Male Preponderance Research Articles

Evaluation of Simplified Geboes Score in Ulcerative Colitis

Background: Ulcerative colitis (UC) is a chronic inflammatory disease of unknown etiology characterized by a relapsing and remitting course. Assessment of disease activity is based on combination of clinical features, endoscopic scoring and histological scoring. Over the years, Histological healing has replaced mucosal healing as the therapeutic endpoint in UC. Various histological parameters have their own significance in predicting treatment outcomes and prognosis. Many histologic scoring systems have been proposed with one such validated score being Geboes score. However, in view of its complexity to use the Simplified Geboes Score (SGS) was developed in 2016. Aim & Objectives: To assess the interobserver agreement of SGS in ulcerative colitis. Methods: This was retrospective study of 6 years duration. Relevant clinical and endoscopic details were documented. 41 cases of UC were included in the study. The SGS scoring was done by two pathologists independently. Agreement for individual grades of SGS and for the detection of Histologic activity (score >3.1) was compared between both pathologists using Cohen’s kappa coefficient. Results: Majority of the patients were in the age group of 15-72 years with male preponderance. Left sided colon was more commonly involved with loose stools being most common symptom. Cohen’s test showed moderate to good agreement for individual grades and good agreement for Histologic activity. Conclusion: The SGS is simple to use and shows good interobserver agreement for histological activity and moderate to good agreement for individual parameter. Therefore, it can be adopted for routine reporting of all biopsies in ulcerative colitis. Keywords: Histological healing, Mucosal healing, Simplified Geboes Score, Ulcerative colitis

Etiological Assessment of Splenomegaly by Clinical and Laboratory Methods in Paediatric Age Group (3 Months To 18 Years)

Introduction: Splenomegaly is the enlargement of spleen. Splenomegaly is a sign seen in various disease processes in infants and children. So, an attempt was made in the present study to know the various etiological factors and clinical features and clinical outcome of splenomegaly in the cases admitted in Prathima institute of medical sciences, Nagunoor, KarimnagarAim and objectives: 1. To establish the possible etiology of Splenomegaly in children by clinical and laboratory methods.Material and methods: 100 children from 3 months to 18years, with varying grades of Splenomegaly of different etiologies, admitted to paediatric wards of Prathima Institute of Medical Sciences, Karimnagar were studied in this observational study between Decembers 2015 to November 2017. Detailed study of each case including history, thorough physical examination and necessary investigations were done to reach the diagnosis.Results: Male preponderance was seen in present study. Maximum incidence of Splenomegaly was seen between 3 months to 6 years age group (62%). Majority of the cases had moderate Splenomegaly (62%). Fever was the most common presenting feature associated with Splenomegaly. Hepatomegaly was the most common association with Splenomegaly. Infections (42%) were the most common cause of Splenomegaly, followed by hematologic (25%) causes.Conclusions: Infections was the most common cause of Splenomegaly in present study. Male preponderance was seen; majority of cases had moderate Splenomegaly and belonged to preschool age group.

A Clinico-pathological Study and Management of Fungal Rhinosinusitis

Background: Fungi are ubiquitous in the environment; hence we are constantly exposed to them. Objectives were to know the clinical presentation, radiological and pathological characteristics and management aspects of fungal rhinosinusitis.Methods: 30 cases of fungal rhinosinusitis reported during study period were evaluated and data was collected through history taking, clinical examination, haematological, histopathological and radiological investigations. Management by surgical & medical modalities were evaluated.Results: Fungal rhinosinusitis is more common in 3rd decade of life with male preponderance and more in low socio-economic status (73.3%). Nasal discharge (100%), nasal obstruction (96.7%), chronic headache (90%) and visual disturbances (23.3%) were important clinical features. Sinu-nasal polyp (66.7%) and allergic mucin (40%) were important associated factors. Orbital extension was seen in 33.3%, intracranial extension (20%) and extension to hard palate (6.7%). Computed Tomography scan had a sensitivity of 56.7% while histopathology and potassium hydroxide mount had a sensitivity of 93.33% in detecting cases. Observed mortality rate was 16.6%.Conclusion: Fungal rhinosinusitis is an important clinical entity which must be considered in all patientspresenting with unresolving rhinosinusitis

Clinico-radiological correlation with outcome in acute epidural haematoma: a tertiary centre experience from Nepal.

Epidural haematoma (EDH) accounts for up to 15% of severe traumatic brain injury (TBI) cases and remains the most common cause of mortality and disability. Several clinical and radiological factors affect patient outcomes. This study aims to correlate patients' clinical and radiological profiles with acute EDH outcomes. A retrospective, single-centred, consecutive case series was conducted on the patients diagnosed with an acute EDH admitted to Tribhuvan University Teaching Hospital (TUTH) between May 2019 and April 2023. The modified Rankin scale (mRS) was used to assess the outcome. Univariate analysis and Kruskal-Wallis H test with Dunn-Bonferroni post-hoc test was conducted. There were 107 patients diagnosed with EDH, of which 52.3% were less than 20 years old with male preponderance. Falls were the most common mechanism of injury (64.5%), and most cases were referred to, not brought directly. The majority had a GCS score greater than or equal to 13 (85%) at presentation, and only 5.5% had a GCS score less than or equal to 8. According to the mRS, most patients had favourable outcomes, with 88.7% having no significant disability and 11.3% having a slight disability. This case series is the largest and most recent report from Nepal and demonstrated that GCS, pupillary response, skull fracture, neurological symptoms, pre-hospital and intra-hospital delay, and management modalities are critical factors in determining the total hospital and ICU stay but did not have an impact on the mRS scores.

Laser Lithotripsy for the Management of Ureteric Calculus

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Patterns of computed tomography imaging findings in patients diagnosed with cerebrovascular accident in Nigeria: a single center study

Background: Stroke is a major challenge to physicians worldwide, with high incidence, mortality, disability rates, and costs. This study was designed to evaluate the patterns of computed tomography imaging findings in patients diagnosed with cerebrovascular accident in Nigeria. Materials and methods: A cross-sectional retrospective study design was adopted to select 320 patients with stroke who underwent CT imaging at a radiological facility in Ibadan, Nigeria. Data such as CT imaging findings in CVA, age and gender of the patients were collected from the CT radiological reports archive for cases done from January 2023 to October 2023. Results: Males were highest 208(65%) and the majority 104(32%) were within the age group of 60-69years. Based on CT findings, the majority 180(56.3%) was haemorrhage and the least 20 (6.3%) was transient ischemic attack. Out of 120 cases of infarcts, 27 (22.5%) were female and males were 110 (61.1%) out of 180 cases of haemorrhagic CVA. Conclusion: Male preponderance was noted in this study. Older adults were commonly affected and haemorrhagic CVA was the commonest CT imaging finding. Improving access to health care for males, and increasing screening and early detection of CVA, could also help to reduce the gender disparity

Clinicopathological Study of Helicobactor Pylori Infection and Gastric Carcinoma at a Tertiary Care Hospital in Kathmandu

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Trends in immunological markers of transfusion transmissible infections among blood donors in Mamfe District Hospital, Southwest Cameroon

BackgroundBlood transfusion is associated with exposure to blood Transfusion Transmissible Infection (TTIs). The threat posed by the blood-borne pathogens is disproportionately distributed in different healthcare facilities in Cameroon. Thus, there is a need for continuous surveillance of TTIs in the country. This study aimed to assess the screening procedure for blood transfusion and determine the trend in immunological markers of TTIs among blood donors at the Mamfe District Hospital.MethodsA prospective descriptive, cross-sectional and analytical study was conducted at Mamfe District Hospital from March to May 2022. A total of 165 blood donors were recruited by the consecutive sampling method. Donors were screened using both Rapid diagnostic tests,T. pallidum haemagglutination test and indirect enzyme-linked immunosorbent assay (ELISA) for the detection of TTIs. Data generated was entered into an Excel spreadsheet and analysed using the statistical software R, version 4.2.0. Statistical analysis included descriptive statistics of percentages, means ± standard deviation, and student t-test was used to compare both diagnostic techniques, and was considered significant when p < 0.05.ResultsA hundred and sixty-five donors were enrolled in the study with a male preponderance giving a male-female sex ratio of 22.5 and a mean age of 32.23 ± 8.60 years. The majority (75.2%) of the donors were of the O-positive blood type, repeat donors (69.1%) and were mainly family replacement and paid donors as against the voluntary blood donors (39.4% and 37.0% vs. 23.6% respectively). overall TTIs prevalence was 18.78% (31/165) (), with HBsAg being the most predominant marker at 12.12% (20/165) followed by Treponema pallidum, HCV and HIV antibodies at 4.85 (8/165), 1.21%(2/165), 0.60% (1/165) respectively. Except for the HBV, The prevalence of TTIs was higher when using a single RDT than the ELISA test, and the difference was significant (p < 0.05).ConclusionBloodborne pathogens remain a major menace to safe blood transfusion practice in Mamfe district hospital and their detection could be easily missed if the RDT method alone is used for donor screening. Therefore, the donor screening protocol in Mamfe District Hospital should systematically incorporate a confirmation diagnostic test such as ELISA.

Nasal cavity extramedullary plasmacytoma: literature review and clinical experience

Abstract BACKGROUND. Extramedullary plasmacytoma is an extremely rare solitary plasma cell neoplasm that occurs in locations other than bone, without involving the bone marrow. It is commonly located in the upper aerodigestive tract. In the head and neck region, the most frequent location is the sinonasal region. MATERIAL AND METHODS. A systemic review in accordance with the PRISMA guidelines was done with research works in PubMed, Elsevier database, Cochrane library, Web of Science, Scopus, Crossref and Google Scholar. The search was carried out using the keywords “plasmacytoma and nose”, “extramedullary plasmacytoma”, “extramedullary plasmacytoma of nose”, “plasmacytoma and nasal cavity”, and “extramedullary plasmacytoma of nasal cavity”. RESULTS. We analysed 27 research works with a total number of 32 cases. The most common presenting symptoms were nasal cavity bleeding. The disease showed a male preponderance (78.1%). Bone erosion was seen in 7 cases. The histopathological examination showed plasma cells arranged predominantly as a uniform population or sheet-like appearance. A common immunohistochemical marker was CD138 (11 cases). Treatment was primarily radiotherapy (43.7%). We are also reporting a case of a 53-year-old male with plasmacytoma of the middle turbinate managed by wide resection and postoperative radiotherapy. CONCLUSION. Though a less common condition, in a case of polypoidal-like lesion with bleeding tendency, the clinician should keep in mind the possibility of extramedullary plasmacytoma. The diagnosis is made with histopathological examination and immunohisto-chemistry of the tissue involved. Treatment can be radiotherapy, surgery, or a combination of modalities.

Prevalence, Pattern and Factors Associated with Developmental Delay amongst Under-5 Children in Nigeria: Evidence from Multiple Indicator Cluster Survey 2011-2017.

Children develop dynamically, and when a child fails to reach age-appropriate developmental milestones compared to their peers, it is considered a developmental delay. In developing nations like Nigeria, several demographics, socioeconomic, childcare and external factors may influence the highly individualised process. This study assessed the prevalence and pattern of developmental delay, across Nigeria's geopolitical zones including identified factors associated with developmental delay, providing insight for appropriate interventions to prevent disability in affected children. This was a secondary analysis of data from the Multiple Indicator Cluster Survey (MICS), which was carried out in rounds 4 (2011) and 5 (2016/2017). Every 5 years, the UNICEF-supported MICS cross-sectional household survey is carried out using the cluster sampling method. A semi-structured, questionnaire administered by the interviewer was used to obtain individual and household-level data. This study comprised a weighted sample of 17,373 under-5 children who had complete data from both survey rounds on characteristics deemed significant for the study. Data were analysed using SPSS version 23. Using the Chi-square test and multivariate binomial logistic regression, factors linked to developmental delay were identified, with 95% confidence intervals (CIs) provided and the significance level set at 5%. The mean age and sex distribution of the children surveyed in both rounds was comparable, with a male preponderance of 51.2% in round 4 and 50.4% in round 5. In both round 4 (51.2%) and round 5 (49.0%), the Northeast zone had the highest prevalence of overall developmental delay while the least prevalence was seen in the Southwest zone (20.3%) and the Southeast zone (14.7%) in round 4 and round 5, respectively. Across all the zones, delay in the literacy-numeracy domain of development was the most prevalent, with the highest (91.3% and 86.7%, respectively) in the Northeast zone during both rounds of the survey. Delay in the physical domain was, however, the least prevalent form of developmental delay across the zones, with the least in South South (20.6%) and Southeast (5.4%) in rounds 4 and 5. The odds of developmental delay were 1.5 and 1.7 times higher amongst children 4 years old than 3 years old in both rounds of the survey. The likelihood of having developmental delay was found to increase with the severity of stunting amongst the children during both rounds of the survey (odds ratio [OR] =1.5; 95% CI = 1.20-1.78 in round 4 and OR = 1.4; 95% CI = 1.16-1.58 in round 5). Children from the poorest wealth index had higher odds of developmental delay (OR = 5.8; 95% CI = 4.92-6.82 in round 4 and OR = 2.5; 95% CI = 1.99-3.10 in round 5). The prevalence of developmental delay is high across all zones; however, the burden varies amongst them. The age of the child, nutritional status and wealth index were indicators of developmental delay in Nigerian under-5 children. This underscores the need for surveillance and interventions focussed on improving child literacy, nutritional status and household standard of living across the zones.

Prospective study of coagulation parameters in septicemic patients

Background and objectives. Sepsis is a critical clinical syndrome characterized by a systemic host response to infection, often leading to organ dysfunction and mortality. The association between early onset coagulopathy and mortality risk in septicemic patients remains an area of active investigation. This study aims to assess the association between early onset coagulopathy and increased mortality risk in septicemic patients. It also seeks to explore the role of procalcitonin (PCT) levels and demographic factors in the prognosis of septicemia. Material and methods. A cross-sectional study was conducted at Saveetha Medical College and Hospital, including 240 subjects who met the inclusion criteria. Patients were evaluated for the presence of coagulopathy (assessed by platelet count, INR, and aPTT values) and their PCT levels within 48 hours of admission. Data on demographic characteristics, underlying illnesses, and 28-day mortality were collected and analyzed. Results. The study population had a male preponderance (53.3%) with a mean age of 56.27 years. Diabetes mellitus was the most common underlying illness (32.5%). Coagulopathy was observed in 52.5% of patients, with thrombocytopenia and deranged INR and aPTT being significant indicators. Patients with life-threatening thrombocytopenia, severe PT-INR, and aPTT derangements showed high mortality rates (100%, 92.4%, and 90%-95.6% respectively). Mortality was significantly associated with coagulopathy and elevated PCT levels (&gt;10.0 ng/ml), with 41.7% of subjects dying within 28 days of admission. Conclusions. Early onset coagulopathy is significantly associated with increased mortality in septicemic patients, highlighting the importance of coagulation parameters and PCT levels in predicting outcomes indicating prompt recognition and management of coagulopathy in septicemia, especially in younger patients and those with elevated PCT levels.

Interpretation of Platelet Histograms and Their Correlation with Peripheral Smear in Data Showing Thrombocytopenia

Objective: To analyze the significance of platelet histograms and peripheral smears in understanding thrombocytopenia and compare them for the incidence of pseudothrombocytopenia.Methods: This prospective study was conducted in the Department of Pathology at a tertiary care medical institute. The study included 200 cases of thrombocytopenia. Platelet parameters (PCT, PDW, MPV) were obtained using an autoanalyzer, and peripheral smears were examined manually. Thrombocytopenia cases were classified into hyper-destructive, hypo-productive, and abnormal pooling categories based on etiology and platelet histogram patterns. The incidence of pseudothrombocytopenia was also compared. A P value of less than 0.05 was considered statistically significant. Results: The gender distribution showed a male preponderance (56% male, 44% female). The mean age of the patients was 26.8 years. The study found hyper-destructive thrombocytopenia to be the most common type, with viral fever, sepsis, and malaria being the common etiologies for this type of thrombocytopenia. Histogram analysis revealed distinct patterns for different types of thrombocytopenia. The study also noted a higher incidence of pseudothrombocytopenia in automated analysis compared to manual methods, with a statistically significant difference.Conclusion: Platelet histograms combined with peripheral smear analysis provide crucial information about the etiology and nature of thrombocytopenia. This integrated approach enhances diagnostic accuracy and aid in effective patient management.

Galactomannan Antigen Assay for the Diagnosis of Invasive Aspergillosis: A Study from a Tertiary Care Hospital of Central India

Invasive Aspergillosis (IA) is a severe and fatal infection, especially in immunocompromised patients. Galactomannan is a polysaccharide antigen present in the cell wall of Aspergillus species, which is secreted into the blood and other body fluids during hyphal growth. Therefore, detecting galactomannan antigen is very useful in diagnosing IA, along with clinical features and radiological findings. The study period was one year (January 2022 to December 2022). The data was collected retrospectively from the medical records and case sheets of all clinically suspected invasive aspergillosis patients. Galactomannan antigen assay was performed using an FDA-approved Platelia Aspergillus EIA test kit, and results were interpreted according to the manufacturer’s instructions (Cut off &gt; 0.5). A total of 236 clinically suspected Invasive Aspergillosis cases were enrolled in the study. Galactomannan positivity was predominantly seen in patients aged 40 – 60 years, with male preponderance. Of 236 patients, 14.40% were immunocompromised, and 85.59% were immunocompetent. According to EORTC/MSG definitions, we got one proven IA case, 21 probable cases (8.89%), and nine (3.81%) possible cases. In immunocompetent individuals also, we observed 48.72% (115/236) galactomannan positivity, especially in old Pulmonary Tuberculosis (PTB) patients. Galactomannan positivity was higher in Broncho alveolar lavage (BAL) samples (n=70, 85.36%) than in serum samples (n=77, 46.67%). We found culture positivity of 14.06%, with Aspergillus fumigatus being the commonest isolate, followed by Aspergillus flavus. There is increased positivity of galactomannan in BAL samples compared to serum; hence BAL is a better specimen for diagnosis of Invasive Pulmonary Aspergillosis (IPA).

Treatment of basilar artery aneurysms with two braided stents: Two centers experience of low-profile visualized intraluminal support stents versus Pipeline flow diverters.

Both low-profile visualized intraluminal support (LVIS)stents and Pipeline flow diverters (FDs) are therapeutic strategies for basilar artery (BA) aneurysms, but they have not been directly compared. A total of 132 consecutive patients with 139 BA aneurysms treated with either LVIS stent or Pipeline FDs were analyzed. Propensity score matching (PSM) was used to control for age, sex, hypertension, aneurysm size, shape, location, and duration of follow-up. The treatment results of these two braided stents were compared. LVIS stent was placed in 88 (63.3%) and Pipeline FDs in 51 (36.7%) procedures. Patients with Pipeline FDs tended to be younger and have less hypertension, whereas aneurysms had larger aneurysm size. After PSM, similar complete or near-complete occlusion rates (76.7% vs 73.3%, p = .766) and favorable functional outcomes (86.7% vs 90.0%, p = 1) were achieved in patients treated with LVIS stents and Pipeline FDs, respectively. Further comparisons were conducted at three different locations (basilar apex/basilar trunk/vertebrobasilar artery junction [VBJ]) separately, and the results showed a higher complete or near-complete aneurysm occlusion rate after Pipeline FD treatment than LVIS treatment (86.7% vs 59.2%, p = .012) only at VBJ, where a particularly high proportion of non-saccular shape (70.9%) and a male preponderance were noted. Both braided stents were effective in the treatment of BA aneurysms, with good occlusion rates and favorable functional outcomes. Pipeline FD achieved a particularly higher aneurysm occlusion rate than LVIS stent at VBJ, where lesions often require reconstruction of the diseased vessel.

Abstract 3832: Fluid-overload associated large B-cell lymphoma and determinants of outcomes: Analysis of a pooled database

Abstract Background: Fluid overload-associated large B-cell lymphoma (FOLBCL) is a new WHO lymphoma entity previously known as PEL-like lymphoma or HHV8-unrelated PEL-like lymphoma. It is a rare lymphoma that arises within fluid-filled body cavities without a solid component. FOLBCL occurs in the absence of immunodeficiency and is commonly associated with conditions associated with fluid overload. It expresses mature B-cell phenotype and occasional EBV infection markers. We conducted this study to delineate key clinicopathological characteristics, prognostic indicators, and treatment modalities that affect outcomes in this rare and newly defined lymphoma subtype. Materials &amp; Methods: To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 115 cases that fit the diagnostic criteria for FOLBCL. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: A total of 115 patients with confirmed FOLBCL were identified. The median age was 74, with a peak incidence between 72 and 82 years. There was a male preponderance with M:F of 2. The pleural, pericardial, and peritoneal cavities were involved in 75%, 34, and 27%. The median duration of symptoms before diagnosis was 1 month. Patients presented with constitutional symptoms and hepatosplenomegaly in 13% and 1%, respectively—no patients presented with lymph node and bone marrow involvement. The median OS of the whole group was 16 months. Patients younger than 70 had better median OS than 70 and older (24 vs. 10 months, p=0.008). The presence of any malignant peritoneal effusion was associated with worse OS when compared to effusion limited to the thoracic cavity (7 vs. 24 months, p=0.005). LDH&amp;gt;500 was also associated with worse OS (p=0.02). Sex, the presence of fluid overload-causing conditions, and serum IL2R levels did not seem to impact OS. MYC re-arrangement had numerically worse OS when present but did not reach statistical significance. Chemotherapy demonstrated superior OS compared to no treatment (24 vs. 7 months, p=0.009). Patients who attained CR as their best response had a superior median OS (p&amp;lt;0.0001). Conclusion: This study presents updated clinicopathologic data from a pooled cohort of patients with FOLBCL. It identifies the age, the primary location of cavitary disease, LDH, active therapy, and quality of response to treatment as key determinants of OS. Citation Format: Philip A. Haddad, Supriya Gupta, Christopher Graham. Fluid-overload associated large B-cell lymphoma and determinants of outcomes: Analysis of a pooled database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3832.

Abstract 3835: Clinicopathologic determinants of survival in malignant histiocytic neoplasms: Analysis of a pooled database

Abstract Background: Malignant histiocytosis, also known as the M-group per the Histiocyte Society classification, represents a rare, aggressive malignant group of histiocytic neoplasms. It includes histiocytic neoplasms that occur de novo (pMHN) and those that develop in association with other malignant diseases (aMHN). However, little is known about factors that impact MHN clinical outcomes. We conducted this pooled database analysis to delineate key clinicopathological characteristics, prognostic indicators, and treatment modalities that affect survival in these rare diseases. Methods: To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 281 cases of MHN. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: A total of 281 patients with confirmed MHN were identified, with 77% pMHN and 23% aMHN. The median age was 45, with bimodal peaks between 0-13 and 52-65. There was a male preponderance with M:F of 1.6. Primary sites of involvement were liver (15%), CNS and spleen (13% each), thoracic, GI, and soft tissues (12% each), bones (11%), skin (10%), H&amp;N (8%), and breast, heart, gonads, pancreas, and kidney (1% each). Lymphadenopathy and bone marrow (BM) were involved in 28% and 18%, respectively. Constitutional symptoms occurred in 12% and hemophagocytic syndrome (HPS) in 6%. The median OS of the whole group was 12 months. BM involvement had a worse median OS (5 vs. 60 months, p=0.0002). Stage 1 disease had better median OS than higher stages (p=0.0008). Furthermore, unifocal had better median OS than multifocal/multicentric disease (60 vs. 7 months, p=0.0001). The presence of inflammatory background positively impacted OS (p=0.01). The occurrence of HPS adversely affected OS (p&amp;lt;0.0001). Compared to no treatment, localized therapies such as surgery (S) and/or radiation therapy (RT) and systemic combination chemotherapy (CT) were statistically superior, with a median OS of 3, 24, and 16 months, respectively (p=0.009). Among systemic therapies, SCT and BRAF/MEK inhibitors were superior to conventional chemotherapy (p=0.02). Having CNS or splenic-lymphatic primary involvement tended to have a numerical but non-significant worse median OS than soft tissue or visceral disease. While female sex, size&amp;lt;10cm, and pMHN seemed to have numerically better OS, they did not reach statistical significance. There was no difference in median OS for age. Conclusion: This study presents updated clinicopathologic data from a pooled cohort of patients with MHN. It identifies BM involvement, stage, extent of the disease, the inflammatory background status, occurrence of HPS, and treatment approach as critical determinants of OS. Citation Format: Philip A. Haddad, Dinesh Keerty. Clinicopathologic determinants of survival in malignant histiocytic neoplasms: Analysis of a pooled database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3835.

Abstract 3833: Primary cutaneous diffuse large B-cell lymphoma-leg type and clinicopathologic determinants of survival: Analysis of a pooled database

Abstract Background: Primary Cutaneous Diffuse Large B-cell Lymphoma-Leg Type (PCDLBCL-LT) is a rare but non-indolent subtype of B-cell lymphoma. While most PCDLBCL-LT starts over the lower extremities, some cases may present at other cutaneous sites. The determinants of survival outcomes in this disease are not very well defined. Therefore, we conducted this pooled database analysis to identify the prognostic factors, clinicopathological characteristics, and therapeutic strategies that influence survival in this disease. Methods: To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 122 cases that fit the diagnostic criteria for PCDLBCL-LT. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS) and disease-free survival (DFS). Results: A total of 122 patients with confirmed PCDLBCL-LT were identified. The median age was 76. There was a male preponderance with M:F of 2.4. Seventy-three percent involved the extremities. The median duration of symptoms before diagnosis was 3.5 months. Involvement of lymph nodes, bone marrow, bone, and CNS occurred in 11%, 3%, 4%, and 3%, respectively. Constitutional symptoms were reported in 5%. The median OS and DFS of the whole group were 39 and 32 months, respectively. Patients younger than 70 had better median DFS (NR vs. 24 months, p=0.02) with a non-significant better median OS. Lymphadenopathy (45 vs. 18 months, p=0.006) and stage T3 compared to T1/T2 (16 vs 41 months, p=0.006) were associated with worse OS. Sex, constitutional symptoms, IHC phenotype, extra-lymphatic/extra-cutaneous organ involvement, and histologic cutaneous patterns did not impact OS. Compared to no treatment, chemotherapy, XRT+/-surgery, and stem cell transplant had numerically better OS without reaching statistical significance (5 vs. 39 vs. 41 vs. NR months, p=0.15). Patients who attained CR as their best response also had a superior median OS compared to responses less than CR and none (61 vs. 23 vs. 11 months, p&amp;lt;0.0001). Conclusion: This study presents updated clinicopathologic data from a large, pooled cohort of patients with PCDLBCL-LT. It identifies age, lymph node involvement, T stage, type of therapy, and quality of response to treatment as critical determinants of OS. Citation Format: Philip A. Haddad, Millicent Amankwah. Primary cutaneous diffuse large B-cell lymphoma-leg type and clinicopathologic determinants of survival: Analysis of a pooled database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3833.

Does Vocal Fold Pathology Play a Role in Determining the Timeline of Presentation to an Ear, Nose, and Throat Surgeon?

Abstract Background: The primary objective is to study the average time duration between the onset of vocal symptoms and presentation to an ear, nose, and throat (ENT) surgeon, in different vocal pathologies. Our second objective is to study gender distribution among various pathologies. Methods: Our voice clinic records were retrospectively reviewed for 1 year, from August 2022, for details regarding gender, and the average time taken for presentation (ATTFP) in months, to an ENT surgeon. Disorders were grouped into vocal fold nodules, polyps, cysts, paralysis/paresis, sulcus, spasmodic dysphonia (SD), and premalignant and malignant conditions. Results: A total of 17 patients of vocal fold nodules (15 females), 47 vocal fold polyp patients (45 males), 40 vocal fold cyst patients (24 females), 64 paralysis/paresis patients (44 males), 41 sulcus patients (31 males), 35 SD patients (22 females), and 65 premalignant and malignant condition patients (51 males) presented to us. The ATTFP for nodules was 8.1 months, 6.8 months for polyps, 10.2 months for cysts, 22.8 months for idiopathic and 6 months for other causes of paralysis/paresis, 32.4 months for sulcus, 26.1 months for SD, and 10.2 months for premalignant and malignant conditions. Conclusion: Sulcus patients took the longest time to present to an ENT surgeon, followed by SD patients, both groups averaging over 2 years. Vocal fold paralysis/paresis patients with a nonidiopathic diagnosis were the earliest to present. A high male preponderance in vocal fold polyps (96%) as opposed to a high female preponderance in vocal fold nodules (88%), both considered phonotraumatic lesions, warrants further research into possible varying etiopathogenesis.

Sanger Sequencing of Exon 14 of RB1 Gene Among North Indian Children with Retinoblastoma

Introduction: The RB1 gene has been studied for decades. A large number of genetic analytical studies on this gene are published in the Western world, but very few studies from India are available online. RB1 is the most critical gene involved in the causation of retinoblastoma, and Exon 14 is one of the highly mutated exons of this gene. Aim: To discover the genetic variants in Exon 14 of the RB1 gene in North Indian retinoblastoma patients. Materials and Methods: This was an inter- and intra-institutional cross-sectional observational study. The Department of Anatomy, Ophthalmology, and Paediatrics at King George’s Medical University UP, Lucknow, collaborated with the Department of Biochemistry, ERA University, Lucknow. After obtaining written informed consent from their parents or legal guardians, 40 clinically and radiologically diagnosed retinoblastoma patients were included as study participants. The age range was 12-84 months. 2 ml of peripheral venous blood was withdrawn from 29 patients, and we obtained tumour tissue from 14 patients. We isolated the genomic DNA, which was amplified by PCR, and the amplified products were sent for Sanger sequencing. Chromatograms were analyzed using the BioEdit software. Results: Most patients (92.5%) were below five years of age. Male preponderance was seen, as there were 37.5% females and 62.5% males. In the majority of cases (72.5%), the tumor was seen unilaterally with predominant involvement of the right eye; while in 27.5% of cases, both eyes were seen affected. We did not observe any variations in the sequences of exon 14. Conclusions: As the RB1 gene has 27 exons, therefore screening for mutations in all exons is required to reach a concrete conclusion. Genetic variants might be located in the intronic regions, which may affect the proper functioning of the RB1 gene; therefore, sequencing of the entire gene will be more helpful. Next Generation Sequencing (NGS) is preferred because of the large size of the gene. KEYWORDS: Retinoblastoma, DNA, PCR, RB1 gene, sequencing.

Head and Neck Lymphoma: Clinico-demographic Profile and Pattern of Presentations in a South Western Nigeria Tertiary Institution

Abstract&#x0D; Running title: A clinic-demographic profile and presentation of patient with head and neck lymphoma in a tertiary institution located in low-middle-income country.&#x0D; Introduction &#x0D; Lymphoma is the second most common malignancy occurring in the head and neck region. It is broadly classified into Hodgkins lymphoma (HL) and non-Hodgkins lymphoma (NHL). It affects nodal and extra-nodal. The clinical presentation is largely determined by the anatomic distribution of the disease, clinical stage of the disease, age of the patients and presence of underlying diseases.&#x0D; Aims and Objectives&#x0D; This study aims to analyse the presentation of head and neck lymphomas over a fifteen years period at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The objectives include; to determine the prevalence and demographic indices (age and gender) of head and neck, document the histopathologic types, and determine the association between the anatomical sites and histopathologic subtypes of lymphomas&#x0D; Materials and Method&#x0D; This is a retrospective study among patients seen and diagnosed histologically with head and neck lymphomas between 2005 – 2019 at the departments of Oral Medicine and Pathology and Morbid Anatomy and Forensic Medicine, OAUTHC. Relevant record were retrieve from patient record and histological register from the hospital registry. Patients with incomplete data were excluded. The study was conducted in accordance with the Declaration of Helsinki, and approved by our institution Ethics Committee Board.&#x0D; Results &#x0D; A total number of 54 cases of head and neck lymphoma were analysed with a prevalence of 30.9%. Out of the 54 cases, 46 were NHL and 8 cases were HL with a ratio of 5.8:1 respectively. A male preponderance was observed (M: F; 2.4:1). The lesion commonly affects patients in 3rd and 4th decade of life. All the histologic variants were seen to affect males more than females except for the unclassified variant of HL which affected both sexes equally. Low-grade and intermediate grade NHL affected the older patients more while high grade and miscellaneous subtypes affected the younger males. The cervical lymph nodes were the most common nodal site while the jaw was the most common extra-nodal site. Eighteen (39.1%) cases of NHL were diagnosed histological as miscellaneous while high and low grade had seven (15.2%) cases each.&#x0D; Conclusion&#x0D; Head and neck lymphoma remain relatively rare. One of every six lymphoma seen was HL, with male preponderance. High grade lymphoma is seen more in the younger patient. Lymphoma affect cervical lymph node more while jaw was the most common extranodal site. Obesity may be a predisposing factor in our environment but require future study to confirm.