Median Time Of Diagnosis Research Articles

Patients with psoriatic arthritis followed in tertiary centers in Southern Brazil have a high prevalence of metabolic syndrome

Introduction/ObjectivePatients with psoriatic arthritis (PsA) have a significant prevalence of metabolic syndrome (MS), however studies conducted in Latin America describing comorbidities of PsA patients are still scarce. The aim of the present work was to estimate the prevalence of MS in patients attending PsA clinics in tertiary university centers in the south region of Brazil and to evaluate the achievement of the minimal disease activity criteria among those with and without MS. Materials and methodsA cross-sectional study was conducted; patients were recruited in two university hospitals and data collected during a routine clinic visit. The prevalence of MS was estimated using the National Cholesterol Education Programme's Adult Treatment Panel III (NCEP/ATP III). The prevalence of patients achieving the MDA criteria was compared between individuals with and without MS using Chi-square test. ResultsOne hundred and five patients with PsA were evaluated, 81 in center A (Rio Grande do Sul) and 24 in center B (Paraná); 54.3% were female (N=57), the average age was 55.7 (SD 11.6) years and the median time of diagnosis in years was 7.4 (.16–42.2). A total of 51.9% (N=54) were diagnosed with MS., hypertension was found in 51.4% (N=54) and obesity in 38.1% (N=40) of the sample. There was no statistically significant association between MS and MDA. ConclusionPatients followed in PsA clinics in university tertiary centers in the south of Brazil have a significant prevalence of MS. This work emphasizes the importance of the screening and treatment of comorbidities in PsA.

MALE BREAST CANCER IN OLDER ADULTS BELONGING TO THE LOWER-INCOME GROUP

Abstract Male breast cancer is a rare type of cancer constituting around 1% of male malignancies. Cases of 21 elderly (aged>60) patients diagnosed with breast cancer were studied with respect to age of onset, treatment choices, access to care, ability to perform activities of daily living (ADL) from CMIG, resource centre on ageing in east India. All 21 patients belonged to lower income group in society and the study was conducted over a 5 year period of 2018-2022. Primary symptom leading to diagnosis was self-detection of lump and the median time of diagnosis from onset of symptoms was 6 months. Twenty of the 21 patients were diagnosed with Stage III or Stage IV breast cancer and 1 patient was diagnosed with Stage I cancer. The average age of diagnosis of the patients was found to be 69 years. The main method of treatment was surgery for patient diagnosed in Stage I and surgery followed by chemotherapy and radiation therapy for the rest. None of the patients underwent hormone therapy and information regarding presence of hormone receptors was not available in all cases. Five of the 21 cases reported metastasis- 4 in bone and 1 in lung. Spouse or adult children were found to be caregivers with no access to trained caregivers or counsellors. All patients showed moderate decline in motor function and ADL after surgery alongwith susceptibility to fall or injury. Free hand exercises showed slight improvement. Further studies can attract state funding and influence heath policies for lower income groups.

Clinico-Hematological Profile of Acute Myeloid Leukemia: Experience From a Tertiary Care Cancer Center in North India.

Complete diagnosis of acute myeloid leukemia (AML) requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping, karyotyping, and molecular genetic testing. The study intends to evaluate the demographic profile, clinical workup, and investigation, including flow cytometric immunophenotyping, in adult and pediatric age groups of AML. This is a retrospective study of AML patients treated between January 2017 and December 2021. Clinical and demographic characteristicsand investigation findings were recorded from case files and the hematology database. A total of 896 cases of AML were registered during the given period, of which 819 cases were de-novo AML. Among those 819 cases, more than two-thirds of cases, i.e., 78.9% (N = 646), received induction chemotherapy. A significantly higher male-to-female ratio was observed (1.5:1). The median age was 22 years. The median time for diagnosis was three days and the median time for treatment intervention was four days. There were significant differences in the Eastern Cooperative Oncology Group (ECOG) performance status scores between pediatric and adult AML patients. Pediatric AML patients presented with better ECOG performance scores (ECOG performance scores 0 and 1) than adult patients (74.76% vs. 43.14%, p < 0.001). Further comparing adult vs. pediatric AML patients, normal karyotype (60.56% vs. 31.93%, p < 0.001) and NPM1 (22.25% vs. 6.72%, p < 0.001)and FLT3-ITD mutations (20.28% vs. 7.98%, p<0.001) were more common in the adult group, whereas AML-ETO (40.76% vs. 16.34%, p < 0.001) was more common in the pediatric group. The study highlights the presenting age is lower than global figures. The median time for initial diagnosis and the start of treatment is within the acceptable norms. Normal karyotype andNPM1and FLT3 mutations were common in adult AML patients, whereas AML-ETO was more common in the pediatric cohort. These findings will help plan prospective studies and see the correlation with treatment outcomes. The laboratory workup practice currently complies with the standard guidelines at our center.

Parental experiences and needs of caring for a child with 22q11.2 deletion syndrome

BackgroundFor a variety of reasons, raising a child with 22q11.2DS has significant psychosocial and financial repercussions for the family caregivers. Our aim was to identify and explain the expectations and concerns of Polish parents of 22q11.2DS children. An online survey was developed consisting of four sections: demographics, emotions experienced by caregivers while performing their duties, attitudes of the respondents about providing care, and finally different aspects of the caregivers’ life satisfaction. The study was conducted with the support of the Polish 22q11 Association.ResultsForty-four caregivers of Polish origin completed the survey, all but one of whom were mothers. Thirty-four per cent (n = 15/44) declared full-time employment. According to 73% (n = 32/44) of those surveyed, the child’s disease has not harmed their relationship with the partner. In spite of the fact that the median diagnosis time was 1.9 years (ranging from 0 to 12 years), the caregivers indicated that they had contacted on average 3.9 doctors before obtaining the right diagnosis (range 1–17). The Internet was the main source of information and knowledge about their child’s disease for 93% of respondents (n = 41/44), while for 54% (n = 24/44) it was the association for people with 22q11DS. Only 26% rated as very good or good the support for caregivers offered by the central and local government or its agendas. The physicians’ knowledge about 22q11DS was positively rated by 14% of respondents (n = 6/44). The most frequently chosen source of support for 66% of respondents (n = 29/44) turned out to be their families, and for 34% – a Facebook support group (n = 15/44). Asked how often they rated their quality of life (QoL) highly, none of our respondents chose the option “always”, although 64% (28/44) gave the answer “often”.ConclusionOur study is the first one in Poland to develop an online survey specifically for use with caregivers of paediatric patients with 22q11.2DS. Our respondents revealed that caring for 22q11.2 children entails a burden that extends far beyond clinical facets and has a significant impact on every dimension of the caregivers’ lives, including their mental health, everyday activities, families, professional career and social lives. At the same time, caregivers are de facto left alone with the bureaucracy of the healthcare system.

Clinical characteristic and prognosis of amyotrophic lateral sclerosis in a cohort of Thai patients

Background &amp; Objective: Clinical course and prognosis in amyotrophic lateral sclerosis (ALS) patients were highly variable. The information in the Thai population is still lacking. This study aimed to determine the clinical association with disease progression and prognostic factors in ALS in Thailand. Methods: This prospective cohort study evaluated 62 patients who has a diagnosis of ALS and followed up at Neurological Institute of Thailand between January 2014 and December 2018. These patients were classified into an alive group and a deceased group. The demographics, clinical characteristics, disease-related severity, and prognosis were analyzed. Results: Of the included patients, there were 40 male and 22 female, the median age at onset was 53.2 years. The median diagnosis time was 13.1 months and median follow-up duration was 18.5 months; 72.6% of patients presented with spinal onset ALS, and 27.4% with bulbar-onset. There were 20 deaths during follow-up, and the median survival time in the deceased cases was 14 months. Worse prognosis factors were bulbar symptoms at onset and low amyotrophic lateral sclerosis functional rating scale (ALSFRS) at diagnosis. Conclusion: The factors associated with lower survival in ALS patients were bulbar symptoms at onset and low ALSFRS at diagnosis.

Clinical and imaging features of lymphomatosis cerebri: analysis of 8 cases and systematic review of the literature

Lymphomatosis cerebri (LC) is a rare type of primary central nervous system lymphoma with diffuse, nonenhancing infiltrative lesions and is often misdiagnosed. Our study aimed to investigate the clinical characteristics and prognosis of LC through analyzing patients from the literature and our own center, so as to improve early diagnosis and treatment. PubMed, Web of Science and our hospital databases were reviewed, and information on demographic, clinical, pathological, cerebrospinal fluid (CSF), neuroimaging and treatment options was extracted. Univariate survival analysis was conducted by generating survival curves and comparing them using the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model to identify the prognostic predictors. A total of 81 patients (median age: 58 years; interquartile range, IQR: 50–66.5 years), 45 males and 36 females, were included. The most common symptoms were cognitive impairment (65.4%) and gait impairment (50.6%). Imaging studies indicated that all 81 patients had supratentorial structure involvement, and 93.8% (76/81) had bilateral hemisphere involvement. There were 53.3% (32/60) patients with CSF pleocytosis and 65% (39/60) patients with increased CSF protein levels. The median time of diagnosis was 4.8 months (IQR: 2.3–6.9 months). Compared with 4 (95% CI: 1.78–6.22) months for all 81 patients, the median OS was 20 (95% CI: 8.24–31.76) months for those who had chemotherapy plus radiotherapy. Multivariate Cox analysis revealed that chemoradiotherapy (HR: 0.12; 95% CI: 0.02–0.68) and higher CSF glucose level (HR: 0.01; 95% CI: 0.00–0.26) were inversely associated with death. The diagnosis of LC should be alerted when neuroimaging with bilateral hemispheric involvement and CSF abnormality with pleocytosis and increased protein. Once the diagnosis is confirmed, the combination of chemotherapy and radiotherapy can be considered if the patient’s physical condition permits.Journal standard instruction requires an unstructured abstract. Kindly check and confirm.We have checked and confirmed that there is no problem.

Clinical significance of Epstein-Barr Virus detection in the cerebrospinal fluid of patients who underwent hematopoietic stem cell transplantation

Objective: To analyze the detection rate, clinical significance, and prognosis of Epstein-Barr virus (EBV) in the cerebrospinal fluid (CSF) of patients following allogeneic hematopoietic stem cell transplantation. Methods: A retrospective analysis was performed on 1100 patients who underwent the CSF virus test after allogeneic hematopoietic stem cell transplantation in Peking University People's Hospital between January 2017 and June 2022. Among them, 19 patients were screened positive for EBV in their CSF, and their clinical characteristics, treatment, and prognosis were analyzed. Results: Among 19 patients with EBV-positive cerebrospinal fluid, 12 were male and 7 were female, with 5 patients aged <18 years and 12 aged ≥18 years, with a median age of 27 (5-58) years old. There were 7 cases of acute myeloid leukemia, 8 of acute lymphocytic leukemia, 2 of aplastic anemia, 1 of Hodgkin's lymphoma, and 1 of hemophagocytic syndrome. All 19 patients underwent haploid hematopoietic stem cell transplantation, including 1 secondary transplant. Nineteen patients had neurological symptoms (headache, dizziness, convulsions, or seizures), of which 13 had fever. Ten cases showed no abnormalities in cranial imaging examination. Among the 19 patients, 6 were diagnosed with EB virus-related central nervous system diseases, with a median diagnosis time of 50 (22-363) days after transplantation. In 9 (47.3%) patients, EBV was detected in their peripheral blood, and they were treated with intravenous infusion of rituximab (including two patients who underwent lumbar puncture and intrathecal injection of rituximab). After treatment, EBV was not detected in seven patients. Among the 19 patients, 2 died from EBV infection and 2 from other causes. Conclusion: In patients who exhibited central nervous system symptoms after allogeneic hematopoietic stem cell transplantation, EBV should be screened as a potential pathogen. EBV detected in the CSF may indicate an infection; however, it does not confirm the diagnosis.

Genital GVHD in Female Children and Adolescents: A Systematic Review of Case Reports and Case Series.

Genital graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) is an underdiagnosed manifestation of chronic GVHD. Few articles have been published in pediatric populations, and there are no established guidelines for the management of this condition in children. This study aims to provide a systematic literature review of the published studies and cases of genital (vulvovaginal) GVHD in girls and adolescents post HSCT, with a focus on the time of diagnosis and clinical manifestations. The authors searched for English-language articles published after 1990, which included full patient details. Thirty-two cases of female patients under 20 years of age were identified. The median time of diagnosis was 381 days (IQR: 226-730 days), and 83% of patients developed Grade 3 vulvovaginal GVHD. Based on these observations, an early pediatric gynecologic examination of these patients, soon within the first year after HSCT, could be suggested for early diagnosis, treatment initiation and prevention of long-term complications.

Role of blue dye test as an early predictor of post-laryngectomy pharyngocutaneous fistula

BackgroundPharyngocutaneous fistula (PCF) is considered the most common suffering complication in laryngectomized patients. PCF occurs variably from 10 to 20% and sometimes reaches more than 60%, as a result of a combination of local and systemic factors related to poor tissue healing and wound breakdown. Development of PCF affects the restoration of normal life after laryngectomy that could potentially lead to major complications affecting patient survival.Aim of studyWe studied the role of blue dye test in the early detection of PCF post-laryngectomy, which could potentially lead to optimum management which can reduce the duration of hospital stay as well as major complications out of salivary leakage.ResultsOut of 64 patients who underwent TL from Jan 2020 till Dec 2021 at a Tertiary Head and Neck Cancer Center, 40 patients were included in the study. All these patients underwent blue dye test and barium swallow considered the standard postoperative leak test. Patients’ characteristics as well as associated comorbidities have been studied as well as blue dye test findings compared to barium swallow, including median time for diagnosis of PCF, duration, management plan, additional leak tests, and length of hospital stay.ConclusionBlue dye test gives a good clue for early detection with proper management of PCF, which could eventually result in early recovery and reduce cost, morbidity, and hospital stay. It can be repeatedly performed to establish a simple, reliable, and safe bedside tool for follow-up.

Efficacy of ruxolitinib for HAVCR2 mutation-associated hemophagocytic lymphohistiocytosis and panniculitis manifestations in children.

Frequent germline mutations of HAVCR2, recently identified in subcutaneous panniculitis-like T-cell lymphoma (SPTCL), are associated with an increased risk of hemophagocytic lymphohistiocytosis (HLH). However, SPTCL-HLH represents a challenge because of the difficulties in treatment with poor survival. Its malignant nature, specifically harbouring HAVCR2 mutations, has also been questioned. To better understand its pathology and treatment, we analysed the clinical data of six patients diagnosed at our centre. The median age at onset was 10.5 years (range, 0.8-12.4). Five patients presented with skin lesions of subcutaneous nodules/plaques and/or ulceration. All patients developed HLH; notably, one infant only had HLH without skin involvement. Histopathologically, only two patients were diagnosed with SPTCL and three were reported as panniculitis with no sufficient evidence of lymphoma. Genetically, germline homozygous mutation of HAVCR2 (p.Y82C) was identified in all patients, with a median diagnosis time of 4.6 months. All patients initially received corticosteroids, immunosuppressants or chemotherapy, achieving unfavourable responses. Strikingly, they responded well to ruxolitinib targeting inflammatory cytokines, allowing rapid disease resolution and/or long-term maintenance of remission. The excellent efficacy of ruxolitinib highlights this disease as an inflammatory condition instead of neoplastic nature and indicates novel agents targeting key inflammatory pathways as an encouraging approach for this disease entity.

Adrenocortical tumors in children: Sri Lankan experience from a single center, and a mini review

BackgroundPediatric adrenocortical tumors include both benign adenomas and highly virulent malignant tumors. However, they are very rare among children. The aim of this study is to evaluate the clinicopathological data of children presenting with adrenocortical tumors and assess their survival in a South Asian population.Case presentationThis is a retrospective cohort study that includes patients diagnosed with adrenocortical tumors from August 2020 to August 2022 followed-up at Lady Ridgeway Hospital. Seven children were diagnosed with adrenal cortical tumors. Their ages ranged from 10 months to 6.5 years. Five of them were boys. All displayed signs of peripheral precocious puberty. One boy phenotypically had features of Beckwith–Wiedemann syndrome. The median time for diagnosis after the onset of symptoms was 4.4 months. The preoperative diagnosis was based on clinical manifestations, elevated dehydroepiandrosterone sulfate levels, and suprarenal masses on computed tomography. All five boys had right-sided suprarenal masses, while the two girls had them on the left side. All underwent surgery for tumor resection. The diagnosis was confirmed based on the histopathology of the adrenal specimens. Four children had a Wieneke score of 4 or more, suggesting the possibility of adrenocortical carcinoma; however, only two of them behaved as malignant tumors. To date, two children have developed local recurrences within a very short period.ConclusionAdrenocortical tumors are uncommon in children, and treatment options are limited. To identify early recurrences, routine clinical, radiological, and biochemical examinations at least once every 6–8 weeks is important.

Patients with psoriatic arthritis followed in tertiary centers in Southern Brazil have a high prevalence of metabolic syndrome

Introduction/ObjectivePatients with psoriatic arthritis (PsA) have a significant prevalence of metabolic syndrome (MS), however studies conducted in Latin America describing comorbidities of PsA patients are still scarce. The aim of the present work was to estimate the prevalence of MS in patients attending PsA clinics in tertiary university centers in the south region of Brazil and to evaluate the achievement of the minimal disease activity criteria among those with and without MS. Materials and methodsA cross-sectional study was conducted; patients were recruited in two university hospitals and data collected during a routine clinic visit. The prevalence of MS was estimated using the National Cholesterol Education Programme's Adult Treatment Panel III (NCEP/ATP III). The prevalence of patients achieving the MDA criteria was compared between individuals with and without MS using Chi-square test. ResultsOne hundred and five patients with PsA were evaluated, 81 in center A (Rio Grande do Sul) and 24 in center B (Paraná); 54.3% were female (N=57), the average age was 55.7 (SD 11.6) years and the median time of diagnosis in years was 7.4 (.16–42.2). A total of 51.9% (N=54) were diagnosed with MS., hypertension was found in 51.4% (N=54) and obesity in 38.1% (N=40) of the sample. There was no statistically significant association between MS and MDA. ConclusionPatients followed in PsA clinics in university tertiary centers in the south of Brazil have a significant prevalence of MS. This work emphasizes the importance of the screening and treatment of comorbidities in PsA.

Outcomes and Determinant Factors of Percutaneous Transcatheter Occlusion among Children with Patent Ductus Arteriosus in the East Coast Malaysia: A 10 Year Experience

Introduction: Transcatheter closure was a well-established procedure in patent ductus arteriosus (PDA). The aim of the study was to determine the outcomes, median time and PDAs closure from diagnosis and the predictive factors which influenced the decision for PDA closure. Material and methods: A 10-year retrospective record review was performed involving patients who had undergone transcatheter closure of PDA from January 2007 to January 2017 at a single centre in the North-eastern of Peninsular Malaysia. Descriptive statistics were used to examine all variables. Kaplan-Meier survival analysis was applied to determine median time for diagnosis and transcatheter closure of PDA. Multiple Cox regression analysis was used to identify predictors for early intervention of PDA closure. Results: A total of 123 patients were recruited with 65.9% of them were predominantly female. The age at the time of diagnosis was between 4-day to 14.5-year-old and median age for undergoing the procedure was 2.6-year-old (range:3-month to 15.8-year-old). The PDA size ranged between 0.2-12mm with 59% of the patients had large size PDA. Successful closure rate was achieved in 96.2 % with 3.8 % having very minimal residual shunt at 2 years post procedure. Complications were noted in 17 patients (4.0% major, 9.8% minor). Overall, the median time to diagnose and to close PDA were 6 months and 16.9 months respectively. Earlier intervention was likely to be performed in younger children (p&lt;0.001) with weight of less than 10 kg (p&lt;0.001). Conclusions: Transcatheter device closure was safe and effective in children with PDA with excellent outcome and minimal complication. Age and weight were the determinant factors for early PDA closure.

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

Colorectal anastomotic leakage (CAL), a severe postoperative complication, is associated with high morbidity, hospital readmission, and overall healthcare costs. Early detection of CAL remains a challenge in clinical practice. However, some decision models have been developed to increase the diagnostic accuracy of this event. To develop a score based on easily accessible variables to detect CAL early. Based on the least absolute shrinkage and selection operator method, a predictive classification system was developed [Early ColoRectAL Leakage (E-CRALL) score] from a prospective observational, single center cohort, carried out in a colorectal division from a non-academic hospital. The score performance and CAL threshold from postoperative day (POD) 3 to POD5 were estimated. Based on a precise analytical decision model, the standard clinical practice was compared with the E-CRALL adoption on POD3, POD4, or POD5. A cost-minimization analysis was conducted, on the assumption that all alternatives delivered similar health-related effects. In this study, 396 patients who underwent colorectal resection surgery with anastomosis, and 6.3% (n = 25) developed CAL. Most of the patients who developed CAL (n = 23; 92%) were diagnosed during the first hospital admission, with a median time of diagnosis of 9.0 ± 6.8 d. From POD3 to POD5, the area under the receiver operating characteristic curve of the E-CRALL score was 0.82, 0.84, and 0.95, respectively. On POD5, if a threshold of 8.29 was chosen, 87.4% of anastomotic failures were identified with E-CRALL adoption. Additionally, score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d, if used on POD3 and POD5, respectively. Regardless of score adoption, episode comprehensive costs were markedly greater (up to four times) in patients who developed CAL in comparison with patients who did not develop CAL. Nonetheless, the use of the E-CRALL warning score was associated with cost savings of €421442.20, with most (92.9%) of the savings from patients who did not develop CAL. The E-CRALL score is an accessible tool to predict CAL at an early timepoint. Additionally, E-CRALL can reduce overall healthcare costs, mainly in the reduction of hospital costs, independent of whether a patient developed CAL.

Clinical features and treatment outcomes of pulmonary actinomycosis.

Pulmonary actinomycosis is a rare and chronic infectious disease that mimics malignancy and is frequently misdiagnosed. There are few reports that address the clinical characteristics of pulmonary actinomycosis. The objective of this research is to evaluate the clinical features, radiological findings, diagnostic approaches and treatment outcomes of pulmonary actinomycosis. Thirty-seven patients with pulmonary actinomycosis histopathologically diagnosed from 2009 to 2021 were analyzed retrospectively. The mean age at presentation was 53.7 (±13.3) years. Frequent symptoms were cough and hemoptysis. The median diagnosis time from the first symptoms was 60 days (interquartile range 18-195). Pulmonary comorbidity was found in 59.5% of cases. The most common thorax computed tomography finding was mass or nodule. The low-attenuation center within the mass or consolidation was observed in 40% of the lesions. The median maximal standardized uptake value of lesions on positron emission tomography (PET) was 6.5 (interquartile range 2.7-10.3). In the majority of cases (97.3%), the diagnosis of pulmonary actinomycosis was not suspected at admission, and 56.8% of patients were misdiagnosed with lung cancer. The mean duration of antibiotic therapy was 9.4 days (range 3-22) with intravenous antibiotics and 64.7 days (range 5-270) with oral antibiotics. Four patients died due to concomitant comorbidities. Eight cases were lost to follow-up. All other cases were fully cured. Pulmonary actinomycosis mimics other diseases, often lung cancer. Clinicians should consider the diagnosis of actinomycosis when they detect a mass or consolidation, especially with a low-attenuation center. PET/CT appears not to be useful for differential diagnosis. A shorter course of antibiotic therapy than traditionally recommended appears to be sufficient.

Non-infectious sternal dehiscence after coronary artery bypass surgery

IntroductionNon-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients.Materials and methodsA retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years.ResultsTwenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups.ConclusionsThe incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.

THE BLEEDING MIGRATION: ESOPHAGEAL INJURY FROM CERVICAL HARDWARE

THE BLEEDING MIGRATION: ESOPHAGEAL INJURY FROM CERVICAL HARDWARE

Characteristics and outcomes of soft tissue sarcoma in Saudi Arabia.

e23544 Background: Soft tissue sarcomas (STS) are a rare heterogeneous group of neoplasms that count for less than one percent of all solid cancers in adults. There is limited data from Saudi Arabia (SA). We aimed to describe the disease characteristics and clinical outcome of STS from a specialized referral center in STS management in SA. Methods: All adult patients treated at King Faisal Specialist Hospital and Research Center between January 2010 and December 2019 were reviewed. Continuous variables are described in median and interquartile range, and categorical variables are described in frequency and compared by the Chi-square test. Survival analysis was estimated by the Kaplan-Meier method and compared by the Log-Rank test. Results: Two hundred fourteen patients diagnosed with soft tissue sarcoma were eligible for the study. The median age at diagnosis was 38 years old (IQR: 26-50.5), and males were (56.1%). The most common histology subtypes were synovial sarcoma (19.6%), liposarcoma (13.5%), undifferentiated pleomorphic sarcoma (11.6%), leiomyosarcoma (9.8%). The most common presentation was painless swelling (49.1%), and the median duration of symptoms was 8 (IQR: 4–13) months. The majority (131 patients, 61.2%) were localized diseases, and the most common primary site was the lower limb (62.1%). The median tumor size was 10 (IQR: 6.8-15) cm, and the tumors were deep to fascia in 144 (67.3%) patients. Eighty-three patients (38.8%) presented with de novo metastasis, and lung (81.9%) was the most common site. The local therapy was as follows; surgery (45.3%), radiation (7.5%), both (41.6%), and none (5.6%). Eighty-five patients received chemotherapy as follows; anthracycline (51%), ifosfamide (28%), and both (23.5%). Seventy-nine patients (36.9%) achieved complete response, 56 (26.2%) developed distant metastasis, and 11 (5.1%) local relapse. Thirty-one patients received salvage chemotherapy, and 30 patients received second-line chemotherapy. The best response of first-line chemotherapy in metastatic patients was CR (3%), PR (14%), SD (8%), and PD (63%). The median follow-up was 37 (IQR: 12-76.75) months. The median OS for the localized disease was not reached, and three years OS was 88.2%. There was a statistical difference in OS between extremities vs. trunk (90.9% vs. 66.7%), (p = 0.01), histological subtypes (p = 0.006), nodal involvement (p &lt; 0.001), T stage (p = 0.03), and complete response 96.9 vs. 68.5% (p &lt; 0.001). The median OS for metastatic disease was 26 (95% CI: 16–35.5) months. The median OS for patients who underwent surgery, radiation, both or none were 26, 23, 31, and 9 months, respectively (p = 0.004). Conclusions: STS in SA is diagnosed at a younger age, with a longer median time for diagnosis and a more advanced stage. Histological subtypes and the advantage of local disease control and metastasectomy are consistent with other figures.

Stimulated Raman Histology for Rapid Intra-Operative Diagnosis of Sinonasal and Skull Base Tumors.

Intra-operative stimulated Raman histology (SRH) is a novel technology that uses laser spectroscopy and color-matching algorithms to create images similar to the formalin-fixed paraffin-embedded (FFPE) section. We aim to assess the accuracy of SRH in a novel range of sinonasal and skull base tumors. Select patients undergoing sinonasal and skull base surgery using the Invenio Imaging™ Nio™ Laser Imaging SRH system between June 2020 and September 2021 were assessed. The SRH images were reviewed for pathologic features similar to frozen section (FS) and FFPE. Time taken for results and diagnostic concordance was assessed. Sixty-seven SRH images from 7 tumor types in 12 patients were assessed. Pathologies included squamous cell carcinoma, rhabdomyosarcoma, inverted papilloma, adenoid cystic carcinoma, SMARCB1-deficient sinonasal carcinoma, mucosal melanoma, metastatic colonic adenocarcinoma, and meningioma. Tumor was identified in 100% of lesional specimens, with characteristic diagnostic features readily appreciable on SRH. Median time for diagnosis was significantly faster for SRH (4.3 min) versus FS (44.5 min; p=<.0001). Where SRH sample site matched precisely to FS (n=32/67, 47.8%), the same diagnosis was confirmed in 93.8%. Sensitivity, specificity, precision, and overall accuracy of SRH were 93.3%, 94.1%, 93.8%, and 93.3%, respectively. Near-perfect concordance was seen between SRH and FS (Cohen's kappa [κ]=0.89). Stimulated Raman histology can rapidly produce images similar to FFPE H&E in sinonasal and skull base tumors. This technology has the potential to act as an adjunct or alternative to standard FS. 4 Laryngoscope, 132:2142-2147, 2022.

Epidemiological Characteristics of COVID-19 Outbreak in Yangzhou, China, 2021.

ObjectiveEpidemiological characteristics of COVID-19 outbreak in Yangzhou city caused by the highly contagious Delta variant strain of SARS-CoV-2 virus were investigated in this retrospective descriptive study to provide prevention and control guidelines for outbreaks in the future.MethodsAll the epidemiological data used in this study were collected manually from the official website of the Yangzhou Municipal Health Committee from 28 July to 26 August 2021, and then were analyzed systematically and statistically in this study.ResultsA total of 570 COVID-19 cases were reported during the short-term outbreak in Yangzhou City. The ages of infected individuals ranged from 1 to 90 years with the average age at 49.47 ± 22.69 years. As for gender distributions, the ratio of male- to-female patients was 1:1.36 (242:328). Geographic analysis showed that 377 patients (66.1%) were in Hanjiang District while 188 patients (33.0%) were in Guangling District. Clinical diagnosis showed that 175 people (30.7%) had mild symptoms, 385 people were in moderate conditions (67.5%), and 10 people were in severe situations (1.8%). Significant age differences were found among the three groups (P < 0.001). However, no significant difference was identified in terms of gender ratio (P > 0.05). Based on the transmission chain formed by 6 generations of infected persons with a clear transmission relationship, the age showed a gradually decreasing trend, while the median time of diagnosis in 2 adjacent generations was 3 days. In addition, the estimated basic reproduction number R0 of the Delta variant was 3.3651 by the classical Susceptible, Infectious, and/or Recovered (SIR) model.ConclusionThe Delta variant of SARS-CoV-2 was highly infectious and has obvious clustering characteristics during the Yangzhou outbreak in China.