Sixth Decade Research Articles

CLINICO-PATHOLOGICAL STUDY OF NON-NEOPLASTIC AND NEOPLASTIC LESIONS OF SINONASAL TRACT AND NASOPHARYNX

Introduction: A various non- neoplastic and neoplastic lesions of sinonasal tract and nasopharynx (NP) are commonly present in clinical practice. The aim of this study is to study clinical and histopathological patterns of lesions of sinonasal tract and nasopharynx in a tertiary care hospital over the period of January 2022 to June 2022. This study of 121 cases (Male 82, Female 39) of nas Methods & Material: al cavity, paranasal sinuses and nasopharynx over the period of 6 months. All received tissues after examination, xed in 10% buffered formalin, processed and stained with Hematoxylin & Eosin to study histopathological patterns. These nasal, paranasa Results: l and nasopharynx lesions were common in sixth and seventh decade of life. Among them 70 (57.85%) non neoplastic and 51 (42.14%) neoplastic lesions. Mucormycosis (23.96%) and polyps (17.35%) were the most common among the non- neoplastic masses; Inverted papilloma (2.47%) most common among benign neoplastic and squamous cell carcinoma (30.75%) was commonest out of all malignant masses. Conclusions: We concluded that complete clinical, radiological/imaging and histopathological helps to categorized lesions into various non-neoplastic and neoplastic types. But histopathological examinations provide a conrmatory diagnosis. Although immunohistochemistry is the nal diagnostic method in few cases.

A Rare Case of Primary Cutaneous B-Cell Lymphoma in a Child

Primary cutaneous lymphomas (PCLs) are non-Hodgkin’s lymphomas present in the skin, with no evidence of extracutaneous disease at the time of diagnosis. PCL is uncommon in children, and those that do exist are mostly of the T-cell lineage. PCL of the B-cell linage is most common in the sixth decade of life and is extremely rare in childhood.

The Importance of Early Chronic Obstructive Pulmonary Disease: A Lecture from 2022 Asian Pacific Society of Respirology

Chronic obstructive pulmonary disease (COPD) affects close to 400 million people worldwide. COPD is characterized by significant airflow limitation on spirometry. Most patients with COPD are diagnosed in their fifth or sixth decades of life. However, the disease begins much earlier. By the time airflow limitation is detected on spirometry, patients with COPD have lost close to 50% of their small airways. Thus, identification of patients with early COPD, defined as persons with preserved spirometry, who demonstrate pathologic or functional hallmarks of COPD, is essential for disease modification and ultimately disease elimination. This paper provides an up-to-date overview of the current case definition of early COPD, its importance, the novel technologies required for its detection in young adults and future directions in therapeutics for treatment.

Will improved neuroradiology facilities debunk the reported rarity of intracranial aneurysms in Sub-Saharan Africa?

Intracranial aneurysms (IAN) are rare in the Sub-Saharan Africa unlike other parts of the world. The debate is whether the low frequency might be apparent because of the scarcity of advanced neuroimaging services, or real. This study investigated if improved imaging facilities would debunk the rarity of IAN in our subregion. This is a retrospective cohort study of prospectively recorded data of patients with subarachnoid hemorrhage (SAH) and IAN managed over 19 years (2003-2021), at the study center with a catchment population of over 47 million. The center witnessed progressive improvements in neuroimaging facilities: 2-Slice, 8-slice, and 64-slice computed tomography (CT) and 0.35T, 1.5T magnetic resonance imaging (MRI) during the period. There were 241 cases of SAH, but only 166 aneurysms were confirmed in 158 patients. Between 2003 and 2008, only 27 IAN patients (4.5 IAN/year) were diagnosed. After introduction of CT angiography/magnetic resonance angiography MRA using 8-slice CT/0.35T magnetic resonance imaging (MRI), between 2009 and 2014, the frequency of IAN increased to 8/year. Between 2015 and 2018 after installation of a 64-slice CT in 2014, the IAN remained the same (8/year). MRI 1.5T was added in 2018, the frequency doubled to 17 cases/year. The females were more (67.7%), the mean age was 46.3 years, but peak incidence was the sixth decade. Internal carotid artery aneurysms including posterior communicating artery were the most common (43%) followed by ACA with anterior communicating artery (24%) and middle cerebral artery (20%). Multiple aneurysms were seen in ten patients. Improved neuroimaging between 2003 and 2021 did not debunk the rarity of IAN in our region.

Versatile Metalloporphyrin‐Based Electrochemical Sensing Applications: From Small Gasotransmitters to Macromolecules

AbstractAt the beginning of his youthful sixth decade, this work is dedicated to Prof. Dr. Fabio Doctorovich. He is distinctive in organometallic chemistry. During his successful career, he has been studying the reactivity and application of metalloporphyrins. Metalloporphyrins are organometallic complexes that exhibit, through synthetic modifications, the ability to tune their optical and electrochemical properties and their selectivity towards a particular molecule or ion. For this reason, they are systems extremely useful as electrochemical sensors to detect and quantify a wide variety of analytes with high selectivity, even in real samples such as food, water, biological fluids, or pharmaceutical compounds. This review presents an up‐to‐date list of reports in which metalloporphyrins are used as electrochemical sensors. In addition to compiling a comprehensive and up‐to‐date list of reported sensors that utilize metalloporphyrins, this work aims to provide an overview of currently available tools and techniques for the detection of various chemical species through similar approaches, which are constantly being developed.

Clinical demographic characteristics and ocular Co-morbidities associated with Secondary lipid keratopathy at a tertiary care center

ObjectiveTo describe the demographics and clinical profile of Secondary Lipid Keratopathy in patients presenting to a multi-tier ophthalmology hospital network in India. MethodsThis cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of Secondary Lipid Keratopathy in at least one eye were included as cases. The data were collected using an electronic medical record system. ResultsOverall, 389 (0.01%) patients were diagnosed with Secondary Lipid Keratopathy. Majority were males (53.5%) and had a unilateral affliction (82.8%). The most common age group at presentation was during the sixth decade of life with 76 (19.5%) patients. The overall prevalence was higher in patients from a lower socio-economic status (0.02%) presenting from the rural geography (0.01%) and in individuals related to agriculture work/ manual labor (0.02%). Of the 456 eyes, mild or no visual impairment (<20/70) was noted in 194 (42.5%) eyes followed by moderate visual impairment (>20/70 to 20/200) in 81 (17.8%) eyes. At presentation, the mean visual acuity was 0.96 ± 1.07 log MAR units. The most associated corneal condition was non-HSV corneal scar (36.8%), followed by spheroidal degeneration (19.7%) and HSV keratitis in (18.6%). ConclusionSecondary lipid keratopathy more commonly affected males presenting during the sixth decade of life. Most (42.5%) of the eyes had mild or no visual impairment. Corneal scar (non-HSV) was the most associated corneal condition in both unilateral and bilateral cases. HSV keratitis was the commonest corneal condition in those between 20 and 40 years, followed by those above 40 years.

Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV.

Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown. We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine-learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within the past 12 months, body mass index, physiologic frailty (VACS Index 2.0), illicit substance and alcohol use disorders, and measures of multimorbidity and polypharmacy. We separately fit multivariable logistic models to each outcome using generalized estimating equations. From these models, the longitudinal extensions of average attributable fraction (LE-AAF) for modifiable risk factors were estimated. Key risk factors for both outcomes included physiologic frailty (VACS Index 2.0) (serious falls [15%; 95% CI 14%-15%]; fractures [13%; 95% CI 12%-14%]), a serious fall in the past year (serious falls [7%; 95% CI 7%-7%]; fractures [5%; 95% CI 4%-5%]), polypharmacy (serious falls [5%; 95% CI 4%-5%]; fractures [5%; 95% CI 4%-5%]), an opioid prescription in the past month (serious falls [7%; 95% CI 6%-7%]; fractures [9%; 95% CI 8%-9%]), and diagnosis of alcohol use disorder (serious falls [4%; 95% CI 4%-5%]; fractures [8%; 95% CI 7%-8%]). This study confirms the contributions of risk factors important in the general population to both serious falls and fragility fractures among older PWH. Successful prevention programs for these outcomes should build on existing prevention efforts while including risk factors specific to PWH.

Primary acinic cell carcinoma in an adolescent female

Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 17% of all primary salivary gland malignancies in adults. ACC most commonly affects the parotid gland, predominating fifth and sixth decades of life and a female predilection. In the paediatric population, mucoepidermoid carcinoma is the most common parotid malignancy, followed by ACC.We report a case of a 16-year-old female, presenting with a slow-growing right parotid lump. Clinical examination revealed a small right parotid nodule, grade I House-Brackmann score and cervical lymphadenopathy. Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland and reactive lymph nodes. Surgical management included a right partial parotidectomy. Immunohistochemistry was negative for S100, positive with DOG-1 and widespread PAS-D-resistant granules throughout the tumour cells, confirming a diagnosis of ACC.ACC is an important differential diagnosis to consider in salivary gland pathology in the female adolescent patient.

Surgical Site Infection in Head and Neck Cancer Patients: Observations from A Tertiary Care Hospital.

Ramakrishna Pai JakribettuBackground Surgical site infections (SSIs) in head and neck cancer (HNC) patients can significantly affect the outcome of the surgery. Appropriate antimicrobial prophylaxis is needed for prevention of SSI. Aim To study the causative agents causing SSI among the HNC patients and their drug resistance pattern. Materials and Methods This was a retrospective study. The antibiotic suspectibility pattern of the aerobic bacteria isolated from the wound infection in the patients underwent surgery for head and neck cancer, admitted from January 2015 to December 2016 were added in the study. The demographic details of patients, pathogens isolated, and their antimicrobial susceptibility were collected, entered into Microsoft Excel, and statistical analysis was done as per percentage of isolates and drug resistance. Results A total of 130 culture-positive pus samples were included in the study. The majority of the samples were from males (71.5%), one-third of the patients belonged to the sixth decade of their life. Buccal mucosa and tongue were the common cancer in the head and neck region. The common gram-negative pathogens were Klebsiella sp. and Acinetobacter sp. and Staphylococcus aureus and Enterococcus sp. among the gram-positive bacteria. Methicillin-resistant S. aureus isolation rate was noted to be as high as 64.28%. High levels of resistance to aminopenicillins, third generation cephalosporins, co-trimoxazole and fluoroquinolones among the gram-negative pathogens. Anti-MRSA drugs such as vancomycin, linezolid, and teicoplanin resistance was not seen among S. aureus . Conclusion The resistance pattern among the pathogens isolated from SSI in HNC patients is alarming. So, implementation of strict infection control practices to prevent SSI rather than treating them with high end antimicrobials is the best option.

Characterization of Stone Events in Patients With Type 3 Primary Hyperoxaluria.

Hallmarks of primary hyperoxaluria type 3 are nephrolithiasis and hyperoxaluria. However, little is known about factors influencing stone formation in this disease. We characterized stone events and examined associations with urine parameters and kidney function in a primary hyperoxaluria type 3 population. We retrospectively analyzed clinical, and laboratory data of 70 primary hyperoxaluria type 3 patients enrolled in the Rare Kidney Stone Consortium Primary Hyperoxaluria Registry. Kidney stones occurred in 65/70 primary hyperoxaluria type 3 patients (93%). Among the 49 patients with imaging available, the median (IQR) number of stones was 4 (2, 5), with largest stone 7 mm (4, 10) at first imaging. Clinical stone events occurred in 62/70 (89%) with median number of events per patient 3 (2, 6; range 1-49). Age at first stone event was 3 years (0.99, 8.7). Lifetime stone event rate was 0.19 events/year (0.12, 0.38) during follow-up of 10.7 (4.2, 26.3) years. Among 326 total clinical stone events, 139 (42.6%) required surgical intervention. High stone event rates persisted for most patients through the sixth decade of life. Analysis was available for 55 stones: pure calcium oxalate accounted for 69%, with mixed calcium oxalate and phosphate in 22%. Higher calcium oxalate supersaturation was associated with increased lifetime stone event rate after adjusting for age at first event (IRR [95%CI] 1.23 [1.16, 1.32]; P < .001). By the fourth decade, estimated glomerular filtration rate was lower in primary hyperoxaluria type 3 patients than the general population. Stones impose a lifelong burden on primary hyperoxaluria type 3 patients. Reducing urinary calcium oxalate supersaturation may reduce event frequency and surgical intervention.

Clinical profile of Non Alcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus

NAFLD is also potentially contributing to an important burden of extra-hepatic chronic complications. For reasons that are not completely clear, NAFLD is more common in men than women and although precise estimates of incidence rates for NAFLD are uncertain (because of difficulties with establishing a precise diagnosis during sequential follow up), current incidence rates are approximately 20/10,000 person years, peaking in the sixth decade of life. Aim: To study the clinical profile of non alcoholic fatty liver disease in type 2 Diabetes Mellitus. Material and methods: A cross sectional study was carried out among 50 cases having type 2 DM were further evaluated for non alcoholic fatty liver disease under Medicine Department of tertiary health care center. Detailed clinical profile of the participants were studied. All data was collected and complied in Microsoft excel. All statistical analyses were performed by using IBM SPSS statistics Version 21.0 (SPSS Inc., Chicago, IL, USA) and openepi version 2.3.1. Results: Majority 79% were in age group &gt;40 years. Mean age in years was 65.8 +11.26, male preponderance was seen. Mean HbA1C was 7.5+0.73, ranging from 5.1 to 12.5. majority 70% had HbA1C &gt;6, 20% had between 5.7- 6 and 10% had &lt;5.7. Mean SGOT was 66.3+ 76.6, mean SGPT was 44.6+46.8, mean ALP was 98.1+40.3.On USG finding majority 60% had grade 1, 30% had grade 2 and 10% had grade 3. Conclusion: Physician treating the type II DM cases having raised lipid and LFT should have a high suspicion of NAFLD. Early diagnosis and treatment of NAFLD will help in minimizing further complications and will have a good prognosis for the disease.

Early management of presbycusis: recommendations from the French Society of Otorhinolaryngology and Head and Neck Surgery, the French Society of Audiology, and the French Society of Geriatrics and Gerontology

Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its management in face-to-face or even distance learning. In case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. It is recommended to perform free-field speech audiometry in noise to measure intelligibility in an environment as close as possible to reality. Questionnaires can be used in addition to audiometry to best assess the patient's disability. It is recommended that hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time elapsed since the fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, integrating different training domains in addition to face-to-face sessions.

A Study to Assess the Knowledge Regarding Self-Breast Examination on Prevention of Breast Cancer Among Women Attending OPD in Sree Balaji Medical and College And Hospital

Self-examination of the breasts is less expensive than mammography. Breast cancer can be discovered sooner, and women's survival rates can be raised. Rural residents have limited access to medical treatment and have a poorer educational position. As a result, it is critical that they be educated about breast cancer prevention and early diagnosis by systematic breast self-examination. Breast cancer risk begins to climb in a woman's early thirties and reaches an all-time high by the time she reaches her sixth decade. Because women between the ages of 30 and 60 are at high risk, an educational programme for them would be quite useful. Because the perceived threat of breast cancer should inspire children to practise breast self-examination on a regular basis, improved knowledge about breast cancer and competence to do breast self-examination at this age would be useful. According to a study, the five-year survival rate of breast cancer patients is 75 percent, and it is suggested that 50 percent of all breast cancer patients worldwide could have their lives extended by increasing public awareness through early detection and effective treatment at the community level.

Clinicopathological Study of Oral Malignancies in Great Eastern Medical School and Hospital

INTRODUCTION Throughout the world, oral cancer ranks sixth in terms of prevalence and accounts for 30% of head and neck malignancies. Increased use of cigarettes, alcohol, and other carcinogenic items has been linked to an increase in the incidence of mouth cancer in India. Despite major advancements in surgery, radiotherapy, and chemotherapy methods, advanced stages of the illness are difficult to treat. The study's aims to calculate and analyse the average age, sex, anatomical subsite, aetiology, morphological characteristics, stage of presentation, and histology of oral cancers. MATERIALS AND METHODS Patients attending the ENT OPD at Great Eastern Medical School and Hospital were evaluated and studied. All malignant tumours of the lip, cheek, alveolus, tongue, floor of the mouth, and hard palate were included in this investigation. To determine the origin and histological grading of the tumour, all patients underwent wedge biopsy of the lesion, followed by histopathology evaluation of the specimen. RESULTS The male to female oral cancer ratio is 3:2. In 50 patients, 22 of them, had buccal cancer. Of the 50 patients, 39 had stage I presentations. CONCLUSION Oral cancer incidence peaked in the sixth decade of life, with a 3:2 male to female ratio. The most typical location is the buccal mucosa. 50 patients, or 22 of them, had buccal cancer. The majority of the subjects showed ulcerative lesions and pain. All of the patients exhibited Squamous cell carcinoma as a histopathological type. Due to increasing knowledge and the accessibility of medical treatments, 39 out of 50 patients appeared at stage I.

Diagnostic and Management Strategies of Bietti Crystalline Dystrophy: Current Perspectives.

Bietti crystalline dystrophy (BCD) is a rare, genetically determined chorioretinal dystrophy presenting with intraretinal crystalline deposits and varying degrees of progressive chorioretinal atrophy commencing at the posterior pole. In some cases, there can be concomitant corneal crystals noted first in the superior or inferior limbus. CYP4V2 gene, a member of the cytochrome P450 family is responsible for the disease and more than 100 mutations have been defined thus far. However, a genotype-phenotype correlation has not been established yet. Visual impairment commonly occurs between the second and third decades of life. By the fifth or sixth decade of life, vision loss can become so severe that the patient may potentially become legally blind. Multitudes of multimodal imaging modalities can be utilized to demonstrate the clinical features, course, and complications of the disease. This present review aims to reiterate the clinical features of BCD, update the clinical perspectives with the help of multimodal imaging techniques, and overview its genetic background with future therapeutic approaches.

The age-related contribution of cognitive function to dual-task gait in middle-aged adults in Spain: observations from a population-based study

Poor dual-task gait performance is associated with a risk of falls and cognitive decline in adults aged 65 years or older. When and why dual-task gait performance begins to deteriorate is unknown. This study aimed to characterise the relationships between age, dual-task gait, and cognitive function in middle age (ie, aged 40-64 years). We conducted a secondary analysis of data from community-dwelling adults aged 40-64 years that took part in the Barcelona Brain Health Initiative (BBHI) study, an ongoing longitudinal cohort study in Barcelona, Spain. Participants were eligible for inclusion if they were able to walk independently without assistance and had completed assessments of both gait and cognition at the time of analysis and ineligble if they could not understand the study protocol, had any clinically diagnosed neurological or psychiatric diseases, were cognitively impaired, or had lower-extremity pain, osteoarthritis, or rheumatoid arthritis that could cause abnormal gait. Stride time and stride time variability were measured under single-task (ie, walking only) and dual-task (ie, walking while performing serial subtractions) conditions. Dual-task cost (DTC; the percentage increase in the gait outcomes from single-task to dual-task conditions) to each gait outcome was calculated and used as the primary measure in analyses. Global cognitive function and composite scores of five cognitive domains were derived from neuropsychological testing. We used locally estimated scatterplot smoothing to characterise the relationship between age and dual-task gait, and structural equation modelling to establish whether cognitive function mediated the association between observed biological age and dual tasks. 996 people were recruited to the BBHI study between May 5, 2018, and July 7, 2020, of which 640 participants completed gait and cognitive assessments during this time (mean 24 days [SD 34] between first and second visit) and were included in our analysis (342 men and 298 women). Non-linear associations were observed between age and dual-task performance. Starting at 54 years, the DTC to stride time (β=0·27 [95% CI 0·11 to 0·36]; p<0·0001) and stride time variability (0·24 [0·08 to 0·32]; p=0·0006) increased with advancing age. In individuals aged 54 years or older, decreased global cognitive function correlated with increased DTC to stride time (β=-0·27 [-0·38 to -0·11]; p=0·0006) and increased DTC to stride time variability (β=-0·19 [-0·28 to -0·08]; p=0·0002). Dual-task gait performance begins to deteriorate in the sixth decade of life and, after this point, interindividual variance in cognition explains a substantial portion of dual-task performance. La Caixa Foundation, Institut Guttmann, and Fundació Abertis.

POEMS syndrome masquearading as Tuberculosis

POEMS syndrome, also called Osteosclerotic myeloma or Takatsuki syndrome or Crow-Fukase syndrome, is a rare multisystemic disease paraneoplastic syndrome under the plasma cell dyscrasias. POEMS is an acronym for Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein elevation, and skin changes. It is usually 1.5 times more common in male than female. Patients often present in the fifth to sixth decades of life and have a median survival rate of 8 to 14 years without successful treatment. Here we described a case of POEMS syndrome in a young 30 years old adult who presented with anasarca, polyneuropathy as initial manifestation and masquerading as tuberculosis. He was successfully treated with Melphalan-Dexamethasone therapy with clinical improvement. Therefore, patients with unexplained polyneuropathy especially when it is associated with endocrinopathy, skin changes or oedema, should be evaluated for POEMS syndrome.

National Lifetime Prevalence and Demographic Factors of Urolithiasis in Iran.

To estimate the current lifetime prevalence of urolithiasis at the national level in Iran and investigate the potential influential demographic factors in different geographical areas. Materials and methods: An epidemiological study was conducted between October 2020 and November 2022 in 31 provinces of Iran at the national level. Data was obtained through telephone interviews with households. Items in the interview included questions about the current and past episodes of urolithiasis, family history of urolithiasis, and demographic and environmental variables of potential interest in urolithiasis. Results: A total of 44186 participants were investigated from 31 provinces of Iran. The overall percentage of those with lifetime prevalence of urolithiasis was 6.6%, including 7.9% for males and 5.3% for females (P<.001). In addition, with regard to the residential location, men were 53% (7.9% vs. 5.2%) more susceptible than women to urinary stones in urban areas and 36% (7.8% vs. 5.7%) more susceptible in rural areas. Out of 31 provinces, the Sistan-baluchistan province had the highest lifetime prevalence (15.6%) and the Golestan province had the lowest (2.1%). The lifetime prevalence of urolithiasis in the rural areas was 6.8% versus 6.5% in the urban areas (P=.29). Regarding age differentiation, the lifetime urolithiasis prevalence has increased up to the age of 70 years. In addition, the most prominent increase in the lifetime prevalence was observed in the age range of 20 to 60 years (from 0.9% to 11.8%). The ethnicity with the highest lifetime prevalence rate of urolithiasis was the Baluch ethnicity (18%). Conclusion: generally, 6.6% of Iranian population suffers from urinary stones during their lifetime. Urolithiasis prevalence has increased 0.06% annually compared to the latest national study that took place 15 years ago. This increasing trend seems to be less prominent than other countries. According to our findings, urinary stones are more prevalent in men than in women and in the third to sixth decade of life regardless of gender. Baluch ethnicity is associated with the highest lifetime prevalence rate of urolithiasis and there is no significant difference between rural and urban areas. However, the ratio of male to female risk of urolithiasis is higher in urban areas compared to rural areas.

The role of the bicuspid aortic valve in sudden cardiac death–findings at cardiac autopsy

BackgroundBicuspid aortic valve (BAV) is the most common congenital cardiac defect in the adult population, with a prevalence of 0.5%-2%. It is well recognized that aortic stenosis (AS), aortic regurgitation (AR) and aertopathy may develop by the fifth or sixth decade of life. There is a paucity of autopsy studies evaluating the hearts of subjects with BAV. The aim of this study is to ascertain the role of BAV in cases of sudden cardiac death. MethodsA database of 6325 whole hearts referred to a specialist cardiac pathology center between 2004 and 2021 was reviewed to identify a subgroup of 91 subjects with a BAV reported. All cases had a negative full body autopsy and toxicology before being referred and subsequently underwent detailed cardiac evaluation including histological analysis by expert cardiac pathologists. ResultsThe mean age of death was 37 ± 16 years (84% male). Death was attributed to aortic valve or aortic disease in 57% (n = 52) of cases; AS 30% (n = 27), endocarditis 11% (n = 10), aortic dissection (AD) 9% (n = 8) and AR 8% (n = 7). In the remaining 43% of cases, BAV was an incidental finding. ConclusionThe majority of deaths in young individuals with BAV were attributed to complications related to the aortic valve or aorta indicating that BAV is not a benign condition. When a BAV is identified, individuals should be appropriately follow-up with imaging to inform the optimal timing of intervention before a complication develops that may predispose the individual to a premature death.

Xanthogranulomatous Cholecystitis: A Rare form of Chronic Cholecystitis

Xanthogranulomatous cholecystitis (XGC) is a rare form of cholecystitis distinguished by the presence of numerous yellow-brown intramural nodules with severe fibrosis and foam cells within the gallbladder wall, which may be misdiagnosed as a Gall Bladder Carcinoma. It is typically diagnosed between the sixth and seventh decades of life, predominantly in females. Clinical signs and symptoms are comparable to those of acute and chronic cholecystitis, making it challenging to distinguish XGC prior to surgery. The case of a 52-year-old man who presented to the emergency department with right upper quadrant abdominal pain for 4 months, radiating into the right shoulder is discussed. Patient was diagnosed to have Chronic Calcular Cholecystitis on Ultrasound. Laparoscopic Cholecystectomy was performed and XGC was diagnosed post-operatively through definitive histopathological examination. Preoperatively and intraoperatively, Xanthogranulomatous Cholecystitis is difficult to diagnose and pathological examination is required for a definitive diagnosis. XGC, which exhibits clinical and radiological signs similar to those of gallbladder tumors, must be included in the differential diagnosis in order to avoid an extensive surgical procedure.