SN Comprehensive Clinical Medicine最新文献

Despite primary colorectal cancer being the third frequent malignancy worldwide, secondary metastasis to the large bowel from another primary cancer is seldom reported. Only a handful of previous cases of primary ovarian cancer metastasizing to the large bowel have been described in literature published in English up to date. We report a case of bilateral ovarian carcinoma with synchronous dual metastasis to the left colon, probably the first report of such nature. A 56-year-old Sri Lankan female presented with left-sided non-specific abdominal pain for 2 months. She was found to have bilateral ovarian tumours with elevated serum CA 125 levels, and near-occluding splenic flexure and descending colon masses. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, left hemicolectomy with regional lymph node dissection and omentectomy. Histology confirmed endometrioid adenocarcinoma of both ovaries with metastatic deposits in both colonic masses and in two out of seven lymph nodes along the left colic vascular pedicle. Both ovarian tumours and both colonic deposits were positively stained for ER and vimentin, and were negative for CK20 on immunohistochemistry indicating ovarian origin. The patient was disease-free at 2 years from the uncomplicated primary surgery having completed adjuvant chemotherapy. This case highlights the importance of the clinicians to be mindful of rare occurrences of large bowel secondary deposits of ovarian origin, especially when patients present with simultaneous large bowel and adnexal masses. Upfront bowel resection than neoadjuvant therapy could be performed safely in cases with impending bowel obstruction with satisfactory outcome.

Knee osteoarthritis (KOA) is a progressive degenerative joint disease. This degenerative process leads to an alteration in the gait mechanics. There are varieties of methods that can be used to evaluate these gait differences. The purpose of this review is to critically analyze the research findings and to outline strategies for evaluating gait anomalies in KOA, including observational, vision-based, and sensor-based and hybrid gait assessment technologies. The gait analysis, carried out by these methods, enables the implementation of procedures suited to patients’ particular need is discussed. In all indices, the advantages and drawbacks of the available tools will be addressed after a concise description of the methods and the implementations in the KOA patients. The quantitative methods, categorized as vision, sensor-based, and hybrid technologies, have features that make them powerful and competitive for various types of requirements. Among these technologies, hybrid technology seems to be the most reliable and accurate because it can assess all aspects of gait assessment. Future studies should be done to develop a KOA gait dataset available publicly, consider all severity levels and all compartment KOA.

Although osseointegration has proven successful at improving the physical deficits that traditional prostheses leave unfulfilled, future innovation should be systematically guided rather than randomly explored. Therefore, this article attempts to summarise, in a systematic manner, the challenges and prospects of osseointegration limb reconstruction for amputees from an implant design and manufacturing point of view, to provide a template for the development of the next generation of osseointegration implants. A scoping literature review was conducted, and key papers were identified and summarised. To combat osseointegration-related infection, advances such as smart implant coatings, mechanical inactivation of bacteria, biofilm eradication, implant monitoring technologies and nanotechnology were evaluated. Regarding production and biomaterials, the potential of 3D printing to balance supply and demand to achieve cost-effectiveness and sustainability were investigated. Considering the evolution of designs and the goal to provide a sensate limb, the prospects of smart implants, biofeedback and myoelectric pattern recognition were also explored. Osseointegration appears to follow a trajectory like that of total joint arthroplasty, which gained widespread clinical acceptance and adoption over the last 50 years. In our opinion, the future of amputee rehabilitation is bright, and we are optimistic osseointegration will continue to progress and advance as new technologies emerge.

The coronavirus disease 2019 (COVID-19) pandemic has restricted face-to-face communication. Social media groups have emerged as a tool for knowledge sharing and problem-solving. However, the unfiltered information exchange can present a dilemma. This study examines the role of a private Facebook group managed by physicians from the same class in the Alexandria Faculty of Medicine during the COVID-19 pandemic. It employs a mixed-methods approach, combining content analysis of group posts and responses with an electronic survey of group members. The content analysis of 185 posts reveals that the majority (89.2%) were problem-related, with logistic help requests and clinical questions being the most common types representing 41% and 37%, respectively. Vaccine-related inquiries (11%) and posts seeking specialist responses to laboratory or radiological investigations (11%) were also present. The analysis further demonstrates that 89.7% of problem-related posts received specific replies, addressing the raised requirements, indicating an engaged and supportive community. Moreover, 0.6% of posts received psychological support or wishes for rapid recovery. Of the problem-related posts, 84.2% were successfully solved, contributing to preliminary diagnosis, referral, prescription, or logistical assistance. The electronic survey measuring member satisfaction shows that the majority (76.4%) of participants reported being satisfied with the group’s services, with high satisfaction rates regarding reply speed, quality of replies, problem resolution, and meeting expectations. Physician social media groups facilitated knowledge exchange, problem-solving, and peer support during the COVID-19 pandemic in Egypt. Future research can explore the long-term impact of these groups on clinical outcomes and physician well-being.

Biventricular takotsubo syndrome (TTS) is an uncommon sudden transient cardiac failure involving both the right and left ventricles. It is more hemodynamically unstable than isolated left ventricular cardiomyopathy, requiring more invasive medical management with prolonged hospital stays. The scarce literature about this condition and an increasing number of cases highlights the importance of this review. We screened 17,254 studies in PubMed, Scopus, Embase, and Google Scholar databases with biventricular TTS keywords. After analyzing case reports and series written in English, we systematically included 60 case reports on biventricular TTS to outline the clinical characteristics, complications, management, and outcomes of biventricular TTS. In this study, patients with biventricular TTS had an average age of 62.8 years, with a majority being older women (> 60 years old). The USA accounted for 32.7% of cases, followed by Japan (14.6%). Common symptoms included shortness of breath (58.2%) and chest pain (32.7%). Hypertension (35.9%) was a common prevalent comorbidity. Echocardiography revealed a low ejection fraction in 18.9% of patients. Treatment modalities involved pressor therapy (50%), intra-arterial balloon pump (6.7%), and extracorporeal membrane oxygenation (4.2%). Triggers included recent bereavement (9.1%), emotional stress (7.3%), and COVID-19 infection (7.3%). Of all the reported complications, the most common were cardiogenic shock (11.7%), followed by AKI, cardiac arrest, multi-organ failure, and complete AV block. The mortality rate was 6.67% in patients with biventricular takotsubo syndrome. This study confirms that biventricular takotsubo syndrome (BiTTS) disproportionately affects older women and is strongly associated with severe clinical outcomes such as cardiogenic shock and mortality. These results underscore the need to prioritize developing evidence-based management strategies tailored to BiTTS to improve outcomes. Pressor therapy and mechanical assistance mitigate symptoms like shortness of breath and chest distress in biventricular TTS.

McCune-Albright Syndrome (MAS) is a mosaic genetic disorder characterized by polyostic fibrous dysplasia, precocious puberty, and café-au-lait skin spots. Due to the affection of various organs, now the clinical spectrum of presentation extends beyond the classical triad. Multiple associated endocrinopathies contribute majorly to the morbidity and mortality of patients. We present a case of a 9-year-old female child affected with MAS with hypercortisolism secondary to a neoplastic adrenal mass lesion with hepatic, pulmonary, and cerebral metastasis. The initial presenting symptom was altered mental sensorium with imaging features suggesting posterior reversible encephalopathy syndrome. Other associated endocrinopathies were also detected. The outcome, unfortunately, was fatal within 22 days of initial presentation. Association of endocrinopathies are common occurrence on cases of MAS; hence, patients must be adequately evaluated for them to prevent morbidity and mortality.

Unilateral diaphragmatic paralysis is often discovered incidentally on a chest radiograph and is an underreported cause of dyspnea on exertion. The common causes of diaphragmatic paralysis seen in clinical practice are phrenic nerve injury following blunt neck trauma or surgery, viral infections (e.g., herpes zoster, poliomyelitis), cervical spondylosis, and cervical or mediastinal compressive tumors. Herein, we describe a case of a middle-aged male who presented with breathlessness on exertion, preceded by a history of acute right-sided shoulder, and neck pain. On examination, there were reduced movements of the right hemithorax, and his chest radiograph showed an elevated right hemidiaphragm. On detailed evaluation and based on his clinicoradiological profile along with nerve conduction studies, he was diagnosed as a case of unilateral paralysis of the right hemidiaphragm secondary to neuralgic amyotrophy. Diaphragmatic dysfunction in the form of weakness or paralysis can be a rare consequence of neuralgic amyotrophy. The clinical outcome of neuralgic amyotrophy with phrenic nerve palsy leading to diaphragmatic paralysis is variable, and many patients may show slow spontaneous recovery.

Vitamin A is a fat-soluble vitamin that plays an important role in immune function, vision, and growth. We analyzed serum-free retinol deficiency in pediatric patients with intestinal failure (IF) or short bowel syndrome (SBS) to determine which clinical factors contribute to vitamin A deficiency in this population. A single-center, retrospective review of 32 children with IF or SBS was conducted examining 6 categorical classifications of patients to test for increased risk of vitamin A deficiency, building a univariate logistic regression model for each category. Few serum assessments were consistent with deficiency (11 out of 347 tests obtained over 153 patient-years). Among these 11 low levels occurring in three patients, 6 were borderline or nearly normal for age and without associated symptoms, and 4 were obtained from one patient with significant ileal inflammation in the context of a STAT1 mutation. One level was obtained in one patient without a corresponding C-reactive protein level, and this patient had 23 subsequently normal serum-free retinol levels. In this small sample size, no patients were symptomatic. In patients who had at least 1 vitamin A test during the prior year without any deficient measurements, there was a 1.3% chance of obtaining a deficient vitamin A level upon subsequent measurement. A low risk of vitamin A deficiency was seen over the course of 153 patient-years, suggesting that frequent, repeated vitamin A assessment may not be needed in patients with normal vitamin A status early in their post-operative IF course.

This study was aimed at evaluating the level of awareness and knowledge of physicians regarding the recognition, knowing the location, and appropriate use of automatic external defibrillators (AEDs). This research was designed as a survey study. The questionnaire comprised 5 sections and 11 questions. The questions were open-ended and yes/no questions. All participants were doctors. After the questionnaire was answered, the participants were categorized into two groups, namely, emergency medicine physicians and other physicians. Data on recognition, knowing the location, and appropriate use of AED were compared between the two groups. The study included 326 participants, and their median (IQR) age was 37 years [33–43]. Of the respondents, 53.7% (175) were men. Thirty-nine (12%) participants were emergency medicine physicians. When the AED recognition rates of the participants were examined, 61.5% (24) of emergency medicine physicians recognized it, whereas only 31.4% (90) of other physicians were able to recognize it (p < 0.001). The rate of emergency medicine physicians knowing the location of the AED in public spaces was 71.8% (28), whereas this rate was 35.2% (101) for other physicians (p < 0.001). In addition, emergency medicine physicians correctly placed the AED pads, which was significantly higher compared with other physicians (74.4% vs 31.0% p < 0.001). Emergency medicine physicians recognized AEDs at a higher rate compared with other specialties. Moreover, more emergency medicine physicians correctly position the AED pads compared with other physicians.