Clinical Medicine & Research最新文献

Objective: The purpose of this study was to determine and interpret the results of surgical intervention, namely, preservation of hearing and facial nerve functionality and reduction of the risk of recurrence and mortality from the disease.Methods: The study conducted a retrospective analysis of the clinical records of 26 patients treated at the state-owned public utility enterprise on the right of economic ownership "Multi-speciality City Hospital No. 1" of Astana (Kazakhstan) during the period from January 1, 2016 to December 31. 2023.Results: The mean age of patients was 49.5 years, of whom 69.1% were female. The most common complaints were throbbing tinnitus, hearing impairment, and dizziness. Regional metastases were observed in 15.4% of cases, and one case (3.8%) had a malignant form of paraganglioma with distant metastases to the liver. Most patients (84.6%) underwent surgery with transmastoidal access. Preoperatively, most patients had hearing impairment, both conductive and sensorineural types, as well as mixed. After treatment, deafness on the tumor side was diagnosed in six patients (23%). In the immediate postoperative period, the facial nerve function (I-II degree) was preserved in more than one-third of patients, and significant dysfunction (V-VI degree) was observed in 17.4% of patients. Early postoperative complications were observed in 13% of patients. Recurrence of tumor growth was detected in two patients (7.7%).Conclusion: This study demonstrates that surgical treatment, complemented by preoperative embolization, is an effective approach for managing middle ear paragangliomas, significantly reducing the risk of bleeding and improving postoperative outcomes.

Chromoblastomycosis (CBM) is a rare chronic, granulomatous mycosis affecting the skin and subcutaneous tissue. It is a deep, slow growing, fungal infection that most often presents with epidermal changes that clinically appear as a hypertrophic and verrucous plaque. We describe an atypical presentation of an immunocompromised male patient, age 76 years, who presented with a 4-month history of painless subcutaneous firm nodules of the left fifth finger. The fungal culture grew Exophiala bergeri, and histopathology showed medlar bodies with lack of pseuodepitheliomatous hyperplasia or epidermal changes commonly seen in CBM. To our knowledge, this is the first case of Exophiala bergeri CBM in the United States, highlighting its unique clinical presentation and expanding the differentials for a subcutaneous nodule.

Behçet's disease (BD) is a multi-systemic, chronic inflammatory disease of unknown etiology, with a multisystemic recurrent course and variable vasculitis. Although the disease onset is usually between the second and fourth decades of life, the preliminary symptoms and signs may appear under the age of 16 years. The prevalence of BD in children is unknown, but it is probably very low. The most common ocular manifestations of pediatric BD include anterior and posterior uveitis, panuveitis, retinal vasculitis, and retinitis. The pathogenesis, treatment, and future directions for pediatric BD are also briefly discussed.

Introduction: Leiomyomatosis peritonealis disseminate (LPD) is an entity with uncertain biological behavior, characterized by multiple smooth muscle intra-abdominal and pelvic nodules that may recur after apparently complete resection. LPD has been predominantly described in childbearing age females. Most case reports with short term follow-up describe this as a benign entity. Only isolated case reports indicate the malignant potential of the disease. A comprehensive collation of cases is lacking in literature.Methods: We present a case of malignant transformation of LPD, confirmed by histology and imaging, occurring over two decades. This patient was originally diagnosed with uterine atypical smooth muscle tumor but developed frank malignancy during follow-up. An increasingly malignant aggressive disease course resulted in ultimate development of liver and lung metastases almost 23 years after original diagnoses, resulting in her demise. A comprehensive literature review was performed, and 213 cases of LPD were described, including the present case. Patients were divided into G1 (reportedly benign), G2 (malignant at presentation), and G3 (malignant transformation).Results: Compared to G1, G2 at presentation were more likely to be symptomatic (73%/88%), larger sized (4.1/8.4 cm), and older aged (38/44). In G1, G2, and G3, the average age was 38.5, 44.3, and 37.5 years, respectively; while the disease specific survival was 100%, 71%, and 40%, respectively. The mean number of surgeries performed in G1, G2, and G3 was 1.6, 1.8, and 3.8, respectively. Hormone receptors were found in 24.4% of cases. The mean reported follow-up time in G1, G2, and G3, respectively, was 44.9, 13.1, and 70.5 months. This suggests with longer follow-up, even apparently benign tumors may develop malignancy. The transformation time to malignancy in G3 was 77.8 months, which is more than the average reported follow-up in G1 (44.9 months).Conclusions: LPD is a potentially malignant condition with long latency prior to transformation. Lifelong surveillance should be considered even in cases originally presumed to be benign. Loss of hormone receptor expression may serve as a marker for this transformation. Circulating Tumor DNA (ctDNA) levels may be associated with development of hematogenous metastases and may be a useful biomarker.

Pelvic floor dysfunction is commonly observed in individuals with spinal cord injury, often resulting in urinary, gastrointestinal, and sexual disturbances. Although pelvic floor rehabilitation is a widely accepted treatment for pelvic floor dysfunction in the general population, its application in spinal cord injury remains insufficiently explored. This study presents clinical experiences with pelvic floor rehabilitation in patients with incomplete motor spinal cord injury, aiming to contribute to the growing body of literature.This case series includes three patients with incomplete spinal cord injury, American Spinal Injury Association Impairment Scale, Grade-D, who underwent individualized multimodal pelvic floor rehabilitation programs. Interventions targeted urinary, bowel, and sexual dysfunctions using pelvic floor muscle training, biofeedback, electrical stimulation, tibial nerve stimulation, and sensory retraining strategies. All three patients demonstrated notable improvements in bladder and bowel continence, voluntary voiding, and sexual function. Subjective reports indicated enhanced functional independence and quality of life. Pelvic floor rehabilitation shows promise as an effective therapeutic option for managing neurogenic pelvic floor dysfunction in patients with incomplete spinal cord injury. Further randomized controlled trials are warranted to establish its efficacy and define optimal intervention protocols.

Background: Cancer and heart failure (HF) are significant causes of morbidity and mortality worldwide. Moreover, there is increasing evidence of a relationship between HF and cancer. Although oncology has experienced significant advancements in cancer therapies, patients with a combination of these conditions represent an important clinical challenge due to varying outcomes among different demographic populations. Therefore, understanding these trends is crucial for targeted interventions.Aims: This study analyzed two decades of mortality data to examine the trends, patterns, and disparities in cancer-related and cancer with HF-related deaths across the United States (US).Methods: Mortality data from 1999 to 2020 were obtained using CDC WONDER, identifying cancer and cancer with HF-related deaths in adults age ≥25 years via ICD-10 codes. Demographic and regional distributions of mortality were analyzed utilizing statistical methods. Joinpoint regression analysis was used to determine trends in age-adjusted mortality rates (AAMR) and annual percentage changes (APC).Results: Between 1999 and 2020, there were 13,880,876 cancer-related deaths in the US, including 567,657 with HF listed as a cause of death. The AAMR for cancer-related deaths decreased from 343.7 to 252.4 per 100,000 (APC: -1.61% [95% CI: -1.70, -1.57] from 1999 to 2018, then -0.62% to 2020). Cancer with HF-related deaths initially declined (AAMR: 15.0 to 10.2 from 1999-2013) but increased from 2013 to 2020 (APC: +6.03%). Males had higher mortality rates than females for both conditions. Cancer-related mortality was highest among non-Hispanic (NH) Whites and Hispanics, while cancer with HF-related mortality was highest among NH Whites and NH American Indians/Alaska Natives. Geographically, the South had the most cancer-related deaths (37.3%), while the Midwest led in cancer with HF-related deaths (4.5%).Conclusions: Cancer-related mortality has declined overall, whereas mortality for cancer with co-existing heart failure has risen since 2013 after an initial decline. Disparities persist, with the highest burden in NH Whites, males, and those in rural or underserved areas. The findings underscore the need for focused interventions aimed at reducing mortality related to cancer and cancer with heart failure, particularly among the vulnerable population.

Eosinophilic fasciitis (EF) is a rare fibrosing disorder caused by an autoimmune response to an unknown trigger. Many possible triggers have been suggested including strenuous exercise, drug or chemical exposure, and preceding infection. We present a case of a female patient, age 69 years, who developed EF following SARS-CoV-2 infection. There have been several advances in the diagnosis and management of EF since it was first described 50 years ago. EF is a mimic of scleroderma, but key clinical features can be used to differentiate between the two diagnoses. Laboratory abnormalities include eosinophilia, elevated inflammatory markers, and hypergammaglobulinemia. A full thickness biopsy of the skin including muscle and fascia is recommended to confirm the diagnosis. Imaging modalities such as ultrasound and magnetic resonance imaging have been increasingly used in the diagnosis and follow-up of EF. Corticosteroids remain the first line in treatment of EF. Combination of steroids and methotrexate have shown the best possible outcome. Early diagnosis is important for better treatment response.

Background: Subclinical hypothyroidism (SCH) is of particular importance due to its high prevalence and its association with cognitive deficits. Patients often express complaints of neuropsychological symptoms and cognitive impairments including lack of attention. Also, patients treated with levothyroxine (LT-4) often report persistent complaints related to mental slowing or lack of attention despite normal TSH levels.Purpose: To investigate the effects of different ranges of TSH on sustained attention in SCH.Methods: Included in the study were 136 participants that were divided into four groups: Group 1, 35 healthy individuals; Group 2, 33 newly diagnosed patients with SCH; Group 3, 36 patients on LT-4 with uncontrolled or elevated TSH; Group 4, 32 euthyroid patients (ongoing LT-4). Laboratory measurements and clinical assessment were done. Rapid visual processing (RVP) task was performed on standardized battery (Cambridge Automated Neuropsychological Test Battery).Results: There was significant impairment in sustained attention (P=<0.05) in Group 2 patients who had neuropsychological symptoms and SCH diagnosed with a TSH range of ≥2.5mIU/L.Conclusion: Our findings encourage screening for sustained attention along with thyroid profile in those who report neuropsychological symptoms. TSH mean range of ≥2.5 mIU/L was established as a more reasonable threshold for evaluating sustained attention and initiating LT-4 in SCH.

The main function of high-density lipoprotein (HDL) is to remove low-density lipoprotein (LDL) from blood vessels through reverse cholesterol transport. In addition, HDL has anti-inflammatory and antioxidant properties. Low HDL level is an independent risk factor for development of coronary artery disease. To manage patients with low HDL levels, general measures such as lifestyle modification, controlling acute metabolic syndrome, and participating in regular endurance exercise are essential. Smoking cessation is a must, and it will often improve HDL levels by 5% to 10%. While statin therapy is the backbone therapy for controlling LDL levels, it also results in elevation of HDL levels by at least 5%. Specific pharmacologic interventions to improve HDL level and function have been disappointing. Cholesteryl ester transfer protein (CETP) is the key metabolic pathway to transfer HDL to LDL; thus, CETP inhibitors result in elevation of HDL levels. Several products were tested in large controlled studies, such as dalcetrapib and evacetrapib; neither resulted in any clinical benefit. Anacetrapib only resulted in very limited benefit and is no longer under active development. The most recent study utilized apolipoprotein A1 infusion in high-risk patients shortly after acute myocardial infarction. There was no benefit in the primary end point of myocardial infarction, stroke, or death. In patients with low HDL, a strategy of having LDL as low as can be possibly achieved may be the most appropriate approach.

Objective: There are two types of criteria for diagnosing gestational diabetes mellitus (GDM). The first is based on measurement of three values on the glucose tolerance test (GTT) and making a diagnosis when any value is abnormal (individual time-point criterion). The second is based on creating a weighted average of the three values and using the average to split glycemic status into normal gestational glycemia (NGG), impaired gestational glycemia (IGG), gestational diabetes (GDM), or high-risk gestational diabetes (hGDM) (unified criterion). There is no information currently regarding how these two criteria relate to each other in the diagnosis of GDM. This study aimed to make this comparison.Design: Cross-sectional study.Setting: Publicly available data on a cohort of women in pregnancy.Participants: Pregnant women from the cohort.Methods: The cross-classification of diagnosis by two criteria was evaluated. The individual time-point criterion had a binary outcome (GDM yes/no), while the unified criterion had the four aforementioned outcomes.Results: Within the low risk (non-GDM) category by the individual time-point criterion, 1 in 85 women would have been deemed at high risk by the unified criterion. More importantly, within the high risk (GDM) category by the individual time-point criterion, 1 in 2 women would have been deemed at low risk by the unified criterion.Conclusion: The standard criterion is not equivalent to the unified criterion in terms of risk estimation. This is important as the unified criterion correlates with area under the GTT curve known to be associated with glucose excursion and is predictive of the net effect of insulin resistance and beta-cell function.