Male Patients Research Articles

Glucose Metabolism and Sex Hormones in Male Patients with Medication-naïve First-episode Schizophrenia: A Large-scale Cross-sectional Study.

Schizophrenia (SCZ) usually begins in early adult life. The underlying molecular mechanisms of SCZ remain unclear. There is evidence for the involvement of abnormalities in metabolic and endocrine systems in SCZ, even in drug-naïve first-episode schizophrenia patients (DNFES). However, the association between impaired regulation of glucose metabolism and sex hormones was not studied in SCZ. This study aimed to evaluate the interrelationship between sex hormones and high fasting glucose levels in male DNFES patients. A total of 99 patients with SCZ were recruited, and fasting glucose, fasting insulin, the insulin resistance index (HOMA-IR), and sex hormones were measured. We found that some male patients with SCZ had abnormal levels in glucose metabolism parameters and gonadal hormones that were not within the normal range. Linear regression analysis adjusted for age, waist circumference, and body mass index showed that testosterone levels were negatively associated with fasting insulin in male patients (β = -0.21, t = -2.2, p = 0.03). Our findings confirm the abnormalities in glucose metabolism parameters and gonadal hormones at the onset of the illness in male DNFES patients with SCZ. In addition, there was an interaction effect between abnormal glucose metabolism and sex hormones in male patients.

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS.

Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

A Retrospective Study of Ballistic Pelvic Fractures With Focus on Short-Term Clinical Outcomes.

To evaluate the orthopaedic management, associated injuries, and outcomes in patients treated for low-velocity ballistic pelvic fractures. Retrospective chart review. Single, urban, Level I trauma center. Patients 15 years or older treated for low-velocity ballistic pelvic (OTA/AO 61 and 62) fractures from May 2018 to August 2021. Primary study measures included pelvic fracture location, concomitant associated injuries, surgical interventions, and antibiotic treatment. Postinjury sequelae evaluated include infection, neurologic deficit, and need for orthopaedic removal of foreign body. Risk factors of postinjury sequelae were investigated. A total of 156 patients with ballistic pelvic fractures were included. The cohort consisted of 135 (86.5%) male patients with a mean age of 29.8 years. One hundred ten (70.5%) patients sustained 2 or more gunshot wounds. Ninety-eight (62.8%) patients underwent an exploratory laparotomy with 79 (50.6%) having a confirmed concomitant intestinal injury. Additional associated injuries included nerve injury (13.5%), vascular injury requiring repair or embolization (10.9%), and bladder injury (10.3%). Nine (5.7%) patients underwent orthopaedic operative management-five (3.2%) patients for operative fixation and 4 (2.5%) patients for removal of intra-articular foreign bodies. Diabetes (odds ratio [OR]: 33.1, P = 0.025), neurologic deficit on presentation (OR: 525.2, P < 0.001), vascular injury requiring repair or embolization (OR: 8.7, P = 0.033), and orthopaedic pelvic fixation (OR: 163.5, P = 0.004) were positively associated with the defined postinjury sequelae at 30 and 90 days of follow-up. There was not a statistically significant association between infection and retained foreign body (OR: 3.95 [95% CI 0.3-58.7, P = 0.318]) or bowel contamination (OR: 6.91 [95% CI 0.4-58.7, P = 0.178]). Ballistic fractures of the pelvis and acetabulum rarely required operative fixation (3.2%) or irrigation and debridement. Neither retained foreign body nor presumed bowel contamination of pelvic fractures had a statistically significant association with infection, which further supports conservative management of these injuries. Patients with diabetes, neurologic deficit on presentation, vascular injury necessitating intervention, and orthopaedic fixation of pelvic fracture are associated with increased risk of postinjury sequelae. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Functional and Aesthetic Lower Lip Reconstruction With Depressor Anguli Oris Muscle Flap and Reverse Superior Labial Artery Flap.

The lower lip is an important anatomical structure involved in daily activities such as eating, drinking, and speaking, as well as in facial expressions. Lower lip defects should be repaired to preserve lip function without disrupting the aesthetic harmony of the lips within the face. This goal is difficult for plastic surgeons because, for functional and aesthetic repair, it is necessary to replace the mucosa, muscle (especially contractile), and skin tissues present in the lip. Subtotal lower lip repair was performed using an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap in seven male patients with a mean age of 63 years. A depressor anguli oris muscle flap was used to repair the orbicularis oris muscle defect. The desepithelialized part of the reverse superior labial artery flap was used for mucosal defect repair, whereas the remaining part was used for skin defect repair. Patients were followed up for an average of 15 months. Patient lips, epithelialization, sensation, and sphincter function were clinically evaluated. Electromyography (EMG) was performed at 6 and 12 months to evaluate the function of the depressor anguli oris muscle flap. All the reverse superior labial artery flaps survived without any loss. Trapdoor deformity developed in the flaps of two patients. The desepithelialized parts of the flaps were completely epithelialized (covered with mucosa) by approximately 6th week. In the EMG controls of the patients at 6 months, the depressor anguli oris muscle was contractible. Sensation regained in the operated lip during the follow-up period. The combination of an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap is an important surgical option for the functional and aesthetic repair of subtotal lower lip defects.

Renal nutcracker syndrome presenting with varicocele: A case series

Introduction and importanceNutcracker syndrome (NCS) is a rare condition characterized by left renal vein compression and presents with diverse clinical manifestations. This case series study aims to evaluate the clinical presentations and outcomes of patients with NCS and varicocele. Case presentationWe reviewed the cases of four male patients, aged 15 to 19 years, who presented with recurrent and grade 3 varicocele after varicocelectomy. All patients reported pain in the hypogastric, flank, or groin areas. Despite the absence of hematuria, NCS was diagnosed based on duplex ultrasound and contrast-enhanced computed tomography (CT) scans. Patients underwent open surgical interventions, including gonadal vein transposition or saphenous vein bypass. Clinical discussionThe absence of hematuria in these cases poses a diagnostic challenge, as current diagnostic criteria for NCS relies on its presence. Our findings underscore the need to consider NCS in patients with varicocele, even in the absence of hematuria. Surgical interventions were effective in resolving the symptoms. After NCS surgery, the varicocele in one patient resolved, and three patients underwent varicocelectomy successfully without recurrence throughout the recovery period. ConclusionThis case series highlights the diagnosis of NCS presenting with varicocele and local pain without hematuria, emphasizing the need for improved diagnostic and management approaches.

Acute carpal tunnel syndrome after atraumatic rupture of the flexor tendons: a case report

Acute carpal tunnel syndrome (ACTS) is a rare entity, mainly associated with traumatic causes, although patients with predisposing factors such as taking anticoagulants or tendinopathies may debut with an atraumatic ACTS. This case study presents the case of a 77-year-old male patient, anticoagulated, who began with rapidly progressive pain and swelling in the right wrist, radiating towards the medial territory, with no history of traumatic triggering event. Examination showed paraesthesia in the volar aspect of the first to third fingers of the hand and increased pain on passive mobilisation of the fingers. Given the progressive evolution of the condition and the lack of response to both physical and pharmacological measures, the carpal tunnel was opened surgically. During surgery, a significant haematoma was observed secondary to the rupture of the deep flexor tendons of the fourth and fifth fingers inside the canal. Following release of the carpal tunnel, complete recovery of the symptomatology occurred. In conclusion, a high degree of clinical suspicion is necessary in a patient with an examination suggestive of ACTS. The treatment of choice is urgent surgical decompression of the carpal tunnel. Early intervention allows resolution of symptoms and reduces complications.

Evaluation of tumor infiltrating lymphocytes as a prognostic biomarker in patients with ductal carcinoma in situ of the breast.

To assess the association between tumor-infiltrating lymphocytes (TILs) in ductal carcinoma in situ (DCIS) samples and disease recurrence. This retrospective cohort study included women aged 18years and older who underwent treatment between January 2007 and December 2020. Male patients, individuals diagnosed with invasive or microinvasive disease based on anatomopathological examination of surgical specimens, and those with a personal history of any other cancers were excluded. Additionally, the presence of "touching TILs" (lymphocytes in direct contact with tumor cells) and periductal desmoplasia were evaluated as complementary methods to represent the immunological microenvironment. The primary outcome was relapse-free survival based on TIL quantification adjusted for potential confounders. Pathologists assessed TILs in the sample with the highest tumor representation and quantified them as a percentage. Survival was evaluated using Kaplan‒Meier curves, log-rank tests, and Cox regression models. A total of 191 patients met the eligibility criteria. The mean follow-up duration was 77.2months, with a recurrence rate of 9.2%. Patients with TILs ≥ 17% had a greater risk of recurrence (HR 2.97, 95% CI 1.17-7.51; p = 0.02). Additionally, focal necrosis (HR 6.4, 95% CI 1.39-34.71; p = 0.018) or comedonecrosis (HR 4.53, 95% CI 1.34-15.28; p = 0.015) were associated with increased recurrence risk. According to the multivariate model, comedonecrosis and TILs ≥ 17% were significantly associated with recurrence (p = 0.034 and p = 0.035, respectively). Regarding the evaluations of "touching TILs" and periductal desmoplasia, no statistical significance was found when assessing their association with disease recurrence. In our cohort, a high percentage of TILs (≥ 17%) and the presence of comedonecrosis were independently associated with DCIS recurrence.

Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis.

This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.

Diagnosis and endodontic treatment of odontogenic cutaneous sinus tracts: A report of two cases

Introduction: The odontogenic cutaneous sinus tract (OCST), caused by pulp necrosis, creates connections between pathological spaces and anatomical structures. Extraoral manifestations pose diagnostic challenges leading to inappropriate treatments such as multiple surgery and antibiotic therapies. Effective management requires the treatment of dental pathology through endodontic therapy or extraction. This paper presents two cases of OCST and emphasizes the importance of accurate diagnosis and successful non-surgical endodontic treatment. Observations: Case report 1: A 23-year-old male patient referred by his dermatologist with a cutaneous sinus tract on his chin that had appeared five years ago. During this period, he reported spontaneous pain and pus discharge from the chin area. The examination revealed a periapical lesion associated with tooth number 31. Cone beam computed tomography (CBCT) revealed the existence of a localized perforation on the buccal alveolar table and a second root canal of the tooth. After six months of follow-up, the cutaneous sinus tract was significantly improved by the appropriate endodontic treatment. Case report 2: A 36-year-old female patient was referred by her dentist to examine a chin lesion that had appeared a month ago. In clinical examination and radiographic assessment, periapical lesion associated with two mandibular central incisor teeth #41 and #31 was observed. After identifying the source of infection, endodontic treatment was carried out, and a good improvement in fistula was observed after one month. Conclusions: The correct diagnosis and treatment of OCST are important for healing. CBCT aids to identify odontogenic origin of the sinus tract through the detection of apical periodontitis and bone lesion. Root canal therapy is the treatment of choice for these cases and should always be attempted first. Monitoring the patients is necessary until complete healing of the disease.

Rare case of massive inguinal dermatofibrosarcoma protuberans: A case report.

DFSP is a cutaneous soft tissue sarcoma. A 35 year old male patient presented with DFSP in the inguinal region which is a rare soft tissue sarcoma which usually presents in the torso, occurring very rarely in the inguinal region. Hence in case of any swelling in the inguinal region, DFSP should be in differential diagnosis.

Descriptive study of patient outcome and satisfaction with telemedicine and physical consultation during and after the COVID-19 pandemic.

This study was conducted to assess patients' outcome and satisfaction with the eye care received with telemedicine and physical consultation at a tertiary care hospital during and after the coronavirus disease 2019 (COVID-19) pandemic. A descriptive study was carried out on 6052 patients who consulted for eye illness at a tertiary care hospital between April 2020 and December 2022. An outcome scoring system was developed and validated for the assessment of patient outcome after providing treatment on telemedicine consultation and physical consultation. Outcome scores for various symptoms were compared pretreatment and posttreatment. Telehealth Usability Questionnaire (TUQ) was used through an online survey to assess patients' satisfaction with teleophthalmology services during the COVID-19 pandemic. An 18-item Patient Satisfaction Questionnaire (PSQ-18) was used to assess the same with physical consultation. A total of 6052 patients were included in the study. Physical consultation group had 2485 patients (41.06%) and the telemedicine group had 3567 patients (58.93%). Male patients constituted 63.11% and females were 36.89%. There was a significant improvement in outcome scores for pain and redness in both physical and telemedicine consultation groups (P < 0.0001). All subgroups of TUQ had significantly high scores (including usefulness, ease of use and learnability, interface quality, interaction quality, and satisfaction and future use), except one subgroup (reliability). Uneducated patients were significantly more satisfied with telemedicine compared to educated patients (P = 0.044). Majority of patients expressed satisfaction with teleophthalmology services. The recent pandemic paved the way for the future integration of telemedicine in ophthalmology, especially if virtual eye examinations attain a higher level of reliability.

The effect of TSH on kidney function

Background: The thyroid gland plays a vital role in the regulation of many physiological processes, including kidney function. Aim: The purpose of this study was to investigate the relationship between thyroid-stimulating hormone (TSH) and kidney function in male and female patients with hyperthyroidism, as well as in healthy control subjects. Method: A total of 60 participants from Najaf city, Iraq, were included in the study. This included 10 male and 10 female control subjects, as well as 20 male and 20 female patients with hyperthyroidism. Blood samples were collected from all participants and analyzed for TSH, urea, and creatinine levels. Result: The results showed a significant increase in TSH levels in both male and female patients with hyperthyroidism compared to control subjects. Urea levels were also significantly higher in hyperthyroidism patients compared to controls, while creatinine levels were not significantly different. In addition, there was a significant difference in the effects of TSH on kidney function between male and female patients with hyperthyroidism. Female patients with hyperthyroidism had significantly higher levels of urea and lower levels of creatinine compared to male patients with hyperthyroidism. These findings suggest a direct effect of TSH on kidney function and highlight the need for regular monitoring of kidney function in individuals with hyperthyroidism, particularly women. Further research is needed to fully understand the mechanisms behind the gender differences observed in this study and to develop targeted interventions for both men and women with thyroid disorders. Conclusion: our study provides valuable insights into the relationship between TSH and kidney function and highlights the need for multidisciplinary care and targeted interventions for individuals with thyroid disorders to prevent or minimize the risk of kidney dysfunction.

Management of pediatric thyroglossal duct cyst: A case report

Introduction: Thyroglossal duct cysts are common congenital neck anomalies in children, diagnosed through clinical assessment and ultrasound, and treated with the Sistrunk procedure to prevent complications like infection and malignancy. Case Description: We present a case of a 4-year-old male patient with a progressively enlarging neck mass for three months. The mass was asymptomatic, did not cause any eating difficulties, and moved upwards during swallowing and tongue protrusion. Upon physical examination, a soft, mobile, cystic mass approximately 3 cm in diameter was identified beneath the hyoid bone. Supporting examinations, including ultrasound and fine-needle aspiration cytology, led to the diagnosis of a thyroglossal duct cyst. The patient underwent a successful Sistrunk procedure, which involved the excision of the cyst along with a portion of the hyoid bone. Postoperative management included administration of intravenous antibiotics and paracetamol, culminating in a full recovery without any signs of infection. The patient exhibited complete wound healing within two weeks. There was no evidence of cyst recurrence during a follow-up examination six months later. Conclusion: Despite being common, thyroglossal duct cysts require thorough evaluation to avoid misdiagnosis, and are typically identified by a slowly growing midline neck mass that moves with swallowing and tongue protrusion, often near the hyoid bone.

Macrophage activation syndrome: An unusual complication of brucellosis

Introduction: During acute septicemic brucellosis, macrophage activation syndrome is a rare but serious complication. We report two cases of acute brucellosis complicated by macrophage activation syndrome (MAS). Materials and methods: We conducted a retrospective study on the medical records of patients admitted for brucellosis complicated by SAM between February 2021 and January 2023. The diagnosis of brucellosis is based on the isolation of brucellosis in blood cultures and/or on positivity serology. The SAM was retained based on Henter's diagnostic criteria. Results: During the study period, 30 patients were hospitalized for brucellosis. The average age is 46.7 years. Acute brucellosis complicated by SAM was noted in two immunocompetent male patients aged 47 and 46 years. Both patients were hospitalized for treatment of recent acute fever with deterioration in general condition, chills and diffuse arthromyalgia. The biological assessment revealed an inflammatory syndrome and pancytopenia in our patients. Blood cultures were requested returning positive for Brucella spp. Both patients presented more than five diagnostic criteria for SAM (fever, SPM, severe pancytopenia, hypertriglyceridemia and hyperferritinemia, histological signs of hemophagocytosis). Our patients improved only under antibiotic therapy. Conclusion: Macrophage activation syndrome is a described but rare complication during brucellosis.

Prevalence of gingival overgrowth among patients at the periodontology clinic of Dental Hospital Universitas Airlangga

Background: The prevalence of dental and oral health problems in Indonesia, including periodontal disease and gingival overgrowth (GO), remains high and requires serious attention from health workers. This study aims to determine the prevalence of GO due to the existing data gap and public concern regarding this condition. Objectives: To determine the prevalence of gingival overgrowth among patients at the periodontology clinic of Universitas Airlangga Dental Hospital. Material and Methods: This study was conducted from August to September 2023 at the Dental and Oral Hospital (RSGM) Universitas Airlangga using a descriptive observational method with a cross-sectional design. The sample was calculated using total sampling from medical record data of patients at the Periodontics Clinic of the Dental and Oral Hospital (RSGM) Universitas Airlangga who met the inclusion criteria in 2022. The study variables included gingival overgrowth (GO), gender, age, and tooth region (sextant). Data were processed using Microsoft Excel and presented as a percentage (%). A descriptive data analysis was carried out to draw a conclusion. Conclusion: The study found that 37.11% of patients at the Dental and Oral Hospital (RSGM) of Universitas Airlangga experienced gingival overgrowth. The percentage of male patients experiencing gingival overgrowth was higher than that of women, with the highest age group being 18-24 years. The tooth area that experienced the most gingival overgrowth was sextant 5, with a total of 29 samples.

Usefulness of hot shot intermittent infusion online hemodiafiltration plus far-infrared therapy for dialysis patients with lower extremity arterial disease: a case report

BackgroundLower extremity arterial disease (LEAD) occurs at a high frequency in dialysis patients and is associated with a poor prognosis. In recent years, intermittent infusion online hemodiafiltration (I-OHDF) combined with far-infrared therapy (FIR) has been reported as being useful in dialysis patients with LEAD. However, there are also reports of worsening of the ulcers and gangrene in some cases. Hot shot I-OHDF (HS I-OHDF), which involves intermittent infusion of heated dialysate, is reported as being more effective than conventional I-OHDF for improving the plasma refilling rate (PRR) and peripheral circulation. We report the case of a patient in whom a lower extremity ulcer healed only after we switched from I-OHDF + FIR to HS I-OHDF + FIR, and the usefulness of this treatment.Case presentationThe patient was a 41-year-old male dialysis patient with LEAD who showed worsening of the ulcers in the lower extremity before he was switched from I-OHDF plus FIR to HS I-OHDF plus FIR; we compared the changes in the lower extremity blood flow, PRR, degree of wound healing, and subjective symptoms over time after the switch to HS I-OHDF plus FIR as compared with the values prior to the switching. As compared with the values during I-OHDF plus FIR, the lower extremity blood flow and PRR increased markedly during HS I-OHDF plus FIR. The wounds in the lower extremity improved over time during HS I-OHDF plus FIR and showed complete healing after 6 months; evaluation by visual analog scales (VASs) showed improved scores for all of fatigue, pain, coldness, and insomnia, and the patient reported improved subjective symptoms. The mechanism underlying the effectiveness of HS I-OHDF plus FIR in promoting wound healing is unknown, however, we speculated that the temperature change in the intermittent infusion solution resulted in increased blood flow in the true capillaries (resting vessels) and transfer of the nonthermal effects of FIR to more peripheral vessels.ConclusionsThis case demonstrates that combined use of HS I-OHDF with FIR can enhance the efficacy of FIR in dialysis patients with LEAD by increasing the lower extremity blood flow and PRR, which is useful for wound healing.

Dramatic improvement of drug-resistant epilepsy following cerebral infarction: a case report

BackgroundAn estimated 30% of patients with epilepsy experience drug-resistant epilepsy, which is the failure to control seizures despite the use of two or more antiseizure medications. Although other treatment options are considered, these alternatives often prove ineffective.Case presentationA 60-year-old East Asian male patient diagnosed with drug-resistant epilepsy experienced several seizures daily despite being on eight different antiseizure medications. Seizures began at age 15. He underwent epilepsy surgery at age 34, yet the seizures persisted. An electroencephalogram revealed multifocal sharp waves in the left hemisphere. Cerebral hemorrhages at ages 47, 50, and 56 were caused by head trauma during seizures. The patient became wheelchair-bound and now resides in a nursing home. At age 58, after suffering an acute cerebral infarction due to occlusion of the left internal carotid artery, his daily seizures ceased entirely. Despite remaining wheelchair-bound, he did not experience a significant decline in his quality of life. The cessation of seizures has reduced his risk of further trauma, and he has remained seizure-free for 3 years on just one antiseizure medication.ConclusionSurgical treatments for epilepsy often fail, with insufficient resection being a leading cause of these failures. In some cases, extensive destruction from an ischemic stroke may be beneficial. Furthermore, this case suggests that infarction therapy could be a potential treatment for patients with drug-resistant epilepsy.

Fluctuating emotional states before and during child sexual abuse and rape: a file review analysis of males in mandated care in The Netherlands

Purpose The purpose of this study is to examine emotional states preceding and during sexual crimes in a Dutch sample of adult male patients who were admitted to mandated clinical care. Design/methodology/approach Emotional states preceding child sexual abuse (CSA) (n = 63) and rape against adults (n = 60) were compared using the Mode Observation Scale. Findings CSA and rape were equally preceded by feelings of vulnerability, undifferentiated anger and loneliness and characterised by callous unemotionality. Emotional manipulation was more dominant in the events leading up to CSA, whereas an exaggerated sense of self-worth was more dominant in the event preceding rape. Substance-related detachment was more common preceding rape but was equally common during both types of crimes. Controlled anger was more common in rape. Practical implications CSA and rape crimes are predominantly characterised by similar emotional states of persons who were admitted to mandated clinical care. This informs the development of more effective therapeutic interventions and support services tailored to the emotional profiles of patients, potentially improving rehabilitation or treatment outcomes. Scientifically, the results of this study provide a compelling foundation for further research into the psychological mechanisms underpinning sexual violence. Originality/value While previous research has often focused on these crimes in isolation, this study bridges a critical gap by examining the emotional commonalities between them. This study challenges the conventional understanding that treats these forms of sexual violence as entirely distinct, proposing instead that they may share underlying emotional dynamics.

Contemporary LDL-cholesterol management in male and female patients at high-cardiovascular risk: results from the European observational SANTORINI study

Abstract Background Middle aged women have a faster increase in atherosclerotic cardiovascular disease (ASCVD) events than men over time. Undertreatment with guideline-recommended therapy in women may be one of the drivers for this burden. Purpose To compare high- or very high-risk male and female patients regarding contemporary 1-year low-density lipoprotein cholesterol (LDL-C) goal attainment, lipid-lowering therapy (LLT) intensity, and major adverse cardiovascular event (MACE) rate. Methods SANTORINI is an observational, prospective study that enrolled high- and very high-cardiovascular risk patients between March 2020 and Feb 2021, across 623 sites and 14 countries in Europe from primary &amp; secondary care settings, with a further 1-year prospective follow-up. We included all patients with an LDL-C measurement at baseline and 1-year follow up (1yFU) for the current analysis. LDL-C goal attainment was defined separately for high and very-high risk categories according to 2019 ESC/EAS guidelines. Results Overall, 5197 males with a mean age of 65 years, and 2013 females with a mean age 66 years were included. At baseline, male patients had higher prevalence of pre-existing ASCVD (81.6% vs. 63.5%), and a lower prevalence of familial hypercholesterolaemia (8.7% vs. 17.2%) than female patients (Table 1). The proportion of patients reaching LDL-C goal improved from baseline to 1yFU, but was greater in males (22.9% and 33.3%, respectively) than females (16.9% and 24.6%, respectively). Similarly, the proportion of patients receiving no LLT decreased from baseline to 1yFU for both sexes, however, more females than males received no LLT at 1yFU (male: 20.7% to 2.7%; female: 23.9% to 3.9%). High intensity statin use increased for both sexes but was higher for males (22.2% to 27.3%) than for females (15.5% to 19.5%) at 1yFU. By contrast, PCSK9i use at baseline and 1yFU was lower for males (6.6% to 9.3%) than for females (9.8% to 13.4%). Nevertheless, the use of combination LLT at 1yFU was lower among females than males (male: 27.8% to 42.2%; female: 26.7% to 40.2%). During follow-up, MACE-4 was higher in males (5.31/100 patient years [PY]; 95% confidence interval [CI]: 4.68–5.95) than in females (3.63/100PY; 95% CI: 2.79–4.47). Similar results were observed for MACE-3 (Table 2). Conclusions Despite similar guideline recommendations, use of combination LLT and high intensity statin therapy was lower in female patients at high or very high cardiovascular risk than in male patients over one year of follow-up. Accordingly, female patients had lower LDL-C goal attainment both at baseline and at one-year. Nevertheless, due to intrinsic risk factors, female patients had lower rates of MACE-4 and MACE-3 than male patients.

Sex-related outcomes in patients receiving shortened or longer dual antiplatelet treatment after percutaneous coronary intervention: a systematic review and meta-analysis

Abstract Background There are known gender disparities in the pathophysiology, clinical presentation, and prognosis of coronary artery disease between male and female patients. Although antiplatelet therapy cessation is more frequent among women, female gender is an independent factor for major bleeding after percutaneous coronary interventions. Considering that the ischemic and bleeding risk of women undergoing PCI differ from men, it follows that the safety and efficacy of shortened, one or 3 months, DAPT (S-DAPT) compared to longer DAPT (L-DAPT) after PCI might differ between the sexes. Purpose Our systematic review and meta-analysis aims to explore the safety and efficacy of S-DAPT versus L-DAPT in men and women having undergone PCI. Methods Three major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized – controlled trials, or subgroup or post – hoc analyses of them. The studies should compare S-DAPT with L-DAPT in male and female patients undergoing PCI, providing separate data. The endpoints were Net Adverse Clinical Events (NACE), Major Adverse Cardiac Events (MACE), all-cause mortality, myocardial infarction and major bleeding. All endpoints were used as per trial defined and should be evaluated in 12-months. The effect of different DAPT regimens was assessed by calculating the risk ratio (RR) with 95% confidence intervals (CIs), using a random-effects model (Mantel-Haenzel). Results A total of eight studies and 46,476 patients were included; women were underrepresented being only the 26% (N=12,063) of the total participants. MACE did not differ significantly in the two arms in the total sample (RR: 0.94, 95%CI: 0.86-1.04); however, they were significantly reduced in women treated with S-DAPT (RR: 0.82, 95%CI: 0.70-0.97) (p-interaction: 0.049). (Figure 1) S-DAPT was associated with a significant reduction in both NACE (RR: 0.91, 95% CI: 0.85-0.99) (Figure 2A) and major bleeding (RR: 0.73, 95% CI: 0.57-0.95) (Figure 2C) in the total sample, without significant differences between male and female patients (p-interaction: 0.14 and 0.053, respectively). All-cause mortality (RR: 0.86, 95%CI: 0.73-1.01) (Figure 2B) and myocardial infarction rates (RR: 1.03, 95%CI: 0.86-1.24) (Figure 2D) were similar in both S-DAPT and L-DAPT in the total sample, without any significant subgroup differences (p-interaction: 0.13 and 0.051, respectively). Conclusions Shortened duration of DAPT significantly decreased MACE in women, in contrast with male patients, showing that women may benefit from abbreviated duration of DAPT. Further studies specifically investigating the optimal duration of DAPT in women are warranted and a sex-based approach could be considered in the management of antiplatelet treatment after PCI.A. NACE B. Mortality C. Bleedings D. MI