Third Decade Of Life Research Articles

Otosclerosis under the magnifying glass.

Otosclerosis is a bone condition affecting the stapes bone within the otic capsule, and its exact cause is still unknown. It is characterized by a lack of proper remodeling of newly formed vascular and woven bone, leading to the development of abnormal osteons and the formation of sclerotic bone. Bilateral otosclerosis is seen in 80% of patients and 60% of otosclerosis patients have a family history of the condition. The etiology of this disease is still unknown, there are lots of theories to explain it. The histopathological (HP) studies of otosclerosis showed that osteoblasts, osteoclasts, vascular proliferation, fibroblasts, and histiocytes were observed in the stapes footplate. The onset of the symptoms occurs by the early third decade of life, usually it doesn't start later. In otosclerosis, the energy exerted by sound at the level of the tympanic membrane is reduced in the inner ear due to the fixation and rigidity of the ossicular chain, leading to hearing loss, especially for low frequencies. The primary clinical symptom of otosclerosis is conductive hearing loss but it is important to note that sensorineural hearing loss and mixed hearing loss can also occur as secondary symptoms of the condition. Another symptom present in patients with otosclerosis is tinnitus. The paper carried out a retrospective study of 70 patients diagnosed with otosclerosis in the Department of Otorhinolaryngology of Emergency City Hospital, Timişoara, Romania, between January 2021 to December 2022. Tissue fragments were processed at Service of Pathology by standard Hematoxylin-Eosin staining. The HP diagnosis was completed using Masson's trichrome staining, Giemsa histochemical staining, and immunohistochemical (IHC) reactions with anti-cluster of differentiation (CD)20, anti-CD3, anti-CD4, anti-CD8, anti-CD34, and anti-CD31 antibodies. The microscopic examination showed a chronic diffuse inflammatory infiltrate that consisted predominantly of mature T-lymphocytes, immunohistochemically positive for CD3, CD4 and CD8. There were also present rare CD20-positive B-lymphocytes. Among the lymphocytes, relatively numerous mast cells were identified, highlighted histochemically by the Giemsa staining. They had numerous purple-violet intracytoplasmic granules. In the connective tissue support, a relatively rich vascular network was identified, consisting of hyperemic capillaries, highlighted immunohistochemically with anti-CD31 and anti-CD34 antibodies. Bone tissues trabeculae showed extensive areas of fibrosis. The collagen fibers were highlighted by Masson's trichrome staining, being stained in green, blue, or bluish green.

Analysis of Socio-Demographic Profiles of Suicidal Hanging Cases to Formulate a Preventive Strategy: An Autopsy-Based Study Conducted at a Tertiary Care Hospital in the North-East Region of India.

Introduction Hanging is a common method of suicide in India and worldwide. Analyzing the socio-demographic characteristics to formulate a preventive strategy to reduce the incidence of suicide by hanging is often considered a low-cost but effective intervention for developing countries like India. The present study reports on preventive measures based on socio-demographic data of suicidal hanging cases brought for autopsy in a city in Northeast India. There is no scientific literature originating from the Northeast region of India that stresses on the preventive aspect of suicidal hanging cases to date. Methods This is an observational study based on retrospective data. Data related to socio-demographic characteristics were collected from all the suicidal hanging cases reported for medicolegal autopsy at a tertiary care hospital in Dibrugarh, a city in Northeast India, from June 2012 to June 2013. Results A total of 1241 cases were brought for autopsy, out of which 70 (5.64%) cases were determined to be death due to suicidal hanging. Male victims accounted for the majority of the cases, and most victims were in their third decade of life. Additionally, various other factors, such as marital status, occupational status, place of occurrence, psychiatric history, pregnancy status, and selection of suspension point, were studied. Conclusion Socio-demographic data generated from various research studies can play a crucial role in the early identification of vulnerable individuals and enable the prompt delivery of mental health services and other measures of interventions. Implementing policy-based strategies, such as restricting access to means and materials used in hanging, can have a positive impact on overall outcomes. Additionally, involving electronic or print media to de-popularize hanging as a clean and painless method proves to be another effective intervention.

Identifying Clinical Features, Frailty, and Treatment Responses of Late-onset Axial Spondyloarthritis

Abstract Objectives: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of sacroiliac joints and spine affecting patients in their second and third decades of life. With the increase in the elderly population in the world, the incidence of spondyloarthropathies, as well as other rheumatic diseases, is expected to increase in old age. The aim of this study is to expand the current knowledge of late-onset axSpA and compare clinical features with early-onset patients. Methods: A total of 123 axSpA patients (42 late-onset axSpA and 81 early-onset axSpA) were included in the study. Patients with symptoms that began after 50 years of age or older were classified as late-onset axSpA. Patients’ baseline clinical and radiographic findings, human leukocyte antigen B-27 status, and C-reactive protein results were recorded. Disease activity was measured by Bath Ankylosing Spondylitis Disease Activity Index. The Clinical Frailty Scale (CFS) was used to assess frailty in patients with late-onset. Late-onset axSpA patients were reassessed for frailty after 6 months of treatment. Results: Late-onset axSpA was female predominant (n = 35/42). About 57.1% of patients had nonradiograhic axSpA. Late-onset patients had a higher incidence of female gender (P = 0.000), peripheral arthritis (P = 0.000), and cervical vertebrae involvement (P = 0.002) compared with early-onset axSpA patients. The response to nonsteroidal anti-inflammatory drugs was similar (P = 0.572) between groups. The median CFS score was 5 at presentation and 3 at month 6 in late-onset axSpA. Patients who received anti-tumor necrosis factor therapy showed greater improvement in CFS scores (P = 0.003). Conclusion: AxSpA is very common in the general population and can have a significant impact on quality of life, particularly in old age. In elderly patients, frailty improves significantly with appropriate treatment. Clinicians should avoid being late in diagnosis and treatment.

Incidence, Prevalence, and Racial and Ethnic Distribution of Inflammatory Bowel Disease in the United States

We sought to estimate the incidence, prevalence, and racial-ethnic distribution of physician-diagnosed inflammatory bowel disease (IBD) in the United States. The study used 4 administrative claims data sets: a 20% random sample of national fee-for-service Medicare data (2007 to 2017); Medicaid data from Florida, New York, Pennsylvania, Ohio, and California (1999 to 2012); and commercial health insurance data from Anthem beneficiaries (2006 to 2018) and Optum's deidentified Clinformatics Data Mart (2000 to 2017). We used validated combinations of medical diagnoses, diagnostic procedures, and prescription medications to identify incident and prevalent diagnoses. We computed pooled age-, sex-, and race/ethnicity-specific insurance-weighted estimates and pooled estimates standardized to 2018 United States Census estimates with 95% confidence intervals (CIs). The age- and sex-standardized incidence of IBD per 100,000 person-years was 10.9 (95% CI, 10.6-11.2). The incidence of IBD peaked in the third decade of life, decreased to a relatively stable level across the fourth to eighth decades, and declined further. The age-, sex- and insurance-standardized prevalence of IBD was 721 per 100,000 population (95% CI, 717-726). Extrapolated to the 2020 United States Census, an estimated 2.39 million Americans are diagnosed with IBD. The prevalence of IBD per 100,000 population was 812 (95% CI, 802-823) in White, 504 (95% CI, 482-526) in Black, 403 (95% CI, 373-433) in Asian, and 458 (95% CI, 440-476) in Hispanic Americans. IBD is diagnosed in >0.7% of Americans. The incidence peaks in early adulthood and then plateaus at a lower rate. The disease is less commonly diagnosed in Black, Asian, and Hispanic Americans.

Conjunctival Nevus.

To provide an up-to-date review of the epidemiology, presentation, diagnosis, and treatment options for conjunctival nevi (CN). Around 17.2%-42% of all conjunctival tumors have been found to be CN, which most frequently present in White individuals between the first to early third decade of life, with equal distribution between males and females. CN commonly occur in the interpalpebral bulbar conjunctiva with pigmentation ranging from amelanotic to dark. Diagnosis is typically made through slit lamp examination, visualized by a well circumscribed, variably elevated, variably pigmented, solitary lesion with clear cysts distributed throughout the pigment. In ambiguous cases, anterior segment optical coherence tomography (AS-OCT) can highlight the presence of sub-clinical cysts, whose presence points to a diagnosis of nevus. However, excisional biopsy with histopathology examination is the gold standard for identifying CN. CN are benign, variably pigmented lesions. They are the most common of the conjunctival melanocytic tumors. Due to the extremely low risk of transformation to malignant melanoma (MM), CN are usually managed with routine observation and photo documentation.

Esthesioneuroblastoma: an institutional based descriptive study of a rare tumor

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

A Clinicopathological Study of Polymorphous Light Eruption

Background: Polymorphous light eruption (PLE) is the most common idiopathic photodermatoses, with a wide range of clinical presentations that tends to mimic a number of dermatoses. Objective: The aim was to study the clinicopathological profile in patients diagnosed with PLE. Materials and Methods: This was a cross-sectional, descriptive study of seventy clinically diagnosed cases of PLE over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation, followed by a skin biopsy that was studied categorically. Results: A male preponderance (62.8%) was observed. Majority of patients were in the 21-30 years’ age group (28.6%). Pruritus was witnessed in 98.5% of patients. The most common morphological type encountered was plaque PLE (35.7%), followed by lichen nitidus type (11.4%). Commonest site of involvement was sides and back of neck (75.7%), followed by dorsolateral aspect of both arms (31.4%). Hyperkeratosis was identified in 82.8%, spongiosis in 87.1%, liquefactive degeneration of basal cell layer in 82.8%, atrophy in 24.2%, and moderate-to-severe lymphocytic dermal infiltrates in 90% of our cohorts. Conclusion: PLE is a disorder with diverse clinical presentations, manifesting usually in the third decade of life that closely mimics a variety of other cutaneous disorders. Histological examination with certain specific criteria enables the clinician to arrive at a concrete conclusion in those cases where clinical findings alone pose diagnostic difficulties.

Prevalence of facial nerve palsy in the neuro-medicine private clinic

Background. Due to dysfunction of the facial nerve (CN VII), Bell’s palsy occurs which is a facial paralysis of unknown cause, but viral infection is suspected. The study aims to determine the prevalence of facial nerve palsy in a private clinic in Basrah. Methods. The study was conducted at a private clinic and involved sixty-five patients with facial nerve palsy. It was a cross-sectional study in which any patient who attended the clinic and exhibited signs and symptoms of lower motor neuron facial nerve palsy underwent an examination to confirm the diagnosis and, if confirmed, were included in the study. While patients with other neurological disorders were excluded. Data collection started between October 1, 2022, and April 30, 2023. A total of 65 patients from the private clinic—males and females—aged from 4 to 70 years old were confirmed as having lower motor neuron facial nerve palsy. Results. This study at a private clinic found that Bell’s palsy was the most common facial paralysis, affecting more males than females and most of the patients in the age range of 18-39 years, also affecting mostly the left side, with onset more frequent during hot and cool weather conditions. Diabetes was significantly related to the onset of Bell’s palsy and weather temperature at the time of the clinic visit. Conclusion. Bell’s palsy has a peak age prevalence in the second and third decades of life, and temperature variations have no effect on the occurrence of Bell’s Palsy. Further studies are needed for an accurate estimation of the number of cases, to assess the severity, impact, and efficacy of Bell’s palsy management.

Central giant cell granuloma in a 10-year-old girl: microsurgical reconstruction with a microvascularized fibula flap

Central giant cell granuloma (CGCG) are rare, proliferative, benign bone tumors characterized by an abundance of multinucleated giant cells. It affects children and young adults, predominantly women, in the second and third decade of life, it’s commonly found in the mandible. The main treatment for giant cell tumors is surgical excision with free histologic margins; in case of mandibular involvement, the use of a vascularized composite bone flap represents the standard for a functional reconstruction. We present the case of a female patient in the first decade of life with a CGCG of aggressive type, located in the ascending branch and right mandibular angle. En bloc resection of the lesion was performed, with a 2-cm margin and mandibular reconstruction at the same surgical time with a free microvascularized flap from the right fibula. CGCG are rare and infrequent tumors during childhood. Due to its uncertain behavior, it is important to rule out other differential diagnoses prior to definitive treatment.

EVALUATING THE ASSOCIATION BETWEEN AGE AND FREQUENCY OF COMMON FINDINGS OF ENDOMETRIAL BIOPSIES

The current analyses aimed to assess the association between age and frequency with the common findings of endometrial biopsies. The retrospective study was conducted in the Department of Pathology, Basic Medical Sciences Institute, Karachi, from January 2014 to January 2020 to evaluate the association of age with normal endometrial phases, hyperplasia, and endometrial carcinoma in the local population. The study was conducted on a total of 103 diagnosed cases. All participants underwent immunohistochemistry testing. The Endometrial malignancies were most common in women aged 61 to 70, with an average age of 54. Hyperplasia without atypia was most common in the age group of 31 to 40 years, with an average age of 33 years, while hyperplasia with atypia was common in women aged between 41 to 50 years. The secretory and proliferative phases were most common in the 4th and third decades of life, with an average age of 42 and 39, respectively. They concluded that endometrioid adenocarcinoma is the most prevalent endometrial malignancy with the highest risk during the 6th decade, while endometrial hyperplasia without atypia is the most prevalent type of hyperplasia with the highest risk during 4th decade of life.

`PATTERN OF HISTOLOGIC VARIANTS OF AMELOBLASTOMA IN A SECONDARY HEALTH CARE FACILITY IN LAGOS STATE: A 5-YEAR RETROSPECTIVE STUDY.

Background: Ameloblastoma is a benign epithelial odontogenic neoplasm which is common amongst the Yoruba ethinc group. The various histologic types have been elucidated.
 Aim: This study aimed to assess the prevalent histologic types of ameloblastoma in a Lagos secondary health care facility.
 Methodology: A 5-year retrospective review of histopathologically diagnosed slides were retrieved. Data extracted include the age, gender, location, ethnicity and histologic variants were analysed by SPSS version 26. Percentages, ratio, mean, standard deviation and crude odd ratio were determined, and p-value ⩽ 0.05 is considered significant.
 Result: A total of seventy-seven histopathologically diagnosed ameloblastoma slides were retrieved. Males were more affected than females in ratio 1.2:1 with the mean age 33.61±13.3. Ameloblastoma was commonest in the third decade of life and more in the mandible than maxilla. Yoruba ethnic group was most affected. The commonest histologic type was the unicystic type with intraluminal subtype accounting for the largest proportion. There was significant association between histologic types and gender (p= 0.037). Crude odd ratio revealed the odds in the unicystic type between male and female {p=0.041; CI=95%, OR=2.649(1.042-6.733)} and in the follicular between male and female {p=0.013; CI=95%, OR=3.855(1.321-11.288)}.
 Conclusion: The unicystic histologic type of ameloblastoma was the commonest, occurring more in females and this was followed by the follicular histologic type which occurred more in males in this Lagos State secondary health care facility.

Clinicopathological and Genetic Characteristics of Patients of Different Ages with Diffuse Sclerosing Variant Papillary Thyroid Carcinoma.

Diffuse sclerosing variant papillary thyroid carcinoma (DSVPTC) is commonly observed in young patients, with a median age at diagnosis in the third decade of life. Further, the risk of recurrence is higher for DSVPTC than for classical PTC. Therefore, this study aimed to describe the clinicopathological and genetic characteristics of patients of different ages with DSVPTC. We retrospectively reviewed 397 patients who underwent thyroidectomy for DSVPTC at Gangnam Severance Hospital, Yonsei University, from January 2005 to December 2017. The mean age at diagnosis was 36.7 ± 11.6 years, with most patients (163, 41.1%) aged 31-40 years. DSVPTC was predominant in women (276, 69.5%). We observed recurrence in 46 (11.6%) patients, with regional nodal recurrence being the most common type of recurrence (32 patients, 69.6%). The mean tumour size was larger in younger patients than in older patients. DSVPTC was more aggressive in paediatric patients with a larger-sized tumour, more common multiplicity, and lateral neck metastasis. Through random sampling, we selected 41 patients by age group and examined the mutations in 119 genes using next-generation sequencing. BRAF, KRAS, and TERT displayed relatively higher mutation rates than other genes. DSVPTC displays different clinical, pathological, and molecular profiles than classical PTC. The BRAF, KRAS, and TERT mutations are the most important, with age-specific differences.

Changing Dynamics of Self-Harm by Attempted Suicidal Hanging during the COVID-19 Pandemic

ABSTRACT Background: The second wave of coronavirus disease (COVID-19) in 2021 was devastating for low- and middle-income countries (LMICs). This led to increased suicide rates among the young, economically productive age group. We analyzed the cohort of attempted suicidal hangings needing admission to the intensive care unit (ICU) and compared the data from the pre-COVID-19 era. Materials and Methods: We conducted a retrospective, observational, cohort study of suicidal hanging cases according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Six-month data of such cases admitted to the neurological ICU after the lockdown of the second wave of COVID-19 from July 2021 to January 2022 were collected. Demographic data along with the cause of attempted hanging, severity of sickness from hanging, and its outcome were gathered and compared with similar data acquired during 2003–2015 by the same authors in the same ICU. Results: There was a threefold increase in the incidence of suicidal hangings needing ICU care, from 9 to 27% in the pre- and post-COVID-19 era. A shift toward older aged males, in the third decade of life, was observed. The common cause of attempted suicide was a familial dispute (P = 0.03). Among the younger age group (18–25 years), increased screen time led to fights in the family. The cohort was also sicker with more severe lung involvement, longer ventilation, and hospital stay (P < 0.001). Conclusion: The increased incidence of hanging among young adults, amid the socioeconomic effects of COVID-19, needs urgent attention. Suicide prevention measures need novel strategies aimed at de-addiction from electronic gadgets and reducing screen time.

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Takayasu arteritis in a young male patient: a case report and review of literature.

Takayasu arteritis is a systemic inflammatory disorder that causes harm to the large and medium arteries and their branches. It is primarily prevalent in Asia, Africa, and Latin America, with the incidence rate in Asia being reported to be 100 times higher than in Europe and North America. Females in their second or third decades of life are most commonly affected by this condition. In our case, a 26-year-old male patient was diagnosed with Takayasu arteritis after he experienced a headache and left upper limb weakness. The initial presentation of Takayasu arteritis includes nonspecific constitutional symptoms like fever, malaise, weight loss, and anorexia. Unfortunately, due to the delayed diagnosis of the disease, patients often experience claudication, absence of pulses, hypertension, myocardial infarction, and cerebrovascular accidents. An early and accurate diagnosis of Takayasu arteritis is vital to reduce the economic, social, and psychological burdens associated with the disease.

Comparative analyses define differences between BHD-associated renal tumour and sporadic chromophobe renal cell carcinoma.

Birt-Hogg-Dubé (BHD) syndrome, caused by germline alteration of folliculin (FLCN) gene, develops hybrid oncocytic/chromophobe tumour (HOCT) and chromophobe renal cell carcinoma (ChRCC), whereas sporadic ChRCC does not harbor FLCN alteration. To date, molecular characteristics of these similar histological types of tumours have been incompletely elucidated. To elucidate renal tumourigenesis of BHD-associated renal tumours and sporadic renal tumours, we conducted whole genome sequencing (WGS) and RNA-sequencing (RNA-seq) of sixteen BHD-associated renal tumours from nine unrelated BHD patients, twenty-one sporadic ChRCCs and seven sporadic oncocytomas. We then compared somatic mutation profiles with FLCN variants and RNA expression profiles between BHD-associated renal tumours and sporadic renal tumours. RNA-seq analysis revealed that BHD-associated renal tumours and sporadic renal tumours have totally different expression profiles. Sporadic ChRCCs were clustered into two distinct clusters characterized by L1CAM and FOXI1 expressions, molecular markers for renal tubule subclasses. Increased mitochondrial DNA (mtDNA) copy number with fewer variants was observed in BHD-associated renal tumours compared to sporadic ChRCCs. Cell-of-origin analysis using WGS data demonstrated that BHD-associated renal tumours and sporadic ChRCCs may arise from different cells of origin and second hit FLCN alterations may occur in early third decade of life in BHD patients. These data further our understanding of renal tumourigenesis of these two different types of renal tumours with similar histology. This study was supported by JSPS KAKENHI Grants, RIKEN internal grant, and the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute (NCI), Center for Cancer Research.

Comparison of MRI versus Arthroscopy in Assessment of Anterior Cruciate Ligament Injuries of The Knee Keeping Arthroscopy as Gold Standard

Objective: To evaluate the correlation between Magnetic Resonance Imaging (MRI) findings and Arthroscopy in diagnosing anterior cruciate ligament (ACL) injuries, using Arthroscopy as the gold standard. Methodology: This prospective cross-sectional study was conducted at the Department of Orthopedic Surgery, Combined Military Hospital, Rawalpindi, from February to August 2019. Clinical evidence of ACL injury was present in 127 individuals. They had an MRI as well as an arthroscopy. The diagnostic efficacy of MRI for ACL tears was evaluated, and its sensitivity, specificity, PPV, NPV, and accuracy were all calculated. Comparisons between arthroscopic and magnetic resonance imaging (MRI) findings yielded three classifications: True Positive (MRI verified by Arthroscopy), True Negative (both MRI and Arthroscopy negative for ACL injury), and False Positive/False Negative (differences between MRI and Arthroscopy). The arthroscopic inspection and MRI findings were entered into SPSS 23 software for tabulation and analysis. When necessary, both descriptive and inferential statistics were used. Results: The study of statistics Arthroscopy was performed on 127 patients, either for diagnostic or therapeutic purposes. A correlation was found when all the data was analyzed and tabulated. The majority of the patients were males (85.8%) in the second and third decades of life. The sensitivity, specificity, NPV, PPV, and accuracy of MRI in diagnosing ACL injuries were 89.89%, 64.28%, 64.28%, 89.89%, and 84.25%, respectively. Conclusion: MRI is an accurate and non-invasive modality for assessing ACL tears, showing good accuracy and high sensitivity. However, Arthroscopy remains the gold standard for diagnosing ACL injuries.

Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture.

Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.

Embolectomy at the Time of Ligation of Femoral Vessels in Psuedoaneurysm in Intravenous Drug Addicts can save Limb

Aim: To determine the impact of embolectomy at the time of ligation of femoral artery in management of pseudoaneurysmin intravenous drug addicts Study design: Descriptive cross-sectional study Methods: This study was carried out at Vascular surgery department, CMH Lahore and included 28 patientsof intravenous drug addiction of both genders presenting in emergency of CMH Lahore with viable limb from 1st August 2021 to31st January 2023. Unsalvageable limbs at the time of presentation were excluded from the study. SPSS Version 20.0 was used for data analysis of age, sex, co-morbidities (infection), mode of presentation and outcome variables. Results: This study comprised of28 patientsadmitted through Emergency Department of CMH, Lahore. The mean age was found to be 32.16 years ±7.63 years. All patients 28(100%) were males with majority belonging to third decade of life 20(71.4%).Chronic viral infection was present in all cases. Almost half of them had hepatitis B virus infection (48%) while cases positive with hepatitis C virus and HIV infections were 37% and 15% respectively.Majority of the patients came to the hospital with bleeding from ruptured pseudoaneurysm (60.7%) and infected pulsatile swelling (32.1%), while pulsatile swelling without bleedingand wrong diagnosis were least common.Alllimbs were salvaged in first and second follow-up visits, 20 patients were lost on follow up on 12th week. Conclusion/Practical implication: Embolectomy is a very useful adjunct in the management of pseudoaneurysm of intravenous drug addicts. It should be routinely practiced in treatment of these patients to save limbs. Keywords: Embolectomy, ligation, femoral vessels, intravenous drug addicts

Associations of Hormonal and Metabolic Parameters with Bone Mineralization in Young Adult Females.

Osteoporosis is characterized by impaired bone mineralization and microarchitecture. An important protective factor is a high peak bone mass (PBM), attained in the second and third decade of life. The aim of the study was to evaluate the effect of hormonal and metabolic parameters on bone mineralization in young adult female patients. A total of 111 participants qualified for the study. Bone mineral density of the lumbar spine (L1-L4) and whole skeleton was measured using dual-energy X-ray absorptiometry (DXA). Hormonal parameters were determined: the concentrations of androstendione, dihydroepiandrosterone sulphate, testosterone, sex hormone binding protein, 17-OH-progesterone, folliculotropic hormone, estradiol, thyrotropic hormone, free thyroxine and cortisol. Metabolic parameters were also examined. The study showed a statistically significant correlation between bone mineral density and estradiol concentration and a negative relationship between cortisol concentration and the bone mineral density (BMD) Z-score of the lumbar spine. Sclerostin measurements taken during this study were not related to bone mineral density. It has been shown that the concentration of the hormones tested, even within the reference range, may affect bone mineralization. We suggest observing the follow-up of the menstrual cycles, as well as analyzing the results of test patients in an annual examination system. However, each clinical case should be considered individually. The sclerostin test is currently not useful in the clinical evaluation of bone mineralization in young adult women.