Predilection Sites Research Articles

Diagnosis and management of bilateral lipoma of the middle ear.

Middle ear lipomas are rare, accounting for less than 1% of all middle ear tumours. To our knowledge there have been only 16 reported patients with middle ear lipoma. Only one of these had bilateral congenital middle ear lipomas. The aim of this review is to comprehensive overview the diagnosis and management of congenital lipomas of the middle ear. A literature review was performed searching multiple data bases, using the key words "middle ear", AND "lipoma", AND "congenital". A total of 116 articles were identified. One hundred were excluded on various criteria, leaving 16 articles for detailed review. Additionally, we report the second case of bilateral congenital middle ear lipoma. Based on this case report and literature review, the incidence of middle ear lipomas is greater in paediatric patients than in adult patients. Middle ear lipomas are distributed evenly between males and females. Three patients had recognised genetic syndromes, while five had prior ventilation tube placement. Clinically patients present with conductive hearing loss and middle ear effusions. In some cases, presence of a white or yellow mass behind the anterior aspect of the tympanic membrane is recognised. The most common location of the masses is in the anterosuperior quadrant of the middle ear, the site of predilection for small congenital cholesteatomas. An MRI scan is most useful in distinguishing between lipoma and cholesteatoma. All cases reported surgical excision of the middle ear lipoma. There was no evidence of recurrence noted up to 4 years follow up. Though rare, congenital lipomas of the middle ear should be a differential diagnosis of a middle ear masses. Early identification can allow surgical lipoma resection with minimal disruption to the ossicular chain. Though there is currently no consensus regarding management, surgical removal and appropriate reconstruction of the ossicular chain if needed, is appropriate.

Racing Performance and Sale Result in 145 Thoroughbreds after Arthroscopic Removal of Osteochondral Fragments from the Lateral Femoral Trochlear Ridge as a Yearling (2012-2015).

The lateral trochlear ridge (LTR) of the femur is the most common predilection site for osteochondritis dissecans (OCD) in the equine stifle. The objective was to investigate the relationship between lesion size, racing performance, and sale result of Thoroughbreds with LTR OCD following arthroscopic removal as a yearling. In this retrospective study, medical records of 145 Thoroughbreds from one equine hospital that underwent surgery for LTR OCD were reviewed; the length and depth of the lesions were measured on preoperative radiographs. Horses were allocated to group S if they were presented to a public yearling sale post-surgery, and horses in group NS were not. Each horse from group S was matched with two control horses from the same sale (group C). Influence of lesion size on racing performance and sale result was analyzed. Racing performance and sale results were compared between different categories of OCD lesion sizes and between the groups. Lesion length and depth did not affect racing performance and did not differ between group S and group NS. However, group S did perform significantly better than group NS. When comparing groups S and C, there were no significant differences in racing performance and sale result. Thoroughbreds that had arthroscopic surgery for LTR OCD as a yearling and were presented on a public yearling sale performed comparable to Thoroughbreds that showed similar potential as a yearling. Sale result is not significantly affected in our study.

Renal Cell Carcinoma Presenting As A Cutaneous Horn

Renal-cell carcinoma develops as an insidious neoplasm, frequently metastasizing to the skin. Cutaneous manifestations vary regarding morphology and sites of predilection. A patient was recently seen demonstrating a metastasis from a renal neoplasm. The lesion was unusual in that it grossly resembled a cutaneous horn. Dermatologists should continue to be alert to the possibility of renal tumor metastasis when evaluating cutaneous tumors.

Wearable Prophylaxis Tool for AI-Driven Identification of Early Warning Patterns of Pressure Ulcers.

As today's society ages, age-related diseases become more frequent. One very common but yet preventable disease is the development of pressure ulcers (PUs). PUs can occur if tissue is exposed to a long-lasting pressure load, e.g., lying on tissue without turning. The cure of PUs requires intensive care, especially for the elderly or people with preexisting conditions whose tissue needs longer healing times. The consequences are heavy suffering for the patient and extreme costs for the health care system. To avoid these consequences, our objective is to develop a pressure ulcer prophylaxis device. For that, we built a new sensor system able to monitor the pressure load and tissue vital signs in immediate local proximity at patient's predilection sites. In the clinical study, we found several indicators showing correlations between tissue perfusion and the risk of PU development, including strongly reduced SpO2 levels in body tissue prior to a diagnosed PU. Finally, we propose a prophylaxis system that allows for the prediction of PU developments in early stages before they become visible. This work is the first step in generating an effective system to warn patients or caregivers about developing PUs and taking appropriate preventative measures. Widespread application could reduce patient suffering and lead to substantial cost savings.

Osteosarcoma PDX-Derived Cell Line Models for Preclinical Drug Evaluation Demonstrate Metastasis Inhibition by Dinaciclib through a Genome-Targeted Approach.

Models to study metastatic disease in rare cancers are needed to advance preclinical therapeutics and to gain insight into disease biology. Osteosarcoma is a rare cancer with a complex genomic landscape in which outcomes for patients with metastatic disease are poor. As osteosarcoma genomes are highly heterogeneous, multiple models are needed to fully elucidate key aspects of disease biology and to recapitulate clinically relevant phenotypes. Matched patient samples, patient-derived xenografts (PDX), and PDX-derived cell lines were comprehensively evaluated using whole-genome sequencing and RNA sequencing. The in vivo metastatic phenotype of the PDX-derived cell lines was characterized in both an intravenous and an orthotopic murine model. As a proof-of-concept study, we tested the preclinical effectiveness of a cyclin-dependent kinase inhibitor on the growth of metastatic tumors in an orthotopic amputation model. PDXs and PDX-derived cell lines largely maintained the expression profiles of the patient from which they were derived despite the emergence of whole-genome duplication in a subset of cell lines. The cell lines were heterogeneous in their metastatic capacity, and heterogeneous tissue tropism was observed in both intravenous and orthotopic models. Single-agent dinaciclib was effective at dramatically reducing the metastatic burden. The variation in metastasis predilection sites between osteosarcoma PDX-derived cell lines demonstrates their ability to recapitulate the spectrum of the disease observed in patients. We describe here a panel of new osteosarcoma PDX-derived cell lines that we believe will be of wide use to the osteosarcoma research community.

Development of a localization-based algorithm for the prediction of leg ulcer etiology.

Diagnostic work-up of leg ulcers is time- and cost-intensive. This study aimed at evaluating ulcer location as a diagnostic criterium and providing a diagnostic algorithm to facilitate differential diagnosis. The study consisted of 277 patients with lower leg ulcers. The following five groups were defined: Venous leg ulcer, arterial ulcers, mixed ulcer, arteriolosclerosis, and vasculitis. Using computational surface rendering, predilection sites of different ulcer types were evaluated. The results were integrated in a multinomial logistic regression model to calculate the likelihood of a specific diagnosis depending on location, age, bilateral involvement, and ulcer count. Additionally, neural network image analysis was performed. The majority of venous ulcers extended to the medial malleolar region. Arterial ulcers were most frequently located on the dorsal aspect of the forefoot. Arteriolosclerotic ulcers were distinctly localized at the middle third of the lower leg. Vasculitic ulcers appeared to be randomly distributed and were markedly smaller, multilocular and bilateral. The multinomial logistic regression model showed an overall satisfactory performance with an estimated accuracy of 0.68 on unseen data. The presented algorithm based on ulcer location may serve as a basic tool to narrow down potential diagnoses and guide further diagnostic work-up.

Analysis of inflammatory markers and tau deposits in an autopsy series of nine patients with anti-IgLON5 disease

Anti-IgLON5 disease is a rare neurological, probably autoimmune, disorder associated in many cases with a specific tauopathy. Only a few post-mortem neuropathological studies have been reported so far. Little is known about the pathogenic mechanisms that result in neurodegeneration. We investigated the neuropathology of anti-IgLON5 disease and characterized cellular and humoral inflammation. We included nine cases (six of them previously published). Median age of patients was 71 years (53–82 years), the median disease duration was 6 years (0.5–13 years), and the female to male ratio was 5:4. Six cases with a median disease duration of 9 years presented a prominent tauopathy. Five of them had a classical anti-IgLON5-related brainstem tauopathy and another presented a prominent neuronal and glial 4-repeat tauopathy, consistent with progressive supranuclear palsy (PSP). Three cases with short disease duration (median 1.25 years) only showed a primary age-related neurofibrillary pathology. Inflammatory infiltrates of T and B cells were mild to moderate and did not significantly differ between anti-IgLON5 disease cases with or without tauopathy. In contrast, we found an extensive neuropil deposition of IgG4 in the tegmentum of the brainstem, olivary nucleus, and cerebellar cortex that was most prominent in two patients with short disease duration without the typical IgLON5-related tauopathy. The IgG4 deposits were particularly prominent in the cerebellar cortex and in these regions accompanied by mild IgG1 deposits. Activated complement deposition (C9neo) was absent. Our study indicates that IgLON5-related tau pathology occurs in later disease stages and may also present a PSP-phenotype with exclusively 4-repeat neuronal and glial tau pathology. The prominent deposition of anti-IgLON5 IgG4 at predilection sites for tau pathology suggests that anti-IgLON5 antibodies precede the tau pathology. Early start of immunotherapy might prevent irreversible neuronal damage and progression of the disease, at least in a subgroup of patients.

Community knowledge, attitudes and practices related to Taenia solium taeniosis and cysticercosis in Zambia.

Several studies on Taenia solium taeniosis / cysticercosis (TSTC) have been conducted in Zambia. However, none has assessed community knowledge, attitudes and practices related to TSTC and epilepsy. A community-based cross-sectional study was conducted between November and December 2022. The design consisted of a questionnaire-based survey conducted in each of the 25 purposely selected villages in Chiparamba Rural Health Centre (RHC) catchment area in Chipata district of the Eastern Province. A total of 588 participants comprising 259 (44%) males and 329 (56%) females with median age of 42 years (range 17 to 92 years) were interviewed. Awareness of the signs and symptoms of taeniosis and human cysticercosis (HCC), including transmission and prevention measures was very low. Whilst the majority had heard about epilepsy, they were not able to link HCC to epilepsy. Most participants were aware of cysticerci in pigs (PCC) including its predilection sites but were not aware of mode of transmission and prevention measures. The pork meat inspection by trained professionals was also not a common practice in the area. Risk perception of T. solium infections was thus very low. Overall knowledge, attitude and practice scores related to T. solium infections and to epilepsy were very low with median scores of 0.38 (IQR 0.25-0.54) for knowledge, 0.25 (0.25-0.50) for attitudes, and 0.31 (0.25-0.44) for practices. Males had better knowledge on TSTC (median = 0.42, p = 0.017, r = 0.098) and better practice scores (median = 0.38, p = < 0.001, r = 0.154) compared to females though the effect size was small. With regards to sanitation and hygiene washing with soap and water was reported by many but only few had a hand washing facility near their latrines. The study shows overall poor knowledge, attitudes and practices related to TSTC among the community of Chiparamba RHC in Chipata district of the Eastern Province of Zambia. This poses a serious challenge for control and elimination of T. solium infections and thus efforts to improve knowledge, attitudes and practices should be made using a One Health approach for the control and elimination of TSTC. Educational programs about TSTC transmission, signs and symptoms, prevention, management and control need to be scaled up in the study area and Zambia as a whole.

Predilection sites of pyoderma gangrenosum: Retrospective study of 170 clearly diagnosed patients.

Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic dermatosis that was difficult to diagnose in clinical practice. Today, the PARACELSUS score is a validated tool for diagnostics. Based on this score, patients with clearly diagnosed PG were examined with regard to predilection sites. In this retrospective study, the data of patients from the University Hospitals of Essen and Erlangen were analysed in whom the diagnosis of PG could be clearly confirmed using the PARACELSUS score. A total of 170 patients, 49 men (29%) and 121 women (71%) with an average age at first manifestation of 55.5 years, could be included in the analysis. The predilection sites were identified as the lower legs in 80.6% of the patients and the extensor sides in 75.2%. Other localisations of PG were the thighs in 14.1%, mammae and abdomen in 10.0% each, back and gluteal in 7.1% each, feet in 5.9%, arms in 4.7%, genital in 3.5% and head in 2.9%. This retrospective study is the first to identify a collective of PG patients with the highest data quality using the PARACELSUS score. It could be shown that PG can basically occur on the entire integument. However, the predilection sites of PG, which have now been reliably identified for the first time, are the lower legs and in particular the extensor sides.

Anatomy of the right atrial appendage and its importance in clinical practice.

The right atrial appendage is an important anatomical marker of the right heart. With the developments in cardiology, more attention has been paid to the right atrial appendage. This article summarizes the progress in research regarding the right atrial appendage anatomy and its clinical value, to collate and augment the relevant data. The shape of the right atrial appendage differs from the left atrial appendage: its outer surface is relatively flat and its internal structure comprises a terminal crest and musculi pectinati. In clinical interventional therapy, the right atrial appendage is often used as the electrode implantation site. The thickness of the musculi pectinati and the wall thickness of the right atrial appendage are closely related to the outcomes in atrial lead implantation. In terms of atrial fibrillation, wherein thrombi formation is frequent, the right atrial appendage is one of the predilection sites of thrombosis. However, the incidence of thrombosis in the right atrial appendage is lower than that in the left atrial appendage. Familiarity with the anatomy of the right atrial appendage is of prime importance in atrial lead implantation, and the role of the right atrial appendage in atrial fibrillation requires further investigation.

Eyelid involvement of primary cutaneous lymphomas: A clinical perspective.

Eyelids may be affected in systemic, ocular adnexal and primary cutaneous lymphomas (PCLs). The frequency of eyelid involvement in PCLs is still not well known and it is not a predilection site for any type. While primary cutaneous T-cell lymphomas (CTCLs) are more commonly seen than primary cutaneous B-cell lymphomas (CBCLs), especially mycosis fungoides (MF) as by far the most frequent type, B cell lymphomas are reported to be the commonest type in eyelid localization on the contrary. PCLs may be located on the eyelids, as the sole manifestation or in association with the involvement of other parts of the eye and elsewhere of the body. MF may present with a rich spectrum of clinical features on the eyelids mostly seen in folliculotropic subtype and advanced-stage disease. Erythematous scaly patches or plaques representing the most commonly encountered eyelid MF lesions may mimic many other dermatological conditions. Diffuse thickening, oedema, poikilodermic changes, atrophy and wrinkling are other suggestive findings of eyelid MF. Milia-like papules, madarosis and ectropion are also seen in the folliculotropic variant of MF, as ectropion is more typical for Sezary syndrome. Eyelids are also a typical location for tumoural MF which has been suggested as a poor prognostic indicator in MF. Papulonodular lesions, large tumours, ulceration, diffuse infiltration, oedema and subcutaneous atrophy on the eyelids may also be seen in other types of PCLs. Keep in mind, the rich clinical spectrum of PCLs on the eyelids may be crucial in early diagnosis in this special localization.

Lymphatic Filariasis Elimination Status: Wuchereria bancrofti Infections in Human Populations after Five Effective Rounds of Mass Drug Administration in Zambia.

Lymphatic filariasis (LF), also commonly known as elephantiasis, is a neglected tropical disease (NTD) caused by filarial parasites. The disease is transmitted via a bite from infected mosquitoes. The bites of these infected mosquitoes deposit filarial parasites, Wuchereria or Brugia, whose predilection site is the lymphatic system. The damage to the lymph system causes swelling in the legs, arms, and genitalia. A mapping survey conducted between 2003 and 2011 determined LF as being endemic in Zambia in 96 out of 116 districts. Elimination of LF is known to be possible by stopping the spread of the infection through large-scale preventive chemotherapy. Therefore, mass drug administration (MDA) with diethylcarbamazine citrate (DEC) (6 mg/kg) and Albendazole (400 mg) for Zambia has been conducted and implemented in all endemic districts with five effective rounds. In order to determine whether LF prevalence has been sufficiently reduced to levels less than 2% antigenemia and less than 1% microfilaremia, a pre-transmission assessment survey (pre-TAS) was conducted. Therefore, post-MDA pre-TAS was conducted between 2021 and 2022 in 80 districts to determine the LF prevalence. We conducted a cross-sectional seroprevalence study involving 600 participants in each evaluation unit (EU) or each district. The study sites (sentinel and spot-check sites) were from districts that were the implementation units (IUs) of the LF MDA. These included 80 districts from the 9 provinces. A total of 47,235 people from sentinel and spot-check locations were tested. Of these, valid tests were 47,052, of which 27,762 (59%) were females and 19,290 (41%) were males. The survey revealed in the 79/80 endemic districts a prevalence of Wb antigens of 0.14% and 0.0% prevalence of microfilariae. All the surveyed districts had an optimum prevalence of less than 2% for antigenaemia, except for Chibombo district. The majority of participants that tested positive for Wuchereria bancrofti (Wb) Antigens (Ag) were those that had 2, 3, and 4 rounds of MDA. Surprisingly, individuals that had 1 round of MDA were not found to have circulating antigens of Wb. The study showed that all the surveyed districts, except for Chibombo, passed pre-TAS. This further implies that there is a need to conduct transmission assessment surveys (TASs) in these districts.

Tinjauan: Implikasi Parasit Cacing pada Komposisi Tubuh Ternak Ruminansia

The effects of gastrointestinal parasties on feed intake and growth is well-established. The emphasis here is on raising awareness that parasites do have effects on body compositon and meat quality atrributes. Body composition refers to the acceptable balance of lean to fat ratio when animals were parasitised or when they were free of parasites. Rejection of carcases due to parasitism is also covered. It was concluded that parasitic infections at subclinical level lead to reduced quantity and impaired quality of meat indirectly by in protein and energy intake as well as through altering and diverting of protein availability for both body maintenance in the forms of establishing resilience to infection as well as repairing of tissues damaged by parasites at sites of predilection. Ineficiency in meat production and alterations to body composition due to nematode parasitism is very much associated with alterations in nutrient absorption and utilisation.

Impacted Inverted Supernumerary Tooth with Regional Odontodysplasia : A Rare Case Report

Regional Odontodysplasia (RO) is a rare developmental disturbance of the teeth affecting the structure of the teeth. The etiology of RO is largely unknown however it is known to consist both the mesodermal and the ectodermal components. The occurrence of RO is twice common in the maxilla than in the mandible. RO most often is known to involve the maxillary central and lateral incisors. The prevalence of RO is rare thus available literature regarding the site and gender predilection, clinical manifestations and radiographic features is limited. Therefore, this case report is presented to provides an overview of the radiographic features of RO Keywords: Ghost teeth, CBCT, Regional odontodysplasia

Clinical investigation of gingival papilla recession after orthodontic treatment in adults.

To investigate the incidence, severity, susceptibility sites of gingival papillary recession (GPR) in adults after orthodontic treatment and the clinical impact of tooth extraction on GPR. A total of 82 adult patients were recruited and then divided into extraction and non-extraction groups according to whether the orthodontic teeth were extracted (teeth that needed to be extracted when performing orthodontic treatment). The gingival conditions of the two groups of patients before and after treatment were recorded using intraoral photos, and the incidence, severity and predilection sites of GPR after correction were investigated. The results indicated that GPR occurred in 29 patients after correction, with an incidence rate of 35.4%. A total of 1648 gingival papillae were recorded among the 82 patients after correction, of which 67 exhibited atrophy, with an incidence of 4.1%. All occurrences of GPR were classified as papilla presence index 2 (PPI 2) (mild). The condition is most likely to occur in the anterior tooth area, especially in the lower incisor area. The results indicated that the incidence of GPR was substantially higher in the extraction group than in the non-extraction group, with the difference statistically significant. Following orthodontic treatment, adult patients will have a certain proportion of mild GPR, which is more common in the anterior tooth area, especially the lower anterior tooth area.

Endothelial CCRL2 induced by disturbed flow promotes atherosclerosis via chemerin-dependent β2 integrin activation in monocytes.

Chemoattractants and their cognate receptors are essential for leucocyte recruitment during atherogenesis, and atherosclerotic plaques preferentially occur at predilection sites of the arterial wall with disturbed flow (d-flow). In profiling the endothelial expression of atypical chemoattractant receptors (ACKRs), we found that Ackr5 (CCRL2) was up-regulated in an endothelial subpopulation by atherosclerotic stimulation. We therefore investigated the role of CCRL2 and its ligand chemerin in atherosclerosis and the underlying mechanism. By analysing scRNA-seq data of the left carotid artery under d-flow and scRNA-seq datasets GSE131776 of ApoE-/- mice from the Gene Expression Omnibus database, we found that CCRL2 was up-regulated in one subpopulation of endothelial cells in response to d-flow stimulation and atherosclerosis. Using CCRL2-/-ApoE-/- mice, we showed that CCRL2 deficiency protected against plaque formation primarily in the d-flow areas of the aortic arch in ApoE-/- mice fed high-fat diet. Disturbed flow induced the expression of vascular endothelial CCRL2, recruiting chemerin, which caused leucocyte adhesion to the endothelium. Surprisingly, instead of binding to monocytic CMKLR1, chemerin was found to activate β2 integrin, enhancing ERK1/2 phosphorylation and monocyte adhesion. Moreover, chemerin was found to have protein disulfide isomerase-like enzymatic activity, which was responsible for the interaction of chemerin with β2 integrin, as identified by a Di-E-GSSG assay and a proximity ligation assay. For clinical relevance, relatively high serum levels of chemerin were found in patients with acute atherothrombotic stroke compared to healthy individuals. Our findings indicate that d-flow-induced CCRL2 promotes atherosclerotic plaque formation via a novel CCRL2-chemerin-β2 integrin axis, providing potential targets for the prevention or therapeutic intervention of atherosclerosis.

Cranial cruciate ligament avulsion due to osteochondrosis dissecans of the stifle joint in a golden retriever dog

AbstractAn 8‐month‐old, entire, male, 32‐kg golden retriever dog was presented with a grade 4/5 right hindlimb lameness. No history of trauma or injury was noted and the clinical symptoms had appeared suddenly. A computed tomography examination of the hindlimbs was performed, and changes in the right stifle joint included moderate joint effusion, synovial thickening, a detached fragment from the medial aspect of the lateral femoral condyle and concurrent changes of the condylar bone. The cortical bone of that area appeared damaged and had lost its smooth margins A cranial cruciate ligament avulsion was later confirmed by arthroscopy. Osteochondrosis dissecans was confirmed histopathologically, based on chondral necrosis and a clear fissure evident in the fragment. Osteochondrosis dissecans is associated with cartilage and bone changes in growing animals. There are known anatomical predilection sites for development of osteochondrosis, one of which is the lateral condyle of the femur. This is the first reported case where the dislodged bone fragment is also the point of origin for the cranial crucial ligament.

Predilection site and risk factor of second primary cancer: A pan-cancer analysis based on the SEER database.

Predilection site and risk factor of second primary cancer: A pan-cancer analysis based on the SEER database.

Epidemiology and Risk Mapping of hard ticks (Ixodidae) infecting Small Ruminants in Khyber Pakhtunkhwa Province, Pakistan

Ticks and tick-borne diseases (TBDs) cause a negative impact on animal health and production globally. Because of the transhumant production system of sheep and goats in Khyber Pakhtunkhwa (KP), Pakistan, registration and tracking system of animals is not possible, which is a prerequisite for the development of early warning systems for any outbreak of TBDs. Therefore, the present study was aimed to investigate the district-wise surveillance and risk mapping to find the epidemiological profile of tick infestation in small ruminants from KP, Pakistan. Ticks (n=6257) were collected from the six selected districts from May 2017- April 2018. A total of 1500 animals (goats=618 and sheep=881) were screened for the presence of ticks on different host predilection sites. A questionnaire depicting epidemiological information was filled, and a geographic information system (GIS) was used to map the risk areas. The study identified six tick species namely, Rhiphicephalus (R.) microplus, Hyalomma (H.) trancatum, H. anatolicum, H. aegyptium, H. asiaticum, and Haemaphysalis bispinosa. The tick prevalence in study districts was 16% in Peshawar, 15.67% Mardan, 12.8% Bannu, 18% Mansehra, 15.67% Mingora, and 21.87% in Dera Ismail Khan. R. microplus was only prevalent in Peshawar (36.18 %) and in Dera Ismail Khan (63.81 %) districts, while Haemaphysalis bispinosa and H. aegyptium were only recorded in Mardan. The intensity of Hyalomma spp. was recorded at 62.92 % followed by Rhipicephalus spp., 36.55%, and Haemaphysalis spp., 1.15%. Hyalomma spp. showed the highest prevalence on all host predilection sites viz: ears (62.2 %), groin areas (60.8%), under the tail (61.9 %), testicular areas (63.2 %), breast (64.5 %), and in hooves (64.7%) as compared to Rhipicephalus and Haemaphysalis species. Similarly, in sheep and goats, the adult ticks were more prevalent in age group 1-2 years (83.28% and 68.98%) followed by &lt; 1 year of age group (82% and 68.89%), respectively. The results revealed high female (61.9%) tick infestation as compared to male ticks (38.1%), whereas the highest female to male tick ratio was 1.77:1 in Haemaphysalis species. The GIS map demonstrated that the degree of tick infestation varied within districts and villages. In conclusion, results recorded that economically vital ticks are extensively distributed all over the KP province and cost-effective control studies are needed to minimize the spread of tick-borne diseases.

Cancer Metastases to the Hand: A Systematic Review and Meta-analysis.

Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.