reported insufficient knowledge in identifying suspicious lesions. Despite this, 94.1% expressed a desire to improve their knowledge. However, only 44.1% actively referred patients with suspicious lesions to dermatologists. There was a significant positive correlation between professional experience and referral rates (p-value < 0.001), indicating that more experienced therapists were more likely to refer patients. The study highlights the critical need for incorporating melanoma detection training into physical therapy education and professional development. Enhancing physical therapists' knowledge and skills in this area could improve early detection and patient outcomes. Despite the potential role of physical therapists in melanoma detection, current training programs lack emphasis on this aspect, underscoring the importance of revising educational curricula to include skin cancer detection techniques. The findings suggest that while physical therapists recognize their role in melanoma detection, there is a significant knowledge gap. Addressing this through targeted education and training could enhance early detection efforts and improve patient care.

Highly sensitive microfluidic sensor using integrated optical fiber and real-time single-cell Raman spectroscopy for diagnosis of pancreatic cancer

Pancreatic cancer is notoriously lethal due to its late diagnosis and poor patient response to treatments, posing a significant clinical challenge. This study introduced a novel approach that combines a single-cell capturing platform, tumor-targeted silver (Ag) nanoprobes, and precisely docking tapered fiber integrated with Raman spectroscopy. This approach focuses on early detection and progression monitoring of pancreatic cancer. Utilizing tumor-targeted Ag nanoparticles and tapered multimode fibers enhances Raman signals, minimizes light loss, and reduces background noise. This advanced Raman system allows for detailed molecular spectroscopic examination of individual cells, offering more practical information and enabling earlier detection and accurate staging of pancreatic cancer compared to conventional multicellular Raman spectroscopy. Transcriptomic analysis using high-throughput gene screening and transcriptomic databases confirmed the ability and accuracy of this method to identify molecular changes in normal, early, and metastatic pancreatic cancer cells. Key findings revealed that cell adhesion, migration, and the extracellular matrix are closely related to single-cell Raman spectroscopy (SCRS) results, highlighting components such as collagen, phospholipids, and carotene. Therefore, the SCRS approach provides a comprehensive view of the molecular composition, biological function, and material changes in cells, offering a novel, accurate, reliable, rapid, and efficient method for diagnosing and monitoring pancreatic cancer.

Treatment of conjunctival palpebral lesions using ruthenium plaque brachytherapy "Sandwich Technique"

ObjectiveTreatment of palpebral conjunctival lesions is problematic due to late diagnosis, difficult surgical approach, and the need to preserve eyelid integrity. We describe our treatment experience using plaque brachytherapy in the "sandwich technique.” DesignA retrospective study. ParticipantsWe reviewed the medical records of patients treated by plaque brachytherapy for conjunctival lesions at the Hadassah Medical Center between January 1, 2013, and January 1, 2024, and included in the analysis patients treated for palpebral conjunctival lesions. MethodsRuthenium plaque was sutured to the palpebral conjunctiva. The matching nonradioactive “dummy” plaque was sutured to the external eyelid to flip the tarsal's curvature. ResultsThe study cohort included 5 patients, 2 men (40%) and 3 women (60%) at a median age of 68.11 years (range: 47-79.7 years). Three patients had conjunctival melanoma (60%), 1 had sebaceous carcinoma (20%), and 1 had extensive carcinoma in situ (20%). All lesions were in the left upper eyelid. Median follow-up was 37.6 months (range: 18.7-110.6 months). Four patients demonstrated a complete response (80%), while one had a partial response (20%). There was local recurrence in 1 patient (20%), and 1 patient had new foci elsewhere (20%). All patients had full local control after adding local treatments. One patient developed metastatic disease and died (20%). All patients had manageable madarosis and conjunctival scars. ConclusionsTreatment of palpebral conjunctival lesions using “sandwich” plaque brachytherapy is safe and effective. To the best of our knowledge, this treatment was never described before, and we believe it should be added to our armamentarium.

Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania.

About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.

Biosensor Based on Zif-8-905% Metal-organic Nanocomposite and Carbon Nanotubes Associated with Concanavalin a for Detection of Alpha-fetoprotein

Introduction:: Lung carcinoma presents an aggressive evolution, with its carriers having reduced survival. Late diagnosis is one of the main factors of death. In the neoplasia in question, there is an established correlation with increases in Alpha-Fetoprotein (AFP) serum concentrations. Methos: Commonly used diagnostic methods are invasive or inaccessible. Therefore, a low-cost, non-invasive method would be extremely promising, and biomarkers can be used to achieve this goal. Electrochemical biosensors are a promising approach for detecting analytes of clinical interest using innovative bioreceptors. In this work, we obtained an electrochemical biosensor based on a hybrid ligand metal-organic structure (ZIF-8-905%) and functionalized carbon nanotubes (MWCNTs- COOH) in association with the lectin Concanavalin A (ConA), as a biorecognition element for detecting AFP in human serum from patients with lung carcinoma. Cyclic Voltammetry (CV), Square Wave Voltammetry (SWV), and Electrochemical Impedance Spectroscopy (EIS) were used to characterize the development of this biosensor. Microscopic analysis through Atomic Force Microscopy (AFM) revealed the formation of ConA-AFP complexes, pointing out the sensor's ability to identify the target analyte. Results: The blocking electron transfer effect in the electrode-redox pair interface assessed AFP detection. The ZIF-8-905%/MWCNTs-COOH/ConA platform exhibited a limit of detection (LOD) of 7.98 ng/mL, and a limit of quantification (LOQ) of 23.78ng/mL was also estimated. In addition, the biosensor showed excellent selectivity towards interfering biomolecules. Conclusion:: Therefore, the biosensor represents an efficient form of detection, contributing to research that aims to detect tumor biomarkers and ensure better prognoses.

Population-based prevalence of congenital defects in a routine sentinel site-based surveillance system in the Western Cape, South Africa.

Lack of data on the burden and scope of congenital disorders (CDs) in South Africa undermines resource allocation and limits the ability to detect signals from potentially teratogenic pregnancy exposures. We used routine electronic data in the Western Cape Pregnancy Exposure Registry (PER) to determine the overall and individual prevalence of CD identified on neonatal surface examination at birth in the Western Cape, South Africa, 2016-2022. CD was confirmed by record review. The contribution of late (≤24 months) and antenatal diagnoses was assessed. We compared demographic and obstetric characteristics between women with/without pregnancies affected by CD. Women with a viable pregnancy (>22 weeks gestation; birth weight ≥ 500 g) (n = 32,494) were included. Of 1106 potential CD identified, 56.1% were confirmed on folder review. When internal and minor CD were excluded the prevalence of major CD identified on surface examination at birth was 7.2/1000 births. When missed/late diagnoses on examination (16.8%) and ultrasound (6.8%) were included, the prevalence was 9.2/1000 births: 8.9/1000 livebirths and 21.5/1000 stillbirths. The PER did not detect 21.5% of major CD visible at birth. Older maternal age and diabetes mellitus were associated with an increased prevalence of CD. Women living with/without HIV (or the timing of antiretroviral therapy, before/after conception), hypertension or obesity did not significantly affect prevalence of CD. A surveillance system based on routine data successfully determined the prevalence of major CD identified on surface examination at birth at rates slightly higher than in equivalent studies. Overall rates, modeled at ~2%, are likely underestimated. Strengthening routine neonatal examination and clinical record-keeping could improve CD ascertainment.

Dendritic cell vaccination combined with irreversible electroporation for treating pancreatic cancer-a narrative review.

Pancreatic ductal adenocarcinoma (PDAC) is 3rd most lethal cancer in the USA leading to a median survival of six months and less than 5% 5-year overall survival (OS). As the only potentially curative treatment, surgical resection is not suitable for up to 90% of the patients with PDAC due to late diagnosis. Highly fibrotic PDAC with an immunosuppressive tumor microenvironment restricts cytotoxic T lymphocyte (CTL) infiltration and functions causing limited success with systemic therapies like dendritic cell (DC)-based immunotherapy. In this study, we investigated the potential benefits of irreversible electroporation (IRE) ablation therapy in combination with DC vaccine therapy against PDAC. We performed a literature search to identify studies focused on DC vaccine therapy and IRE ablation to boost therapeutic response against PDAC indexed in PubMed, Web of Science, and Scopus until February 20th, 2023. IRE ablation destructs tumor structure while preserving extracellular matrix and blood vessels facilitating local inflammation. The studies demonstrated IRE ablation reduces tumor fibrosis and promotes CTL tumor infiltration to PDAC tumors in addition to boosting immune response in rodent models. The administration of the DC vaccine following IRE ablation synergistically enhances therapeutic response and extends OS rates compared to the use of DC vaccination or IRE alone. Moreover, the implementation of data-driven approaches further allows dynamic and longitudinal monitoring of therapeutic response and OS following IRE plus DC vaccine immunoablation. The combination of IRE ablation and DC vaccine immunotherapy is a potent strategy to enhance the therapeutic outcomes in patients with PDAC.

AB023. Early diagnosis and treatment lead to improve survival of glioblastoma patients.

Glioblastoma (GBM) is one of the worst prognostic cancers and one of the reasons is that GBM patients rapidly deteriorated and half of them had a Karnofsky performance status (KPS) with 70 or less at the initial presentation. We discuss the significance of early diagnosis and treatment to the clinical outcomes of GBM patients. Data of IDH-wildtype GBM patients treated at our institution between 2010 and 2019 were retrospectively reviewed. Patients were classified into early or late diagnosis groups with a threshold of 14 days from initial symptoms. Also, patients were divided into early, intermediate, and late surgery groups with thresholds of 21 and 35 days. Patients were also divided into two groups: neurosurgeon and non-neurosurgeon groups, based on the primary doctor whom patients sought for an initial evaluation. Representative symptoms and patient prognosis were examined. Of 153 patients, 72 and 81 were classified into the early and late diagnosis groups. The proportion of patients with preoperative KPS scores ≥90 was 48.6% and 29.6% in the early and late diagnosis groups (P=0.01). Median overall survival was significantly longer in the early surgery group (n=43) than in the late surgery group (n=86) (28.4 vs. 18.7 months, P=0.006). The neurosurgeon group exhibited a significantly shorter duration from the first hospital visit to the first surgery than the non-neurosurgeon group (18 vs. 29 days, P<0.001). Furthermore, the overall survival of the neurosurgeon group was significantly more prolonged than that of the non-neurosurgeon group (22.9 vs. 14.0 months, P=0.04). Early diagnosis and surgery within 3 weeks from the initial symptoms are associated with improved patient survival. Early GBM treatment will be beneficial for patients with GBM. A short duration from the first hospital visit to the first surgery is essential in enhancing GBM patient prognosis.

Early-stage diagnosis of ovarian cancer via digital immunoassay on a SlipChip

Ovarian cancer (OC) is one of the three major gynecologic malignancies and has the highest mortality rate because of the late diagnosis. Liquid biopsy based on serum protein biomarkers has demonstrated great potential for early diagnosis but remains limited by the analysis performance of conventional immunoassay technologies, such as chemiluminescence, and biomarkers, such as CA125. To address this challenge and achieve accurate early-stage diagnosis of OC, we developed a digital immunoassay on a SlipChip (DiSC) for quantitative analysis of a potential serum protein biomarker, Spondin-1 (SPON1). The DiSC system achieved a limit of detection (LoD) of 23 fg/μL for digital quantification of SPON1. The DiSC system was utilized to quantify the serum level of SPON1 in 357 clinical serum samples, including 63 from patients with benign ovarian tumors and 294 from patients with malignant ovarian cancer, ranging from stages I to IV. SPON1 concentrations were significantly different in samples from patients with malignant ovarian cancer. Notably, significantly different SPON1 levels were observed in early stages (I and II), in lymph node-negative cases (N0), and before metastasis (M0), suggesting that SPON1 could serve as a sensitive diagnostic biomarker for early-stage OC. The differential diagnostic model based on SPON1 levels quantified using DiSC demonstrated an area under the curve (AUC) of 0.8187 for early-stage OC, a significant improvement over CA-125 (AUC = 0.6967). For OC of all stages, the AUC was 0.8225, which could be further increased to 0.8750 when combined with CA-125. This showcases the potential of SPON1 as a novel biomarker for sensitive early-stage diagnosis of ovarian cancer and the capability of the DiSC system in discovering low-abundance biomarkers for disease diagnosis.

A late diagnosis of Systemic lupus erythematosus diagnosed as rheumatism: A case series from Tumbi Regional Referral hospital in Pwani, Tanzania

A late diagnosis of Systemic lupus erythematosus diagnosed as rheumatism: A case series from Tumbi Regional Referral hospital in Pwani, Tanzania

Epidermal growth factor receptor and programmed cell death-1 expression levels in peripheral T cell subsets of patients with non-small cell lung cancer.

Lung cancer is the leading cause of cancer-related deaths, in part due to its late diagnosis. Increased epidermal growth factor receptor (EGFR) expression in cancer cells is associated with a poor prognosis, and EGFR tyrosine kinase inhibitors are widely used in cancer treatment. This study aimed to clarify the relationship between EGFR expression on T cells and cancer prognosis in patients with non-small cell lung cancer (NSCLC). Forty patients with NSCLC and 40 healthy volunteers were included in this study. Peripheral CD4+T helper (Th1, Th2, Th9, Th17, Th1Th17, follicular and peripheral Th) and cytotoxic T lymphocyte (CD8+follicular and peripheral T) subsets were identified with flow cytometry according to their chemokine receptors. EGFR expression on T lymphocytes in relation to overall survival (OS) was investigated in patients with NSCLC. The patients [mean age (min-max) = 64.03 (45-83); 20 stage I-III and 20 stage IV] had increased EGFR expression on CD3+T, CD4+Th, Th1, Th2, and Th17 cells compared to the controls (p < 0.05). High EGFR expression on CD3+T, CD4+Th, Th1, and Th2 cells was associated with poor OS. Also, PD-1 expression on lymphocytes, CD3+T, and Th cells was increased in patients with NSCLC compared to controls. The high expression of EGFR and PD-1 on Th cells and the reduced percentage of lymphocytes and Th cells, especially in stage IV patients with NSCLC, revealed that increased EGFR activity may trigger apoptosis of Th cells and promote the development of metastases, while high EGFR expression on CD3+T, CD4+Th, Th1, and Th2 cells may be an independent poor prognostic marker in NSCLC.

Laparoscopic repair of a symptomatic right congenital morgagni hernia in an elderly patient: a rare case report

Morgagni hernia is a rare form of congenital diaphragmatic defect on the anterior part of the diaphragm with a prevalence of 2-3%. We report a case of a 70-year-old female who presented with burning chest pain, intermittent and colicky upper abdominal pain occasionally associated with nausea and vomiting, and constipation for 4 months. Imaging studies, including X-ray, ultrasound, CT scan, and MRI, were suggestive of a right-sided congenital Morgagni hernia. Late diagnosis of this condition in adults is extremely rare, and in the elderly, it is even rarer. The patient underwent successful laparoscopic diaphragmatic hernia repair with prosthetic mesh placement. The postoperative period was uneventful, and the patient was discharged on the fifth postoperative day. Minimally invasive surgical techniques provide definitive treatment for patients with uncomplicated Morgagni hernia cases, offering a shorter recovery time and a low complication rate.

Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer.

The perianal disease affects up to one-third of individuals with Crohn's disease (CD), causing disabling symptoms and significant impairment in quality of life, particularly for those with perianal fistulising CD (PFCD). The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing. Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents, endoscopic procedures and surgical techniques that show promising results. Among these, mesenchymal stem cells injection is a particularly hopeful therapy. In addition to the burden of fistulas, individuals with perianal CD may face an increased risk of developing anal cancer. This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes. Currently, there is no established formal anal screening programme. In this review, we provide an overview of the current state of the art in managing PFCD, including novel medical, endoscopic and surgical approaches. The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD, intending to propose a risk-based surveillance algorithm. The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.

The marks of leprosy: disabilities caused by plantar lesions in discharged patients.

Leprosy is a chronic infectious disease that has a slow evolution and is characterized by dermatoneurological involvement. The health challenges surrounding this disease are closely related to the stigma that results from the physical disabilities it causes. This is due to its high rate of late diagnosis and the peculiar deformities that occur in its advanced stage.Evaluate the clinical and epidemiological aspects of patients with plantar lesions who were treated for leprosy in a dermatology referral unit.This is a cross-sectional exploratory field study that was conducted at the Reference Center in Tropical Dermatology and Venereology Alfredo da Matta (FUHAM), in Manaus, Amazonas, Brazil.We evaluated 36 patients with disabilities as a result of leprosy and who had plantar lesions. The most common ulcer site was the medial region of the plantar surface, which presented dryness and maceration with yellowish seropurulent exudate, fibrinous tissue and grade 2 depth.The study made it possible to observe the evolution of plantar ulcers resulting from the disease process, then evaluate them and discuss recommendations regarding the treatment and prevention of this type of physical disability.