Tertiary Referral Hospital Research Articles

Ultra-Widefield Fluorescein Angiographic Features Influencing Visual Prognosis in Coats Disease.

To investigate the retinal vascular abnormalities in both affected and fellow eyes of presumed unilateral Coats disease patients using ultra-widefield fluorescein angiography (UWF-FA) and their association with visual prognosis. A retrospective review of medical records was conducted on 30 patients diagnosed with presumed unilateral Coats disease, who were evaluated with UWF-FA from March 2003 to May 2024 at a tertiary referral hospital. Clinical features and multimodal imaging findings were evaluated, and factors related to final visual outcomes were analyzed. All 30 patients were diagnosed with presumed unilateral Coats disease at presentation, comprising 11 childhood-onset (36.7%) and 19 adult-onset patients (63.3%). Retinal vascular telangiectasia was observed in 51.7% of the fellow eyes. The extent of telangiectasia and exudate in the affected eyes did not significantly correlate with the extent of telangiectasia in the fellow eyes. In the more affected eyes, the childhood-onset group had a significantly greater extent of capillary dropout compared to the adult-onset group (5.0 clock hours vs. 2.8 clock hours, p = 0.023). In the fellow eyes, telangiectasia tended to be more frequent in the childhood-onset group, without statistical significance (63.6% vs. 44.4%, p = 0.160). In the multivariable regression analysis, the final best-corrected visual acuity (BCVA) in the more affected eyes was significantly associated with initial BCVA. The mean extent of telangiectasia in the temporal and nasal quadrants (odds ratio, 12.759; p = 0.043) and the initial BCVA of the more affected eyes (odds ratio, 11.841; p = 0.024) were identified as prognostic factors for final moderate to severe visual loss (Snellen BCVA <20 / 66). About half of the presumed unilateral Coats disease cases exhibited features of the bilateral disease. Visual prognosis is associated with the peripheral retinal telangiectasia in the temporal and nasal quadrants as well as initial BCVA in the affected eyes while it is not associated with retinal vascular abnormalities in the fellow eyes.

Clinical Features and Visual Outcome of Infectious Keratitis Associated with Orthokeratology Lens in Korean Pediatric Patients.

To investigate the clinical features and visual outcome of infectious keratitis associated with orthokeratology (Ortho-K) lens in Korean pediatric patients. We retrospectively reviewed medical records of patients diagnosed with Ortho-K lens-related infectious keratitis from June 2005 to April 2020 at a tertiary referral hospital. Patients' demographics, clinical features, microbiological evaluation, and treatment methods were assessed, and factors related to final visual outcomes were analyzed. The study included 26 eyes from 26 patients (19 female and 7 male patients; mean age, 11.9 years), with an average Ortho-K lens wear duration of 33.7 ± 21.2 months. The highest number of cases occurred in summer (11 of 26 cases, 42.3%). Central or paracentral corneal lesions were observed in 25 cases (96.2%), with a mean corneal epithelial defect size of 5.13 mm2. Pseudomonas aeruginosa was the most commonly isolated organism (n = 5), followed by Serratia marcescens (n = 4). All patients responded to medical treatment without needing surgical intervention. 72% of cases achieved favorable visual outcomes (Snellen best-corrected visual acuity [BCVA] >6 / 12), while 8% experienced severe visual impairment (Snellen BCVA ≤6 / 60) due to residual central corneal opacities. Multivariable analysis showed that non-summer seasons (p = 0.043), duration from symptom onset to presentation (p = 0.040), and corneal epithelial defect size (p = 0.002) were significantly associated with final logarithm of the minimum angle of resolution BCVA. Failed autorefraction at presentation due to an Ortho-K-related infectious keratitis lesion was a significant predictor of poor final visual outcome (Snellen BCVA ≤6 / 12; odds ratio, 38.995; p = 0.030). Ortho-K lens-related infectious keratitis can lead to permanent corneal opacities and potentially devastating visual outcomes in children. Delayed time to presentation, large corneal lesions, failure of autorefraction, and non-summer seasons were associated with poorer outcomes. Proper education and early detection would be key to safe use of orthokeratology lenses in pediatric patients.

Evaluating the Effectiveness of a Structural Allograft in Medial Open Wedge High Tibial Osteotomy in Patients With and Without a Lateral Hinge Fracture.

A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Case series; Level of evidence, 4. We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score-Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P > .05). The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture.

Depression and related factors among patients with post‐COVID‐19 conditions: Cross‐sectional, hospital‐based study

AbstractBackground and AimsThe COVID‐19 crisis has significantly impacted public health, particularly mental health. This study aims to determine the prevalence of depression and related factors among patients with post‐COVID‐19 conditions in an outpatient clinic at a tertiary referral hospital in Southern Vietnam.MethodsA cross‐sectional survey was conducted among 410 patients with post‐COVID‐19 conditions in an outpatient clinic at the University Medical Center Ho Chi Minh City. A convenience sampling method was used to screen for depression using the Patient Health Questionnaire‐9 (PHQ‐9).ResultsA total of 410 patients participated in the study. Depression was observed in 23.7% of respondents, categorized as mild (80.4%), moderate (16.5%), or severe (3.1%) based on PHQ‐9 scores. Factors influencing depression included age 50 years or older, religion, education level, full‐time employment, marital status, family contact, use of anti‐inflammatory drugs, hospital admission due to COVID‐19, chronic diseases, hypertension, and post‐COVID‐19 symptoms (shortness of breath, palpitations, fatigue, headache, abdominal pain, brain fog, insomnia, and loss of appetite). The most common symptoms reported were cough, dyspnea, shortness of breath, fatigue, and loss of appetite. A p‐value of less than 0.05 indicated statistical significance.ConclusionThe prevalence of depression among patients with post‐COVID‐19 conditions in the outpatient clinic was high. Improving mental health and quality of life, alongside the prevention and treatment of COVID‐19, should remain public health priorities.

Incidence of Ceramic Component Fractures in Total Hip Arthroplasty Using Contemporary Ceramic-On-Ceramic Bearings: A Retrospective Study Spanning Two Decades From Two Tertiary Referral Hospitals

IntroductionCeramic-on-ceramic (CoC) bearings have been widely used in total hip arthroplasty (THA) due to their excellent wear properties. However, ceramic component fractures remain a concern. This study aimed to report the incidence of third- and fourth-generation ceramic component fracture and identify factors that might influence this complication. MethodsA total of 9,280 hips that underwent THA with third- and fourth-generation CoC bearings at two tertiary institutions between 1997 and 2023 were retrospectively reviewed, and the incidence and associated factors of CoC bearing fracture were determined. We performed a Kaplan–Meier survival analysis to assess implant survivorship. Logistic regression was applied to evaluate the influence of implant size and patient-specific factors on the risk of revision. ResultsOut of the 9,280 THA procedures, there were 33 (0.36%) revisions for CoC bearing fracture. Specifically, revisions for fracture were performed for zero out of 6,654 fourth-generation CoC heads, 26 (0.990%) of 2,626 third-generation CoC heads, two (0.030%) of 6,654 fourth-generation CoC liners, and five (0.190%) of 2,626 third-generation CoC liners. All ceramic head fractures occurred in a 28 mm head. Younger age was related to both ceramic head and liner fracture. ConclusionsTo our knowledge, this is the largest two-center retrospective study on CoC bearing fractures to date. The risk of revision for fracture of CoC bearings is low, as previously reported. Our data were comparable to recent evidence suggesting that the latest generation of ceramic components can significantly decrease the incidence of head fracture but not liner fracture. Factors such as younger age and men may be associated with an increased risk of ceramic component fractures. Level of evidenceIII, therapeutic.

Evaluation of the Glomerular Filtration Rate in AKI by Kinetic Estimated Glomerular Filtration Rate in a Tertiary Referral Hospital in Mexico

Evaluation of the Glomerular Filtration Rate in AKI by Kinetic Estimated Glomerular Filtration Rate in a Tertiary Referral Hospital in Mexico

P99-2 Clinical characteristics of osteosarcoma in tertiary referral cancer center hospital in Jakarta, Indonesia

P99-2 Clinical characteristics of osteosarcoma in tertiary referral cancer center hospital in Jakarta, Indonesia

Occurrence of blaOXA-116 Carbapenemase in Escherichia coli ST2519 of Clinical Origin: A Report from Northeast India.

Carbapenem-resistant Escherichia coli pose a significant threat to global public health due to the dearth of available treatment options, resulting in infections with high mortality and morbidity. The study aimed to investigate the mechanism of carbapenem resistance in a carbapenem non-susceptible E. coli isolate recovered from an urinary tract infection patient admitted to a tertiary referral hospital, through whole-genome sequencing using Illumina NovaSeq 6000 platform. Carbapenemase production followed by antibiotic susceptibility testing were performed following Clinical Laboratory Standard Institute guidelines.Polymerase chain reaction targeting carbapenemase genes was performed followed by an investigation of horizontal transferability. The Center for Genomic Epidemiology database was used to analyze the sequenced data. ST2519 E. coli BJD_EC1808 with a genome size of 5.8 Mb harbored Col440I plasmid and a chromosomally located blaOXA-116 gene with an IS18 element upstream, along with multiple antibiotic resistance genes conferring clinical resistance toward beta-lactams, aminoglycosides, amphenicols, sulfonamides, tetracyclines, trimethoprim, rifampin, macrolide, and streptogramin antibiotics and antiseptics. E. coli ST2519 harboring blaOXA-116 associated with a mobile genetic element exhibiting carbapenem resistance is a public health threat due to its limiting effect on the therapeutic usage of carbapenem and their dissemination into carbapenem non-susceptible phenotypes will contribute to carbapenem resistance burden and, therefore, warrants urgent monitoring and clinical intervention.

Predictors of interferon-gamma release assay results and their association with COVID-19 infection outcomes.

An 'indeterminate' interferon-gamma release assay (IGRA) result used in the diagnosis of latent TB infection (LTBI) is most commonly due to an inadequate control (or 'mitogen') response, which may reflect underlying T-cell dysfunction. We performed a single-centre, retrospective study on COVID-19 patients admitted to a tertiary referral hospital who had IGRA testing conducted over a 5-month period. The primary outcomes included predictors of indeterminate IGRA results and associations with COVID-19 outcomes. A total of 181 patients were included for analysis. Approximately one-third of patients hospitalised with COVID-19 with IGRA testing performed (60/181) had an indeterminate result. The likelihood of an indeterminate IGRA was increased in patients with a history of solid organ transplant and a higher severity of COVID-19 at the time of testing. An indeterminate IGRA was associated with a higher risk of severe COVID-19 and a higher risk of admission to the ICU during admission to the hospital. No difference in mortality between the two subgroups was found. Our study demonstrated that COVID-19 patients on immunosuppression had a high likelihood of an indeterminate IGRA result, which was associated with markers of disease severity and immunosuppression. In this cohort, an indeterminate result was associated with worse COVID-19 outcomes.

Resilience in Healthcare: A Hospital-based Investigation of Breast Cancer Diagnostics Amid the Pandemic in Indonesia

Background: Widespread disruptions in healthcare services have occurred due to ongoing challenges during the pandemic. The tremendous impacts have struck countries with limited resources, greater distances of geographical access to healthcare services, and a shortage of healthcare personnel. Long delay of diagnosis and disruption in patient care affects the long-term prognosis of breast cancer. This study was conducted to investigate the effects of the COVID-19 pandemic and government-mandated social restrictions on the provision of diagnostic services for breast cancer patients in a tertiary referral hospital. The study aimed to explore how travel restrictions and patients' apprehension about COVID-19 exposure have contributed to notable declines in diagnostic and treatment procedures for breast cancer within this healthcare setting. Methods: This study was retrospective design and used a hospital registry to collect information on demographics, imaging, and pathology from January 2018 to September 2021. Breast ultrasound (US) and mammography data were collected from the Picture Archiving and Communication System (PACS), while pathology data were collected from e-medical records. The descriptive statistics of the annual total volume of imaging and pathological examinations were interpreted and statistics were only calculated for diagnostics mammography. Results: Between 2018 and 2021, the volume of monthly breast sonograms drastically decreased by 65% in 2020 and 2021 during the pandemic, while mammography significantly reduced by more than 40% from the 2019 levels. Breast US and mammography procedures were significantly lower during the first and second waves of the pandemic in March until May 2020 and June until September 2021, respectively. Although the proportion of breast ultrasound-guided fine-needle aspiration biopsy (FNAB) increased year by year, the number of FNAB for primary breast lesions significantly decreased by 84% in 2020 and 2021. Conclusions: We observed significant decreases in diagnostic procedures for breast cancer. Reconfiguration of breast cancer care scheduling is required to accommodate the potential for increased hospital visits after the travel restrictions.

Adnexal Masses in Pregnancy: A Single-Centre Prospective Observational Cohort Study

Objective: To prospectively determine the nature of adnexal masses diagnosed during pregnancy and investigate whether ultrasound was a reliable means of assessing these. Methods: A single-centre prospective observational cohort study was conducted in a large tertiary referral hospital in London. Pregnant women with an adnexal mass detected at or prior to the 12-week routine ultrasound received a detailed ultrasound by a level II ultrasound practitioner at the time of detection; at 12 weeks; 20 weeks; and 6 weeks postpartum. The following outcomes were recorded: subjective impression of the mass; International Ovarian Tumor Analysis simple rules classification; resolution and intervention rate; and the incidence of complications related to the mass. Results: A total of 28,683 pregnant patients were scanned and an adnexal masses was detected in 277 patients, yielding an incidence of 1%. 274 participants were included in the analysis. Subjective impression was as follows: simple 75.9%; dermoid 29.1%; endometrioma 6.6%; haemorrhagic 3.3%; para-ovarian 2.6%; torted simple 0.7%; decidualized endometrioma 0.4%; fibroma 0.4%; theca luteal 0.4%; and borderline ovarian tumour: 0.7%. There was a significant reduction in the volume at each scan (p &lt; 0.0001). Approximately 74.2% of the masses resolved spontaneously. Surgery was performed in 14/274: 2 antenatally, 6 at caesarean section, and 6 postpartum. In 5/247 (2%), there were complications due to the mass. Using IOTA simple rules, 272/274 (99.3%) (p &lt; 0.0001) were classifiable. Only 1/274 (0.4%) had malignant features as per IOTA (p = 0.05). As there were no confirmed malignancies, the accuracy of IOTA simple rules could not be calculated. Conclusions: Adnexal masses in pregnancy are uncommon and the majority spontaneously resolve. Malignancy is rare, as are complications. In the absence of concerns regarding malignancy or cyst accident, there is no need for additional monitoring of these masses during pregnancy.

Microbial Diversity and Antimicrobial Susceptibility from Wound Dehiscence Isolates in an Indonesian Tertiary Referral Hospital

Healthcare-associated infections (HAIs) remain a critical issue for public health in Indonesia, with wound dehiscence associated with surgical site infections (SSIs) being one of them. Globally, SSIs are known as the most common postoperative complications with a heightened prevalence, particularly in low to middle-income countries. With its retrospective and descriptive design, this study aimed to illustrate the microbial patterns identified in Prof. Dr. I.G.N.G. Ngoerah General Hospital from 12 January 2020 to 12 December 2022. The study includes all patients who underwent surgery and were subsequently diagnosed with wound dehiscence and SSIs. Specimens were collected from patients and submitted to the Microbiology Laboratory at the hospital above. Bacterial identification and susceptibility testing to antimicrobials were performed using the Vitek 2 Compact System (bioMerieux, Marcy l'Etoile, France). Patient information was sourced from medical records. Out of 172 samples, 151 (87.8%) yielded positive cultures. Among these, 151 (87.8%) were found to be positive. Gram-negative bacteria were found to be most prevalent, with Escherichia coli (20.2%) and Pseudomonas aeruginosa (19.6%) being the most frequently isolated bacteria. The bacteria isolated were mostly susceptible to amikacin (72.1%), followed closely by meropenem (71.4%). This information could contribute to the development of an empirical antibiotic therapy protocol for wound dehiscence or SSI cases in this local context.

The Use of Proton Pump Inhibitors in Patients Aged 65 Years and Above in an Academic Tertiary Referral Hospital

Abstract Background Proton Pump inhibitors (PPIs) are some of the world's most frequently prescribed medications. While PPIs are generally well tolerated, they do carry with them several associated adverse effects ranging from electrolyte disturbances to altering the absorption and thus the effectiveness of other co-administered medications to more severe concerns such as high frequencies of gastrointestinal infections and possibly even respiratory tract infections. Being so commonly prescribed, often for inappropriate or unknown indications, they become an important and relatively easy target for review. Methods A retrospective review of electronic health care records of individuals aged 65 years and older admitted under general medical teams in an academic tertiary referral hospital over the course of a calendar month was undertaken to evaluate typical PPI usage encountered, including frequency of PPI prescriptions at both admission and discharge, recorded indications, and impact of review by clinical pharmacists. Results Of the 77 individuals included in this study, 59 (77%) were prescribed a PPI at some point during admission. Of the patients surviving to discharge, 98% (n = 53) remained on a PPI at discharge. One patient (2%) had a PPI stopped before discharge. Indications for a PPI were explicitly stated in 25% (n = 15) of patients prescribed a PPI. A further 27% (n = 16) could have an indication derived from information within the electronic health record. One (2%) patient was prescribed a PPI, and a duration was indicated. Conclusion Most PPI prescriptions lack documentation regarding the indication and intended duration and may be inappropriately prescribed. The frequency of usage of PPIs in an older population that is more at risk of the adverse effects of PPIs makes them ideal targets and models for evaluation of prescribing practices and deprescribing efforts.

Fat Mass Index Predicts the Effect of Weight Loss and Quality of Life Early After Laparoscopic Sleeve Gastrectomy.

Fat mass index (FMI) is a body composition indicator that reflects body fat content. Laparoscopic sleeve gastrectomy (LSG) is widely performed in patients with obesity. This study aimed to evaluate the value of the FMI in predicting weight loss effect and quality of life early after LSG. From January 2014 to July 2022, the clinical data and computed tomography (CT) images of patients who underwent LSG at a tertiary referral teaching hospital were analyzed. Body composition indicators were calculated using the SliceOmatic software. Achieving initial body mass index within 6months postoperatively was defined as early eligible weight loss (EEWL). The relationship between body composition and EEWL was analyzed. A total of 243 patients were included. Receiver operating characteristic (ROC) curve analysis showed that the predictive value of the FMI for EEWL in patients after LSG was higher than that of other indicators (all P < 0.05; area under the curve = 0.813). The best FMI cut-off point was 13.662. Accordingly, the patients were divided into the high-FMI group and low-FMI group. The %EWL and BMI of patients in the low-FMI group at 1, 3, 6, 9, 12, and 24months after surgery were better than those in the high-FMI group (all P < 0.001). Patients in the low-FMI group had higher BAROS (Bariatric Analysis and Reporting Outcome System) scores than those in the high-FMI group (P < 0.001). Compared with other body composition indicators, FMI can effectively predict the early effect of weight loss and quality of life after LSG.

Characterisation of β-thalassemia mutations in a tertiary care referral hospital in southern India- A descriptive study

Characterisation of β-thalassemia mutations in a tertiary care referral hospital in southern India- A descriptive study

Evaluation of outcomes and risk factors for recurrent preeclampsia in a subsequent pregnancy.

The aim was to evaluate the pregnancy outcomes and identify risk factors for recurrent preeclampsia (PE). Retrospective analysis of patients discharged with PE between January 1, 2010, and January 1, 2023, from two tertiary referral hospitals. They were classified into recurrent and non-recurrent groups based on the presence of PE in subsequent pregnancies. Among 519 women who had a subsequent pregnancy after a history of PE, 153 developed recurrent PE while 366 did not. The recurrent cases included 81 preterm PE, of which 41 were early-onset PE (EOPE). Recurrent PE correlated significantly with prior EOPE, HELLP syndrome, placental abruption, and stillbirth, as well as with current chronic hypertension (CH) and type 2 diabetes. The recurrent group showed a 5.8-fold higher risk of preterm birth (PTB) compared to the non-recurrent group (50.7% vs. 8.7%). Notably, 58.1% of the PTBs in the non-recurrent group were spontaneous. Logistic regression identified previous EOPE (aOR: 4.22 [95% CI: 2.50-7.13]) and current CH (aOR: 1.86 [95% CI: 1.09-3.18]) as independent contributors for recurrent PE. Furthermore, recurrent preterm PE shared the same risk factors: previous EOPE (aOR: 5.27 [95% CI: 2.82-9.85]) and current CH (aOR: 2.99 [95% CI: 1.57-5.71]). The morbidity of CH in subsequent pregnancy peaked at 31.9% when women with a history of EOPE delivered within three years. Previous EOPE and current CH were sequentially crucial risk factors for the development of PE and preterm PE during the next pregnancy. This may clarify risk stratification in prenatal management for women with a history of PE.

Isolated Severe Neutropenia in Adults, Evaluation of Underlying Causes and Outcomes, Real-World Data Collected over a 5-Year Period in a Tertiary Referral Hospital.

Background and Objectives: In clinical practice, neutropenia is frequently accompanied by other cytopenia; isolated non-chemotherapy-induced severe neutropenia is less frequent and its differential diagnosis can be challenging. In this real-world study with data collected over a 5-year period in a tertiary referral hospital, we primarily sought to identify underlying causes of isolated severe neutropenia (<0.5 × 109/L). Secondly, we aimed to analyze its management and outcomes. Materials and Methods: From 444,926 screened patients, after exclusion of patients with chemotherapy, radiotherapy, hematological neoplasms, additional cytopenia, and benign ethnic neutropenia, we identified and analyzed data from 70 patients (0.015%) with isolated severe neutropenia. We thus confirmed that the occurrence of isolated severe neutropenia is a rare event, even in a tertiary hospital. Results: The median age at diagnosis was 34 years (range 1-81) and 65% were female. Acute neutropenia was more frequently observed (n = 46/70, 65.7%); the main underlying causes in this group were drugs (n = 36/46, 78%) followed by infections (n = 10/46, 21.7%). We identified 24 (34.3%) patients with chronic neutropenia. The majority of them (n = 12/24, 50%) had an idiopathic form (CIN), 8/24 (33%) were autoimmune (AIN), and 4/24 (17%) were congenital. Conclusions: This study demonstrates the rarity and heterogeneity of isolated severe neutropenia and the steps to consider in its diagnostic work-up and management. Epidemiological characteristics, diagnostic work-up, and management including hospitalizations are described. Due to the high frequency of metamizole-induced neutropenia observed in this study, we want to raise awareness about its use, since this complication generates frequent hospitalizations even in young, otherwise healthy patients. Furthermore, recurrent infections in chronic forms of idiopathic neutropenia were quite common, suggesting a difference in phenotypes and need for therapy consideration depending on the clinical course.

Breast cancer molecular subtype classification according to immunohistochemistry markers and its association with pathological characteristics among women attending tertiary hospitals in Tanzania

BackgroundBreast cancer immunohistochemistry is a biological characteristic of the tumour which has a role to diagnose molecular subtype, prognosticate and guide treatment and is categorised into 4 subtypes. Data in Tanzania was lacking and was based off data extrapolated from studies in Western Africa thus hypothesizing that women of African ancestry predominately develop Triple Negative Breast Cancer (TNBC). MethodsA retrospective cross-sectional study was carried out at two tertiary referral hospitals on participants who were recruited from the cancer registries from 2015 to 2022. Prevalence of each molecular subtype was determined and association between molecular subtype to demographic and pathological characteristics were evaluated. Predictors of molecular subtypes was then determined using logistic regression. ResultsTotal number of participants were 1214, median age was 50 (IQR: 41–61), median tumor size was 5 cm (IQR: 4–7) with lymph node positivity in 73.7 %. Immunohistochemistry studies showed estrogen, progesterone and Human Epidermal Growth Factor Receptor 2 (HER2) receptor positivity in 54.4 %, 34.4 % and 27.8 % of cases respectively. Molecular subtype classification prevalence for Luminal A was 21.17 % (95 % CI: 18.87–23.47), for Luminal B 35.75 % (95 % CI: 33.05–38.45), for HER2 enriched 11.86 % (95 % CI: 10.04–13.68) and for TNBC 31.22 % (95 % CI: 28.61–33.83). Significant association was seen between molecular subtype with age, tumor size, tumor grade and lymph node involvement. Predictors of Luminal tumors were larger tumor size (aOR 1.217, 95 % CI: 1.149–1.291) no lymph node involvement (aOR 0.429, 95 % CI: 0.313–0.589) while an advanced tumor grade reduced likelihood (aOR 0.041, 95 % CI: 0.011–0.019). ConclusionIn Tanzania Luminal B was most predominant subtype presenting at an earlier age and associated with more favorable pathological characteristics.

Unilateral radiotherapy for tonsillar cancer with multiple ipsilateral neck lymph nodes.

For tonsillar cancer with multiple ipsilateral neck lymph nodes, the safety and efficacy of unilateral radiotherapy (RT) have long been a topic of debate. We performed retrospective analyses of patients having ipsilateral neck lymph nodes treated with unilateral RT in two tertiary referral hospitals. This study accrued 29 patients who were diagnosed as well-lateralized tonsillar cancer with multiple ipsilateral neck lymph nodes and underwent unilateral RT from March 2000 to March 2020. Patients underwent treatment with one of the following options or a combination of them: induction chemotherapy, surgery, RT, and concurrent chemoradiotherapy. We analyzed the recurrence pattern and survival with special attention to contralateral neck failure. Also, treatment-related toxicities were compared with a 1:1 matched cohort of those who received bilateral RT, using propensity score matching analysis. At a median follow-up of 68 months, no contralateral neck failure was observed. Five-year actuarial locoregional recurrence-free survival, distant metastasis-free survival, and overall survival were 85.6%, 91.8%, and 92.7%, respectively. Both the acute and chronic grade 2 xerostomia occurred in 10.3% of the patients. When the toxicity for unilateral RT was compared to that of bilateral RT using a propensity score-matched cohort, a significantly lower rate of acute xerostomia was observed in unilateral RT group (55.1% vs. 82.7%, p=0.002), primarily at grade 2 level (10.3% vs. 51.7%, respectively). The results of our study suggest that unilateral RT can be safely performed in well-lateralized tonsillar cancer patients with multiple ipsilateral neck lymph nodes.

Subtotal versus total gastrectomy for distal diffuse-type gastric cancer.

Diffuse-type gastric carcinoma in an aggressive form of gastric cancer. Surgery is the only potentially curative treatment. It is controversial whether patients with diffuse-type gastric carcinoma should undergo total or subtotal gastrectomy when feasible. The aim of this study is to analyze the oncologic outcomes and overall survival of patients diagnosed with distal diffuse-type gastric cancer undergoing subtotal versus total gastrectomy with curative intent. This retrospective study included all patients with histologically confirmed diffuse-type distal gastric carcinoma and clinical staging cT1-4M0, who underwent surgery with curative intent between 2011 and 2020 in a Tertiary Referral Hospital in Chile. Clinical and pathological staging was conducted using the 8th Edition of the American Joint Committee on Cancer Classification. STG group was comprised by patients who underwent subtotal gastrectomy and TG group by patients who underwent total gastrectomy. Both groups were compared in relation to sociodemographic variables, pathology reports and perioperative data which were obtained from electronic medical records. Data analysis was obtained with Stata 16.1 Statistical Software. One hundred and thirty patients underwent curative intent surgery. Subtotal gastrectomy with D2-lymphadenectomy was completed in 68 patients (52%). An R0 resection was achieved in all patients. Median number of resected lymph nodes, tumor size, proximal margin and depth of invasion were similar in both groups. Pathologicstaging was similar between both groups, the most frequent being Stage 3(54%). After a median follow-up of 47 months [0.3-157], no difference was observed in overall survival between both groups (5-year-OS 63% in STG group versus 51% in TG group, p = 0.097). Oncologic and survival outcomes were similar in patients submitted to subtotal and total gastrectomy,suggesting that a subtotal gastrectomy with D2-lymphadenectomy for distal diffuse-type gastric carcinoma is not associated with a decrease in median overall survival and is an adequate surgical approach when technically feasible.