Persistent Disease Research Articles

Water pollution, cholera, and the role of probiotics: a comprehensive review in relation to public health in Bangladesh

Cholera, a disease caused by Vibrio cholerae, remains a pervasive public health threat, particularly in regions with inadequate water sanitation and hygiene infrastructure, such as Bangladesh. This review explores the complex interplay between water pollution and cholera transmission in Bangladesh, highlighting how contaminated water bodies serve as reservoirs for V. cholerae. A key focus is the potential role of probiotics as a novel intervention approach for cholera prevention and management. Probiotics are promising as an adjunctive approach to existing therapies as they can enhance gut barrier function, induce competitive exclusion of pathogens, and modulate host immune responses. Recent probiotic advancements include engineering strains that disrupt V. cholerae biofilms and inhibit their virulence. Integrating probiotics with traditional cholera control measures could significantly enhance their effectiveness and provide a multifaceted approach to combating this persistent disease. This review aims to shed light on the potential of probiotics in revolutionizing cholera management and to offer insights into their application as both preventive and therapeutic tools in the fight against this enduring public health challenge.

Comparative study of management strategies for immune checkpoint inhibitor-induced inflammatory arthritis: rheumatologists versus oncologists.

Immune checkpoint inhibitors (ICIs) have significantly improved cancer treatment outcomes but are associated with immune-related adverse events (irAEs), such as inflammatory arthritis (ir-IA). Management of ir-IA is evolving, with corticosteroids as the primary treatment, though some cases require steroid-sparing agents. This study aimed to compare initial mean prednisolone doses and disease persistence over 12 months in patients with rheumatoid arthritis (RA)-like ir-IA managed by rheumatologists or oncologists. This retrospective observational study involved patients who developed RA-like ir-IA after ICI treatment for advanced cancers between September 2015 and January 2019 at a tertiary hospital in Brisbane, Australia. Patient records were reviewed up to January 2020 to evaluate chronicity. Data were collected, and statistical analyses compared the management between rheumatologists and oncologists. A total of 871 patients received ICI and 246 had irAEs, with 20 developing RA-like ir-IA. Nine were managed by an oncologist and 11 by a rheumatologist. The mean dose of prednisolone commenced by a rheumatologist was 14 mg compared to 53.3 mg by an oncologist (P = 0.0058). Patients managed by a rheumatologist were more likely to receive conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) (odds ratio 16, P = 0.023). Thirteen patients required ongoing maintenance treatment, while seven had resolution within 12 months of disease onset. RA-like ir-IA comprised 8% of ICI-related irAEs. During the study period, patients managed by rheumatologists received lower initial prednisolone doses and more frequent csDMARD than oncologists. A multidisciplinary involvement between rheumatologists and oncologists in the event of ir-IA is crucial.

Ginsenoside reprogramming microglia through the FGF/FGFR1 inhibits post traumatic stress disorder.

Post traumatic stress disorder (PTSD) is a serious and persistent mental diseases. Nowadays, Treatment of PTSD patients in clinical practice is mainly based on drug therapy accompanied by psychological therapy. However, the therapeutic effect is unsatisfactory. It is urgent to detect how to treat PTSD patients. Here, we found that ginsenoside can significantly relieve PTSD symptoms in mice model. Rg3, one of the main pharmacological components of ginsenoside, prevents PTSD by promoting alternatively activated M2 phenotype microglia while inhibiting classically activated inflammatory M1 phenotype microglia. Mechanistically, Rg3 up-regulates fibroblast growth factor receptor 1 (FGFR1) expression in microglia to suppress excessive activation of microglia and reduce neuronal apoptosis. Importantly, knocking down FGFR1 expression in BV2 cells promoted a pro-inflammatory phenotype of BV2 cells, while over-expressing FGFR1 reversed this effect. In vivo PTSD mice model results showed that knockdown FGFR1 prevents the therapeutic effect of Rg3, which indicates that FGFR1 is an essential target of PTSD. Our results reveal that Rg3 may be a potential drug to treat PTSD patients.

TP53 genetic heterogeneity in recurrent or second primary head and neck squamous cell carcinoma.

Head and neck squamous cell carcinomas (HNSCC) frequently recur, and patients often develop second primary tumors. Their distinction is clinically challenging. TP53 mutational heterogeneity may indicate novel molecular events rather than resistant clones' expansion or persistent disease. Surveillance and therapeutic strategies should be adjusted, especially in the case of a second primary arising in an already irradiated field.

Evaluating Utility of Allergy Testing in Management of Nasal Obstruction Following Inferior Turbinate Reduction

IntroductionAllergic rhinitis (AR) within the pediatric population affects more patients than any other chronic disease. Inferior turbinate hypertrophy (ITH) is a common cause of nasal obstruction in children and is strongly associated with AR. Inferior turbinate reduction (ITR) surgery is used in patients with ITH who have failed medical management. While surgery is curative for most, there remains a subset of patients who continue to have symptoms of nasal obstruction despite ITR, which can cause discomfort and significant impacts on quality of life. Additionally, some patients with persistent disease go on to require revision surgery. The objectives in this study were to assess the impact of allergy testing results in patients undergoing ITR and evaluate if they predict long-term durability of surgical outcome. MethodsA retrospective chart review of patients undergoing ITR between January and December of 2015 was performed. Data pertaining to demographics, allergy testing results, surgical technique, and medical management was collected. Patients who underwent concomitant procedures at the time of ITR were excluded. Data analysis included descriptive statistics, chi-squared tests, and t-test analyses. Results297 patients who underwent ITR were included for data analysis. Overall, 20.9% of patients had recurrent nasal obstruction after ITR and 5.4% required revision surgery. Among all included patients, 37.7% underwent allergy testing of which 53 (47.3%) tested positive and 54 (48.2%) tested negative; results were unknown for 5 (4.5%) patients. In patients with positive allergy tests, 36% had recurrent nasal obstruction and 11% required revision surgery. In patients with negative allergy tests, 41% had recurrent nasal obstruction and 13% required revision surgery. There were no significant associations among those with positive and negative allergy tests and recurrence of nasal obstruction or need for revision surgery. Patients with a documented clinical diagnosis of AR were more likely to have recurrence of nasal obstruction after surgery than those without (28% vs 12%, p=0.001) and were more likely to require revision surgery (9% vs 1%, p=0.001). ConclusionsITR is a reasonable choice for the treatment of nasal obstruction in children. However, there remains a subset of patients who have recurrent nasal obstruction following initial surgery. Allergy testing results do not appear to impact the rate of recurrent nasal obstruction or the need for revision surgery. Therefore, the utility of allergy testing may have a limited benefit in the management of nasal obstruction in children. However, a clinical diagnosis of allergic rhinitis does appear to be a prognostic factor for experiencing post-operative recurrent nasal obstruction and requiring revision surgery.

Axial spondyloarthritis.

Axial spondyloarthritis manifests as a chronic inflammatory disease primarily affecting the sacroiliac joints and spine. Although chronic back pain and spinal stiffness are typical initial symptoms, peripheral (ie, enthesitis, arthritis, and dactylitis) and extra-musculoskeletal (ie, uveitis, inflammatory bowel disease, and psoriasis) manifestations are also common. Timely and accurate diagnosis is challenging and relies on identifying a clinical pattern with a combination of clinical, laboratory (HLA-B27 positivity), and imaging findings (eg, structural damage on pelvic radiographs and bone marrow oedema on MRI of the sacroiliac joints). The Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis are widely used for research and have contributed to a better understanding of the gestalt of axial spondyloarthritis. Persistent disease activity, assessed mainly by the Axial Spondyloarthritis Disease Activity Score, leads to irreversible structural damage and functional impairment. Management involves non-pharmacological (eg, education, smoking cessation, exercise, physiotherapy) and pharmacological therapy. Non-steroidal anti-inflammatory drugs remain first line pharmacotherapy, while tumour necrosis factor, IL-17, and Janus kinase inhibitors are considered second-line therapies. Future advances are expected to increase disease awareness, facilitate early and accurate diagnosis, optimise disease management, and enhance overall quality of life in patients with axial spondyloarthritis.

Assessing the Status of Banded Leaf and Sheath Blight Disease of Maize (Zea mays L.) Caused by Rhizoctonia solani f. sp. sasakii in West Bengal, India

Maize is one of the most important cereal crops grown under diverse environments due to its range of plasticity. It is called the “Queen of Cereals” because of its highest yield potential. Various diseases significantly affect maize crops, with banded leaf and sheath blight being particularly impactful, leading to substantial reductions in crop yield. This study examined the prevalence of banded leaf and sheath blight (BLSB) in maize across various districts of West Bengal during 2020 and 2021. The findings revealed significant spatial and temporal variations in the incidence of BLSB. Districts such as North 24 Parganas and Paschim Medinipur demonstrated consistently high levels of disease severity, whereas Darjeeling recorded the lowest incidence. However, localized disease persistence was observed in regions like Uttar Dinajpur and Paschim Medinipur. The research underscored the considerable variability in susceptibility to BLSB across various maize cultivars. Notably, the Syngenta Babycorn variety exhibited a consistently elevated vulnerability to this pathogen, indicating a potential area for targeted mitigation strategies. The findings emphasize the need for integrated disease management strategies, including resistant varieties and cultural practices to mitigate BLSB.

Optimizing Exclusion Criteria for Clinical Trials of Persistent Lyme Disease Using Real-World Data.

Although eligibility criteria for clinical trials significantly impact study outcomes, these criteria are often established without scientific justification, leading to delayed recruitment, small sample sizes, and limited study generalizability. Persistent Lyme disease (PLD) presents unique challenges due to symptom variability, inconsistent treatment responses, and the lack of reliable biomarkers, underscoring the need for scientifically justified eligibility criteria. This study examines the effects of commonly used enrollment criteria on sample yield in PLD clinical trials using real-world data (RWD) from the MyLymeData patient registry. The study also compares the effects of these criteria on enrollment for PLD versus acute Lyme disease (ALD) trials and evaluates the scientific rationale for each criterion. Data from 4183 Lyme disease patients enrolled in the MyLymeData registry were analyzed to assess the prevalence and cumulative impact of various criteria on sample yield. A comparative analysis of cohorts with PLD (n = 3589) versus ALD (n = 594) was conducted to identify differences in sample attrition. In a large PLD cohort study, we found that current commonly used eligibility criteria would exclude approximately 90% of patients, significantly limiting study generalizability. Substantial differences in sample attrition between PLD and ALD cohorts highlight the need for tailored criteria. The strength of scientific justification varied widely among criteria. This study demonstrates the importance of using RWD to optimize eligibility criteria in PLD clinical trials. By providing insights into the balance between sample attrition and scientific justification, researchers can enhance trial feasibility, generalizability, and robustness. Our RWD sample demonstrates that researchers could substantially increase the sample yield from 10% to 64% by loosening restrictions on coinfections and misdiagnoses of chronic fatigue syndrome, fibromyalgia syndrome, and psychiatric conditions.

Epigenetic alterations and memory: key players in the development/progression of chronic kidney disease promoted by acute kidney injury and diabetes.

Chronic kidney disease (CKD) is a highly prevalent global public health issue and can progress to renal failure. Survivors of acute kidney injury (AKI) have an increased risk of progressing to CKD by 8.8-fold and kidney failure by 3.1-fold. Further, 20%‒40% of individuals with diabetes will develop CKD, also known as diabetic kidney disease (DKD). Thus, preventing these kidney diseases can positively impact quality-of-life and life-expectancy outcomes for affected individuals. Frequent episodes of hyperglycemia and renal hypoxia are implicated in the pathophysiology of CKD. Prior periods of hyperglycemia/uncontrolled diabetes can result in development/progression of DKD even after achieving normoglycemia, a phenomenon known as metabolic memory or legacy effect. Similarly, in AKI, hypoxic memory is stored in renal cells even after recovery from the initial AKI episode and can transition to CKD. Epigenetic mechanisms involving DNA methylation, chromatin histone post-translational modifications and non-coding RNAs are implicated in both metabolic and hypoxic memory, collectively known as "epigenetic memory." This epigenetic memory is generally reversible and provides a therapeutic avenue to ameliorate persistent disease progression due to hyperglycemia and hypoxia and prevent/ameliorate CKD progression. Indeed, therapeutic strategies targeting epigenetic memory are effective at preventing CKD development/progression in experimental models of AKI and DKD. Here, we review the latest in-depth evidence for epigenetic features in DKD and AKI, and in epigenetic memories of AKI-to-CKD transition or DKD development and progression, followed by translational and clinical implications of these epigenetic changes for the treatment of these widespread kidney disorders.

Different disease activity trajectories in early axial spondyloarthritis lead to significantly different long-term outcomes: a trajectory-based analysis of the DESIR cohort over 10 years

IntroductionThe study aimed to identify and describe disease activity trajectories over 10 years in patients with recent-onset axial spondyloarthritis (axSpA) and determine their impact on long-term outcomes.MethodsThis prospective, multicentre study...

Expert Perspective: Management of Relapses in Giant Cell Arteritis.

Giant cell arteritis (GCA) is a relapsing large-vessel vasculitis with risk of serious ischemic manifestations including vision loss and vascular damage in the form of large-artery stenosis, aneurysms and dissections. Approximately 50% of patients treated with glucocorticoid (GC) monotherapy and 30% of patients receiving adjunctive therapy with tocilizumab experience disease relapses, often during the first 2 years after diagnosis. Although most relapses in GCA do not involve life- or organ-threatening presentations and can be controlled successfully, frequent relapses may lead to increased use of GC and consequent treatment-related morbidity, in addition to risk of further vascular damage. Emerging data suggests that persistent disease activity may lead to increased vascular morbidity. Additionally, while tocilizumab decreases the frequency of relapses, more than 50% of patients relapse after discontinuation of therapy. Therefore, while interleukin-6 blockade suppresses disease activity, it does not restore tolerance. In this article, we discuss the practical diagnosis and management of GCA relapses from an expert perspective. Current treatment options for GCA relapses, including those recommended by international guidelines, and novel potential therapies are reviewed.

Prolonged Surveillance in Inverted Papilloma Reveals Delayed Recurrence and Lack of Benefit to Frozen Section.

To reduce recurrence rates of inverted papilloma (IP), some have argued for the use of intraoperative frozen margins; results remain mixed and studies critically lack lengthy surveillance periods. We aim to elucidate the impact of prolonged surveillance and intraoperative frozen margins on IP recurrence. This is a retrospective analysis of patients who underwent resection of IP at a tertiary care center over a 10-year period from 2008 to 2018 followed by subsequent surveillance. Patient demographics, tumor and operative characteristics, and recurrences were analyzed. Our analysis includes 199 patients, with 37 recurrences and an average recurrence time of 44.4 months; 57% of patients received intraoperative frozen sections and recurrence rates were similar between those who received frozen sections and those who did not (20.1% vs 15.5%, P = .36). Patients with recurrences within 5 years of surgery were more likely to have received frozen sections than those with recurrences beyond 5 years (P < .01). There was no difference in surgical approach or extent of disease in those who received frozen margins. Patients that received frozen sections were more likely to have multiple sites of attachment (56.5% vs 38.1%, P = .01) and persistent disease following a previous resection at an outside institution (67.0% vs 44.0%, P = .001). Our average time to recurrence was 44.4 months, significantly longer than surveillance times reported in the literature, indicating that longer periods of surveillance are necessary to capture late recurrences. Our analysis is the first and largest American cohort to look at IP resection in a standardized fashion and find that recurrence rates are similar between patients receiving frozen sections or not.

Integrating single-cell RNA-Seq and machine learning to dissect tryptophan metabolism in ulcerative colitis

BackgroundUlcerative colitis (UC) is a persistent inflammatory bowels disease (IBD) characterized by immune response dysregulation and metabolic disruptions. Tryptophan metabolism has been believed as a significant factor in UC pathogenesis, with specific metabolites influencing immune modulation and gut microbiota interactions. However, the precise regulatory mechanisms and key genes involved remain unclear.MethodsAUCell, Ucell, and other functional enrichment algorithms were utilized to determine the activation patterns of tryptophan metabolism at the UC cell level. Differential analysis identified key genes associated with tryptophan metabolism. Five machine learning algorithms, including Random Forest, Boruta algorithm, LASSO, SVM-RFE, and GBM were integrated to identify and categorize disease-specific characteristic genes.ResultsWe observed significant heterogeneity in tryptophan metabolism activity across cell types in UC, with the highest activity levels in macrophages and fibroblasts. Among the key tryptophan metabolism-related genes, CTSS, S100A11, and TUBB were predominantly expressed in macrophages and significantly upregulated in UC, highlighting their involvement in immune dysregulation and inflammation. Cross-analysis with bulk RNA data confirmed the consistent upregulation of these genes in UC samples, highly indicating their relevance in UC pathology and potential as targets for therapeutic intervention.ConclusionsThis study is the first to reveal the heterogeneity of tryptophan metabolism at the single-cell level in UC, with macrophages emerging as key contributors to inflammatory processes. The identification of CTSS, S100A11, and TUBB as key regulators of tryptophan metabolism in UC underscores their potential as biomarkers and therapeutic targets.

Autologous blood in the management of ocular surface disorders.

Autologous blood therapy has emerged as a promising modality in managing ocular surface disorders. This review provides a comprehensive overview of the current literature regarding the use of autologous blood in ocular surface disorders, encompassing its physiological basis, clinical applications, techniques, challenges, and future perspectives. The ocular surface, comprising the cornea, conjunctiva, and tear film, plays a critical role in maintaining visual function, and its disruption can lead to various pathological conditions. With its rich composition of growth factors, cytokines, and other bioactive molecules, autologous blood offers therapeutic potential in promoting corneal wound healing, reducing inflammation, and improving tear film stability. Clinical studies have demonstrated the efficacy and safety of autologous blood therapy in diverse ocular surface disorders, including persistent epithelial defects, neurotrophic keratopathy, and dry eye disease. However, challenges such as variability in treatment response, adverse effects, and optimal patient selection remain areas of concern. Further research is needed to elucidate the underlying mechanisms of action, refine treatment protocols, and explore synergistic approaches with other therapeutic modalities. Despite these challenges, autologous blood therapy holds promise as a valuable adjunctive treatment option for ocular surface disorders, offering new avenues for improving patient outcomes and quality of life. This review examines the mechanisms underlying ocular surface disorders while discussing existing autologous blood-based therapies for managing these disorders. Current clinical trials are also summarized, and a comparison between autologous blood therapy and conventional eyedrops is attempted. Finally, safe techniques and protocols for autologous blood medicine are elucidated, and adverse effects and future perspectives of this novel therapy are reviewed.

Computational Pathology-Enabled Residual Tumor Estimation is a Prognostic Factor for Overall Survival in Anal Squamous Cell Carcinoma.

Anal squamous cell carcinoma (SCC) incidence has increased, and treatment has shifted from surgery to chemoradiotherapy (CRT), with salvage abdominoperineal resection (APR) being reserved for persistent/recurrent cases. This study evaluates the utility of different Tumor Regression Scoring Systems (TRSS) in predicting survival in anal SCC patients, using pathologists' observations and digital pathology. Cases managed surgically from 2005 to 2019 were collected. Residual tumor was assessed by multiple methods (gross tumor size, largest focus of tumor on H&E slide, average of residual tumor in all submitted H&E slides, JES, Chirieac, Schneider, Hermann, CAP scoring system). Three expert pathologists individually estimated ("eyeballed") the residual tumor % based on residual tumor/tumor bed (single representative H&E slide). The QuPath software was used to measure tumor volume on the same slide. American Joint Committee on Cancer (AJCC) 8th staging, and outcome data were retrieved from electronic medical records. The study involved 48 participants, predominantly female (56%), with a median age of 57. Most were Caucasian. HPV-positive was present in 77% of those assessed (17/22). Initial treatment included chemoradiation (CRT), followed by APR (79%) or pelvic exenteration (21%). Complications (13%), persistent disease (33%), and recurrence (54%) led to surgical interventions. 51% had moderately differentiated SCC, whereas 42% were poorly differentiated. Lymphovascular invasion (44%), perineural invasion (38%), and lymph node metastasis (13%) were present. Distant metastasis was rare (2%). Median overall survival was 3.2 years. Positive margins (HR 4.12, 95% CI 1.83, 9.28) and larger tumor size (HR 1.02 95% CI 1.01, 1.03) were associated with an increased hazard of death. Most residual tumor measurement methods were not significantly associated with overall survival. Interobserver agreement (based on "eyeballing") was moderate (kappa 0.4). Computational pathology-based residual tumor percentage was the only method significantly associated with outcome, with each 10% increase in the residual tumor percentage corresponding to a 1.23-fold higher hazard death (95% CI 1.03, 1.46; p=0.024). This study highlights computational pathology's important role in predicting outcomes in anal SCC treated with CRT and surgery. Specifically, the computational assessment of the residual tumor percentage proves to be a strong predictor of overall survival, outperforming other established TRSS methods.

Changing paradigms in asthma management.

Asthma is a complex clinical syndrome characterized by airway inflammation that can cause variable, usually reversible airway obstruction and bronchial hyperreactivity. This illness has a spectrum from intermittent to persistent that has mild, medium or severe intensity. As our understanding of the underling inflammatory pathway grows, so too does our catalogue of advanced treatments (such as monoclonal antibodies), opening the path for treatment individually curated for patients. The current approved therapies are directed against IgE, interleukin (IL)-5, IL-5 receptor, IL-4 receptor subunit-α and most recently thymic stromal lymphopoietin (TSLP). These therapies all have demonstrated efficacies that make them variably effective in patients with moderate to severe persistent disease. More recently, other inflammatory molecules have been therapeutically targeted and are currently under clinical investigation for future potential use. However, a significant concern remains: the high financial costs for these advanced therapies continues to pose a significant burden both to patients and the healthcare system. Novel uses of long-acting bronchodilator-corticosteroids inhalers may reduce the use of highly priced biologics in many patients with comparatively less severe disease. Furthermore, the variability in patient response demands further research into to identify which patients will best respond to which specific therapy.

Evolution of sympatric host-specialized lineages of the fungal plant pathogen Zymoseptoria passerinii in natural ecosystems.

The barley disease Septoria Speckled Leaf Blotch, caused by the fungus Zymoseptoria passerinii, last appeared in North America in the early 2000s. Although rare in crops, field sampling of wild grasses in the Middle East revealed the disease persistence in wild barley. Identification of Z. passerinii in various wild barley species prompted us to examine genomic signatures of host specialization and trace the emergence of the domesticated-barley-infecting lineage. Furthermore, we applied virulence assays and confocal laser microscopy to evaluate whether the disease development differs between wild and domesticated barley. Wild- and domesticated-host-infecting populations have diverged, and phylogenetic relationships support the evolution of sympatric host-specialized lineages in wild hosts. Cross-virulence assays showed that Z. passerinii from domesticated hosts infect domesticated barley and its wild ancestor, Hordeum spontaneum. However, wild isolates from Iran did not infect domesticated barley. Wild and domesticated pathosystems have similar disease timing and progression, suggesting its persistence does not depend on a shorter period of incubation. The study supports that a wide range of hosts can foster the evolution of host-specialized lineages in sympatry and provide novel insights into the evolution of understudied fungal pathogens on wild hosts.

Impact of Diet on Gum Health in Adults: A Prospective Cohort Study

Periodontal diseases such as gum disease and periodontitis are persistent inflammatory disease processes which are multifactorial including diet. Nutrition’s influence over periodontal disorders may result via systemic inflammation as well as oral bacterial community adaption. This study conducted to assess the relationship between dietary patterns and adult periodontal health with regards to clinical determinants and inflammation biomarkers. The analysis presented here was based on a prospective cohort study that included 300 adults, aged between 20 and 60 years, with three different nutrition patterns: group A – those consuming a lot of fruits, vegetables “group B – those with an average mixed diet and group C – those whose diet consists of high number of refined sugars and processed foods. Various parameters to periodontal health such as baseline and 6-months changes in bleeding on probing (BOP), plaque index (PI), and probing depth (PD) were evaluated. Data analysis was performed through ANOVA and regression modeling. Group A showcased remarkable improvement in the periodontal parameters as significant reductions were recorded for BOP (45.7%), PI (33.3 %), and PD (17.6%) coupled with lowered CRP (30.4%) and IL-6 (28.9%) concentrations (p &lt; 0.001). BOP (15.3%) PI (19%) PD (11.1%) CRP (24%) and IL-6 (16.7%) levels, GA, and GAG increased for Group C as a marked deterioration was witnessed all over (p &lt; 0.001). Strong positive correlations were found during the correlation analysis between nutrient-rich diets and improved periodontal outcomes. Proper nutrition, in particular diets enriched in vitamins and minerals, improves health of the periodontium, while those high in sugar-sweetened beverages worsen the inflammation of the periodontium. These results suggest the growing need for dietary counseling within the framework of significant periodontal disease management.

Prognostic value of pre-ablation stimulated thyroglobulin in children and adolescents with differentiated thyroid cancer.

To investigate the prognostic value of pre-ablation stimulated thyroglobulin (ps-Tg) in children and adolescents with persistent differentiated thyroid cancer (DTC) following initial radioiodine therapy (RAI). Patients were classified into "no clinical evidence of disease" (NED), "biochemical persistent disease" (BPD), and "structural/functional persistent disease" (S/FPD) groups, based on their therapeutic response to initial RAI. BPD patients were further categorized as incomplete response (IR) or Non-IR; S/FPD patients were categorized as remission or Non-remission. Receiver operating characteristic (ROC) curves were used to assess the predictive value of ps-Tg for long-term prognosis. Univariate and multivariate regression analyses were performed to identify risk factors for IR in BPD group and Non-remission in S/FPD group. In total, 130 patients were included, with NED (32), BPD (61), and S/FPD (37) patients. Multivariate analysis identified therapeutic response to initial RAI as the only independent predictor of IR in the BPD group. ROC analysis determined an optimal ps-Tg threshold of 112.40 ng/mL for predicting Non-remission in S/FPD patients. Multivariate analysis further confirmed that ps-Tg > 112.4 ng/mL was significantly associated with Non-remission. Findings indicate ps-Tg as a valuable predictor of long-term prognosis in children and adolescents with persistent DTC post initial RAI.

Remission of persistent hypertension and hypokalaemia following redo adrenalectomy for primary aldosteronism - case report.

We report on a case of a 67-year-old male who was referred to our care with persistent aldosteronism post adrenalectomy. Biochemical failure after surgery is rare after surgery for primary aldosteronism (PA). Persistent hypokalaemia and raised aldosteronism is an indication of treatment failure after surgery. Causes of failure may be multiple aldosterone producing nodules or diffuse hyperplasia, inappropriate or incomplete lateralization studies, presence of CACNA1D -mutated aldosterone producing adenomas (APAs) and incomplete or partial adrenalectomy. In our case the persistent disease was imaged with METOMIDATE PET as the patient had a previous history of adrenal vein clipping during index surgery. The patient underwent reoperative adrenalectomy and was cured of hypokalaemia and hypertension, despite a long duration of his disease. This case highlights some of the reasons for biochemical failure and work up of the patient for reoperative surgery.