Sixth Decade Research Articles

Computed tomographic assessment of renal length in correlation to anthropometric parameters: A cross-sectional hospital-based observational study from Iraq

Abstract Background: Measuring the renal size is an important parameter used in the assessment of patients with renal diseases. There is no conventional nomogram for kidney length in the Iraqi population. Objectives: The main objective of our study was to evaluate the ranges of normal renal length in our population. Material and Methods: The right and the left kidney lengths were measured by computed tomography (CT) scan in 100 adult individuals without apparent renal condition. Analysis for differences was conducted according to laterality, age, and sex. The correlation of renal length with anthropometrical indices like body weight, height, body mass index (BMI), and body surface area (BSA) was also evaluated. Results: The mean length of the right kidney was 11.4 cm for males and 10.2 cm for females, and of the left kidney was 11.5 cm in males and 10.8 cm in females. The mean renal lengths in the Iraqi population were similar to Iranian and American populations. The left kidney was longer than the right. Age-group analysis exhibited a significant decline in renal length beyond the sixth decade. There was a modest positive correlation of renal length with height, weight, and BSA but no correlation with BMI. Conclusion: The research supports the knowledge of the standard renal length range in a study population of apparently healthy Iraqi individuals by using CT scan imaging and derives linear regression equations that can be simply used in clinical practice to estimate the renal length according to body indices such as height or weight.

Outer retinal corrugations in late-onset retinal degeneration: a diagnostic finding demonstrated with multimodal imaging

ObjectiveLate-onset retinal degeneration (L-ORD) is a rare autosomal dominant retinal degeneration that presents in the sixth decade and leads to severe visual loss. The objective of this paper is to...

The current status of fibromyalgia in Korea: an electronic population health data study in Korea.

Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and tenderness in the muscles, ligaments, and soft tissues. It is a chronic pain condition often accompanied by other symptoms and comorbidities. To effectively manage FM, it is crucial to obtain fundamental epidemiological data pertaining to the target population. Therefore, this study was conducted to elucidate the epidemiological characteristics of FM in the Korean population. Population-based medical data of 51,276,314 subscribers to the National Health Insurance Service of Korea from 2014 to 2018 were used in this study. The overall incidence of FM ranged from 441 (2014) to 541 (2018) cases per 100,000 person-years, with a higher prevalence observed among female patients compared to male patients. The incidence gradually increased until middle age, followed by a decrease. The highest incidence rates were observed in the fifth decade of life for females and the sixth decade of life for males. When categorizing the affected parts of the body, the shoulder region was observed to be the most frequently affected. A comparison of the drug prescriptions based on medical specialty showed that antidepressants were the most commonly prescribed medications. The management of FM leads to consistent increases in medical expenses, regional disparities, and variations in prescription patterns across different medical specialties. The findings of this study will not only contribute to the understanding of FM characteristics but also provide a vital foundation for efficient management of FM in Korea.

Gluteal Tendinopathy: Critical Analysis Review of Current Nonoperative Treatments.

» Gluteal tendinopathy/greater trochanteric pain syndrome (GTPS) is the most prevalent of all lower limb tendinopathies, affecting 1 in 4 women older than 50 years and commonly individuals within their fifth and sixth decades of life regardless of activity level.» The condition is believed to originate from age-related degenerative changes about the hip abductor tendon insertions and the surrounding bursae, and is exacerbated by congenital and acquired abnormal hip biomechanics.» Treatment of gluteal tendinopathy/GTPS often begins with noninvasive nonoperative modalities such as activity modifications, nonsteroidal anti-inflammatory drugs, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies have been used; however, there remains a lack of comparative efficacy between these adjunct treatments.» In this article, we examine the available literature regarding the nonoperative management of gluteal tendinopathy/GTPS and provide insight into the effectiveness of current treatment modalities.

Inverted Sinonasal Papilloma: Update and Literature Review

Inverted sinonasal papilloma is a benign neoplasm that usually affects the intra-nasal cavity and adjacent paranasal sinuses. Inverted papillomas have three unique features that distinguishes them from other sinonasal tumors including; a propensity for local destructive growth, a high rate of recurrence and risk of malignant transformation. The reported yearly incidence is about 0.6 to 1.5 cases per 100,000 people per year and they usually account for 0.5% to 4% of all nasal tumors. They occur at the following locations; both lateral nasal walls, ethmoidal cells, maxillary sinus, the frontal sinus, sphenoid sinuses and the nasal septum in decreasing order. It occurs most commonly in the fifth and sixth decades of life with a male-to-female ratio of 2-3:1. Inverted papilloma can arise from the entire Schneiderian membrane and molecular genetics have confirmed that it is an actual neoplasm that arises from a single progenitor cell. Most cases are diagnosed from clinical history and thorough physical examination. However, complete removal of all affected tissue with thorough histopathological evaluation is recommended to ensure a correct diagnosis. While there is yet no established pathognomonic histopathological feature to predict recurrence with all certainty, there is ongoing investigation for predictive markers of recurrence. Smoking seems to be a recognized risk factor for developing multiple recurrences and there is evidence that the presence of HPV serotypes 16 and 18 could be predictive of malignant transformation. The main aim of treatment is to achieve compete surgical resection and to prevent recurrence and malignant transformation. A period of clinical follow up is recommended after treatment. The aim of this review is to provide a comprehensive and updated overview of the clinical presentation, diagnosis, management and prognosis of this unique lesion.

Mortality due to malignant neoplasms of the liver and intrahepatic biliary tract in the state of Mato Grosso in 2020

Malignant neoplasms of the liver and intrahepatic biliary tract occupy the third place of cancer deaths in the world and the second most deadly in men and the sixth in women. Eating habits characterized by the consumption of food with high caloric and glycemic indexes, associated with a sedentary lifestyle, provide a greater risk of developing hepatic steatosis, as well as obesity, which, together with the increased incidence of chronic viral hepatitis, excessive alcoholism, and age over 50 years, constitute the main risk factors for the development of these types of cancer. In addition, due to the chronicity of liver pathologies, the diagnosis is usually late, a factor that contributes to increase the mortality rate. Thus, the objective of this work is to analyze the epidemiological profile of deaths due to liver cancer and intrahepatic biliary tract that occurred in the state of Mato Grosso in 2020. This is a cross-sectional study based on data from the Mortality Information System (SIM), made available by the Department of Informatics of the Unified Health System (DATASUS), and in the population estimate of the Brazilian Institute of Geography and Statistics (IBGE) for 2020. A study was carried out of the epidemiological profile of deaths related to liver and intrahepatic biliary ducts neoplasms (CID 10 C-22) of the state of Mato Grosso for the year 2020 regarding age group, sex (gender), and race. A total of 120 deaths due to malignant neoplasms of the liver and intrahepatic biliary tract were reported, corresponding to a mortality rate of approximately 3.4 deaths/100,000 inhabitants, with the proportion of deaths between men and women approximately 4:3. For both sexes, there is an abrupt increase in the incidence of deaths after the sixth decade of life, corresponding to 90% of deaths due to this pathology. Regarding the racial evaluation, deaths are more incident in the yellow race, with about 4.97 deaths/100,000 inhabitants, followed by the black race with 4.87 deaths/100,000 inhabitants. Thus, it is evident that deaths from liver and intrahepatic biliary tract malignant neoplasms in the state of Mato Grosso, in 2020, were concentrated from the sixth decade of life, especially in men, with emphasis on the yellow race. It should be noted that the analysis of epidemiological characteristics is essential for the development of screening policies and early diagnosis in patients with modifiable and non-modifiable risk factors.

Evolving Pink Papule in a Young Female

Eccrine porocarcinoma (EPC) is a rare cutaneous adnexal tumor derived from sweat glands. Typically, EPC presents as a nonspecific erythematous papule or nodule most commonly on the head, neck, or lower extremities of females in the sixth or seventh decade of life. This tumor may arise from an existing benign eccrine poroma or occur de novo. Herein, we report a case of a growing erythematous nodule with overlying telangiectasia on the lower extremity of a woman in her twenties. Biopsy revealed a cyst-like lesion beneath the epidermis comprised of clear fluid material. Both solid and cystic components were present alongside pleomorphic tumor cell aggregates characterized by mitotic figures, hyperchromasia, and necrosis. The combination of clinical presentation and the presence of ductal structures on histopathologic analysis led to a diagnosis of EPC. This case reinforces the critical importance of histopathologic analysis of a nonspecific lesion that has evolved over time and may resemble other forms of cutaneous malignancy.

Educational level and its association with dopamine transporter loss in patients with Parkinson's disease

BackgroundAccording to the cognitive-reserve concept, higher educated dementia patients tolerate more brain pathology than lower educated patients with similar impairment. Here, we examined whether higher education is associated with more severe dopamine terminal loss at the diagnosis of Parkinson's disease (PD). MethodsDopamine transporter (DaT) SPECT information of 352 de novo PD patients and 172 healthy controls (HC) were retrieved from PPMI. Correlation analyses were performed between education years and regional DaT signal (i.e., putamen, caudate, striatum), correcting for UPDRS-III, age, sex and MoCA. Second, using a median split on education (Md = 16 yrs), high and low education groups were determined, which were matched for demographic and/or clinical scores and compared based on regional DaT signals. Finally, moderation analyses were conducted in the PD cohort, assessing the effect of education on the relation between putaminal DaT capacity and UPDRS-III. All analyses were performed across the entire cohorts and separately for three age ranges (sixth, seventh and eighth life decade). ResultsOnly PD patients in their eighth life decade presented a positive association between education and regional dopamine signalling. A significant moderation effect of education on the association between putaminal DaT signal loss and motor symptom severity was observed in this group (B=3.377, t=3.075, p = .003). The remaining analyses did not yield any significant results, neither in the PD nor HC cohort. ConclusionHigher education is not related with greater tolerance against dopamine loss in PD, but may nonetheless assert protective effects at more advanced age.

Ocular Lymphoma: Detection, Management, and Treatment

Primary intraocular lymphoma is a rare manifestation of primary central nervous system lymphoma. It most often affects patients in the sixth and seventh decades of life and has a predilection for immunocompromised patients, particularly males, whom it affects twice as often as females. Because of the ability of primary intraocular lymphoma to mimic less severe conditions such as uveitis, its detection can be difficult. The diagnosis should be suspected in all elderly patients with chronic uveitis unresponsive to corticosteroid or antibiotic therapy. Although no therapeutic paradigm has been defined, combining chemotherapy and radiation therapy is the most effective treatment for the condition. Without multicenter clinical trials focused on improved treatment strategies, optimal disease management will continue to be challenging. The increasing frequency of ocular lymphoma has underscored the need to meet this challenge. In this article, the authors aim to provide ophthalmologists and primary care physicians with the tools necessary to hasten early recognition and prompt treatment of the disorder. Although no cure exists, recent studies with rituximab have shown promising results in treating intraocular lymphoma.

Decades of beauty: Achieving aesthetic goals throughout the lifespan.

Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment). To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade. This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20-60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns. Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes. Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance.

Correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy.

In addition to ensuring cancer control, prevention of incontinence which significantly impact patients' quality of life, is also an important issue in robot-assisted radical prostatectomy (RARP) operations. In this study, we aimed to find the correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy. This study included 162 patients treated with RARP with perioperative data and at least 1 year of follow-up. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. The continence recovery rate in our study was assessed at 6th week, 3rd month, 6th month, 9th month, and 12th month, post-surgery. Logistic regression analysis evaluated the association between the predictive factors and urinary continence recovery in the early and late stages. The majority of patients with prostate cancer present in sixth decade of life. The majority of our patients (56.7%) were categorized as high risk using D'Amico classification. The continence rate in our study at 6th week, 3rd month, 6th month, 9th month, and 12th month were 40.1%, 72.2%, 85.2%, 89.5%, and 91.4%, respectively. No improvement in continence status was observed after 1 year in our study. There was significant correlation of age with continence status at 6th week, 3rd month, and 6th month. The young age is associated with early recovery of continence. At 3 and 9 months, the non-diabetics cases achieved significantly higher continence rates than diabetics (p < 0.05) which shows that diabetes causes delay in attainment of continence. The young age may be associated with early recovery of continence, but further validation requires large number of cases. We attributed good continence recovery rate to meticulous dissection and preservation of good urethral length.

Clinical Profile, Demographic Distribution and Risk Factors of Parafoveal Telangiectasia: An Electronic Medical Record-Driven Big Data Analytics from a Multitier Eye Care Network

ABSTRACT Objective To describe the demographics and clinical profile of parafoveal telangiectasia (PFT) and compare risk factors for diabetic retinopathy (DR) among PFT and non-PFT patients. Methods This cross-sectional hospital-based study included 2,834,616 new patients presenting to a multi-tier ophthalmology hospital network in India between August 2010 and June 2021. Patients with a clinical diagnosis of PFT in at least one eye were included as cases. The data were collected using an electronic medical record system. Results Overall, 2,310 (0.081%) patients were diagnosed with PFT. Most of the patients were female (62.42%) with (odds ratio [OR] = 2.08), and had bilateral (84.85%) affliction. The most common age group at presentation was during the sixth decade of life with 825 (35.71%) patients. The overall prevalence was higher in patients from an upper socio economic status (0.242%) presenting from the metropolitan geography (0.113%; OR = 2.37). Systemic history of diabetes mellitus (DM) with a mean duration of 122.03 ± 95.59 months was seen in 849 (36.75%) and hypertension in 609 (26.36%) patients. Of the 4,270 eyes, 2,441 (57.17%) eyes had a visual impairment of mild or no visual impairment (<20/70) followed by moderate visual impairment (>20/70–20/200) in 1022 (23.93%) eyes. The risk of sight threatening diabetic retinopathy (STDR) among PFT patients was higher (OR = 1.43) compared to non-PFT cohort. Choroidal neovascular membrane (CNVM) was observed in 481 (11.26%) eyes. Conclusion PFT is more common in females and is predominantly bilateral. PFT is more common in upper socio economic status and majority of the eyes had mild or moderate visual impairment. Diabetes and Hypertension are associated risk factors in PFT.

Histologic pattern analysis of cutaneous basal cell carcinoma at a tertiary care hospital in South India

Basal cell carcinoma (BCC) is one of the common malignant disease of the skin worldwide. An attempt at a simplified, accurate histologic classification of BCC based on histologic growth patterns is done in this study. This paved way to the concept of risk typing BCC into low and high-risk types. This is a retrospective descriptive study of skin biopsies diagnosed as BCC between 2010 and 2018 in the Department of Pathology in a tertiary care teaching hospital in Karnataka. H&amp;E stained sections were reviewed, histopathologically subtyped and further categorized into high and low risk types. IHC for BerEP4 was done in ten diagnostically challenging cases. The patients were followed up for six months after the study period. 79 cases of BCC were studied with majority of them being classified as high risk BCC (83.54%), with nodular type (51.89%) being the most common histological subtype. BCCs were seen predominantly in patients in the sixth decade with a female preponderance in both high and low risk BCCs. Majority of the patients with genetic predispositions were of young age and included xeroderma pigmentosa and oculocutaneous albinism. IHC for BerEP4 showed strong and diffuse membranous staining in all ten cases. Recurrence was noted in two cases and metastasis following three recurrences was noted in one case. An accurate histologic classification of BCC based on growth pattern is of great significance as it reflects the biological behaviour of the tumour. Risk typing BCC into high and low risk types further guides the management of BCC. High risk categories mandate more aggressive and decisive treatment to prevent recurrences and also helps predict the prognosis for the patient.

Spherical means-based free-water volume fraction from diffusion MRI increases non-linearly with age in the white matter of the healthy human brain

The term free-water volume fraction (FWVF) refers to the signal fraction that could be found as the cerebrospinal fluid of the brain, which has been demonstrated as a sensitive measure that correlates with cognitive performance and various neuropathological processes. It can be quantified by properly fitting the isotropic component of the magnetic resonance (MR) signal in diffusion-sensitized sequences. Using N=287 healthy subjects (178F/109M) aged 25-94, this study examines in detail the evolution of the FWVF obtained with the spherical means technique from multi-shell acquisitions in the human brain white matter across the adult lifespan, which has been previously reported to exhibit a positive trend when estimated from single-shell data using the bi-tensor signal representation. We found evidence of a noticeably non-linear gain after the sixth decade of life, with a region-specific variate and varying change rate of the spherical means-based multi-shell FWVF parameter with age, at the same time, a heteroskedastic pattern across the adult lifespan is suggested. On the other hand, the FW corrected diffusion tensor imaging (DTI) leads to a region-dependent flattened age-related evolution of the mean diffusivity (MD) and fractional anisotropy (FA), along with a considerable reduction in their variability, as compared to the studies conducted over the standard (single-component) DTI. This way, our study provides a new perspective on the trajectory-based assessment of the brain and explains the conceivable reason for the variations observed in FA and MD parameters across the lifespan with previous studies under the standard diffusion tensor imaging.

The Demographic and Clinicopathological Characteristics of Hepatopancreatobiliary Cancers From a Specialized Center in India.

Introduction Hepatopancreatobiliary (HPB) cancers are a distinct group requiring specialized multidisciplinary care. The present study was an analysis of HPB cancers. Methods The institutional data for two years from 2017 to 2018 was retrieved from the hospital-based cancer registry (HBCR) database in Excel format (Microsoft® Corp., Redmond, WA). The demographic details, method of diagnosis, tumor characteristics, and disease extent of the patients with HPB primary sites were retrospectively analyzed. Results Out of the 1417 patients with HPB malignancies, 1193 were analyzed. Most of the patients at our center hailed from North India. The distribution of HPB cancers was as follows: hepatocellular carcinoma (HCC) (n=717, 60.1%), gallbladder (GB) (n=230, 19.3%), periampullarycarcinoma (n=76, 6.37%), head of the pancreas (HOP) (n=55, 4.61%), extrahepatic bile duct (EBD) (n=53, 4.44%), intrahepatic bile duct (IBD) (n=32, 2.68%), and body of the pancreas (BOP) (n=30, 2.52%). The most common disease presentation of HPB cancers was in the seventh and sixth decades of life. Male predominance was seen in all HPB cancers except in GB with a higher incidence in females. The predominant cause of chronic liver disease (CLD) with HCC was viral-related (53.7%) with hepatitis B virus (HBV) (34.3%) higher than hepatitis C virus (HCV) (19.2%)followed by non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) (24.8%) and then alcohol. Adenocarcinoma was the most common morphology in pancreatobiliary malignancies. The disease presentation was locoregional in 63.4% of HCC, 69.7% of periampullary carcinoma, and 50.9% of HOP cases. The patients with EBD and IBD cancers presented commonly with locoregional disease extent in 60.4% and 62.5%, respectively. Perihilar subsite was more commonly detected (71.7%) as compared to the distal one in the patients with EBD cancers. The patients with GB cancers (GBC) presented with distant metastases in 53.5% and locoregional disease in 33%. Distant metastases were present in 76.7% of the patients with BOP cancers. The liver was a common site of distant metastases in GB, periampullary, and pancreatic cancers. Conclusions The present study highlights the characteristics and the variations in disease presentation in different primary tumor sites of HPB cancers. In view of the common locoregionally advanced disease presentation of HCC, the patients with CLD need surveillance for the early detection of lesions. As the patients with HPB cancers show advanced disease presentation, effective locoregional and systemic therapies are needed.

Epidemiology and Outcomes Associated with PR Prolongation.

PR prolongation is defined primarily as delayed conduction through the AV node, but can also signify delayed electrical impulse propagation through any part of the conduction system. The prevalence of PR prolongation ranges from 1% to 5% in patients younger than 50 years, with increasing prevalence, after the sixth decade of life and in patients with organic heart disease. Contemporary studies have documented increased risk of atrial arrhythmias, heart failure, and mortality in patients with PR prolongation. Future studies are needed to more accurately risk stratify elderly patients with PR prolongation who may be at increased risk of adverse outcomes.

The Six Decades of the Capital Asset Pricing Model: A Research Agenda

This paper re-examines the presence of the Sharpe–Treynor–Lintner–Mossin capital asset pricing model (CAPM) in the finance literature and is accompanied by a bibliometric summary analysis. The popular model is in its sixth decade; we summarized the relevance of the CAPM using publication and citation trends, as well as identifying its most prolific and impactful contributors. This paper is based on a systematic review of the literature and was completed with the help of various bibliometric techniques. During the study process, we presented a map of various themes and areas of the CAPM and its evolution. Our findings indicate that the extant literature on this topic (the cost of capital, asset pricing, portfolio, risk management, beta, systematic risk, and value premium) is based on the principles and assumptions of the CAPM. We are considering suggestions on the future use, trend, and direction of the CAPM, based on our summary of thematically developed clusters.

A Review of the Current Literature on Pleomorphic Adenoma.

Pleomorphic adenomas (PA) are the most common benign salivary gland tumors. They arise from the major salivary glands, as well as the minor salivary glands. They may arise rarely from the palate, oral cavity, neck, and nasal cavityalso. Yet, the fourth, fifth, and sixth decades of life are the most common for them to manifest. Forty percent of them occurin males and 60% in females.It is a benign mixed tumor, whichhas three components: an epithelial component, a myoepithelial cell component, and a mesenchymal component.A fibrous capsule separates these cells from the surrounding tissues. Itgenerally presents as a slowly progressingpainlessswelling, which is well-delineated, nonsymptomatic, and not involving the facial nerve. Salivary gland tumors can be accurately diagnosed before surgery using fine-needle aspiration (FNA), ultrasonography (USG), and computed tomography (CT) scan. Calponin, cluster of differentiation 9 (CD9), glial fibrillary acidic protein (GFAP), Mcl-2, metastasis suppressor gene (NM23), p63, S-100, smooth muscle actin (SMA), and SRY-box transcription factor 10 (SOX10) exhibit the majority of the positive reactions in pleomorphic adenomas. The diagnostic marker pleomorphic adenoma gene 1 (PLAG1) is frequently employed since it is specific for pleomorphic adenoma.Although benign, these epithelial tumors have a propensity to recur and undergo malignant transformation if incompletely excised, leading to increased morbidity in these patients. A review of the consensus guidelines and literature was conducted, and the online literature on the subject from 2002wasincluded. This article is not a complete review of all the available literature; rather, it is a comprehensive review of the topic.

COMPARING THE EFFICACY OF ROM EXERCISES WITH AND WITHOUT SCAPULAR MOBILIZATION IN PATIENTS WITH ADHESIVE CAPSULITIS

Objective: Adhesive capsulitis, or frozen shoulder, is a condition characterized by shoulder pain and limited range of motion. Its cause and pathophysiology are not well understood. The prevalence is estimated to range from 2% to 5% in the general population, with a higher incidence in women and individuals in their fifth and sixth decades of life. The optimal treatment approach for adhesive capsulitis is currently unclear, although ROM exercises are commonly prescribed. Scapular mobilization may enhance outcomes by addressing scapular dyskinesis and muscle imbalances.&#x0D; Methods: A comparative study with 30 subjects diagnosed with adhesive capsulitis was conducted. Subjects were randomly assigned to two groups: ROM exercises with scapular mobilization (Group 1) and ROM exercises without scapular mobilization (Group 2). The study took place at PMCH, Udaipur, for 12 w, with sessions lasting 30 min per day, 5 d a week. Inclusion and exclusion criteria were established, and outcome measures such as pain scores, ROM measurements, functional assessments, and patient-reported outcomes were used.&#x0D; Results: The analysis of SPADI scores revealed that Group A had a mean score of 41.73 (SD = 4.69, SE = 0.86), while Group B had a mean score of 42.40 (SD = 3.29, SE = 0.84), with a mean difference of 0.67. The t-test indicated a significant difference between the groups (t = 1.335, p = 0.021). Similarly, for VAS scores, Group A had a mean score of 3.20 (SD = 0.67, SE = 0.17), Group B had a mean score of 3.06 (SD = 0.70, SE = 0.18), with a mean difference of 0.14. The t-test also revealed a significant difference between the groups (t = 5.95, p = 0.038). These results demonstrate notable distinctions in both SPADI and VAS scores between Group A and Group B.&#x0D; Conclusion: The study supports the effectiveness of combining scapular mobilization with ROM exercises for adhesive capsulitis. The group receiving both interventions showed greater improvements in shoulder range of motion and pain reduction compared to the ROM exercises alone group. Incorporating scapular mobilization into the treatment approach may enhance the management of adhesive capsulitis. Further research is needed to validate these findings and customize treatments based on individual patient characteristics.

Esthesioneuroblastoma: an institutional based descriptive study of a rare tumor

Background: Esthesioneuroblastoma is a slow-growing rare malignant neuroectodermal tumor arising from the olfactory epithelium. It has a bimodal incidence with peaks in the second and third decades of life and the sixth and seventh decades of life with equal incidence among men and women. Prognostic factors include the Hyams grade and modified Kadish stage. This study analyzed the clinicopathological features of esthesioneuroblastoma. Materials and methods- Retrospective study of patients who were diagnosed with esthesioneuroblastoma at a tertiary care hospital between January 2012 and May 2019 was conducted. The research was performed according to the World Medical Association Declaration of Helsinki. Institutional research committee approval (IEC: 473/2019) was obtained. Results: Clinicopathological profiles of 8 patients who were diagnosed with esthesioneuroblastoma during the period were included. Among the eight patients, five were female and three were male. Common presenting complaints were nasal obstruction, difficulty in breathing, epistaxis, local pain, and anosmia. The average age of presentation was 52 years, ranging from 14 to 73 years. Anterior rhinoscopic examination in these cases showed a polypoid mass located in the nasal cavity. According to the Hyams grading system, three of the eight cases were grade-2 and the remaining five cases were grade-3 Hyams histological grade. Three cases exhibited foci of ganglioneuroblastic transformation. Three patients had metastases to cervical lymph nodes and three patients had recurrence. Conclusions: Esthesioneuroblastoma is a rare aggressive malignant tumor. It can exhibit divergent epithelial or ganglionic differentiation. A proper diagnosis should be made, graded and staged before proceeding to treatment.