Male Patients Research Articles

Spinal teratoma with recurrent epileptic episodes in adults: a case report

Introduction Spinal teratomas are rare, accounting for nearly 0.2-0.5% of all spinal tumors and 2% of all teratomas. Teratomas at the conus medullaris location do not inherently lead to epilepsy. However, potential epileptic seizures is caused when a teratoma ruptures and the chemical stimulation of teratoma components enter the dural sac. Case presentation A 31-year-old Asian male patient suffering from epileptic onset and poor antiepileptic treatment was demonstrated. The spinal imaging examination was performed, and the patient suffered a space-occupying lesion within the conus medullaris related to spinal deformity, spinal embolism, etc. The autoimmune encephalitis spectrum revealed mGluR5 antibody IgG (+) 1:10 response. The patient stabilized after treatment with hormones and human immunoglobulin. Some hair and lipid droplets could be observed in the dural sac intraoperatively, and more hair and lipid-like material were present in the spinal cord. Postoperative pathology established the diagnosis as a conus medullaris teratoma in adults. Epileptic seizures stopped after surgery, and no additional seizures were reported during the 33-month follow-up period. Conclusions Conus medullaris teratoma rupture in adults rarely causes epileptic seizures. For spinal deformity patients with unexplained epileptic symptoms, spinal MRI can be helpful in early diagnosis, and more appropriate treatment improves disease prognosis.

Ultrasound-guided percutaneous thrombin injection for the management of upper extremity pseudoaneurysms: 20 years of tertiary care center experience.

To evaluate the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of upper extremity pseudoaneurysms. An institutional database containing 8,316,467 radiology reports was searched for suitable cases over a 241-month period. Fourteen female and 10 male patients, average age of 69.7 years (range 29-93) underwent a total of 26 procedures for the management of upper extremity pseudoaneurysms, involving the radial (n = 9), brachial (n = 9) or other upper extremity arteries (n = 6). Baseline demographic and pseudoaneurysm characteristics were documented, together with primary and secondary success, failures, and complications. All procedures were performed with real-time ultrasound guidance. The mean pseudoaneurysm volume was 9.93 cm3 (range 0.06-111.62 cm3). Twelve cases were related to central line placement or arterial access. Primary success was obtained in 50% (n = 12) after a single ultrasound-guided thrombin injection, and secondary success was achieved in an additional six (for a total success of 75%). Success was highest for the treatment of brachial artery pseudoaneurysms (87.5%), and in those who were diagnosed within 7 days of the inciting event, findings that were statistically significant (p-value 0.046 and 0.002, respectively). Ultrasound-guided percutaneous thrombin injection is safe and effective for managing upper extremity pseudoaneurysms.

Diagnosis and Management of Intrascrotal Nerve Tumors: A Prospective Study

Background: Intrascrotal nerve tumors, though rare, are significant due to their potential impact on patient health and the complexities in management, especially in distinguishing benign from malignant tumors.Objective: The study aimed to evaluate the diagnosis and management of intrascrotal nerve tumors, focusing on clinical presentation, tumor characteristics, and treatment outcomes.Methods: This prospective study was conducted at the Urology Department, Institute of Kidney Diseases, HMC, Peshawar, from January to June 2023. Fifty-five male patients with confirmed intrascrotal nerve tumors were included. Data were collected from medical records, including demographic information, clinical symptoms, imaging findings, biopsy results, and treatment details. Tumor characteristics were assessed through ultrasonography and MRI. Statistical analysis was performed using SPSS version 25, with significance set at p < 0.05.Results: The mean age was 45.23±2.78 years. Benign tumors accounted for 65% of cases with a mean size of 2.8 cm, while malignant tumors (MPNSTs) accounted for 35% with a mean size of 4.5 cm. Complete excision was achieved in 95% of cases; recurrence was 32% in malignant tumors (p = 0.001). The overall survival rate for malignant tumors was 58% (p = 0.002).Conclusion: Intrascrotal nerve tumors present diagnostic and management challenges, particularly MPNSTs, which require aggressive treatment and close follow-up due to high recurrence rates.

Histologic spectrum and outcome of Human papillomavirus (HPV)-associated oral cavity squamous cell carcinoma: a single center experience and a survey of The Cancer Genome Atlas (TGCA) cohort.

While high-risk human papillomavirus (HPV) serves as an essential pathogen and an important prognostic and predictive biomarker for oropharyngeal squamous cell carcinoma, it occurs at low frequency (2.2-6%) in oral cavity squamous cell carcinoma (OCSCC). To date, the pathologic features of HPV-associated OCSCC (HPV( +)-OCSCC) have been sparsely reported and its prognosis is not well-defined. We herein described detailed clinicopathologic features and outcomes of a retrospective series of 27 HPV( +)-OCSCC, including 13 from Memorial Sloan Kettering Cancer Center (MSKCC) and 14 from The Cancer Genomic Atlas program (TCGA). The frequency of HPV positivity in OCSCC was 0.7% in MSKCC cohort and 4.9% in TCGA cohort. Although HPV( +)-OCSCC was predominantly non-keratinizing (in 81%) with various degree of maturation, its histologic spectrum was expanded to include keratinizing subtype (19%), adenosquamous carcinoma (7%), and papillary architecture (subtype, 7%). HPV( +)-OCSCC predominantly affected male patients (male:female ratio = 12.5:1) and (ex) smokers (77%). It might occur in mandibular mucosa, floor of mouth, tongue, retromolar trigone, buccal mucosa, maxillary mucosa, or hard palate. In oral cavity, positivity of HPV by RNA in situ hybridization was required, and p16 immunohistochemistry alone was insufficient to confirm the HPV + status. The positive predictive value of p16 immunopositivity in detecting HPV infection was 68%. HPV-positivity did not appear to affect outcomes, including disease specific survival and progression free survival in OCSCC.

Case Report: Glaucoma Inducing Visual Hallucinations and Psychotherapy Intervention

Introduction: Charles Bonnet Syndrome (CBS) has a high prevalence rate among individuals with Age-related Macular Degeneration (AMD), reaching 15.8% and affecting nearly one-third of AMD patients in vision rehabilitation centers. However, it rarely occurs in patients with glaucoma or cataracts, with a prevalence rate of approximately 2.8% and 2-6%, respectively. CBS is more common among the elderly, with an average age ranging between 70 and 85 years. The prevalence in patients with low vision issues is about 19.7%. Case Presentation: A 75-year-old male patient visited the psychiatric outpatient clinic complaining about seeing children, who were invisible to others. The patient was referred from an ophthalmology clinic and had been diagnosed with glaucoma. Visual hallucinations caused significant distress, and treatment consisted of sertraline 50 mg along with Cognitive Behavioral Therapy (CBT). Accordingly, there were signs of improvement after the 7th session of CBT. Conclusion: CBS often occurs in elderly patients who experience vision decline stemming from various eye diseases, specifically glaucoma. The rare nature and its low prevalence make diagnosis and the provision of appropriate therapy challenging. Proper therapy can reduce visual hallucinations, which potentially cause significant anxiety.

Alcohol consumption in cancer patients receiving psycho-oncologic care analysis of socio-demographic, health-related and cancer-related factors.

The carcinogenic effects of alcoholic beverages and the negative impact of alcohol consumption on cancer progression and treatment outcomes are well established in oncology research. Many cancer patients experience significant psychological distress, often manifesting as elevated levels of depression and anxiety. In the general population, alcohol consumption is commonly used as a coping mechanism for such distress. For cancer patients facing substantial psychological challenges, psycho-oncology care is available to help manage their symptoms and the overall impact of their condition. However, there is limited understanding of the alcohol consumption patterns in this particularly vulnerable group of patients, as well as the disease-related factors that may influence their drinking behavior. This study aims to examine the prevalence of potentially risky alcohol consumption in cancer patients receiving psycho-oncology care and to identify sociodemographic, health-related, and psychosocial factors associated with alcohol consumption after cancer diagnosis. By understanding drinking patterns and the factors associated with them, we aim to promote healthier behaviors and enhance treatment outcomes for cancer patients receiving psycho-oncology care. A consecutive sample of 1.225 patients from the psycho-oncology outpatient clinic of the University Medical Center Hamburg Eppendorf (UKE) was analyzed with regard to their alcohol consumption behavior using the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C). Self-report questionnaires were employed to assess sociodemographic, health-related, and cancer-specific information. For statistical analysis, multiple linear regression was utilized. In the sample of cancer patients receiving psycho-oncology support one in six of both female and male patients showed risky alcohol drinking behavior (e.g. AUDIT-C above three for women and four for men). In the analysis (R-Square: 0.056) male gender (regression coefficient B 0.686, 95% CI: 0.453-0.919) and patientsreporting a higher physical health-related quality of life (SF8-PCS) (B 0.021, 95% CI: 0.011-0.032) were associated with higher levels of alcohol consumption, whereas having children (B -0.481, 95%CI: -0.700- -0.262) was associated with lower alcohol consumption. With regard to cancer type, a single-factor analysis of variance with gender as the centered covariate showed that patients with gastrointestinal cancer had had lower average consumption levels compared to the groups of patients with breast cancer, melanoma, genitourinary cancer, and lymphoma. Also, patients with sarcoma had lower average consumption levels than patients with lymphoma. The results allow to identify patient characteristics and cancer types associated with higher or lower alcohol consumption levels and higher likelihood of risky consumption behavior in this sample of cancer patients receiving psycho-oncological support. Cancer patients are particularly susceptible to the hazardous effects of alcohol consumption. The results of this study help to identify cancer patients at risk of worsening prognosis due to alcohol consumption and to develop intervention programs to minimize alcohol consumption in this group.

A novel RPE65 variant p.(Ala391Asp) in Leber congenital amaurosis: a case report and literature review in Japan

IntroductionIn Japan, inherited retinal dystrophy caused by biallelic variants of the RPE65 gene is exceedingly rare. The purpose of this study was to describe a Japanese male patient with a novel variant in RPE65 associated with Leber congenital amaurosis (LCA).Case reportThe patient, diagnosed with LCA, exhibited infantile nystagmus and reported experiencing night blindness since early childhood. At 27 years of age, the patient underwent an ophthalmologically evaluation. Corrected visual acuity was Snellen equivalent 20/133 in the right eye and Snellen equivalent 20/100 in the left eye. Fundus examination revealed alterations in the retinal pigment epithelium characterized by hypopigmentation and narrowing of retinal vessels. Fundus autofluorescence imaging demonstrated a generally diminished autofluorescent signal. Full-field electroretinography identified a generalized dysfunction of both rod and cone systems in each eye. Whole exome sequencing identified a novel missense variant in RPE65 (NM_000329.3): c.1172C > A p.(Ala391Asp), which was classified as pathogenic, as well as a recurrent variant p.(Arg515Trp).ConclusionThis study provides valuable insights into the genotype–phenotype correlation of RPE65-associated LCA in Japanese patients, with critical implications for enhanced diagnostic accuracy and informed therapeutic decisions.

The examination of detrusor underactivity in multiple system atrophy

AimsThe urinary dysfunction in multiple system atrophy (MSA) is characterized by large post-void residuals (PVR) due to impaired bladder contractility. However, the evaluations of bladder contractility are not well validated in MSA. Because the bladder contractility index can be generally represented as Pdet Qmax (detrusor pressure at maximum urinary flow rate) + kQmax (maximum urinary flow rate), we aim to examine which “k” value is suitable for representing bladder contractility concerning its correlations to PVR and voided percentage (VOID%).MethodsWe retrospectively reviewed 133 patients with MSA (74 males, 59 females, mean disease duration 3.2 years) who underwent an urodynamic study. We calculated bladder contractility using the formula PIPk = Pdet Qmax + kQmax by increasing the “k” value from 0.1 to 10 by increments of 0.1. We calculated the correlations between each PIPk (k = 0.1–10.0) and PVR and VOID%.ResultsThe correlational coefficients between PIPk and VOID% were larger than those between PIPk and PVR. The correlational coefficients between PIPk and VOID% reached a plateau level at a “k” value >5.0 in male patients, suggesting that currently used formulas such as Pdet Qmax + 5Qmax for males might be appropriate for male MSA patients. However, the correlational coefficients between PIPk and VOID% reached a plateau level in female patients when the “k” values were >6.0, which might overestimate bladder contractility in female patients.ConclusionAlthough currently used formulas such as Pdet Qmax + 5Qmax might be appropriate for male MSA patients, formulas for female patients need further evaluation.

Handling bad news in a male reproductive health clinic: a speech act perspective

Communication is a crucial tool in all forms of interaction. The medical world without communication is inconceivable. Guided by Austin’s speech act theory, this work explores how doctors relay bad news in the form of infertility diagnoses in a reproductive health clinic in Kenya and the responses of male patients to this news. It is a qualitative study in a public health facility in Nakuru town in Nakuru County, Kenya. The two male patients recruited for this study were willing to participate without payment or coercion. The conversation on reproductive health problems between the doctor and male patients was collected using participant observation. The diagnosis of male infertility can be a significant source of distress for male patients as it challenges traditional perceptions of masculinity. Similar locutionary and illocutionary acts can elicit very different perlocutionary acts. An utterance, once made, cannot be altered, nor can its effect. A man’s emotional response to an infertility diagnosis is profound and irreversible. Bad news in a reproductive health clinic includes male infertility diagnoses, a condition that impacts the masculine identity of a man and threatens his entire existence.

Risk Factors Associated with Angiographic Severity of Coronary Artery Disease Based on Serum Uric Acid: A Study in a Tertiary Care Hospital, Chattogram, Bangladesh

Background: Coronary Artery Disease (CAD) is a leading cause of death worldwide, identifying risk factors and severity is crucial for management and prevention. Serum Uric Acid (SUA) has been proposed as a potential marker for the severity of CAD. Elevated SUA levels are associated with endothelial dysfunction, oxidative stress, and inflammation, all of which contribute to the development and progression of atherosclerosis. This study aims to determine the association of risk factors with the severity of CAD using SUA levels. Materials and methods: This was a cross-sectional observational study conducted in the Department of Cardiology at CMCH in Chattogram over one year from October 2020 to September 2021. After case selection demographic data were collected and transthoracic echocardiography was performed on study patients. Results: The study analyzed the association between SUA level and CAD severity in 130 patients undergoing coronary angiography. The mean SUA level was 5.06 mg/dl and was significantly associated with the presence of CAD, number of vessel involvement and severity of CAD assessed by the Gensini score. The mean SUA level in cases with CAD was significantly higher (5.26 ± 1.32 mg/dl) than in cases without CAD (4.22 ± 1.03 mg/dl). Conclusion: This study concluded that demographic variables and risk factors are associated with the severity of CAD. The severity of CAD was higher in elderly and male patients. The study suggests that when assessing the risk in a CAD patient, hyperuricemia should be considered. IAHS Medical Journal Volume 6(2) December 2023; 48-52

Geneticand phenotypic characterization of a novel ST45-K43 carbapenem-resistant Klebsiella pneumoniae strain causing bloodstream infection: a potential clinical threat.

Klebsiella pneumoniae is a common pathogen of nosocomial infection, which can cause pneumonia, urinary tract infection, cystitis, and bloodstream infections (BSIs). Here, we genetically characterize a novel carbapenem-resistant K. pneumoniae (CRKP) strain recovered from the blood of a 44-year-old male patient with severe acute necrotizing pancreatitis and septic shock in China. The strain is a ST45 K. pneumoniae with a novel serotype of K43, named 18SHX166. The susceptibility testing results showed that 18SHX166 was resistant to cephalosporin and carbapenems but still susceptible to ceftazidime-avibactam, quinolones, colistin, and amikacin. Genomic sequencing revealed that 18SHX166 contains three plasmids, namely pSHX166-Hv, pSHX166-KPC, and pSHX166-3. pSHX166-Hv harbored the iucABCD operon, encoding the siderophore of aerobactin. pSHX166-KPC harbored blaKPC-2 gene and possessed complete conjugative regions. The conjugation experiment verified pSHX166-KPC as a self-transmissible plasmid mediating the dissemination of antibiotic resistance, with a conjugation rate of 2.21 × 10-5. Additionally, the growth curve showed that 18SHX166 demonstrates a higher growth rate than the control strains. The characteristics of 18SHX166 indicate a potential high risk of clinical transmission.IMPORTANCEST45-K43 carbapenem-resistant Klebsiella pneumoniae isolate, 18SHX166, carries a carbapenem resistance plasmid and virulence plasmid. It has the characteristics of multidrug resistance, high transmissibility, and a fast growth rate, which could pose a threat to the control of antimicrobial resistance and clinical transmission, causing a severe challenge to public health.

Simple Geographic Distribution of Patients with Stroke According to their Medical Care Financing System in a Private University Hospital

Aims: To reveal the geographical distribution of stroke patients in a private university hospital in Jakarta, Indonesia according to their address and further divide them into three sub group of using universal health coverage (UHC) vs other type of insurance ((OTI) vs private non insurance patient (private) Study Design: simple retrospective cross-sectional study. Place and Duration of Study: Sample: Medical record from patients of the Department of Neurology, Rumah Sakit Universitas Kristen Indonesia, Jakarta Indonesia; a private university hospital located in Jakarta Indonesia, between January 2021 and December 2023. Methodology: We analyzed medical record of 162 patients (90 men, 72 women; age range 15-87 years (mean age 61.12 SE± .82) with history of stroke and at the present routinely underwent routine medical control (outpatient) or with current diagnosis of stroke (inpatient in our hospital). We further divided them based on their medical care financing system (UHC vs OTI vs private) and using the help from GPS service made available by Google Maps™ we simply try to make a geographical distribution of those patients based on their address/residence location Results: Geographical distribution of patients using UHC were closer to the hospital compared to the other 2 non UHC medical care financing users. Conclusion: Our analysis regarding stroke patients in our hospital (2021-2023), we found that 55.6% male patients, 42% were in the range of age between 55-64 years old, most of the patient (94.4%) using BPJS as their medical care financing system, with 27.7% came from sub district Makkasar which is near from our hospital. Further analysis using the help of Google maps™ we can show that the UHC or BPJS health referral system has facilitated patients receiving health services at the health facility closest to their residence.

Vitamin D Status among Patients Visiting an Urban Tertiary Care Hospital, Dhaka

Background: Majority of the Bangladeshi population lives in an areas receiving ample sunshine throughout the year. Despite this fact multiple studies have shown wide prevalence of vitamin D deficiency in our country in all ages and both sexes. Adequate vitamin D status has an important clinical advantage for maintaining various activities as well as preventing diseases. In this lab based retrospective study, it was determined the prevailing condition of vitamin D deficiency among adult patients visiting MH Samorita Hospital and Medical College outdoor. The present study aimed to focus on assessing Vitamin D status of adult patients visited a tertiary care hospital of Dhaka city. Materials and methods: This was a retrospective study. A total of 72 cases were chosen by random sampling with records of vitamin D status, age and sex from July to December, 2022.The results were statistically analyzed with Statistical Packages for Social Science (SPSS-24). Results: Out of total subject (n=72) none of them showed toxic serum concentration of vitamin, 12.5 % had sufficient, 23.6% had insufficient and 63.9% had deficient levels of vitamin D. Gender wise comparison of vitamin D status showed male patients, 28.3% were deficient in vitamin D, 47.1% were insufficient, and a substantial 77.8% had sufficient levels. In contrast, a much higher proportion of female patients were deficient (71.7%) or insufficient (52.9%) in vitamin D, with only 22.2% having sufficient levels. According to age wise distribution, the highest percentage of vitamin D deficiency (58.7%) was observed in the youngest age group (18-30 years), while the proportion decreased in older age groups (30.4% for 31-50 years and 10.9% for 51-65 years). Conclusion: Vitamin D is an important vitamin which impacts many systems of the body .This study indicates that 63.9 % of subjects are vitamin D deficient which is very much alarming. So, it becomes paramount to further scrutinize the associated factors apart from age and gender. To this end, further studies are needed. IAHS Medical Journal Volume 6(2) December 2023; 68-72

Novel MLH1 nonsense variant in a patient with suspected Lynch syndrome

Loss-of-function germline variants of MLH1 cause Lynch syndrome. Here, we present the case of a 43-year-old male patient diagnosed with cecal and transverse colon adenocarcinomas. The characteristics of the case met the revised Bethesda guidelines, and the tumors demonstrated a high frequency of microsatellite instability. Genetic testing for mismatch repair genes (indicative of Lynch syndrome) revealed a novel heterozygous germline pathogenic variant, NM_000249.4:c.856A>T/NP_000240.1:p.(Lys286Ter), in MLH1.

Pseudoinvasion and squamous metaplasia/morules in colorectal adenomatous polyp: a case report and literature review

BackgroundSubmucosal pseudoinvasion and squamous metaplasia (SM) are incidental and special morphological findings in colorectal adenomas, and both can mimic invasive carcinoma. The coexistence of these two findings further increases the risk of misdiagnosis, posing a great diagnostic challenge to pathologists. From 1979 to 2022, only 8 cases have been reported, which was extremely rare. In this report, we presented a case of sigmoid colon adenoma accompanied by pseudoinvasion and SM. Additionally, relevant literature was analyzed to summarize the clinical and pathological characteristics.Case presentationA 51-year-old Chinese male patient presented with fresh blood after defecation. Electronic colonoscopy revealed multiple polyps, which were removed using a snare and subjected to high-frequency electrocoagulation resection. The largest polyp, located in the sigmoid colon, was a thick pedunculated and lobulated polyp with a maximum diameter of 2.8 cm. The surface of the polyp showed slight ruggedness and redness, and it was sent for pathological examination. Grossly, the polyp had a lobulated and slightly rough surface. Microscopically, it showed a tubulovillous adenoma with focal high-grade dysplasia and mucosal muscle hyperplasia. Glandular elements were observed in the submucosal layer, forming a well-defined lobular structure. Some of the glands displayed cystic change, and focal SM could be seen within the adenoma. SM could manifest as discrete solid cell nests of varying sizes or cribriform-morular-like structures. Immunohistochemical staining showed that SM cells were diffusely positive for cytokeratin 5/6 (CK5/6); p40, p63, and cytokeratin 20 (CK20) were negative; while caudal type homeobox 2 (CDX2) was weakly positive. β-catenin showed abnormal nuclear expression, and an extremely low Ki67 proliferation index was observed.ConclusionsCoexistence of SM and pseudoinvasion in colorectal adenomas is highly rare. It is more commonly observed in males and tends to occur in the sigmoid colon. It primarily manifests in tubulovillous adenoma and tubular adenoma, with a majority of cases exhibiting a pedicle. Histologically, it is similar to invasive lesions. The cystic dilation of the submucosal glands, hemosiderin deposition, and the presence of a lamina propria around the submucosal glands without adjacent desmoplastic reaction, suggest pseudoinvasion rather than cancer. The bland cytological morphology and Immunohistochemical markers play a crucial role in distinguishing SM from true invasive lesions.

A prospective study of the association between varicoceles and semen quality in men with infertility

BackgroundMale infertility is a global problem, and varicoceles are a common and treatable cause of male infertility. This study prospectively evaluated the effects of varicoceles on the fertility status and potential among Nigerian men. The consequences of the presence, location, and grades of varicoceles on the fertility status of infertile men with varicoceles were determined using a Doppler scrotal ultrasound scan and their seminal fluid parameters.MethodsOne hundred infertile males with clinical varicoceles (study group) and 100 infertile males without varicocele (control group) were recruited. Varicoceles were confirmed/excluded and graded with an ultrasound scan in each subject. They also all had a seminal fluid analysis to measure their fertility potential. The findings were compared and correlated in the two groups.ResultsMost subjects in the study group (67%) had bilateral varicoceles, 31% had isolated left varicoceles, and only 2% had isolated right varicoceles. The majority of the participants (61%) in the study group had secondary infertility, while the majority (63%) in the control group had primary infertility (p = 0.001). There were significant increases in the prevalence of azoospermia (p = 0.008) and oligospermia (p = 0.030) with the higher grades of left varicoceles.ConclusionBilateral varicoceles were significantly present in males with infertility in the study group. Varicoceles were more common in males with secondary infertility, and higher grades of varicoceles were significantly more associated with azoospermia and severe oligospermia. We recommend the routine use of ultrasound scans to diagnose varicoceles for the optimal management of infertile male patients.

Comparison of clinical, hormonal, pathological and treatment outcomes of ectopic Cushing's syndrome by sex: results of a multicenter study.

To compare clinical and hormonal data, neuroendocrine neoplasia (NEN) localization, treatment, and survival outcomes in ectopic Cushing's syndrome (ECS) by sex. Eleven experienced centers from our country participated in this retrospective study. The clinical and hormonal features, tumor imaging, pathological results, treatment modalities, and disease courses of the patients were evaluated. 28 female and 26 male patients with ECS were compared. The mean age at diagnosis, clinical characteristics, and hormonal evaluation results were similar. However, insulin-requiring diabetes mellitus (p = 0.04) and osteoporosis with fractures were more common in males (p = 0.03). While more patients with increased DHEA-S levels than the upper limit of normal were found to be higher in females, central hypothyroidism were higher in males (p = 0.02). At the diagnosis, 36 NENs (68% of females and 69% of males) were localized. Small cell lung carcinoma was higher in males (p = 0.02), and the frequency of other NENs was not different. Curative surgery was performed on 61% of females and 46% of males. Tumor size, Ki-67 labeling index, positive ACTH immunostaining, local lymph node and distant metastasis rates were similar in both sexes. In the follow-up, the tumor became visible in 7 of 10 females and 4 of 8 males after medical treatment and/or bilateral adrenalectomy. The remission rates (65% of females, 62% of males) and NEN-related death rates (14% of females, 30% of males) were similar. While ECS has a similar disease course in many aspects in males and females, hyperglycemia and osteoporosis are more severe in males.

Detection of KPC-3 producing Escherichia coli ST410 in Volos, Greece.

Escherichia coli A382 was isolated in July 2024 from a positive blood culture obtained from the central venous catheter of a male patient undergoing chemotherapy at the Hospital of Volos, Thessaly, Greece. Whole-genome sequencing analysis revealed that the isolate A382 is E. coli belonging to the ST410 high-risk clone, which co-harbors the blaKPC-3 and blaSHV-182 genes on an IncX3 plasmid. It also harbors blaTEM-1 and has five replicons, as follows: IncX3, IncQ1, CoIRNAI, IncF1A, and IncFIB. Complete genome analysis revealed that E. coli A382 isolate carries a range of virulence factors (iutA, iucC, fimH, fdeC, yehA, yehD, yehC, yehB, cgs, ahha, ccI, hlyE, papC, irp2, fyuA, lpfA, and nlpl) and many other non-beta-lactam resistance determinants, including dfrA14 and sul2, but it is susceptible to aminoglycosides, nitrofurantoin, tigecycline, colistin and ceftazidime-avibactam. In conclusion in this study, we describe the phenotypic and genome characteristics of an extensively drug-resistant E. coli ST410.

Sex disparity, prediagnosis lifestyle factors, and long-term survival of gastric cancer: a multi-center cohort study from China

BackgroundThis multi-center cohort study aimed to investigate whether sex and prediagnosis lifestyle affect the prognosis of gastric cancer.MethodsPatients with gastric cancer were from four gastric cancer cohorts of the National Cancer Center of China, The First Hospital of Lanzhou University, Lanzhou University Second Hospital, and Gansu Provincial Cancer Hospital. Prediagnosis lifestyle factors in our study included body mass index (BMI) at diagnosis, usual BMI, weight loss, the history of Helicobacter pylori (Hp) infection, and the status of smoking and drinking.ResultsFour gastric cancer cohorts with 29,779 gastric cancer patients were included. In total patients, female patients had a better prognosis than male patients (HR = 0.938, 95%CI: 0.881–0.999, P = 0.046). For prediagnosis lifestyle factors, BMI at diagnosis, usual BMI and the amount of smoking were statistically associated with the prognosis of gastric cancer patients. Female patients with smoking history had a poorer survival than non-smoking females (HR = 0.782, 95%CI: 0.616–0.993, P = 0.044). Tobacco consumption > 40 cigarettes per day (HR = 1.182, 95%CI: 1.035–1.350, P = 0.013) was independent adverse prognostic factors in male patients. Obesity paradox was observed only in male patients (BMI < 18.5, HR = 1.145, 95%CI: 1.019–1.286, P = 0.023; BMI: 23–27.4, HR = 0.875, 95%CI: 0.824–0.930, P < 0.001; BMI ≥ 27.5, HR = 0.807, 95%CI: 0.735–0.886, P < 0.001).ConclusionsSex and some prediagnosis lifestyle factors, including BMI at diagnosis, usual BMI and the amount of smoking, were associated with the prognosis of gastric cancer.

Improving health behaviours and attitudes around podoconiosis in Northern Western Ethiopia: Implementation and intervention effectiveness.

Assessing how interventions are implemented is essential to understanding why interventions may or may not achieve their intended outcomes. There is little evidence about how interventions against Neglected Tropical Diseases (NTDs) are being implemented. Guided by the Context and Implementation of Complex Intervention (CICI) framework, we evaluated an ongoing intervention against the NTD podoconiosis to examine the implementation process and its effectiveness in terms of improving shoe wearing practices, increasing knowledge and reducing stigmatizing attitudes towards podoconiosis in rural Ethiopia. We employed an exploratory mixed methods approach, qualitative followed by quantitative, between April and July 2022 to assess implementation agents, theory, strategy, process and outcomes of the intervention. We conducted document analysis, observations, focus group discussions, in-depth interviews and key informant interviews for the qualitative phase. We administered a survey to 369 rural residents, of whom 42 were affected by podoconiosis. The implementers utilized government healthcare centers in a bid to mainstream podoconiosis services within local healthcare structures. The implementers provided training for health professionals and the public and distributed supplies to patients over a three-month period. The intervention reached 62% of patients, but female patients were less likely to participate than male patients. Only 18% of community members had participated in health education campaigns linked to the intervention. Involvement in the intervention resulted in improved shoe wearing practice and holding fewer stigmatizing attitudes. However, internalized stigma among patients was still rife; and the plan to utilize community assets to extend the intervention activities was not effective. Implementers must monitor the fidelity and progression of programs on a constant basis to make corrections. They also need to expand health education, provide psychosocial support and design economic empowerment programs for patients to reduce stigma. They must also collaborate with policy makers and international partners to sustain program activities at intervention delivery points.