Third Decade Of Life Research Articles

Outcome and predictors of failure of abdominal surgical repair of high vesico-vaginal and vesico-uterine fistulae at Gezira Hospital for Renal Disease and Surgery

BackgroundUrogenital fistula can arise from various causes, leading to the development of diverse surgical procedures. The prevention and treatment of obstetric fistula continue to pose challenges in low-income countries.AimTo assess the outcomes and predictors of failure of surgical repair for urogenital fistulas, specifically high vesico-vaginal fistula (VVF) and vesico-uterine fistula (VUF), within our context.MethodsConducted a prospective hospital-based study involving 100 female patients with urogenital fistula (95 VVF and 5 VUF) who underwent abdominal surgical repair at Gezira Hospital for Renal Diseases and Surgery from 2018 to 2023. Collected data encompassing demographics, obstetric history, fistula etiologies, Swab test, cystoscopy findings, urine diversion, ureteric re-implantation, and repair outcomes.ResultsThe majority of women were aged 20–29 years (39%), illiterate (62%), and had a low socio-economic status (87%). Lack of antenatal care was noted in 77% of patients. Fistula etiologies were predominantly obstetric (70%), mainly due to spontaneous vaginal delivery (SVD), with the remaining 30% attributed to gynecological causes (hysterectomy). In terms of fistula characteristics, all patients had a high-level fistula, 95% had a single fistula, and 69% had a posterior wall fistula. Successful closure was achieved in 84% of cases, with 11% experiencing ureteric involvements. The analysis of failures pointed to recurrent fistulae (50%), larger fistula size (31%), and the presence of multiple fistulae (19%) as notable predictors of unsuccessful repair.ConclusionVVF was the prevalent type of urogenital fistula in our population. Risk factors included being in the third decade of life, illiteracy, low socioeconomic status, and a lack of prenatal care. Obstetric causes, particularly prolonged and obstructed labor through SVD, dominated the etiology. Surgical procedures resulted in successful closure in 84% of cases. Recurrent fistulae, larger size, and multiple occurrences emerged as predictors of surgical repair failure.

Exertional Angina in a Young Woman Caused by Large Cardiac Paraganglioma

Coronary ischemia is uncommon in patients in their third decade of life. We present a 21-year-old woman with classic exertional angina secondary to a large cardiac paraganglioma. Cardiac paragangliomas are rare extra-adrenal neuroendocrine tumors that arise from chromaffin cells. Cardiac symptoms can be related to catecholamine excess or anatomical compression.

Age- and sex-specific normative values for muscle mass parameters in 18,625 Brazilian adults.

The present study aimed to provide age- and sex-specific normative values for muscle mass parameters in Brazilian adults. Data pertaining to Brazilian adults (18+ years) who attended a nutritional clinical between January 2018 and July 2022 were analyzed. Muscle mass parameters were assessed using a bioimpedance digital scale (InBody 230, GBC BioMed NZ). Assessments were conducted under standard conditions, with participants refraining from physical exercise for 96 h and from eating or drinking (including water) for 8 h before evaluations. A total of 18,625 Brazilian adults were analyzed. Normative values for absolute and relative (height, m2) muscle mass and appendicular muscle mass (ASM) were calculated. In addition, specific age-related changes in muscle mass parameters were observed. In women, muscle mass peaked between the ages of 40-49 before gradually declining at an average rate of 5.7% per decade from the sixth decade of life onwards. ASM reached its peak earlier, during the third decade of life, and started to decline later, from 50 to 59 years. In contrast, absolute and ASM peaked at 40-49 years and declined from the sixth decade of life in men. Both sexes displayed a slightly greater decline in ASM than in muscle mass (13 vs. 12%). The present study provides normative values for absolute and relative muscle mass and ASM in Brazilian adults. Furthermore, important specific age-related changes in muscle mass parameters were observed. These data have public health implications and might serve as a reference tool to guide health professionals.

Odontogenic lesions associated with impacted teeth: A 5-year retrospective institutional study

Introduction: Odontogenic lesions related to impacted teeth are common findings in routine dental exams, with the potential to cause tooth pain, displacement, bone expansion, or even bone erosion. Thus, their early detection is important. This study aimed to evaluate the frequency of such lesions based on patient age, gender, and location at the Tehran University of Medical Sciences, School of Dentistry, over five years.
 Materials and Methods: This retrospective study evaluated records from the Oral Pathology Department, covering a five-year period. The association of odontogenic lesions with impacted teeth was assessed. Data on lesion type, patient age and gender, involved jaw, lesion location, and affected teeth were extracted from patient records. Statistical analysis was performed using SPSS 24.
 Results: Out of 815 odontogenic lesions, 44.4% were associated with impacted teeth. The patient distribution was 52.48% male and 47.52% female. Lesions were most prevalent in the third decade of life (24.58%), and third molars (59.39%) were frequently involved. The posterior mandible (68.5%) and mandibular third molar (55%) were common sites. Dentigerous cysts had the highest frequency (35.4%), with odontogenic cysts (developmental) occurring more frequently (70.7%) than odontogenic tumors.
 Conclusion: The study underscores a significant association between odontogenic lesions and impacted or unerupted teeth. Periodic follow-ups are crucial for retaining impacted teeth based on these findings.

Odontogenıc Keratocyst: A Case Report

Odontogenic keratocyst was first mentioned in the literature by Mikulicz in 1876, and described by Philipsen in 1956. These cysts are developmental odontogenic cysts arising from dental laminate remnants. Generally, these cysts can be seen in the second or third decade of life, in both mandibular and maxillary jaws; but most often they are localized in the mandibular jaw. A 23-year-old male patient who came to our clinic complaining of swelling in the lower jaw and did not have a systemic disease had a radiolucent lesion measuring about 4 * 2 cm in the mandible and lateral tooth area in the maxilla. Enucleation of radiolucent lesions which are localized in maxillary and mandibular jaws was performed. Both lesions were sent to the pathology laboratory for detailed examination. Extraction of the impacted right mandibular canine was made. According to the pathology report, a diagnosis of odontogenic keratocyst was made to both lesions. In this case keratocysts were seen as multiocular, and it was suspected that there could be Gorlin Goltz syndrome. According to the medical genetic report of the patient, who does not have any systemic diseases, Multilocular Odontogenic Keratocysts could not be associated with Gorlin Goltz syndrome.

A case of primary adrenal insufficiency unfolding itself as a genetic syndrome

ABSTRACT Addison disease can occur at any age but most often presents during the second or third decades of life. An 11-year-old male child presented to us with complaints of pigmentation of the skin, decreased appetite, and weight loss from the last 1 year. He also had visual disturbances and learning disabilities from last 6 months. Investigations revealed the diagnosis of adrenal insufficiency and neuroimaging done was suggestive of diffuse demyelination. For further confirmation, a blood sample was sent for determination of very long chain fatty acids, which revealed accumulation of C26 fatty acids, thus confirming the diagnosis of adrenoleukodystrophy. He was treated with hydrocortisone, fludrocortisone, and anti-oxidants and was referred for bone marrow transplantation. X-linked adrenoleukodystrophy is a genetic disease, so a high index of suspicion is required to diagnose it in cases presenting primarily with non-neurological symptoms.

Very Young Onset Behavioral Variant Frontotemporal Dementia: A Case Series

ABSTRACT Frontotemporal dementia (FTD) is a clinical syndrome characterized by progressive changes in personality, behavior, and/or language with relative sparing of memory/learning. The behavioral variant of FTD (bvFTD) typically presents with insidious onset of changes in personality and behavior with a gradually progressive course. Such presentation can be easily attributed to other psychiatric disorders such as schizophrenia, obsessive compulsive disorder, or mood disorders. The most common age of presentation of bvFTD is in the fifth or sixth decades of life. However, in this case series, we present two rare cases of very early onset bvFTD with the onset of symptoms as early as third decade of life who were misdiagnosed as other psychiatric disorders.

Heterogeneity of gut microbiome compositions in the third decade of life in Japanese women: insights from a comparative analysis.

The reasons for sex-associated gut microbiota differences have not been determined, and although sex hormones, diet, and other factors are considered to contribute to them, many of these factors are age related. To shed light on this complex interplay, our study aimed to investigate and compare the gut microbial compositions of males and females across a broad range of ages, aiming to identify sex-associated disparities and potential causal factors. Our study encompassed a comprehensive analysis of gut microbiota data obtained from 444 Japanese individuals, ranging from newborns to centenarians, sourced from the DNA Data Bank of Japan. We categorized the subjects into 13 distinct age groups and examined their relative microbial abundances, as well as alpha and beta diversities, in relation to sex and age. No difference was observed between gut microbiota relative abundances or alpha diversities between men and women at any age. However, the study showed that the heterogeneity of gut microbiota among women in their 20s was greater than in men. To confirm the general occurrence of this difference, we conducted additional analyses using seven datasets: three from Japan and four from other countries. Interestingly, this variance was particularly noticeable within Japanese women. We also showed a potential link between the observed heterogeneity and dietary fiber intake. It is hoped this study will provide clues that aid in the identification of factors responsible for sex-associated differences in gut microbiota compositions.

Arthroscopic Reconstruction of Injured Anterior Cruciate Ligament Using Peroneus Longus Graft With Fixed Loop Endobutton - A Prospective Study.

ACL injuries are more common amongst active young people where RTA and sports injuries predominate as the most common methods of injury ACL reconstruction with peroneus longus graft method have been used more frequently nowadays. The advantages of peroneus longus graft are, Adequate graft length of minimum of 25 to 30 cm. Adequate thickness of minimum 8.5 to 9mm,Less incidence of graft thinning, Lesser hamstring and quadriceps weakness, Minimal donor site morbidity. Minimal restriction of ankle movements. A prospective study of 25 patients with injured anterior cruciate ligament without meniscal injury within the age group of 18-55 years managed with arthroscopic reconstruction of anterior cruciate ligament with peroneus longus graft and fixed loop endobutton at femoral side and interference screw at tibial side. Functional outcome was assessed using clinical examination, International Knee Documentation committee and Lysholm knee scoring scale, FADI score (foot and ankle disability index score). Patients were followed up at 2, 4, 8, 12weeks and 6, 8 months post-operatively. This study consists of 25 cases of Anterior Cruciate Ligament injury. ACL rupture was common in second and third decade of life. In our study, 18(63.34%) were sports related injuries, 5(26.66%) were due to road traffic accidents and 2(10%) were atraumatic degenerations. 22(80%) showed excellent results and 3(20%) showed good results. Arthroscopic ACL reconstruction using peroneus longus graft and Fixed-loop Endobutton and interference screws provided excellent post-operative clinical outcome in terms of knee stability, subjective knee and ankle function and range of movements of the knee and ankle in our study.

Overview: Research on the Genetic Architecture of the Developing Cerebral Cortex in Norms and Diseases.

The human brain is characterized by high cell numbers, diverse cell types with diverse functions, and intricate connectivity with an exceedingly broad surface of the cortex. Human-specific brain development was accomplished by a long timeline for maturation from the prenatal period to the third decade of life. The long timeline makes complicated architecture and circuits of human cerebral cortex possible, and it makes human brain vulnerable to intrinsic and extrinsic insults resulting in the development of variety of neuropsychiatric disorders. Unraveling the molecular and cellular processes underlying human brain development under the elaborate regulation of gene expression in a spatiotemporally specific manner, especially that of the cortex will provide a biological understanding of human cognition and behavior in health and diseases. Global research consortia and the advancing technologies in brain science including functional genomics equipped with emergent neuroinformatics such as single-cell multiomics, novel human models, and high-volume databases with high-throughput computation facilitate the biological understanding of the development of the human brain cortex. Knowing the process of interplay of the genome and the environment in cortex development will lead us to understand the human-specific cognitive function and its individual diversity. Thus, it is worthwhile to overview the recent progress in neurotechnology to foresee further understanding of the human brain and norms and diseases.

AYURVEDIC MANAGEMENT OF VATARAKTA W.S.R. TO GOUT WITH GUDUCHI KSHEERPAKA A REVIEW

Numerous health-related concerns occur globally as a result of changes in everyone's lives, resulting in a variety of systemic diseases. One of these degenerative and chronic joint and musculoskeletal diseases that mainly affects individuals in their second and third decades of life is Vatrakta, which is a joint disease that is briefly discussed in classical Ayurvedic texts. Vatrakta and gout can be compared based on their clinical similarities. According to recent studies, the prevalence of gout has grown. Medications used to treat hyperuricaemia or gout only provide temporary relief and have a number of adverse effects, finding an effective treatment is essential. Guduchi Ksheerpaka Sevan was advised by Aacharya Charaka and Vagbhata regarding how to manage Vatrakta. For Vatrakta, the preferred medication is Guduchi (Tinospora cordifolia (Willd.) Miers ex hook. & Thoms). Ingredients are easily accessible, and the preparation process is simple and easier to consume.

HISTOPATHOLOGICAL VARIANTS OF AMELOBLASTOMA AMONG PATIENTS PRESENTED TO KHYBER COLLEGE OF DENTISTRY PESHAWAR

Objectives: To determine the frequency of diff erent Histopathological variants of Ameloblastoma among patients reporting to the Oral and Maxillofacial surgery unit of Khyber College of Dentistry Peshawar. Materials and Methods: A total of 97 histologically diagnosed cases of Ameloblastoma presented at the Khyber college of Dentistry Peshawar kpk Pakistan, over 18 months period were included in this study and data was analyzed descriptively with respect to the patient’s ages, gender, tumor location, duration, presenting symptoms and radiographic features. Results: Follicular type was found as the most common (64.9%) variety while the least common was Basaloid (2.1%) and Granular type (2.1%). The age range was (11-70 years) with most commonly aff ecting 3rd decade (21 to 30 years) of life, mean ±SD of (32.26 ±11.02 years) and was more frequent in males. Follicular Ameloblastoma was commonly found in the Angle and Ramus region of the mandible. Conclusion: Ameloblastoma aff ects male more frequently than female in the Second and third decades of life. Mandible is more aff ected than Maxilla at posterior portion. The most frequent type of Ameloblastoma is the follicular type, followed by the plexiform, Acanthomatous and desmoplastic type. The granular and Basaloid types were the least frequent.

Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study

Introduction: The aim of the present study was to evaluate the incidence, aetiology and patterns of maxillofacial injuries in a tertiary trauma hospital in Nepal.
 Methods: A retrospective analysis of all the maxillofacial trauma patients operated at the Department of Plastic, Cosmetic and Maxillofacial Surgery, B and B Hospital, Lalitpur, Nepal between 1st March, 2015 and 31st December, 2020 was performed. Data were collected for each patient in regards to age, gender, cause and nature and type of the injury and the treatment provided.
 Results: Among 409 patients operated in this period for maxillofacial injuries, 83% (n=356) were male and 17% (n=73) were female. Patients in the second and third decade of life were found to be more prone to sustain maxillofacial injuries. Road traffic accident was the most frequent cause (n=331; 77%) followed by physical assault (n=46; 10.7%) and falls (n=42; 9.7%). Mandible was the most commonly fractured bone (n=125; 26.5%). Fracture of parasymphysis, combined symphysis and condyle fracture and parasymphysis and angle fracture were the most common patterns of mandible fracture.
 Conclusions: The major cause of maxillofacial injuries among patients operated in our hospital was road traffic accident which directly reflects the poor traffic system and improperly planned roads.

Keratoconus in India: Clinical presentation and demographic distribution based on big data analytics.

This paper aims to describe the clinical presentation and demographic distribution of keratoconus (KCN) in India by analyzing the electronic medical records (EMR) of patients presenting at a multitier ophthalmology hospital network. This cross-sectional hospital-based study included the data of 2,384,523 patients presenting between January 2012 and March 2020. Data were collected from an EMR system. Patients with a clinical diagnosis of KCN in at least one eye were included in this study. Univariate analysis was performed to identify the prevalence of KCN. A multiple logistic regression analysis was performed using R software (version 3.5.1), and the odds ratios are reported. Data were obtained for 14,749 (0.62%) patients with 27,703 eyes diagnosed with KCN and used for the analysis. The median age of the patients was 22 (inter-quartile range (IQR): 17-27). In total, 76.64% of adults (odds ratio = 8.77; P = <0.001) were affected the most. The majority of patients were male (61.25%), and bilateral (87.83%) affliction was the most common presentation. A significant proportion of the patients were students (63.98%). Most eyes had mild or no visual impairment (<20/70; 61.42%). Corneal signs included ectasia (41.35%), Fleischer ring (44.52%), prominent corneal nerves (45.75%), corneal scarring (13.60%), Vogts striae (18.97%), and hydrops (0.71%). Only 7.85% showed an association with allergic conjunctivitis. A contact lens clinic assessment was administered to 47.87% of patients. Overall, 10.23% of the eyes affected with KCN underwent a surgical procedure. the most common surgery was collagen cross-linking (8.05%), followed by deep anterior lamellar keratoplasty (1.13%) and penetrating keratoplasty (0.88%). KCN is usually bilateral and predominantly affects males. It commonly presents in the second and third decade of life, and only a tenth of the affected eyes require surgical treatment.

A social profile of deaths related to sickle cell disease in India: a case for an ethical policy response.

India accounts for 14.5 percent of the global SCD newborns, roughly over 42,000 a year, second to sub-Saharan Africa. Despite the availability of cheap diagnostic and treatment options, SCD remains a largely neglected disease within healthcare policy and practice. Epidemiological modeling based on small, often dated, regional studies (largely from sub-Saharan Africa) estimate that between 50 and 90 percent of affected children will/die before the age of 5 years. This premise, coupled with targets of reducing under 5 mortality (SDG 4), privileges public health interventions for screening and prevention of new births, undermining investments in long-term health and social care. This paper presents a retrospective, descriptive analysis of the socio-demographic profile of 447 patients diagnosed with sickle cell or sickle-beta thalassemia, who died following admission at a tertiary care entre in India. We used anonymized hospital records of 3,778 sickle cell patients, admitted in pediatric and adult/medical wards between January 2016 and February 2021. A majority of hospital deaths occurred in the second and third decades of life, following a hospital admission for a week. The overall mortality during 2016-2019 was 14% with little gender difference over time. Contrary to our expectations, the number of hospital deaths did not increase during the first year of the COVID-19 pandemic, between 2020 and 2021. The conclusion highlights the importance of longitudinal, socio-demo-graphic data on deaths as providing important insights for identifying ethical policy interventions focused on improving SCD outcomes over time, reducing inequities in access to care, and preventing what might be considered "excess" deaths.

DNAJC30 Gene Variants Are a Frequent Cause of a Rare Disease: Leber Hereditary Optic Neuropathy in Polish Patients.

Leber hereditary optic neuropathy (LHON) is a rare disorder causing a sudden painless loss of visual acuity in one or both eyes, affecting young males in their second to third decade of life. The molecular background of the LHON is up to 90%, genetically defined by a point mutation in mitochondrial DNA. Recently, an autosomal recessive form of LHON (LHONAR1, arLHON) has been discovered, caused by biallelic variants in the DNAJC30 gene. This study provides the results of the DNAJC30 gene analysis in a large group of 46 Polish patients diagnosed with LHON, together with the clinical characterization of the disease. The c.152A>G (p.Tyr51Cys) substitution in the DNAJC30 gene was detected in all the patients as homozygote or compound heterozygote. Moreover, we identified one novel variant, c.293A>G, p.(Tyr98Cys), as well as two ultra-rare DNAJC30 variants: c.293A>C, p.(Tyr98Ser), identified to date only in one individual affected with LHONAR1, and c.130_131delTC (p.Ser44ValfsTer8), previously described only in two patients with Leigh syndrome. The patients presented here represent the largest group of subjects with DNAJC30 gene mutations described to date. Based on our data, the autosomal recessive form of LHON caused by DNAJC30 gene mutations is more frequent than the mitochondrial form in Polish patients. The results of our study suggest that Sanger sequencing of the single-exon DNAJC30 gene should be a method of choice applied to identify a molecular background of clinically confirmed LHON in Polish patients. This approach will help to reduce the costs of molecular testing.

Clinical Evaluation: An Essential Tool for Diagnosis

Low back pain is one of the commonest and leading causes of hospital visits, functional limitation and absence from work in the world.1 Low back pain can occur at any age, but its highest prevalence is in third decade of life. Avascular necrosis of Hip commonly presents at the age of 35-50 years with mean age being 36 years.3 Presenting complaints of both lumbar spine and hip pathologies are overlapping which include low back pain with associated buttock, groin, anterior thigh, and knee pain. Therefore, identifying the exact pain generator becomes crucial, where clinical evaluation plays a vital role.

Odontome – A Single-institutional Cross-sectional Study of 31 Years from Mumbai and Case Report with Modified Gallego’s Stain

Abstract Background: Odontomas are the most prevalent type of benign odontogenic tumor. They are made up of several dental hard and soft tissues arranged in diverse patterns. They have slowed growth and normally do not have any symptoms to go along with it. They are not regarded as real neoplasms and are more commonly referred to as hamartomas. There have been very few retrospective studies published in the literature. Objective: The aim of this study was to examine the clinical findings and histological aspects of 17 odontoma cases as a single-institutional investigation. Materials and Methods: It is a study that was conducted in the past. Data from 17 odontoma cases were collected, then separated, and statistically analyzed based on the number of instances reported, the kind of odontoma, the site of occurrence, age, sex, clinical and histological features, and so on. A brief case report is also provided. Results: Of the 17 cases of odontoma reported, 14 were complex odontoma and only 3 were compound odontoma. The age group of 20–29 years had the highest incidence. It was discovered more commonly in the lower jaw than in the maxilla. Conclusion: The study indicated a higher prevalence of complex odontomas than compound odontomas in males aged 20–29 years (third decade of life). Early detection and treatment are critical for avoiding disparities.

Managing Addiction and Overdose Deaths: The Debate Over America's Safe Injection Spaces.

In the decade between 2010 and 2020, the number of people killed by opioid overdoses more than tripled, reaching 68,630. Among drug users in their second and third decades of life, hepatitis B and C are also on the rise. New York City's two new supervised drug injection sites (SDISs) reversed 114 overdoses within two months, and 585 people injecting drugs visited the facility 4,974 times. By providing medical professionals and a sterile and safe environment, supervised injection sites reduce overdose risk and save lives. This suggests that SDISs could be an important adjunct to currently failing strategies to combat the nation's raging opioid crisis, particularly in the aftermath of the COVID-19 pandemic. Here, we examine the perception and impact of SDISs as well as efforts by the United States Congress (H.R. 7029 and H.R. 6159) toward their prevention. We look into the perspectives of major stakeholders, such as residents, business owners, drug users, legislators, taxpayers, and the general public, and investigate the short- and long-term consequences of SDISs based on crime statistics and published data on opioid use, overdose deaths, and blood-borne disease transmission rates.

The incidence of movement disorder increases with age and contrasts with subtle and limited neuroimaging abnormalities in argininosuccinic aciduria.

Argininosuccinate lyase (ASL) is integral to the urea cycle detoxifying neurotoxic ammonia and the nitric oxide (NO) biosynthesis cycle. Inherited ASL deficiency causes argininosuccinic aciduria (ASA), a rare disease with hyperammonemia and NO deficiency. Patients present with developmental delay, epilepsy and movement disorder, associated with NO-mediated downregulation of central catecholamine biosynthesis. A neurodegenerative phenotype has been proposed in ASA. To better characterise this neurodegenerative phenotype in ASA, we conducted a retrospective study in six paediatric and adult metabolic centres in the UK in 2022. We identified 60 patients and specifically looked for neurodegeneration-related symptoms: movement disorder such as ataxia, tremor and dystonia, hypotonia/fatigue and abnormal behaviour. We analysed neuroimaging with diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) in an individual with ASA with movement disorders. We assessed conventional and DTI MRI alongside single photon emission computer tomography (SPECT) with dopamine analogue radionuclide 123 I-ioflupane, in Asl-deficient mice treated by hASL mRNA with normalised ureagenesis. Movement disorders in ASA appear in the second and third decades of life, becoming more prevalent with ageing and independent from the age of onset of hyperammonemia. Neuroimaging can show abnormal DTI features affecting both grey and white matter, preferentially basal ganglia. ASA mouse model with normalised ureagenesis did not recapitulate these DTI findings and showed normal 123 I-ioflupane SPECT and cerebral dopamine metabolomics. Altogether these findings support the pathophysiology of a late-onset movement disorder with cell-autonomous functional central catecholamine dysregulation but without or limited neurodegeneration of dopaminergic neurons, making these symptoms amenable to targeted therapy.