Discoveries (Craiova, Romania)最新文献

Angiosarcoma is an extremely uncommon mesenchymal neoplasm overall and moreso in female genital organs such as the ovary. Diagnosing primary ovarian angiosarcoma remains challenging on clinical grounds due to the absence of specific clinical symptoms as well as on histopathological analysis especially in poorly differentiated subtypes due to non-specific and overlapping morphologic features. Misdiagnosis in such scenarios can be devastating as this tumor is clinically very aggressive. We describe a case of primary ovarian angiosarcoma in a 33-year-old multiparous female with bilateral ovarian masses and metastasis at diagnosis. Histopathologic appraisal revealed a poorly differentiated malignant tumor with varied differential diagnoses. The saviour in such a scenario was the immunohistochemistry findings, underlining the incredible utility of this technique in the precise diagnosis and evasion of misdiagnosis. This case accentuates the paramount importance of precise diagnostic modalities in shaping clinical practice and enriching the scientific understanding of rare and aggressive neoplasms. Against this backdrop, the potential pitfalls and pearls while dealing with this entity have been elucidated, along with a review of the recent literature.

Breast sarcomas are a diverse group of malignant neoplasms originating from the mammary stroma. They are uncommon tumors, often occurring as a component of other tumors. Among malignant breast mesenchymal tumors, pure sarcomas lacking epithelial components are even rarer, comprising only 0.5% of breast tumors. The most common types include angiosarcomas, liposarcomas, and osteosarcomas. Pure, primary, and de novo chondrosarcomas are exceedingly rare within breast sarcomas, with very few cases reported. Distinguishing them from metaplastic carcinoma and phyllodes tumors with chondromatous areas entails extensive sampling to exclude proliferating ductal elements. Herein, we present a case of primary chondrosarcoma of the breast in a 72-year-old Indian woman. Initial core biopsy suggested a primary chondroid neoplasm or a heterologous component of a phyllodes tumor. The patient underwent modified radical mastectomy, and histological examination confirmed chondrosarcoma, grade 1, after thorough sampling.Clinical Relevance: This case emphasizes the necessity of incorporating rare sarcomatous breast tumors into the differential diagnosis for breast masses, especially those with chondroid differentiation. The report also reinforces the pivotal role of accurate histopathological evaluation in guiding appropriate surgical and adjunctive treatment, which can significantly impact prognosis in such rare malignancies.

Herpes simplex virus (HSV) encephalitis is a life-threatening consequence of HSV infection of the central nervous system. Early antiviral therapy is most effective, necessitating prompt diagnosis. We report a case of atypical HSV encephalitis. The appearance of a strong headache followed by impairment of consciousness during the postoperative course in a 70-year-old patient who underwent surgical removal of a follicular thyroid carcinoma. Diffusion-weighted MRI detected brain abnormalities on the second day after the onset of symptoms, and polymerase chain reaction identification of HSV-1 DNA confirmed the diagnosis. A positive prognosis was achieved due to the decision to start specific, high-dose antiviral therapy based on clinical suspicion. A firm diagnosis was established by Tzanck smear and polymerase chain reaction.

Inter-coronary communication is a rare congenital anomaly, defined as a connection between two patent coronary arteries, and was first described in 1972. We report the case of a 61-year-old Emirati female who presented to the emergency department with chest pain and palpitations, along with a strong family history of cardiac disease. She was initially diagnosed with indolent hypertrophic obstructive cardiomyopathy and accordingly managed; however, the patient remained symptomatic. Further investigations revealed inter-coronary communication between her left circumflex (LCX) and left anterior descending (LAD) coronary arteries. This case highlights the importance of recognizing inter-coronary communications for better outcomes in patients with HOCM, as well as their potential clinical significance with the need for further studies to be done to pinpoint the true significance.

Female physicians constitute an increasing proportion of the total physician workforce. Lengthy training often causes delays in family planning. When they feel ready and plan to have children, they might face demanding work hours, limited options for parental leave and child support, and potential stigmatization by peers and superiors. The impact of these factors on female physicians' fertility, pregnancy complications, professional growth, and perceptions of a career in medicine as a barrier to motherhood is not well-established. The goal of this study was to identify the main challenges and risk factors for pregnancy complications among U.S. female physicians.  Age, stress, adverse working conditions, occupational hazards, and insomnia were some of the main factors that can affect female physicians' fertility. A higher rate of infertility and older age at delivery were observed among female physicians working in surgical specialties. Being a physician is often associated with higher rates of infertility and pregnancy complications than the general population.   Although female physicians are increasing in number, they continue to encounter challenges in family planning and personal and professional life balance.  More research is needed to assess policy gaps, stigma, stereotypes, and risk factors, especially among different specialties. It becomes essential to develop effective strategies to adequately address these concerns and to offer equal and accessible reproductive care for female physicians.

Among the various side-effects of coronavirus disease 2019 (COVID-19) vaccinations, vestibular neuritis (VN) has been found to have some interesting association with the vaccinations. This paper mainly focuses on exploring different associations between COVID-19 vaccination and VN. A systematic search was conducted on electronic databases including PubMed, Google Scholar, and Cochrane using MeSH terms for case reports published until July 2023. A total of 6 case reports involving 7 individuals from 6 different countries were documented. Reports were analyzed to identify presenting symptoms, diagnosis, treatment, and pathophysiological mechanisms related to the relevant issues. The studies included a diverse range of individuals with ages ranging from 40 to 61 years, with an average age of 51 years and a male predominance. The average time between vaccination and symptom onset was 6.35 days. Prominent clinical features observed in the case reports included acute onset vertigo, nausea, vomiting, nystagmus, and gait instability. Diagnostic studies primarily involved vestibular test and brain imaging. Available treatment options consisted of vestibular suppressants, steroids and vestibular rehabilitation. This review highlights the diverse and clinically relevant associations between COVID-19 vaccination and vestibular neuritis. The findings underscore the importance of conducting further studies to explore the causative links in this correlation and gain a better understanding of the relationship.

Hip fractures are a serious global health concern with a substantial impact on senior patients' mobility, quality of life, and morbidity. Patients with psychiatric pathology may experience heightened levels of distress, making pain management more challenging. The presence of multiple comorbidities may complicate the therapeutic management of hip fractures. Treatment plans must be carefully tailored to accommodate each individual's unique medical history and current health status. We looked for improving pain evaluation and management in patients with dementia and choosing the best treatment according to age and comorbidities. This study highlights the mortality rate in surgically and non-surgically treated patients and possible correlations with other factors. We conducted a prospective study on 184 patients over 60 years old, with dementia and hip fractures, between 2018 and 2020 in Romania, within the Galati County Clinical Hospital. We applied the Charlson Comorbidity Index, ACE III test, EQ5D5L, and Harris test scores to assess the comorbidities, respectively, pain levels, mobilization in daily life activities, self-care and severity of dementia to exert the optimal treatment for patients with dementia and hip fracture. Our study pointed out that pain was frequently excruciating in non-operated patients compared to those who were operated. Most non-operated patients were immobilized in bed, they required careful and permanent care, while most of the operated patients experienced lower pain levels. While some risk factors of morbidity and mortality, such as comorbidities, severity of dementia, high age, and previous living situations are not preventable, delayed surgery, and general anesthesia risks may be prevented. Despite the treatment, mortality was high both at 6 months and 2 years, with increased survival rate in surgical treated patients. Our study addresses issues such as the importance of mental state evaluation in elderly patients in therapeutic decisions, the surgical intervention and the particularities in pre- and postoperative pain control in patients with dementia, topics that are insufficiently established in the current practical guidelines.

This case report examines a rare cardiovascular abnormality, the Aberrant Aortic Origin of the Right Coronary Artery (AAORCA), in a 75-year-old patient with a history of myocardial infarction, acute renal injury, and cardiogenic shock. Rapid medical intervention, including coronary angioplasty, demonstrated the significance of prompt care. Chronic issues, including tobacco use and left ventricular dysfunction, complicated matters, emphasizing the importance of comprehensive long- term therapy. This study underscores the critical clinical significance of AAORCA (Anomalous aortic origin of the right coronary artery) following the SCARE 2023 reporting criteria. This abstract emphasizes the delicate relationship between congenital defects, chronic hazards, and proactive healthcare in complex cardiovascular situations.

Glioblastoma represents the most common and aggressive primary malignant central nervous system tumor, often manifesting with unusual signs. This case report highlights a patient diagnosed with glioblastoma following an unusual cardiac presentation, with syncopes, sinus bradycardia, and atrial bigeminy. A 51-year-old female, brought to the emergency room after experiencing repeated syncope episodes, displayed neurological deficits upon examination. Noteworthy, she presented abnormal ECG showing sinus bradycardia and atrial bigeminy. Following the diagnostic procedure, a tumor was identified with indication to surgical removal. A subtotal tumor resection was obtained and the morphopathology examination led to a glioblastoma diagnosis. Interestingly, post-operatively, the ECG was completely normalized. However, the patient experienced complications, consisting of a massive thromboembolism. While sporadic cases describe unusual glioblastoma manifestations, this report is unique in showcasing atrial bigeminy, among other ECG manifestation. The remission of atrial bigeminy post-operatively suggests its association with the glioblastoma. Tumor localization in the basal ganglia is crucial in understanding such manifestations. Idiopathic cardiac manifestations should not be disregarded, holding potential relevance in central nervous system etiology considerations.

Artificial intelligence (AI) and machine learning based applications are thought to impact the practice of healthcare by transforming diagnostic patient management approaches. However, domain knowledge, clinical and coding expertise are likely the biggest challenge and a substantial barrier in developing practical AI models. Most informatics and AI experts are not familiar with the nuances in medicine, and most doctors are not efficient coders. To address this barrier, a few "no-code" AI platforms are emerging. They enable medical professionals to create AI models without coding skills. This study examines Teachable Machine™, a no-code AI platform, to classify white blood cells into the five common WBC types. Training data from publicly available datasets were used, and model accuracy was improved by fine-tuning hyperparameters. Sensitivity, precision, and F1 score calculations evaluated model performance, and independent datasets were employed for testing. Several factors that influence the performance of the model were tested. The model achieved 97% accuracy in classifying white blood cells, with high sensitivity and precision. Independent validation supported its potential for further development. This is the first study that demonstrates the value of a free no-code algorithm based AI platforms use in hematopathology using authentic datasets for training. It opens an opportunity for the healthcare professionals to get hands-on experience with AI and to create practical AI models without coding expertise.