Space Involvement Research Articles

DEVELOPMENT OF THE ROMANIAN EXTENDED NATIONAL SECURITY STRATEGY FOR THE PERIOD 2025-2030. PROMOTING INTERESTS IN A DYNAMIC WORLD, UNPREDICTABLE IN FULL EXPANSION AND CHANGE

In the last three decades, Romania has evolved greatly through the individual and joint action of its citizens and has achieved national objectives essential for internal stability and development and strengthening its external position: integration in NATO and the European Union. The extended national security policy is built on fundamental values and benchmarks, being the expression of the common national consensus and effort. In addition to these goals, Romanians have affirmed, on numerous occasions, their attachment to defending the rule of law and democracy, the independence of the judiciary, the fight against corruption, their attachment to involvement in the public space, an indication of the development of a participatory political culture. As a state that continues to reform and aims at stability and modernization, the progress of the citizens of Romania must be the foundation of the actions of the institutions of the rule of law.

Social interaction in an inclusive educational space in the context of studying the existential foundations of being a person with disabilities

Introduction. Considering the existential foundations of the existence of a person with disabilities in an inclusive educational space is conceptually, practically, and methodologically significant for philosophical and socio-cultural aspects of studying the specifics of inclusive reality. In line with modern philosophical trends, searching for and forming a correct conceptual and categorical apparatus is crucial; such an apparatus will be the theoretical basis for adequate presentation and interpretation of issues arising in the study of an inclusive society. Using the concept of social interaction, the work aims to consider how individual existential aspects of a person with disabilities are formed and implemented in an inclusive educational space. Materials and methods. The theoretical basis of the work is scientific sources concerning the everyday issues of people with disabilities, associated with a systematic approach to the functional features and mechanisms of the inclusive educational space. Correct and adequate presentation of priority tasks and transformation directions for an inclusive society, based on existential and phenomenological approaches, actualizes the use of symbolic interactionism, phenomenological reduction, and the praxemic method. Research results. An integral study of the life activity of people in different social groups and strata, complexes of motives for behavioral activity, and psycho-emotional reflection of radical transformations in the inclusive society are priorities of theoretical understanding of an inclusive educational space. Social interaction in the educational space is associated with the fact that a cognitive individual with disabilities reconstructs other subjects with disabilities as completely conscious objects from the point of view of intersubjectivity and using one’s own experience of understanding and interpreting the origins and essence of one’s own individual existence. Conclusion. Considering the existential foundations of an individual with disabilities primarily concerns their construction in relation to individual experience and with an emphasis on the complex of associations and experiences of sensory representations and the system of mental images. Substantial characteristics of individual experience allow constructing multi-level models that reflect the complexity of intentions and existential experiences of a person with disabilities and the features of their own interval trajectory of involvement in the inclusive educational space.

Trans-cending Parenthood: Lived Experiences of Parents Raising Transgender and Gender Expansive Children

This Interpretative Phenomenological Analysis (IPA) study, informed by the application of queer theory, examined eleven parents’ narratives about raising Transgender and Gender Expansive (TGE) children. The subjective experiences of these parents’ transcendence into parenting a TGE child informed one superordinate theme, the impact of living in a conventional society on the unique parenting experiences of raising TGE children. Evoked by the superordinate theme, the subtheme socio-cultural-political influences, encompasses preconceived ideas and assumptions experienced by each parent as they navigate raising a TGE child within a conventional society. Other subthemes include internalizing cishet norms and safety concerns, cishet language and cognitions on gender, and protective feelings and reactions to family and community judgments which demonstrate the multiple realities of each participant. The final subtheme, peer-led play support group, embodies these parents’ involvement in an affirming space. This data, and the meaning made from it, align with the realities of each participant and their experiences as a collective to inform this paper, which concludes with implications for supporting parents of TGE children and considerations for future research.

Radiographic differences in deep fascial space infections versus localized acute apical abscesses: A cone-beam computed tomographic-based observational study

ABSTRACT Aim: The objective of this study was to evaluate anatomical differences and patterns of bone loss in patients with acute apical abscess (AAA) clinically presenting as a localized swelling or with concomitant fascial space involvement (FSI) using cone-beam computed tomographic (CBCT) imaging. Materials and Methods: Thirty CBCT images of AAA cases presenting with fascial space involvement (FSI) and 31 cases of localized acute apical abscess (LAAA) were evaluated. Factors that were recorded included the presence/absence of cortical disruption, the distance of the involved tooth apex to the buccal and lingual/palatal cortex, the length of the anatomic root/s of the involved tooth, and the volume of the endodontic lesions. Results: The median for the volume of the lesions was 138 mm3 for the FSI group and 154 mm3 for the LAAA group (P > 0.05). Radiographic evidence of cortical disruption was seen in 26.7% of the cases with FSI and 41.9% of the cases with LAAA (P > 0.05). The mean for the distance of the apex to the buccal cortex was the only statistically significant difference between the two groups and was 4.2 mm for the FSI group and 3 mm for the LAAA group (P < 0.05). Conclusions: CBCT assessment showed root apices associated with fascial space involvement tended to be more confined in cancellous bone. Although a significant difference between the two conditions was found, the inflammatory process is complex, and CBCT assessment alone cannot predict AAA remaining as a localized swelling versus spreading to fascial spaces.

Revision Surgery Following Primary Reconstruction for Hand Syndactyly

Web creep and scar contracture are established complications of syndactyly reconstruction; however, few reports characterize risk factors for revision surgery. The purpose of this investigation was to examine the rate and risk factors of reoperation for congenital hand syndactyly. Patients undergoing syndactyly reconstruction from 2007 to 2021 at a single children's hospital were reviewed. Cases with less than 1 year of follow-up were excluded. Demographic, surgical, and outcomes data were recorded by each web space to account for mixed treatments. In total, 514 web spaces in 231 children were reviewed with a mean follow-up of 6.0 years after primary reconstruction; 66 (12.8%) web spaces in 51 (22.1%) children underwent revision. The most common procedures were web space deepening due to web creep (57.9% of cases) and digital scar contracture release (45.6%); these were augmented in a minority (17.5%) of cases by other aesthetic/functional procedures. Revisions occurred at a median of 1.7 years after primary reconstruction. First web spaces (thumb-index finger) were most frequently reoperated (33.3%). On multivariable analysis, first web space involvement, complete syndactyly, and complications after the primary reconstruction significantly increased odds of revision. Age at primary reconstruction was not a significant predictor. Following revision, 10.5% of cases had recurrent web creep, and 14.0% had recurrent scar contracture. Eight (1.6%) web spaces in seven (3.0%) children required multiple revisions. Approximately 13% of syndactyly reconstructions (22% of patients) require reoperation. Most revisions occur within 4 years of primary reconstruction. Complete syndactyly, complications after the primary reconstruction, and first web space involvement increase the risk of revision; age at primary reconstruction is not a risk factor. Revision outcomes mirror the index procedure, with 10% to 14% of revised web spaces experiencing recurrent web creep or contracture. Therapeutic IV.

A Cross-Sectional Survey Investigating Māori and Non-Māori Cancer Patients' Views on Psychedelic-Assisted Therapy in Aotearoa New Zealand.

People with cancer experience higher rates of psychological dysfunction than the general population, with extreme inequity among indigenous people. Psychedelic-assisted therapy (PAT) is a reemerging area with promising evidence as a treatment for mental health difficulties. The current study aimed to investigate the perceptions of PAT in indigenous (Māori) and non-indigenous cancer patients in Aotearoa, New Zealand. Eighty-five cancer patients (Māori n = 32, non-Māori n = 53) completed a brief anonymous survey assessing demographics, psychological factors, and awareness and perceptions of PAT. Participants were recruited online (via social media and cancer support e-mail lists) and in person at Auckland City Hospital. Maori had significantly poorer psychological well-being than non-Māori. All participants had low awareness of this novel treatment and held largely neutral attitudes. Regression analyses revealed that predictors of more favorable attitudes toward PAT included greater awareness of psychedelics, advanced cancer stage, younger age, poorer holistic well-being, greater demoralization, and prioritizing treatment effectiveness over possible risks and uncertainty. The current study provides a foundational step in exploring perceptions toward PAT in indigenous and non-indigenous groups. These results have the potential to shape future research trials investigating PAT and further highlight the importance of indigenous involvement in the psychedelic research space.

HOW DOES WOMEN IN SECURING ELECTORAL VOTE IN INDONESIAN POLITIC? INSIGHT FROM SOUTH SUMATERA PROVINCE

The issue of women's representation in politics has become an interesting discourse in various countries, even in Indonesia. The advancement of female candidates needs to be appreciated in the midst of the patriarchal culture that is still inherent in Indonesia. The presence of women in politics cannot be separated from the role of family ties. This is the focus and purpose of this article, which is to describe the family ties that influence women's electability in politics. The research method used in this article is a qualitative-descriptive method through literature study to explain the family ties factor in Ratu Tenny Leriva's representation as a senator for the 2024 South Sumatra Electoral District. Using the theoretical framework of the Richter model of family ties, this study reveals that Ratu Tenny Leriva's election cannot be separated from Herman Deru's position and influence. As a former Governor, Regent, and Chairman of the Regional Representative Council of the NasDem Party in South Sumatra, Herman Deru facilitated Ratu Tenny Leriva in building a positive image, popularity, and electability, despite being a new-comer and still 23 years old. This can be seen from Ratu Tenny Leriva's involvement in various public spaces and campaign periods, where many billboards or posters include Herman Deru's photo. This family bond is an important factor and political modality in Ratu Tenny Leriva's electability in South Sumatra in 2024.

Diagnostic utility of apparent diffusion coefficient in preoperative assessment of endometrial cancer: are we ready for the 2023 FIGO staging?

BackgroundAlthough endometrial cancer (EC) is staged surgically, magnetic resonance imaging (MRI) plays a critical role in assessing and selecting the most appropriate treatment planning. We aimed to assess the diagnostic performance of quantitative analysis of diffusion-weighted imaging (DWI) in preoperative assessment of EC.MethodsProspective analysis was done for sixty-eight patients with pathology-proven endometrial cancer who underwent MRI and DWI. Apparent diffusion coefficient (ADC) values were measured by two independent radiologists and compared with the postoperative pathological results.ResultsThere was excellent inter-observer reliability in measuring ADCmean values. There were statistically significant lower ADCmean values in patients with deep myometrial invasion (MI), cervical stromal invasion (CSI), type II EC, and lympho-vascular space involvement (LVSI) (AUC = 0.717, 0.816, 0.999, and 0.735 respectively) with optimal cut-off values of ≤ 0.84, ≤ 0.84, ≤ 0.78 and ≤ 0.82 mm2/s respectively. Also, there was a statistically significant negative correlation between ADC values and the updated 2023 FIGO stage and tumor grade (strong association), and the 2009 FIGO stage (medium association).ConclusionsThe preoperative ADCmean values of EC were significantly correlated with main prognostic factors including depth of MI, CSI, EC type, grade, nodal involvement, and LVSI.

Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score.

Left ventricular assist devices (LVAD) improve survival for patients with cardiac failure, but LVAD-specific infection (VSI) remains a challenge with poorly understood predictive risk factors. The indications and use of escalating medical treatment to surgical debridement and potential flap reconstruction are not well characterized. A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed. The primary outcome measures were 90-day and overall mortality after VSI. Cox proportional hazards regression was used to generate a risk prediction score for mortality. Of the 760 patients undergoing primary LVAD implantation, 255 (34%) developed VSI; of these patients, 91 (36%) were managed medically, 134 (52%) with surgical debridement, and 30 (12%) with surgical debridement and flap reconstruction. One-year survival after infection was 85% with median survival of 2.40 years. Factors independently associated with increased mortality were diabetes (hazard ratio [HR] 1.44, p = 0.04), MRSA infection (HR 1.64, p = 0.03), deep space (pump pocket or outflow cannula) involvement (HR 2.26, p < 0.001), and extracorporeal membrane oxygenation after LVAD (HR 2.52, p < 0.01). Factors independently associated with decreased mortality were flap reconstruction (HR 0.49, p = 0.02) and methicillin-sensitive Staphylococcus aureus infection (HR 0.63, p = 0.03). A clinical risk prediction score was developed using these factors and showed significant differences in median survival, which was 5.67 years for low-risk (score 0 to 1), 3.62 years for intermediate-risk (score 2), and 1.48 years for high-risk (score ≥3; p < 0.001) patients. We developed a clinical risk prediction score to stratify patients with VSI. In selected cases, escalating surgical treatment was associated with increased survival. Future work is needed to determine whether early surgical debridement and flap reconstruction can alter outcomes in select cases of VSI.

The Clinical and Surgical Characteristics of Parotid Tumors with Parapharyngeal Space Involvement-A Multicenter Experience of the Polish Salivary Network.

Backgrounds/Objectives: Parotid gland tumors (PGTs) with parapharyngeal space (PPS) involvement have a specific clinical course and they can be a great challenge for surgeons, especially due to more difficult approaches and the risk of serious complications. The aim of this study is to present the characteristics of PGTs with PPS involvement. Methods: Retrospective, multicenter analysis of 1954 primary PGTs from 5 years (2017-2021) was performed. Comparative analysis was performed between groups with and without PPS involvement and included the following clinical and histopathological data: age, sex, place of residence, tumor size, FNAC result, percentage of malignant tumors, histological diagnosis, radicality of resection, and postoperative facial nerve (FN) dysfunction. Results: PPS involvement was found in 114 patients (5.83%). Secondary tumors affecting the deep lobe or the entire gland were predominant (46 and 60 cases, respectively). In a univariate analysis of tumors with and without PPS involvement, statistically significant differences were found in their size > 4 cm (12.97% vs. 37.72%), percentage of malignant tumors (7.12% vs. 17.55%), incidence of Warthin Tumors (WTs) (43.58% vs. 24.56%), percentage of R1 resection (5.53% vs. 12.50%), and rate of FN paresis (17.15% vs. 53.34%). Multivariate analysis showed that tumors with PPS involvement were statistically significantly characterized by larger size (tumors > 4 cm were 2.9 times more frequent), 2 times less frequent occurrence of WTs, and 1.6 times higher risk of FN paresis. Conclusion: PGTs with PPS involvement show certain clinical and histological differences and require more complex surgical accesses. Therefore, they cannot be treated as "ordinary" tumors occupying the deep lobe.

Multilevel sources of strength and school-based racial discrimination: Competing factors associated with mental health among African American college students.

Despite increasing diversity on predominantly White college campuses, African American college students remain subject to racial discrimination, creating a complex array of mental health stressors. In this study, we adopted a strengths-based approach to mental health in this population and investigated (a) whether school-based discrimination contributes to negative mental health outcomes; (b) whether internal, interpersonal, and campus sources of strength contribute to positive mental health outcomes; and (c) whether internal sources of strength moderate the mental health effects of discrimination. Secondary analysis was performed on public data from African American college students (N = 1,444; Mage = 24.67, SDage = 7.87) who participated in the Healthy Minds Study between 2017 and 2020. Healthy Minds Study is a cross-sectional survey examining mental health factors in U.S. university student populations. School-based racial discrimination was negatively associated with flourishing and positively associated with depression. Flourishing was positively associated with all sources of strength, including academic persistence, religiosity, racial identity, race-based affinity space involvement, and campus climate for diversity. Depression was inversely associated with persistence, religiosity, and affinity space involvement. Except for persistence, internal sources of strength did not mitigate the negative effects of discrimination on mental health outcomes. Policies are needed that hold accountable campus members who perpetrate race-based aggressions, tangible support systems involving African American mentors and cultural affinity groups, and strengths-based audits of students seeking mental health care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Re-defining pT4b buccal mucosa squamous cell carcinoma: Looking beyond palliation in select patients

ObjectivesReports in the last 2 decades suggest that selected patients with masticator space invasion can be treated surgically with reasonable survival. This study is an attempt to identify prognosticators for disease free (DFS) and overall survival (OS) in surgically treated pT4 buccal mucosa squamous cell carcinoma (BMSCC) patients. Material and methodsThe cohort for this retrospective study comprised 213 patients with pT4a/b BMSCC, treated with curative intent surgery from August 2011 through December 2019. Depending upon masticator space invasion (MSI) patients were divided into 3 groups viz. pT4a, involvement of masseter and/or medial pterygoid (Low MSI) and involvement of lateral pterygoid and/or temporalis (High MSI). ResultsThe median follow-up in this study was 45 (2–123) months. The 5-year DFS was 53 %, 42 % and 21 % for pT4a, Low MSI and high MSI groups, respectively. The 5-year OS was 68 %, 43 % and 21 % for these three groups. The MSI (HR 1.5, p = 0.113 for Low MSI, HR 2.98, p < 0.001 for high MSI), perineural invasion (PNI) (HR 2.17, p = 0.001) and extranodal extension (ENE) (HR 2.74, p = 0.001) predicted poor DFS on multivariate analysis. OS was worse in patients with MSI (HR 1.86, p = 0.020 for Low MSI, HR 3.46, p < 0.001 for high MSI), PNI (HR 2.48, p < 0.001) and ENE (HR 3.02, p = 0.001) on multivariate analysis. Adjuvant treatment improved both OS and DFS. ConclusionSelect patients with masticator space involvement can benefit from aggressive treatment. Radiation with or without chemotherapy in adjuvant setting can further improve prognosis in these patients.

The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0).

Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.

Can Hounsfield unit density value accurately predict prelaryngeal invasion in laryngeal carcinoma cases

ObjectiveThe Hounsfield unit density value (HUDV) is a relative quantitative measurement of radio density used by radiologists in the interpretation of computed tomography (CT) images. Our aim is to investigate the role of HUDV in evaluating pre-epiglottic space (PES) involvement of laryngeal carcinoma. MethodsSeventy-four patients treated for laryngeal carcinoma in our clinic between 2014 and 2019 were included in the study. The invasion status of PES was determined radiologically and pathologically. HUDV was measured with a circular selected region of interest, with a constant size of 10 mm2 for PES. The relationship between patological PES invasion, radiological PES invasion, and HUDV was evaluated. ResultsMeasuring HUDV to determine PES invasion (74.3 %) was significantly higher than​​ conventional CT evaluation (59.5 %) (p = 0.001). The agreement coefficient (kappa value) of the conventional CT evaluation and the HUDV regarding PES involvement was 0.673, which was interpreted as ‘good’. ConclusionHUDV could be used as an additional tool in diagnosing pre-epiglottic space invasion in laryngeal cancer.

Histopathological Analysis of Retinoblastoma: Insights into Prognostic Factors and Chemotherapeutic Response

Background: Retinoblastoma is a highly aggressive ocular malignancy that mainly impacts young children. It is essential to comprehend the histopathological characteristics of this tumour to determine the most effective treatment approaches. Furthermore, recognizing high-risk histopathological factors can help predict the prognosis and guide treatment decisions for patients with retinoblastoma. Objective: To analyse the histopathological features in eyes with retinoblastoma primarily treated by enucleation and those treated with chemoreduction. The goal is to identify high-risk factors and improve treatment modalities, prognosis, and reduce morbidity and mortality. Methods: 40 enucleated eyes registered from October 2021 to October 2023 had been studied. Histopathological findings were evaluated according to age, sexlaterality, choroid, sclera, optic nerve, subarachnoid space involvement, necrosis, and calcification, degree of differentiation, chemotherapeutic effect and tumor regression after chemotherapy and histoprognostic factors. Grading and staging were done according to 8th AJCC classification of eye tumor. Results: Rosettes, necrosis, calcification were common histological findings in this study. High risk factor assessment was very crucial in staging and prognosis. Chemotherapy treated eyes showed varying degrees of response. Conclusion: Histopathological evaluation guide further management to prevent metastasis.

Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis

ObjectiveThe present systematic review was performed to identify risk factors associated with life-threatening complications of head and neck space infections (LCHNSI) within the included studies and assess the magnitude of their impact on patients. MethodsWe systematically searched PubMed, Web of Science, EmBase, Scopus and CNKI for articles that reported risk factors associated with life-threatening complications of head and neck space infections from inception to 14 December 2023. Only factors reported in at least three papers were considered in the meta-analysis. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using fixed effects model and random effects model. The between-study heterogeneity of effect size was quantified using the Q statistic and I2. In addition, subgroup analysis stratified by study characteristics and sensitivity analysis were performed to explore the potential sources of heterogeneity and the stability of the results. ResultsThe review included a total of 29 studies. The results revealed that the risk factors which associated with LCHNSI were included diabetes mellitus (OR = 3.31, 95 % CI: 2.49–4.40), total leukocyte count(≥15 × 109/L) (OR = 1.21, 95 %CI: 1.04–1.42), multiple space involvement (OR = 4.32, 95 %CI: 3.47–5.38), combined systemic diseases (OR = 9.94, 95 %CI: 6.30–15.67), advanced age(≥60) (OR = 3.90, 95 %CI: 2.80–5.44), dyspnoea (OR = 23.39, 95 %CI: 12.41–44.10), high temperature(≥39°C) (OR = 3.23, 95 %CI: 2.02–5.17), retropharyngeal space involvement (OR = 3.62, 95 %CI: 2.06–6.35), parapharyngeal space involvement (OR = 4.62, 95 %CI: 2.27–9.42). ConclusionsAccording to the current analysis, diabetes mellitus, total leukocyte count(≥15 × 109/L), combined systemic diseases, multiple space involvement, advanced age(≥60), dyspnoea, high temperature (≥39 °C), retropharyngeal space involvement, parapharyngeal space involvement were the risk factors for LCHNSI. To mitigate the incidence of LCHNSI, clinical staff should carefully manage these risk factors, ensure prompt diagnosis, and implement timely preventive measures.

Late Stage at Diagnosis of Cervical Cancer and Its Correlates at a Large Regional Referral Hospital in Uganda: A Cross-Sectional Study.

Background The stage of disease at diagnosis is one of the major determinants of survival in women with cervical cancer. Most women with cervical cancer in low- and middle-income countries (LMICs) present to hospitals with advanced stages, thus reducing their survivorship following the diagnosis. Factors correlated with late-stage disease at diagnosis are not completely explored. This study aimed to describe the association between sociodemographic, clinical, and metabolic characteristics with late-stage disease at diagnosis in women with cervical cancer attending the Mbarara Regional Referral Hospital in Southwestern Uganda. Methodology We conducted a cross-sectional study of women with histological diagnoses of invasive cervical cancer between November 2022 and August 2023. Women who presented to the hospital with the International Federation of Gynecology and Obstetrics stage IIb and above were considered to have late-stage cervical cancer while those with stage IIa and below were considered to have early-stage disease. We used modified Poisson regression to determine the factors independently associated with the outcome. Results We enrolled 157 women. The average age of the participants was 52.4 years. The majority of the participants (83.4%) had late-stage disease at diagnosis. Women with adenocarcinoma (adjusted prevalence ratio (aPR) = 1.18, 95% confidence interval (CI) = 1.10-1.38) and those with lymphovascular space involvement on histology (aPR = 1.30, 95% CI = 1.05-1.60) were more likely to have late-stage disease at diagnosis while women living with human immunodeficiency virus (aPR = 0.83, 95% CI = 0.71-0.97) were less likely to present with late-stage disease at diagnosis. None of the sociodemographic and metabolic characteristics were associated with late-stage disease at diagnosis. Conclusions The number of women presenting with late-stage cervical cancer is high. Efforts to increase the availability and uptake of cervical cancer screening services in LMICs should be reinforced. Cervical cancer treatment services should be decentralized to increase accessibility.

Childhood Posterior Fossa Tumours: Experience from a Tertiary Center in Nepal

Background: Brain tumour is a common problem in paediatric age group and posterior fossa is the commonest location. Treatment of these tumours is difficult due to a confined space and potential involvement of brainstem. The aim of this study is to analyse the clinical features, radiological findings, pathological diagnosis, surgical management, postoperative complications and outcome in 3 months in paediatric patients with posterior fossa tumours. Method: Retrospective chart review of 24 patients treated in the Department of Neurosurgery, TUTH, between 2019 April – 2023 April was done. The variables included were age, sex, clinical features, radiological findings, histopathological diagnosis, management and postoperative complications. Results: Twenty-four patients (30%) out of 80 childhood tumors were located in posterior fossa. The most common presenting symptoms was headache in 83.3% and vomiting in 75%. The most common location of tumour was the fourth ventricle in 66.7% while most common tumour histology was Type IV medulloblastoma in 45%. The commonest mode of treatment in 90% of cases was Ventriculoperitoneal (VP) shunting followed by surgical excision of tumour. Conclusion: Posterior fossa tumours are common tumour occurring in children. Majority of the patients presented with features of raised intracranial pressure and gait ataxia. Fourth ventricle and cerebellar vermis are the most common location. Most common histology types are medulloblastoma followed by pilocytic astrocytoma and ependymoma. Management involves addressing acute hydrocephalus followed by definitive surgery. Keywords: Medulloblastoma, Paediatrics, Posterior fossa, Surgery, Ventriculoperitoneal shunt

An Improved Staging System of Adenoid Cystic Carcinoma in the External Auditory Canal.

The purpose of this study was to define an improved staging system for adenoid cystic carcinoma (ACC) in the external auditory canal (EAC) based on biological behaviors, image findings, and the prognosis of patients with ACC in the EAC. A retrospective study. A single center data. We performed a single-institution retrospective review of 154 patients with ACC in the EAC between January 2004 and September 2021. Risk factors associated with disease-free survival (DFS) and cancer-specific survival (CSS) of ACC in the EAC were identified using univariate and multivariate cox regression analysis. Then an improved staging system was proposed and compared with the Pittsburgh-modified tumor, node, and metastasis (TNM) staging system for statistical differences in DFS and CSS. An improved staging system of ACC in the EAC was defined, in which stage T4 were subclassified into T4a and T4b and were statistically different from the Pittsburgh-modified TNM staging system in DFS and CSS. We also found that the dura mater, facial nerve, sigmoid sinus, deep lobe of parotid gland, and parapharyngeal space involvement were significantly associated with poor prognosis of ACC in the EAC. The improved staging system is more accurate in predicting survival prognosis than Pittsburgh-modified TNM staging system for patients with ACC in the EAC, and may provide more efficient guidance of treatment strategy. The improved staging system of ACC in the EAC is more accurately to predict survival prognosis, and provide guidance of treatment plan than Pittsburgh-modified TNM staging system.

The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece.

Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this studyis to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greeceas well as analyze the quantitative and qualitative parameters of patient characteristics and management data. This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specificallybetween 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively.In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.