Predominant Symptoms Research Articles

FREQUENCY OF DIFFERENT PRESENTATIONS IN MYOCARDIAL INFARCTION PATIENTS WITH AND WITHOUT DIABETES

Background: Myocardial infarction (MI) presents with a spectrum of symptoms, and diabetic patients often exhibit atypical or less pronounced presentations, which may delay diagnosis and treatment. Understanding the variation in symptomatology between diabetic and non-diabetic patients is essential for timely intervention. Objective: To determine the frequency of various clinical presentations of myocardial infarction and compare symptom patterns between diabetic and non-diabetic patients. Study Design: Cross-sectional observational study. Setting: Cardiology Department, Rehman Medical Institute, Peshawar. Duration of Study: From February 23, 2025, to May 23, 2025. Methods: A total of 164 patients (both diabetic and non-diabetic), aged 35 to 90 years, and diagnosed with MI were included. Clinical symptoms such as chest pain, arm pain, epigastric pain, jaw pain, nausea/vomiting, anxiety, and cold sweats were recorded and compared between the diabetic and non-diabetic groups. Data were analysed using descriptive statistics and Chi-square tests, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 65.7 ± 16.47 years, with males comprising 56.7% of the cohort. Chest pain was the most commonly reported symptom (72%). Diabetic patients had a significantly higher frequency of epigastric pain (16.5%, p = 0.03), anxiety (32.9%, p = 0.01), and cold sweats (43.0%, p = 0.04) compared to non-diabetics. Other symptoms, such as arm pain, jaw pain, and nausea/vomiting, showed no statistically significant differences between the two groups. Conclusion: Chest pain remains the predominant presenting symptom in both diabetic and non-diabetic MI patients. However, diabetic patients are more likely to present with atypical symptoms such as epigastric pain, anxiety, and cold sweats. These findings underscore the need for heightened clinical suspicion and broader diagnostic criteria when assessing diabetic patients for MI.

Exploring the Manifestation of Non-motor Symptoms in Parkinson's Disease in a Tertiary Care Center: A Comprehensive Analysis

Background: Non-motor symptoms (NMS) in Parkinson’s disease (PD) can influence cognition, emotion, sleep, and autonomic systems. NMS frequently precede motor symptoms, underscoring the necessity for a thorough comprehension of these symptoms, especially in heterogeneous populations like India. This study aims to explore the NMS of PD in a cohort from eastern India.Materials and methods: Sixty consecutive patients with PD were enrolled in this study after considering the inclusion and exclusion criteria. Informed consent was obtained from each patient after ethical clearance from the institutional ethics committee. Data were collected by using the standardized Movement Disorder Society Non-Motor Symptoms Rating Scale (MDS-NMS) to assess various NMS. Additionally, the study categorized patients into clinical subtypes based on their predominant symptoms and it analyzed how NMS manifested in each subtype. The correlation between NMS was also assessed.Result: Gastrointestinal (GI) issues were the most common NMS, affecting all 60 (100%) patients. Depression affected 59 (98.33%) patients, followed by anxiety in 57 (95%) patients. Only two (3.33%) patients reported sexual dysfunction, while 55 (91.67%) patients reported pain, and 54 (90%) patients reported cognitive impairment. Constipation was more common among symptoms of the GI domain. Twenty-seven (45%) patients had developed at least one NMS prior to the diagnosis of PD. Younger patients (<60 years) tend to experience more severe emotional symptoms like depression and anxiety. Older patients (60-80 years) showed increasing severity of physical symptoms like pain, fatigue, and GI issues, along with cognitive decline. No statistically significant differences were observed for NMS severity between the akinetic-rigid versus tremor-predominant subtypes of PD.Conclusion: The findings emphasize that NMS are prevalent in nearly all PD patients. Addressing NMS in clinical practice is crucial for improving patient outcomes. Particularly in India, where these symptoms may be underdiagnosed, the study highlights the need for routine screening and management of NMS to enhance overall care strategies for PD patients.

Psychosis with Treatment-resistant Sexual Hallucinations in a Young Adult Female

Abstract Schizophrenia-spectrum disorders can present with varied symptomatology, with sexual hallucinations being a relatively rare symptom. Such hallucinations can also occur due to underlying organic etiology like epilepsy, and it is important to rule out such conditions. Sexual hallucinations are often under-reported due to the stigma attached to such topics, but early diagnosis, and institution of appropriate treatment with antipsychotics, can lead to effective resolution of symptoms. Such symptoms are usually distressing for patients, but can sometimes be pleasurable. The case reported here, is that of a young female, provisionally diagnosed with schizophrenia, with a differential diagnosis of schizoaffective disorder, whose predominant symptoms included sexual hallucinations, sexually inappropriate behavior, and delusions with sexual content, which were mostly pleasurable for her, with only occasional guilt feelings. Although there was an initial good response to olanzapine, subsequently the symptoms became resistant to treatment and ultimately responded to a combination of Clozapine and Lithium.

Multimodal diagnostic approach for identifying Actinomyces odontolyticus pneumonia: a case report and literature review

The emergence of next-generation sequencing (NGS) has significantly improved the detection rate of Actinomyces species in pulmonary actinomycosis (PA), a rare and diagnostically challenging infectious disease. Here, we report a case of an elderly patient with a history of pyoderma gangrenosum who presented with pulmonary infiltrates and was subsequently hospitalized. Both histopathological examination of tracheoscopic biopsy specimens and NGS analysis of bronchoalveolar lavage fluid (BALF) confirmed infection with Actinomyces odontolyticus (A. odontolyticus). The patient exhibited marked clinical and radiological improvement following a period of amoxicillin/clavulanic acid therapy. Additionally, we performed a retrospective analysis of 11 documented cases of A. odontolyticus-associated pneumonia reported between 1978 and 2025. These cases were primarily diagnosed through pathogen culture and histopathology, with most patients demonstrating favorable outcomes following timely intervention. The age distribution of the cohort ranged from 11 to 64 years, with cough, sputum production, and dyspnea being the predominant symptoms. Notably, chest imaging findings varied widely. We anticipate that these findings will enhance clinical awareness of PA, facilitating early detection, accurate diagnosis, and improved patient management. To our knowledge, this represents the first reported case of A. odontolyticus pneumonia diagnosed using a combined NGS and histopathology approach, as well as the largest case series published for this condition.

Inflammation and psychomotor retardation in depression: The moderating role of glymphatic system.

Inflammation and psychomotor retardation in depression: The moderating role of glymphatic system.

Determining the Magnitude of Surgery in Patients With Adult Scoliosis: A Systematic Review of the Role of Limited Fusions.

Study DesignSystematic reviewObjectiveThe role of limited fusions compared with extensive reconstructions of the spine has not been well defined. The objective of this study is to review the current literature and provide evidence-based recommendations regarding the magnitude of surgery for patients with adult scoliosis, including indications and limitations of short-segment (≤3 levels) fusions.MethodsA systematic review of the literature was conducted using PubMed/MEDLINE, Cochrane Library, Ovid and Google-Scholar using the following terms: "adult spinal deformity", "adult scoliosis", "degenerative scoliosis", "scoliosis" together with "spinal fusion", "spinal instrumentation" and "fusion". Inclusion criteria were comparative studies comprised of thoraco-lumbar or lumbo-sacral adult scoliosis treated with short- or long-segment fusion. Other types of deformities were excluded.ResultsOf the 1736 articles identified from initial query, 9 studies comprised of 660 patients with adult scoliosis who underwent a short-segment fusion (SSF, n = 366) or a long-segment fusion (LSF, n = 294) were included and analyzed for clinical and radiographic outcomes. Summative results indicate that patients undergoing SSF have lower complication rates (.21vs .36 complications/patient), lower revision rates (9% vs 28%), and though LSF patients had greater scoliotic curvatures and sagittal imbalance at baseline, both groups had significant clinical improvement after surgery. However, the heterogeneous nature of the published data calls into question the reliability of these summative results.ConclusionsJudicious use of SSF can achieve satisfactory clinical outcomes in carefully-selected patients with adult scoliosis. Factors to consider when selecting patients for SSF include predominant symptoms, patient expectations, comorbidities and spino-pelvic parameters.

Impact of ACE2 and TMPRSS2 Activity on Clinical Manifestations of COVID-19 in Pointe-Noire, Congo

Introduction: The COVID-19 pandemic caused by SARS-CoV-2 exhibits marked clinical heterogeneity, ranging from asymptomatic cases to severe complications. Viral entry depends on ACE2 and TMPRSS2 proteins, whose activity may influence disease progression. Objective: To evaluate the association between ACE2 and TMPRSS2 activity and the severity of COVID-19 clinical manifestations. Methods: A cross-sectional descriptive study included 170 RT-PCR confirmed SARS-CoV-2 patients. Demographic (age, sex) and clinical (symptom) data were extracted from medical records. ACE2 and TMPRSS2 protein activity was measured using immunoenzymatic assays from blood samples. Patients were stratified into moderate and severe forms according to standardized clinical criteria. Results: The average age was 31.7 ± 4.4 years (range 24–68), with a male predominance (78%). Predominant symptoms in severe forms included fever (54.6%), cough (55.6%), and ageusia (56%). A significant correlation was found between ACE2 activity and severe disease forms (p &lt; 0.001). TMPRSS2 activity was also associated with severity, though less prominently (p = 0.029). Conclusion: These findings suggest that ACE2 and TMPRSS2 activity may serve as predictive biomarkers of COVID-19 severity. Quantifying these markers could enable early patient stratification and optimized therapeutic strategies. Prospective studies are needed to validate their clinical utility.

Giant Congenital Hiatal Hernia in a Child – A Rarity

ABSTRACT Congenital paraesophageal hernia is a rare condition in the pediatric population, with giant hiatal hernia (HH) being even more uncommon. We report a case of a 3-year-old male who presented with epigastric pain after meals, recurrent respiratory symptoms, early satiety, and a history of pneumonia. Imaging studies, including a chest X-ray, upper gastrointestinal (UGI) contrast study, and contrast-enhanced computed tomography thorax, confirmed a sliding HH. The laparoscopic evaluation revealed 80% of the stomach herniating into the thoracic cavity through lax esophageal hiatus contained in a sac. The patient underwent UGI endoscopy and laparoscopic reduction of contents, sac excision, diaphragmatic crural repair, and Thal’s anterior fundoplication. Postoperative recovery was uneventful, with the patient remaining asymptomatic on follow-up. Congenital paraesophageal hernias are believed to arise from embryologic abnormalities and often present with atypical symptoms, such as respiratory distress, making early diagnosis challenging. The etiology can be confirmed only after ruling out all the acquired causes of HH. Surgical intervention is the preferred treatment, particularly in cases of giant HH, to prevent complications such as volvulus and obstruction. Adhering to key surgical principles – including complete hernia reduction, crural repair, and an appropriate antireflux procedure – ensures optimal outcomes. This case highlights the rarity of congenital giant HH in children and its unusual presentation with predominant respiratory symptoms. Laparoscopic repair, following established surgical principles, proved to be an effective and minimally invasive approach, leading to a successful outcome.

Lactation abnormality during breastfeeding in a patient with Chanarin-Dorfman syndrome: A new clinical symptom?

Introduction: Chanarin–Dorfman syndrome (CDS) is a rare genetic disorder caused by impaired lipid metabolism, leading to the accumulation of lipid vacuoles in various types of cells. CDS is characterized by multi-organ involvement, most notably non-bullous ichthyosiform erythroderma. Herein, we reported a patient with Chanarin–Dorfman syndrome presenting a new clinical symptom. Case presentation: The case involved a 32-year-old woman with a molecular diagnosis of CDS who exhibited reduced breast milk production during both of her breastfeeding periods. The patient had previously been diagnosed with CDS based on the clinical features and gene sequencing results of a mutation in the abhydrolase domain containing 5 (ABHD5) gene. The patient had experienced two uncomplicated pregnancies and deliveries. Based on laboratory tests and imaging findings, common causes of decreased lactation were ruled out. Discussion: ABHD5 gene encodes a cofactor for adipose triglyceride lipase, which is a member of the patatin-like phospholipase family. While ichthyosis was the predominant symptom of CDS, other common clinical manifestations included hepatomegaly, cataracts, and muscle weakness, among others. Decreased breast milk production is an unusual symptom, which is not be reported by . We explore whether this symptom may be related to a mutation in the abhydrolase domain containing 5 (ABHD5) gene. We propose two possible mechanisms: first, that gene mutation may alter the gene regulation involved in breast milk production, and second, that it may increase the risk of metabolic syndrome, which could impair lactation. Conclusion: This case report provides a unique and noteworthy contribution by identifying a previously unreported clinical manifestation of CDS and suggesting a potential role for the ABHD5 gene in lactation biology. Our findings may have implications for genetic counseling in women with CDS who are planning to have children.

Analysis of the incidence and risk factors of low anterior resection syndrome after radical sphincter-preserving surgery for locally advanced rectal cancer treated with neoadjuvant immunotherapy: a single-center retrospective study

Objective: To explore the impact of neoadjuvant immunotherapy on the occurrence of low anterior resection syndrome (LARS) in patients with locally advanced rectal cancer who underwent restorative anterior resection, and to analyze associated risk factors. Methods: This study was an observational study. Patients with adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma of the rectum located 0-10 cm from the anal verge who received neoadjuvant immunotherapy followed by curative restorative anterior resection at Peking University Cancer Hospital between November 2019 and February 2024 were retrospectively examined. Exclusion criteria were as follows: (1) metastasis detected preoperatively;(2) follow-up <1 year or stoma closure <6 months; (3) local recurrence or metastasis during follow-up; and (4) stoma without closure or stoma re-creation. The Chinese version of the LARS questionnaire was used to assess bowel function by telephone interview, and patients were classified based on score into no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The incidence of LARS, major LARS, and associated risk factors were analyzed. Results: A total of 52 patients (34 men) were included for analysis. Mean age was 58.0 ± 9.8 years and mean body mass index was 25.1 ± 2.6 kg/m2. Median follow-up was 27.5 months (range, 12.0-63.7). Median LARS score was 21 (range, 1-41). Twenty-six patients (50.0%) developed LARS after surgery, and half of these (13 cases) were classified as major LARS. Stool clustering (repeated defecation within 1 hour) was observed in 80.8% (42/52) of patients. Distance between the tumor edge and the dentate line [odds ratio (OR), 3.597; 95% confidence interval (CI), 1.140-11.360; P=0.026], management of the left colic artery (OR, 0.133; 95% CI, 0.026-0.691; P=0.008), and interval of stoma closure (OR, 5.250; 95%CI, 1.381-19.960; P=0.011) were significantly associated with LARS. Interval of stoma closure was significantly associated with major LARS (OR, 4.200; 95%CI, 1.064-16.584; P=0.040). In multivariate logistic regression, ≤3.5 cm between the tumor edge and the dentate line (OR, 7.407; 95%CI, 1.377-40.000; P=0.020), non-preservation of the left colic artery (OR, 8.403; 95%CI, 1.183-58.823; P=0.033) and interval of stoma closure >6 months (OR, 10.865; 95% CI, 2.039-57.896; P=0.005) were independent risk factors for LARS. Interval of stoma closure >6 months (OR, 4.356; 95% CI, 1.105-17.167; P=0.035) were independent risk factors for major LARS. Conclusion: Patients with locally advanced rectal cancer treated with neoadjuvant immunotherapy experienced a high incidence of LARS after curative surgery, with stool clustering as the predominant symptom. Tumor edge-dentate line distance ≤3.5 cm, non-preservation of the left colic artery, and interval of stoma closure >6 months were risk factors for LARS.

Acute respiratory distress syndrome : Pathophysiology, definition and treatment strategies

Acute respiratory distress syndrome (ARDS) is defined as an acute inflammatory syndrome leading to increased pulmonary capillary leakage and subsequent interstitial and alveolar pulmonary edema. Hypoxia is the predominant symptom. The definition of ARDS comprises acute onset, bilateral patchy infiltration on chest X‑ray and areduction of the ratio of arterial partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2), which also determines the classification into mild (≤ 300), moderate (≤ 200) and severe (≤ 100) ARDS. Treating the underlying cause is the only causal treatment measure. The aim of adjunctive therapy is the maintenance of life or organ functions by ensuring an adequate gas exchange without further damaging the lungs. Adjunctive therapy consists mainly of individually adapted "protective" ventilation treatment and the prone position. In severest ARDS, the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) can improve survival if strict criteria for indications and contraindications are followed.

Persistence of nocturia after BPH surgery: a multicenter study.

Nocturia may be one of the most persistent and bothersome lower urinary tract symptoms (LUTS) in men treated for benign prostatic obstruction (BPO). This study aimed to evaluate the evolution of nocturia after endoscopic enucleation of the prostate (EEP) and identify predictors of no postoperative improvement. We conducted a multicenter retrospective study of 120 men who underwent EEP for LUTS/BPO and nocturia evaluation using voiding diaries. Patients with isolated nocturia were not considered for surgery. Outcomes were categorized into complete remission, partial improvement, stability, or worsening. At a median follow-up of 15 months, 45% of patients achieved complete remission of nocturia, 19% experienced partial improvement, 30% remained stable, and 6% worsened. The median time for improvement was 6 months. Cox regression analysis identified predominant overactive bladder symptoms as the only significant predictor of no response (HR 1.68; 95% CI, 1.01-2.82; p = 0.04). No significant association was found with age, body mass index, prostate volume, or cardiometabolic comorbidities. This multicenter study highlights that while nocturia often persists after EEP, nearly two-thirds of patients experience meaningful improvement, emphasizing both the potential benefit of surgery and the multifactorial nature of the symptom.

Top ten causes of non-arthritic hip pain: A comprehensive review.

Hip pain in young patients is a common complaint that can pose diagnostic challenges. Clinical evaluation of hip pain requires strong foundational knowledge of relevant anatomy, careful history-taking, focused physical examination, and appropriate imaging techniques. Rapid advancements in hip arthroscopy techniques over the past decade has made it an essential tool in assessing and managing hip pain. This article aims to provide an evidence-based update on ten common causes of non-arthritic hip pain. These causes are categorized into three groups based on predominant symptom location to facilitate the readers' understanding and enhance evaluation of hip pain in the clinical setting. Each condition is discussed with an overview of relevant anatomy, clinical features and evaluation methods, as well as management strategies, emphasizing arthroscopic techniques where applicable.

Abdominal tuberculosis in children: a systematic review on current advances.

To study the published literature on abdominal tuberculosis in children in the last 10years. A PubMed search was done on 27th March 2025 with keywords "pediatric abdominal tuberculosis", using the filter of last 10years. The articles were screened for relevance and the data were compiled on gender, age, presenting complaints, diagnosing criteria, associated pathologies, surgical management, complications and outcomes. The search yielded 194 articles. After screening for relevance, 143 articles were excluded. 51 articles were studied. A total of 807 cases were studied in 51 articles, with female preponderance. The largest series was of 218 children. The age was predominantly in the adolescent period. The youngest child was an 8-day neonate with congenital tuberculosis. Predominant symptoms included fever, pain abdomen, abdominal distension, constipation, diarrhea, ascites and weight loss. Unusual presentations included splenic microabscess, liver abscess in HIV positive cases, deep vein thrombosis, mesenteric artery stenosis and intracranial sinus thrombosis. Mycobacterial cultures showed 50-75% positivity. Concomitant pulmonary tuberculosis was reported in 6 studies. The management included medical with or without surgical management. The main indication for surgical management was intestinal perforation. Pediatric abdominal tuberculosis is an enigma due to the vague symptoms and needs to be differentiated from other conditions.

Treatment of Central Neurocytoma.

Objective: Central neurocytomas (CNs), classified as CNS (central nervous system) grade 2 tumors, are exceptionally rare tumors, accounting for approximately 0.1-0.5% of all intracranial neoplasms, and are typically characterized by a benign clinical course and frequent association with hydrocephalus. This study aims to present a comprehensive analysis of surgical and adjuvant therapies for CN. Methods: The study comprised all patients who underwent microsurgical tumor removal in our center over the past decade (2013-2023). Clinical manifestations, surgical and adjuvant therapy approaches, MRI and histological findings, clinical outcomes, and recurrence-free survival were evaluated. Results: A total of eleven patients (six men, mean age of 28.0 years; five women, mean age of 53.6 years) underwent surgical treatment. Intraventricular tumors were the most common (72.7%, n = 8). The predominant presenting symptoms were headache and visual disturbances. All tumors exhibited contrast enhancement on MRI. Hydrocephalus was present in five patients. The Ki67 proliferation index ranged from 2% to 10%, with nine patients exhibiting Ki67 > 3%. The median recurrence-free survival was 38.0 months (IQR: 25.0-53.0). The most severe postoperative complications included aphasia, hemiparesis, and memory impairment, resulting in a postoperative Karnofsky Performance Status (KPS) below 70% in five patients. Follow-up assessments showed significant symptomatic improvement in all affected patients. Conclusions: Gross total resection is the recommended first-line therapy with favorable neurological outcomes and for atypical CN as well. Adjuvant radiotherapy should be reserved for tumor progression and recurrence. The role of adjuvant chemotherapy remains unclear, but it may be an option for CN with a high proliferation index.

Surgical removal of ingested magnets in children: A retrospective clinical analysis of 16 patients and review of the literature

Foreign body ingestion is a common pediatric emergency. Notably, the inadvertent ingestion of magnets is frequently initially asymptomatic, only to be detected days later when gastrointestinal damage has already manifested. We conducted a retrospective review of the medical records of 16 pediatric patients who underwent surgical removal of ingested magnets at our hospital between January 2018 and December 2023. This review encompassed the patients’ demographic characteristics, the interval from ingestion to admission, clinical presentation, diagnostic techniques, the type and number of ingested magnets, location of injury, surgical interventions, and postoperative outcomes. The study sample comprised 11 boys and 5 girls, with a median age of 3.6 years (range, 1–14 years). The predominant presenting symptoms were abdominal pain (n = 6), abdominal pain accompanied by vomiting (n = 3), and a combination of fever, diarrhea, and seizure (n = 1); 6 patients were asymptomatic. Neodymium bead magnets were the most commonly ingested type, noted in 13 patients. All 16 patients underwent either laparoscopic exploration or laparotomy due to clinical deterioration or confirmed complications. For 13 patients, magnet removal with primary bowel repair was performed, whereas in 3 patients, magnet removal combined with segmental resection and primary bowel repair was necessary. Fifteen of the 16 patients recovered without complications; however, wound infections occurred in 2 patients, and 1 patient required adhesiolysis and segmental resection of the jejunum due to intestinal obstruction. One patient died of septic shock. The 15 surviving patients are currently in excellent condition. Magnet ingestion by children, particularly when multiple magnets are involved, constitutes a surgical emergency. Timely identification and prompt surgical intervention are critical to preventing severe complications. Improved educational and preventive strategies (including public awareness initiatives regarding the hazards of small magnets) are essential to reducing the frequency of these incidents.

Patterns of Respiratory Symptoms and Asthma Diagnosis in School-Age Children: Three Birth Cohorts.

Many studies used information on wheeze presence/absence to determine asthma-related phenotypes. We investigated whether clinically intuitive asthma subtypes can be identified by applying data-driven semi-supervised techniques to information on frequency and triggers of different respiratory symptoms. Partitioning Around Medoids clustering was applied to data on multiple symptoms and their triggers in school-age children from three birth cohorts: MAAS (n = 947, age 8 years), SEATON (n = 763, age 10) and ASHFORD (n = 584, age 8). 'Guided' clustering, incorporating asthma diagnosis, was used to select the optimal number of clusters. Five-cluster solution was optimal. Based on their clinical characteristics, including frequency of asthma diagnosis, we interpreted one cluster as 'Healthy'. Two clusters were characterised by high asthma prevalence (95.89% and 78.13%). We assigned children with asthma in these two clusters as 'persistent, multiple-trigger, more severe' (PMTS) and 'persistent, triggered by infection, milder' (PIM). Children with asthma in the remaining two clusters were assigned as 'mild-remitting wheeze' (MRW) and 'post-bronchiolitis resolving asthma' (PBRA). PBRA was associated with RSV bronchiolitis in infancy. In most children with asthma in this cluster wheezing resolved by age 5-6, and predominant symptoms were shortness of breath and chest tightness. Children in PBRA had the highest hospitalisation rates and wheeze exacerbations in infancy. From age 8 years (cluster derivation) to early adulthood (18-20 years), lung function was significantly lower, and FeNO and airway hyperreactivity significantly higher in PMTS compared to all other clusters. Patterns of coexisting symptoms identified by semi-supervised data-driven methods may reflect pathophysiological mechanisms of distinct subtypes of childhood wheezing disorders.

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure.

Acute heart failure is the most common cause of hospital admission in patients aged > 65 years, with congestion being the predominant symptom. It is widely known that congestion is the main cause of readmission and its association with poor outcomes. This study aimed to determine the cutoff value of the phase angle using bioelectrical impedance analysis in the first 24 h after admission for the prediction of in-hospital mortality and all-cause mortality or rehospitalization 90 day post discharge in patients with acute heart failure. The dataset analyzed for this protocol included 219 patients who presented to the emergency department with acute heart failure, of whom 115 died during hospitalization, 90 days post discharge, or were readmitted during the same period. Through univariable analysis using Cox proportional hazards regression analysis, potential predictors were identified, and a multivariable Cox proportional hazard model was used to identify the significant prognostic factors associated with patient survival and to control for confounding variables. Analysis of the phase angle adjusted by different predictors using restricted cubic splines revealed that lower values were directly associated with the risk of 90 day readmission or death post discharge, particularly when the cutoff value of PhA was <4.0°. All developed models showed moderate discriminatory ability (C-statistic < 0.80); however, the in-hospital mortality model demonstrated the highest discrimination ability (C-statistic, 0.75).

The many faces of ovarian sex cord stromal tumors: a clinicopathological analysis at a tertiary cancer center in North India

BackgroundOvarian sex cord-stromal tumors (OSCSTs) represent a rare and heterogeneous group of neoplasms originating from the ovarian sex cords and stroma. These tumors account for approximately 5–7% of all ovarian cancers. They encompass a diverse array of histopathological subtypes and exhibit significant histomorphological diversity, which underpins their varied clinical presentations and biological behaviors. The authors embarked on this study to chronicle the clinical presentation, the myriad histologic miens of OSCSTs, the associated diagnostic pitfalls and utilitarian pearls, treatment strategies, and outcomes of these patients.MethodsA retrospective analysis was conducted on patients diagnosed with OSCSTs at a tertiary cancer care center in North India from July 2019 to June 2023, over a period of 4 years, with due approval from the Institutional Ethics Committee.ResultsThirty-five patients with OSCSTs were identified, affecting 88.6% adults and 11.4% children or adolescents. The predominant symptoms were abdominal pain (65.7%) and distension (42.8%). Bilateral ovarian involvement was ascertained in 42.8% of cases, and metastasis was detected in 34%, predominantly in the omentum/peritoneum. The most common histological type was adult granulosa cell tumors, followed by fibromas, Sertoli-Leydig cell tumors, juvenile granulosa cell tumors, and steroid cell tumors. These tumors manifested a confounding variety of histomorphologic facets, resulting in consideration of wide-ranging differential diagnoses. Early-stage (stage I) disease was diagnosed in 57.7% of cases, while 42.3% presented at advanced stages (stages III and IV). There were no significant differences in histopathological features across the stages; however, higher stages correlated significantly with disease progression. Over a median follow-up period of 36 months, the overall 5-year survival rate was 95.5% ± 4.4%, with a mean survival time of 66.2 months.ConclusionOSCSTs exhibit a wide range of histopathological features and predominantly present at an early stage, with a high overall 5-year survival rate. However, advanced-stage OSCSTs can behave erratically clinically, necessitating the prediction of such occurrences. Pathologists must be conversant with the histologic diversity and be vigilant in avoiding misdiagnosis. The role of a multidisciplinary focus on developing efficacious models for risk assessment stratification cannot be overemphasized.

Polyserositis in Dengue Fever: Its prevalence and Association with Clinical and Laboratory Parameters in a Tertiary Care Hospital

Dengue fever is an emerging public health problem in a large endemic population in tropical and sub-tropical areas of the world. This study was aimed at analyzing the prevalence and association of clinical and laboratory parameters in dengue fever. Total 439 fever cases were screened out of which 176 were detected to have dengue infection. The mean age of the study participants was 32.9 ± 12.5 years. In our study we detected serous cavity involvement in 152 patients and in this group 110 (62.5%) patients had single serous cavity involvement which was either pleural cavity or peritoneal cavity and 42 (23.9%) had polyserositis. 24 patients had no involvement of the serous cavity. We observed that haemoglobin level, blood urea and Packed cell volume was notably higher and platelets were low in patients with polyserositis. While fever was the predominant symptom, there were atypical presentations, such as diarrhoea. This study helps in comprehensive understanding of the normal and atypical clinical symptoms, as well as the potential consequences of dengue and its significance on serositis, which is crucial for prompt diagnosis and effective treatment.