Median Duration Of Symptoms Research Articles

Survival and toxicity outcomes of hypofractionated conformal radiotherapy compared to conventionally fractionated radiotherapy in the treatment of diffuse intrinsic pontine gliomas.

Diffuse intrinsic pontine gliomas are associated with dismal survival outcomes. Conventional fractionation radiation to a dose of 60Gy is the standard of treatment. This retrospective review aims to compare survival and toxicity outcomes of patients treated with conventional fractionation (CF) and hypofractionation (HF) radiotherapy. Treatment-naïve diffuse intrinsic pontine glioma patients undergoing radical radiation were analyzed. CF was delivered to a dose of 50-60Gy in 25-30 fractions, while HF was delivered as 38-40Gy in 12-15 fractions. All patients were planned via the volumetric modulated arc therapy (VMAT) technique. A total of 64 patients were eligible for analysis. The median age of presentation was 10years. Motor deficit was the most common presenting complaint in 51.6% of the patients, with a median symptom duration of 2months. The pons was the most frequent site of disease epicenter in 71.8% of the patients. After a median follow-up of 9.45months (range 0.23-72.63months), 23 patients died, and 28 patients experienced disease progression. The unadjusted hazard ratio (HR) for death in patients treated with HF as compared to CF was 1.330 (95% CI 0.522-3.386) (p-value 0.550, by Cox regression analysis). The median OS for the entire cohort was 13.9months, while it was 9.7months (95% CI 5.65-13.74) and 15.1months (95% CI 9.02-21.18) (p-value = 0.547) with CF and HF, respectively. On multivariate analysis, disease epicenter in the pons was the only significant factor associated with PFS. Hypofractionation was associated with a significantly higher aspiration rate and Ryle's tube requirement (p-value 0.027). Hypofractionated radiation can be considered for diffuse intrinsic pontine glioma with optimum supportive care.

Health-related quality of life following bisphosphonate therapy in individuals with Paget’s disease of bone – A study from a teaching hospital in Southern India

ABSTRACT Background: Paget’s disease of bone (PDB) is associated with considerable morbidity because of bony pains, fractures, and deformities. Remission, as assessed by reduction in alkaline phosphatase levels, does not necessarily correlate with improvement in quality of life (QoL). Health-related quality of life (HR-QoL) in affected individuals is not well-studied in India. This study attempts to describe the QoL in individuals with PDB. Methods: In this prospective observational study spanning 6 years (Jan 2017–Dec 2022), we included 29 treatment-naïve patients diagnosed with PDB based on clinical, biochemical, and radiographic features. All patients received treatment with antiresorptive agents. SF-36 questionnaire was administered before treatment and at review. Results: A total of 29 patients with PDB (20 males), with a mean (SD) age of 68.1 (9.8) years, were included. Symptomatic disease was seen in 23/29 (79.3%) and polyostotic disease in 25/29 (86%) subjects. The median duration of symptoms was 6 months (0–24 months). The most frequently involved skeletal sites were the pelvis (69%), vertebrae and sacrum (68%), followed by the skull (48%) and lower limb (48%). The subjects were treated with parenteral zoledronate (65.5%), oral alendronate (24.1%), and denosumab (6.9%). There was a significant improvement in all eight domains of QoL (P = 0.0001) as assessed by the SF-36 questionnaire. The maximum improvement (27.2%) was observed in the physical functioning domain (P = 0.0001). Conclusion: This study assessed various domains in QoL by using the SF-36 questionnaire at baseline and post-treatment with antiresorptive agents, and it was noted that there was a significant improvement in all domains of QoL.

Role of Fractional Exhaled Nitric Oxide for Monitoring Bronchial Asthma

Background: Monitoring during treatment of asthma is usually done by various clinical tools, spirometry, sputum eosinophils and fractional exhaled nitric oxide. Fractional exhaled nitric oxide is a simple and noninvasive tool and has a good agreement with asthma control test score. This study aims to correlate fractional exhaled nitric oxide with asthma control test score. Methods: This cross-sectional study was conducted at National Academy of Medical Sciences, Bir hospital, Chest unit, Department of Medicine, over a duration of six months. Patients aged more than 18 years with bronchial asthma diagnosed at least three months prior were included into the study. Those with recent severe exacerbations, known other chronic respiratory disease and smokers were excluded. Asthma control test score was obtained at baseline. All included patients underwent fractional exhaled nitric oxide measurement followed by measurement of Forced vital capacity(FVC) Forced expiratory volume in one second (FEV1) and FEV1/FVC ratio. Results: Forty patients with a mean age of 40.5±11.1 years were included in the study. Majority were females (65%) and the median duration of symptoms was 24 months (Interquartile range= 18-60). Mean fractional exhaled nitric oxide level was 27.8 (±16.0) parts per billion (ppb) and asthma control test score was 19.3 (±4.7). Mean fractional exhaled nitric oxide levels were significantly different across different severity (well controlled, partially controlled and poorly controlled) of asthma (p=0.013). The mean fractional exhaled nitric oxide values and total asthma control test score shows statistically significant negative correlation (Pearson correlation coefficient (r) = -0.462, p=0.003). Asthma control test and FeNO values guided the change of inhaled steroid dose in 17 of the 40 patients. Conclusion: Fractional exhaled nitric oxide can be used when available, along with asthma control test for monitoring control and adjusting the inhaled steroid dose in asthma. Keywords: Asthma control test (ACT); bronchial asthma; Fractional exhaled nitric oxide (FeNO).

Long-term Results of Proximal Pole Scaphoid Nonunion Treated with Retrograde Fixation and Non-vascularized Cancellous Bone Autograft

Aim: To evaluate the long-term clinical and functional results of patients diagnosed with scaphoid bone proximal pole nonunion and who underwent retrograde fixation with non-vascularized cancellous autograft from the distal radius and a cannulated, headless screw via a volar approach. Material and Methods: Twenty-nine patients, 2 female, and 27 male, who underwent surgery with the diagnosis of scaphoid proximal pole nonunion were evaluated in this study. All patients underwent retrograde fixation with a non-vascularized cancellous autograft from the distal radius and a headless cannulated screw using a volar approach and the same rehabilitation program was applied. The clinical and functional scores of the patients were evaluated before surgery and at the last follow-up. Results: The mean age of the patients was 30.66±7.34 (range, 18-40) years. The median symptom duration was 11 (range, 6-18), and the median follow-up period after surgery was 55 (range, 36-67) months. When the maximum isometric strength of the forearm muscles of the healthy and surgical sides was evaluated at the last follow-up, the mean hand-grip strength test values of the healthy side were significantly higher than the pathological side (p

Analysis of Concussions with Persisting Symptoms Caused by Motor Vehicle Crashes in 136 Vehicle Occupants Shows that Females Are Vulnerable Road Users.

At the Canadian Concussion Centre, we treated 136 patients from 2000 to 2020 who sustained concussion plus persisting concussion symptoms (C+PCS) as motor vehicle occupants involved in motor vehicle crashes (MVCs). This center specializes in the treatment of patients with C+PCS. The objective of the present study was to identify strategies for preventing concussion among vehicle occupants involved in MVC. Indeed, this is the first study focused on C+PCS in MVC occupants, and our main purpose was to evaluate the effectiveness of onboard concussion prevention strategies. In this retrospective, consecutive cohort of 136 patients with C+PCS, we examined the patients' demographic and injury features in relation to the nature of the MVC including speed, direction of impact, and availability, deployment, and effectiveness of onboard occupant safety measures including seatbelts, head restraints, and airbags. The most frequent combination of factors was a belted female driver of an automobile struck from behind by another automobile. Surprisingly, the entire patient cohort comprised more females (69.1%) than males (30.9%), and rear-end collision was the most common type in females. Most injured occupants of both sexes were wearing seatbelts, but only a minority of the crashes caused airbag deployment. The seven most common symptoms were headache (84.6%), anxiety (72.8%), sensitivity to light (70.6%), memory problems (69.9%), sensitivity to noise (66.2%), irritability (56.6%), and depression (55.9%). Whiplash was a frequent associated injury in both sexes. Complete recovery from C+PCS was rare, and most patients with known follow-up continued to suffer from persisting symptoms for months to years. The median symptom duration for all 136 patients was 30.0 months (interquartile range: 16.8-56.0 months). Based on these findings, we conclude that females are indeed vulnerable road users with respect to C+PCS, and our literature search showed that there had been some previous evidence of increased injury risk of other injuries in female occupants. We recommend that additional prevention strategies are required to reduce the post-crash acceleration-deceleration "bobble-head" movement of the head on trunk causing both concussion and whiplash as has been accomplished in auto racing. Also, these prevention measures must be investigated in crash studies that include low-to-high speed rear-end collisions using anthropometrically appropriate models of male and female occupants reflecting the range of sizes of both sexes. There is a need for more concussion brain injury prevention research focusing on the vulnerability of female occupants, which has not been sufficiently addressed even though the deficiency was identified many years ago. The sex inequity of current onboard motor vehicle concussion brain injury prevention measures especially with respect to females should be addressed by governments and the automobile and insurance industries.

Primary Extradural Meningioma: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes.

Objective: This systematic review consolidates the literature on primary extradural meningiomas (PEMs), a rare subset of meningiomas. We describe the clinical features, management strategies used, and treatment outcomes for published cases. Methods: A systematic review was conducted using PRISMA guidelines across multiple databases to 29 July 2024. Inclusion criteria were adult patients with primarily extradural meningioma and where individual patient clinical data were provided. Results: Of 216 studies that met the initial search criteria, 41 satisfied the final inclusion criteria. These 41 studies included 82 patients with 84 total PEMs. The cohort was balanced between sexes with a median age of 46 (range 18-82). Frequent symptoms at initial presentation included pain/headache (46%), weakness (44%), paresthesias (24%), and a palpable superficial mass (23%). The median duration of symptoms to diagnosis was 11 months (range 0.75-120). Surgical resection was the primary treatment approach, achieving a gross total resection in 67% of cases. The majority of lesions were classified as WHO grade 1 (87%). A recurrence was identified during the published follow-up in 11% of cases and a higher WHO grade was expectedly associated with a greater risk of recurrence. The described practice was to use adjuvant radiotherapy in recurrent and high-grade cases. Most cranial lesions were located in the frontal bone, while most spinal lesions affected the cervical spine. Post-treatment symptom improvement or resolution was described in almost all patients at the last follow-up. Conclusions: In comparison to intradural meningiomas, PEMs largely follow a more indolent course with a longer duration of symptoms prior to diagnosis, more benign symptoms, a higher proportion of grade 1 tumors, and favorable outcomes; however, there is a small subset of PEMs with extension outside the cranium and spine that require specific considerations for management.

Vanishing Bile Duct Syndrome in Pediatric Hodgkin Lymphoma: First Statistical Analysis of All Published Cases in Children and a Case Report.

Hodgkin lymphoma with vanishing bile duct syndrome is a rare paraneoplastic syndrome and has never been studied in the pediatric population. The objectives of this study were to determine the clinical characteristics of this rare condition in children through a literature review, and a descriptive analysis of all published cases with the index case report. All reported cases fulfilling the inclusion criteria were found through a literature search, and analyzed in descriptive statistics. A total of 10 cases were included in the study with a median age of 9.5 years and a male-to-female ratio of 9:1. The median duration of symptoms was 5.5 weeks with 3 cases having jaundice before the symptoms of lymphoma. The median bilirubin level was 8.4mg/dL. Seven cases received modified chemotherapy, and 5 used ursodeoxycholic acid. The survival rate was 50%. Normalization of liver functions after the lymphoma treatment was observed in 4 cases and was the only statistically significant factor (P=0.01) associated with the outcome. This is a rare entity in the pediatric population with a guarded prognosis comparable to the adult counterparts but a marked male predominance.

Feasibility of laparoscopic modified Frey procedure for chronic pancreatitis: a prospective 6 case series.

Chronic pancreatitis (CP) is characterized by longstanding inflammation of the pancreas. Several authors have reported minimally invasive treatment of this CP (pancreaticoduodenectomy, lateral pancreaticojejunostomy, Frey procedure) with promising short-term outcomes. This is a case series of 6 patients diagnosed with CP and treated using the laparoscopic modified Frey procedure at Hue Central Hospital, Vietnam. Six patients (5 males and 1 female) with CP and operated on using modified Frey's procedure. The median age was 45 years old. The mean of Body Mass Index was 16.3 kg/m2. The median preoperative duration of symptoms was 3.3 years. All patients were presented with a dilated main pancreatic duct (mean diameter of 7.8 mm). The median time to first bowel movement was 1.5 (1-2) days. The median postoperative hospital stay was 7 (5-11) days. No reoperation or mortality was recorded. The laparoscopic modified Frey procedure is feasible and safe with good short-term and mid-term outcomes for chronic pancreatitis.

Protein quantitative trait loci identifies genetic biomarkers of proteins associated with measures of myocardial fibrosis in new-onset, treatment naive rheumatoid arthritis

Abstract Introduction The excess risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) compared to the general population is attributed to chronic inflammation. Identifying the underlying mechanisms and shared inflammatory pathways more precisely would enable tailored treatment. Purpose To identify genetic variants associated with the cardio-metabolic-inflammatory proteomic signature in patients with early, treatment-naïve RA and low CVD risk. Methods The Coronary Artery Disease Evaluation in RA (CADERA) study was a bolt-on to a RCT of patients with early, treatment-naïve RA and low CVD risk profile (maximum of 1 traditional CVD risk factor and no diabetes mellitus). Normalised expression of 334 proteins from 75 CADERA patients who underwent cardiovascular magnetic resonance imaging (CMR) was measured using the Olink Proximity Extension Immunoassay across Inflammation, Cardiovascular II, III and Cardiometabolic panels. Genome-wide single nucleotide polymorphism (SNP) data were generated using the Illumina Global Screening Array and was imputed and checked for data quality using standard approaches. Proteins associated with CMR parameters were identified using Bayesian mixed effects linear regression. Protein quantitative trait locus (pQTL) analysis was then performed using linear regression models adjusted for age, gender, and systolic blood pressure. Cis-pQTLs were defined as SNPs within 1Mb of the protein-encoding gene, and significance threshold was set at 1e-5. Due to sample size, trans-pQTLs were not considered in this analysis. Linkage disequilibrium (LD) clumping was performed using PLINK software to identify index SNPs defined as the most significant variant in LD (r2 <0.5) within a region of +/- 250Kb. Results Following quality control 318 proteins and 5,971,781 SNPs were available for analysis in 75 CADERA patients. The median age was 51 years [inter-quartile range (IQR) 40 - 61] with 52/75 (69%) females, 40/75 (53%) current/ex-smokers, and median body mass index (BMI) 26.4kg/m2 (IQR 23.3 - 28). Participants had a median RA symptom duration of 21.9 weeks (IQR 14.4 - 32.7). Only 8/75 (10%) reported a history of hypertension, hypercholesteroaemia or family history of CVD. 54 out of 318 proteins were associated with CMR measures of myocardial fibrosis and/or vascular stiffness. 460 cis-pQTLs were identified for 20 out of the 318 proteins. LD clumping revealed 40 cis-pQTLs independently associated with these 20 proteins. Of these, NOTCH3 (rs34763630) was positively associated with extracellular volume, and SELPLG (rs7980427) was negatively associated with late gadolinium enhancement as detected on CMR (table 1). No other proteins with genetic support were associated with CMR measures. Conclusion This study for the first time, implicates genetic markers associated with two proteins as putative candidate biomarkers of CMR-identified myocardial fibrosis in new-onset RA that now warrant validation in an independent cohort.

Adult-Onset EIF2B-Pathies: A Clinical, Imaging and Genetic Profiling with Literature Review.

Vanishing white matter syndrome is one of the leukoencephalopathies caused by recessive mutations in gene EIF2B1-5. Adult-onset EIF2B-pathies (clinical onset after age 16 years) have been reported to be less common. Description of the clinical, imaging and genetic profile of adult-onset EIF2B-pathies and comparison of Indian cohort with Asian and European cohorts. Report of two cases of adult-onset EIF2B-pathies and a comprehensive review of genetically confirmed adult-onset EIF2B-pathies since 2001 from Indian, Asian and European cohorts. Two patients were females, with median age at presentation of 25.5 years (24-27 years) and onset at 19 years (18-20 years). The median duration of symptoms was 6.5 years (6-7 years). Both had cerebellar ataxia, spasticity, cognitive impairment and bladder involvement. Brain magnetic resonance imaging (MRI) showed leukoencephalopathy with rarefaction in both patients and corpus callosum involvement in one patient. Genetics showed homozygous missense variant in the EIF2B3 gene in both patients. The Indian cohort of seven patients had similar clinical and radiological features and common variants in EIF2B3 (n = 4). The Asian cohort had 24 cases, and the European cohort had 61 cases with similar clinical features, radiological features and common variants in EIF2B5. Adult-onset EIF2B-pathies have a distinct clinical profile of female predominance with cerebellar ataxia, spasticity and cognitive decline as the commonest triad of clinical manifestations and leukoencephalopathy with rarefaction on brain MRI. Variants in EIF2B5 were common in the Asian and European cohorts and EIF2B3 in the Indian cohort.

Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility

BackgroundCholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria.MethodsAll patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia.ResultsSeventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy.ConclusionEndoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.

Predictors of moderate-to-severe side-effects following COVID-19 mRNA booster vaccination: a prospective cohort study among primary health care providers in Belgium

BackgroundCOVID-19 vaccine effectiveness declines months after vaccination. Therefore, it is likely that during the next few years, people may be repeatedly offered a booster vaccine to enhance humoral immunity levels. A growing number of people are questioning whether the benefits of a booster vaccine outweigh the side-effects.ObjectiveThis study aims (1) to identify the most frequently reported side-effects after different doses of COVID-19 mRNA vaccines, (2) and the longest lasting symptoms; and (3) to predict the likelihood of having moderate-to-severe side-effects after a booster COVID-19 mRNA vaccine given individual- and vaccine-specific characteristics.Design, setting, and participantsSecondary analysis of a prospective cohort study in primary health care providers (PHCPs) in Belgium conducted between December 2020 and December 2021, and in February-March 2023.MethodsIn nine subsequent surveys over a period of 2 years vaccine dose-number and side-effects after COVID-19 vaccines were collected. A Generalized Estimation Equations approach on the data of the first and second booster dose was used to investigate the probability of having moderate-to-severe side-effects after mRNA booster vaccination. Predictive performance of a binary classifier was assessed by looking at discrimination (i.e., quantified in terms of the area under the receiver operating characteristic curve). The final prediction model was validated using data with regard to the third booster by assessing misclassification rate, sensitivity and specificity.ResultsIn total, 11% of the PHCPs had moderate-to-severe side-effects after their booster COVID-19 mRNA vaccine. The most common side-effects of COVID-19 mRNA doses included fatigue, local pain at the injection site, general pains, and headache. These side-effects typically lasted for a median of 1 to 2 days. The final model included five predictors: sex, alcohol consumption, history of moderate-to-severe side-effects after any previous dose, recent COVID-19 infection, and the booster dose-number (first, second). Having experienced moderate-to-severe side-effects after any previous dose was the strongest predictor of moderate-to-severe side-effects following an mRNA vaccine booster, with an odds ratio (OR) of 3.64 (95% CI: 2.80–4.75). The OR for female sex was 1.49 (95% CI: 1.21–1.84) implying that females have a higher odds of moderate-to-severe side-effects following booster vaccination. The differences in effect for booster dose-number, alcohol consumption and recent COVID-19 infection was not significant.Conclusion and relevanceCOVID-19 mRNA booster vaccination implies a low prevalence of moderate-to-severe side-effects among PHCPs, with a short median duration of symptoms if any. The strongest predictors are a history of moderate-to-severe side-effects after any previous dose and being female. These reassuring findings can help addressing concerns about booster vaccination and encourage their uptake.Trial RegistrationNCT04779424 (registration date: 2021-02-22).

Is early-onset colorectal cancer an evolving pandemic? Real-world data from a tertiary cancer center.

Early onset Colorectal Cancer (EOCRC), defined as those diagnosed under the age of 50, has been increasing rapidly since 1970. UK data on EOCRC are currently limited and better understanding of the condition is needed. A single-center retrospective study of patients with EOCRC treated over 9 years (2013-2021) at a large UK cancer center was performed. Clinicopathological features, risk factors, molecular drivers, treatment, and survival were analyzed. In total, 203 patients were included. A significant increase in cases was reported from 2018-2019 (n = 33) to 2020-2021 (n = 118). Sporadic EOCRC accounted for 70% of cases and left-sided tumors represented 70.9% (n = 144). Median duration of symptoms was 3 months, while 52.7% of the patients had de-novo metastatic disease. Progression-free survival after first-line chemotherapy was 6 months (95% CI, 4.85-7.15) and median overall survival (OS) was 38 months (95% CI, 32.86-43.14). In the advanced setting, left-sided primary tumors were associated with a median OS benefit of 14 months over right-sided primaries (28 vs 14 months, P = .009). Finally, primary tumor resection was associated with median OS benefit of 21 months compared with in situ tumors (38 vs 17 months, P < .001). The incidence of EOCRC is increasing, and survival outcomes remain modest. Raising public awareness and lowering the age for colorectal cancer screening are directions that could improve EOCRC clinical outcomes. There is also a need for large prospective studies to improve the understanding of the nature of EOCRC and the best therapeutic approaches.

PDOC-07 THE CLINICOPATHOLOGICAL PROFILE AND VALUE OF MULTIDISCIPLINARY MANAGEMENT OF PEDIATRIC BRAIN TUMORS IN A LOW-INCOME SETTING

Abstract OBJECTIVE The management of paediatric brain tumours in low-income countries is challenging, and survival rates are low, making multi-disciplinary teams (MDT) inevitable in quality management. In Uganda, paediatric neuro-oncology services are in their infancy. This study evaluated the management of paediatric brain tumours at the Uganda Cancer Institute (UCI) to assess the contributions of MDT management in improving patient care and outcomes. METHODS A retrospective records review of paediatric brain tumours at the UCI between 2017 and 2021 was conducted. Patient and tumour characteristics, as well as MDT management, were sourced. A survey among MDT members was conducted to explore their perspectives. RESULTS Thirty-five paediatric brain tumour cases were treated at UCI, with a median age of 8.0 years (IQR 4.0–11.0) and a median duration of symptoms of six months (IQR 3.0-8.5). The majority (25.7%, n=9) were craniopharyngiomas, 14.3% (5/35) were astrocytomas, 11.4% (4/35) were medulloblastomas, and 8.6% (3/35) each were ependymomas and pineoblastomas. Overall, 22 (62.9%) of the cases were discussed on the MDT. The number of cases discussed in the MDT increased over the five years: 0/3 (0.0%) in 2017, 3/5 (60.0%) in 2018, 2/4 (50.0%) in 2019, 6/9 (66.7%) in 2020, and 11/14 (78.6%) in 2021. The proportion of multidisciplinary management decisions implemented also increased: 0% in 2018, 50% in 2019, 83.3% in 2020, and 81.8% in 2021. The majority of patients (12/15, 80.0%) for whom MDT recommendations were implemented were alive. Lack of neurosurgical resources (46.7%), imaging (46.6%), diversity of MDT roles (26.7%), access to radiotherapy (20.0%), and pathology (20.0%) were recognized as major impediments to paediatric neuro-oncology management. CONCLUSIONS Implementing multidisciplinary management decisions benefited children with brain tumours and decreased abandonment and patient loss to follow-up at the Uganda Cancer Institute. Greater emphasis should be placed on increasing resources and actionable treatment recommendations.

Effects of a plank-based strength training programme on muscle activation in patients with long COVID: a case series.

This study aimed to analyse the effects of a plank-based strength training programme on muscle activation in patients with long COVID. Case series study that included patients with long COVID who participated in a 12-week trunk and pelvic muscle strength training programme. Clinical variables and the modified fatigue impact scale (MFIS) were used to assess fatigue levels. Percentage of muscle activation during a core muscle plank was measured via surface electromyography. Pre- and post-intervention results were compared using the Wilcoxon signed-rank test and evaluated with Cohen's D effect size (ES). Twenty-one subjects participated in the study; 81% female, mean age 47.5 years (range: 28-55 years), and median duration of symptoms 21 months (range: 5-24 months); 90.5% of the participants experienced fatigue (MFIS score = 38). Muscle activation during plank exercises improved across all muscles after the intervention, with significant increases in the left (p = 0.011, medium ES) and right external oblique (p =0.039, small ES) muscles and the right latissimus dorsi muscle (p = 0.039, small ES). Additionally, significant reductions in fatigue were observed in the total MFIS score (p = 0.004, medium ES) and in the physical (p < 0.001, large ES) and psychosocial subscales (p = 0.033, small ES). Results suggest that a plank-based strength training programme may be effective in enhancing trunk and pelvic muscle activation in individuals with long COVID.

Priapism in South West Nigeria—Short and Intermediate-Term Outcomes

Abstract Background: Priapism is usually defined as penile erection that lasts more than 4 h beyond sexual stimulation and orgasm or is unrelated to sexual stimulation. The overwhelmingly more common low-flow priapism is typically painful, while high-flow priapism is typically painless. Interventions are varied depending on the aetiology and timing of the presentation. The outcome in most cases depends on the timing of the intervention. Objective: This study aimed to review the presentation and short- and intermediate-term outcomes of treatment of priapism in patients in Southern Nigeria. Materials and Methods: This was a retrospective 10-year study conducted from 2010 to 2019 of all adult patients diagnosed with priapism who were admitted to the adult urology units in two Government University Teaching hospitals in South West Nigeria. Results: The records of 61 patients were analysed. The mean age was 27.54 years ± 6.22 with a range of 15–56 years. The median duration of symptoms before presentation was 36 h with a range of 2 to 336 h. Eleven patients (18%) presented within 24 h of onset of symptoms. Sickle cell disease (SCD) and idiopathic aetiology were the most common causes of priapism, accounting for 44 (72.1%) and 8 (13.1%) respectively. Corporal aspiration resolved the priapism in 22 (36.1.%), while corpora–glandular shunt was the final treatment in 36 (59.1%). Fifty-seven per cent had erectile dysfunction (ED), while penile gangrene with autoamputation was observed in one patient (1.6%). Sixty-six per cent and 62% of patients who presented within &lt; 36 h and 36–72 h, respectively, experienced normal erection at 6 months after surgery. Erectile function got progressively worse after 72 h, with all patients with ischemic priapism lasting more than 1 week developing ED. There was no statistically significant relationship between the variants of SCD and the risk of ED in patients who presented within 72 h. Conclusion: The incidence of ischemic priapism was high, with sickle cell disease being the most common cause. The risk of ED was significantly worse after 72 h. The aetiology of priapism did not significantly influence the risk of ED.

The Challenge of IBD-Related Arthritis Screening Questionnaires in Early and Predominantly Entheseal Phenotypes.

Inflammatory bowel disease (IBD)-related arthritis is recognized as the most prevalent extraintestinal manifestation (EIM) of IBD. The objective of this study was to determine the prevalence and characteristics of undiagnosed IBD-related arthritis and to compare two screening questionnaires, DETection of Arthritis in Inflammatory boweL diseases (DETAIL) and IBd Identification of Spondyloarthritis Questionnaire (IBIS-q), for early disease detection. Between April and October 2023, both the DETAIL and IBIS-q questionnaires were administered to consecutive IBD outpatients visiting the University Hospital of Udine, Italy. During routine gastroenterology evaluations, patients aged > 18years with Crohn's disease (CD) or ulcerative colitis (UC) were requested to complete both questionnaires. Subsequently, all patients who completed the questionnaires underwent a blinded rheumatological evaluation within 2weeks. Patients with a previous diagnosis of IBD-related SpA were then excluded. Overall, 203 patients were enrolled, of whom 26 were excluded because of a prior diagnosis of inflammatory arthritis. Among the remaining 177 patients, 10/177 (5.6%) received a new diagnosis of IBD-related arthritis. The median duration of symptoms before diagnosis was 4 (IQR 1.8-10.5) months. Imaging-confirmed enthesitis was the predominant pattern in 8 out 10 cases (80%, with 8 out 8 lacking concomitant peripheral arthritis), axial involvement in 1 out 10 cases (10%), and peripheral arthritis in 1 out 10 cases (10%). The DETAIL questionnaire exhibited higher specificity, but lower sensitivity compared to the IBIS-q, with a sensitivity of 40.0% (12.2-73.8) and specificity of 84.4% (78.0-89.6) versus a sensitivity of 70.0% (34.8-93.3) and specificity of 74.3% (66.9-80.7). Both questionnaires performed less effectively than in other studies. This study highlights a significant proportion of undiagnosed IBD-related arthritis (5.6%). Enthesitis emerged as the predominant pattern of newly diagnosed arthritis in our cohort, likely due to the recent onset of symptoms. Our study underscores the importance of entheseal involvement in early IBD-related arthritis and the importance of incorporating entheseal involvement into screening questionnaires.

Visual deterioration secondary to medial sphenoid wing meningioma: systematic assessment of patient-reported outcomes and factors contributing to recovery after surgical treatment.

Visual acuity (VA) constitutes an important outcome measure in surgery for medial sphenoid wing meningioma (SWM). This study aimed to assess the recovery of tumor-associated impairment of VA and its impact on patient-reported outcome measures (PROMs) as an indication of vision-related quality of life in patients who had undergone surgery for medial SWM. From 2009 to 2018, 153 consecutive patients with medial SWM underwent surgical treatment at the authors' institutions. Tumor-associated VA was evaluated both on admission and during postoperative follow-up examinations, using Snellen charts. Multivariable analysis was performed to identify independent predictors for postoperative improvement of VA. PROMs were collected based on the National Eye Institute 25-Item Visual Function Questionnaire. Of patients with medial SWM, 53 of 153 (35%) experienced preoperative impairment of VA. The median preoperative duration of visual symptoms was 12 (IQR 3-17) months for the entire study cohort. Multivariable analysis revealed a preoperative duration of visual symptoms ≤ 4 months to be independently associated with postoperative improvement of VA (p = 0.009). Evaluation of PROMs indicated a superior postoperative qualitative extent in the overall health (p = 0.027) and activities of daily living (p = 0.031) categories if preoperative duration of visual impairment was ≤ 4 months. The overall preoperative duration of tumor-related visual impairment significantly correlates to the extent of postoperative visual improvement as well as vision-related PROMs in medial SWM surgery. These results might aid in preoperative patient counseling and help optimize decision-making and preoperative estimation of long-term visual outcome.

Value of the central sensitisation inventory in patients with axial spondyloarthritis.

In many patients with axial spondyloarthritis (axSpA), pain persists despite anti-inflammatory medication. Quantitative sensory testing (QST) indirectly assesses altered somatosensory function, though its clinical practicality is limited. The Central Sensitisation Inventory (CSI) could be an alternative in the initial assessment of central sensitisation (CS). This study aimed to investigate the value of the CSI in evaluating CS in patients with axSpA by (1) assessing somatosensory function related to CS with QST and (2) exploring associations between CSI, QST, patient and disease characteristics and pain-related psychosocial factors. Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort underwent QST, including pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). Participants completed questionnaires assessing CS (CSI), illness perception (Revised Illness Perception Questionnaire, IPQ-R), pain-related worrying (Pain Catastrophising Scale, PCS), fatigue (Modified Fatigue Impact Scale, MFIS), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and coping. QST measurements were stratified for CSI≥40. 201 patients with axSpA were included; 63% male, 64% radiographic axSpA, median symptom duration 12 years (IQR 5-24), mean Axial Spondyloarthritis Disease Activity Score 2.1±1.0. Patients with CSI≥40 had significantly lower PPTs and higher TS than CSI<40 (p<0.004). No significant differences in CPM were observed. In multivariable linear regression, sex, PCS, IPQ-R Identity, MFIS and HADS anxiety were independently associated with CSI (78% explained variance). In this large cross-sectional study in patients with axSpA, the CSI appears as a useful initial CS assessment questionnaire. When CSI scores indicate CS, considering pain-related psychosocial factors is important. These results emphasise the need for a biopsychosocial approach to manage chronic pain in patients with axSpA.

Early Bone Ischemia in Pediatric Acute Hematogenous Osteomyelitis and its Association With Progression to Chronic Osteomyelitis: New Insights From Gadolinium-enhanced Subtraction MRI.

Acute hematogenous osteomyelitis (AHO), the most common osteoarticular infection in children, carries a significant risk for chronic complications. Predicting chronic complications early in the course of disease is challenging. The underlying pathogenesis of complications is not fully understood. Children who presented to Sultan Qaboos University Hospital, Muscat, Oman between January 2015 and April 2022 for AHO were identified by a search of magnetic resonance imaging (MRI) records. Children between 1 month and 18 years of age who did not meet exclusion criteria, and whose MRI also included gadolinium-enhanced subtraction (GES) sequences were included in the analysis. Outcomes were compared between patients who showed early evidence of bone ischemia and those who did not. The analysis included 11 children who had GES MRI sequences from among 18 AHO cases in total. Median age was 5 years (IQR, 4-9), and 82% were males. Median duration of symptoms at presentation was 5 days (IQR, 3-7). GES sequences showed early bone ischemia in 6 of 11 (55%) patients. Patients with early bone ischemia were treated with significantly longer durations of IV antibiotics (median 23 vs. 10 days, P = 0.017) and oral antibiotics (median 134 vs. 29 days, P = 0.004), and required more surgical debridements (median 3 vs. 0 debridements, P = 0.017). Chronic osteomyelitis only developed among patients with early bone ischemia (5/6 vs. 0/5, P = 0.015). In pediatric AHO, GES MRI sequences revealed early bone ischemia in a significant proportion of patients. Early bone ischemia was strongly associated with progression to chronic osteomyelitis.