Introduction and importance: When compared to other cranial nerve palsies idiopathic unilateral oculomotor nerve palsy with pupillary sparing is one of the least noted neurological conditions. Moreover, there lies a series of diagnostic dilemmas to come into a final diagnosis resulting in several array of clinical investigations. Hence, there is a delay in prompt management.
Case summary: An elderly female without any known comorbidities presented with the complaint of headache, dizziness and dropping of left eyelid. Several arrays of diagnostic workups was done to come to a diagnosis, but even with rigorous laboratory investigations and radiological examinations, a common working diagnosis could not be made. Hence with a diagnosis of exclusion after proper neurological and neuro-ophthalmological examination, idiopathic unilateral common oculomotor nerve palsy was identified for which improvement with steroids was noted in the patient.
Discussion: Idiopathic unilateral complete oculomotor nerve palsy is considered as a diagnosis of exclusion when all the diagnostic parameters fail to signify and positive results. The vague symptomatic presentation of the disease condition further compels the treating physician to carry out several panels of laboratory to radiological investigations. But if identified in time the treatment modality is straightforward.
Conclusion: The diagnostic quandary in timely identification of such disease conditions needs a pertinent diagnostic guideline so as to avoid the unwanted panel of investigations.
{"title":"Idiopathic unilateral complete oculomotor nerve palsy: a case report of diagnostic quandary.","authors":"Sagun Ghimire, Shikher Shrestha, Dinuj Shrestha, Kajan Ranabhat, Suman Bhattarai, Kritick Bhandari, Rikesh Kc","doi":"10.1097/MS9.0000000000002514","DOIUrl":"10.1097/MS9.0000000000002514","url":null,"abstract":"<p><strong>Introduction and importance: </strong>When compared to other cranial nerve palsies idiopathic unilateral oculomotor nerve palsy with pupillary sparing is one of the least noted neurological conditions. Moreover, there lies a series of diagnostic dilemmas to come into a final diagnosis resulting in several array of clinical investigations. Hence, there is a delay in prompt management.</p><p><strong>Case summary: </strong>An elderly female without any known comorbidities presented with the complaint of headache, dizziness and dropping of left eyelid. Several arrays of diagnostic workups was done to come to a diagnosis, but even with rigorous laboratory investigations and radiological examinations, a common working diagnosis could not be made. Hence with a diagnosis of exclusion after proper neurological and neuro-ophthalmological examination, idiopathic unilateral common oculomotor nerve palsy was identified for which improvement with steroids was noted in the patient.</p><p><strong>Discussion: </strong>Idiopathic unilateral complete oculomotor nerve palsy is considered as a diagnosis of exclusion when all the diagnostic parameters fail to signify and positive results. The vague symptomatic presentation of the disease condition further compels the treating physician to carry out several panels of laboratory to radiological investigations. But if identified in time the treatment modality is straightforward.</p><p><strong>Conclusion: </strong>The diagnostic quandary in timely identification of such disease conditions needs a pertinent diagnostic guideline so as to avoid the unwanted panel of investigations.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002515
Alamjeet K Sidhu, Shreya Khandelwal, Francis V Dominic Savio, Simranjeet Bedi, Yashash D Pathak
Introduction and importance: Tsukamurella species are rare, aerobic, gram-positive bacteria known to cause infections, primarily in immunocompromised individuals. This case report presents a rare instance of a mucosal infection caused by Tsukamurella species following a nasal septum procedure in an immunocompetent patient.
Case presentation: A 51-year-old man with a history of multiple hereditary exostosis, allergic rhinitis, and recent nasal fracture repair presented with persistent fevers and low back pain. Postoperatively, he developed sinus pain and small oral lesions, initially treated with antibiotics for presumed sinusitis. Despite treatment, his fever persisted, leading to an emergency department visit. Laboratory tests indicated sepsis, but a CT scan of the sinuses showed no sinusitis. Despite broad-spectrum antibiotics, the patient's fever continued. On admission day 9, nasal endoscopy and culture identified Tsukamurella species. The patient was treated with augmentin, fluconazole, and levofloxacin, leading to the resolution of symptoms and discharge with ongoing treatment.
Clinical discussion: Tsukamurella species are uncommon pathogens that are often associated with bacteremia in immunocompromised individuals. This case highlights the diagnostic challenges and the importance of considering unusual pathogens in postprocedural infections, even in immunocompetent patients. Accurate identification and appropriate management are critical in improving outcomes for patients with Tsukamurella infections.
Conclusion: This case underscores the need for vigilance in diagnosing rare infections like Tsukamurella, even in immunocompetent individuals. The successful resolution with combination therapy highlights the importance of appropriate antibiotic selection in managing such infections.
{"title":"Mucosal infection with Tsukamurella species following nasal septum procedure: a rare case report.","authors":"Alamjeet K Sidhu, Shreya Khandelwal, Francis V Dominic Savio, Simranjeet Bedi, Yashash D Pathak","doi":"10.1097/MS9.0000000000002515","DOIUrl":"10.1097/MS9.0000000000002515","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Tsukamurella species are rare, aerobic, gram-positive bacteria known to cause infections, primarily in immunocompromised individuals. This case report presents a rare instance of a mucosal infection caused by Tsukamurella species following a nasal septum procedure in an immunocompetent patient.</p><p><strong>Case presentation: </strong>A 51-year-old man with a history of multiple hereditary exostosis, allergic rhinitis, and recent nasal fracture repair presented with persistent fevers and low back pain. Postoperatively, he developed sinus pain and small oral lesions, initially treated with antibiotics for presumed sinusitis. Despite treatment, his fever persisted, leading to an emergency department visit. Laboratory tests indicated sepsis, but a CT scan of the sinuses showed no sinusitis. Despite broad-spectrum antibiotics, the patient's fever continued. On admission day 9, nasal endoscopy and culture identified Tsukamurella species. The patient was treated with augmentin, fluconazole, and levofloxacin, leading to the resolution of symptoms and discharge with ongoing treatment.</p><p><strong>Clinical discussion: </strong>Tsukamurella species are uncommon pathogens that are often associated with bacteremia in immunocompromised individuals. This case highlights the diagnostic challenges and the importance of considering unusual pathogens in postprocedural infections, even in immunocompetent patients. Accurate identification and appropriate management are critical in improving outcomes for patients with Tsukamurella infections.</p><p><strong>Conclusion: </strong>This case underscores the need for vigilance in diagnosing rare infections like Tsukamurella, even in immunocompetent individuals. The successful resolution with combination therapy highlights the importance of appropriate antibiotic selection in managing such infections.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002517
Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu
Stage III breast cancer, characterized by locally advanced tumors and potential regional lymph node involvement, presents a formidable challenge to both patients and healthcare professionals. Accurate prediction of survival outcomes is crucial for guiding treatment decisions and optimizing patient care. This publication explores the potential clinical utility of predictive tools, encompassing genetic markers, imaging techniques, and clinical parameters, to improve survival outcome predictions in stage III breast cancer. Multimodal approaches, integrating these tools, hold the promise of delivering more precise and personalized predictions. Despite the inherent challenges, such as data standardization and genetic heterogeneity, the future offers opportunities for refinement, driven by precision medicine, artificial intelligence, and global collaboration. The goal is to empower healthcare providers to make informed treatment decisions, ultimately leading to improved survival outcomes and a brighter horizon for individuals facing this challenging disease.
III 期乳腺癌的特点是局部晚期肿瘤和潜在的区域淋巴结受累,这给患者和医护人员都带来了严峻的挑战。准确预测生存结果对于指导治疗决策和优化患者护理至关重要。本刊物探讨了预测工具的潜在临床效用,包括遗传标记、成像技术和临床参数,以改善 III 期乳腺癌的生存结果预测。整合这些工具的多模式方法有望提供更精确和个性化的预测。尽管存在数据标准化和基因异质性等固有挑战,但在精准医疗、人工智能和全球合作的推动下,未来仍有改进的机会。我们的目标是让医疗服务提供者能够做出明智的治疗决策,最终改善患者的生存状况,为面临这一挑战性疾病的患者带来更光明的前景。
{"title":"Predictive models and biomarkers for survival in stage III breast cancer: a review of clinical applications and future directions.","authors":"Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu","doi":"10.1097/MS9.0000000000002517","DOIUrl":"10.1097/MS9.0000000000002517","url":null,"abstract":"<p><p>Stage III breast cancer, characterized by locally advanced tumors and potential regional lymph node involvement, presents a formidable challenge to both patients and healthcare professionals. Accurate prediction of survival outcomes is crucial for guiding treatment decisions and optimizing patient care. This publication explores the potential clinical utility of predictive tools, encompassing genetic markers, imaging techniques, and clinical parameters, to improve survival outcome predictions in stage III breast cancer. Multimodal approaches, integrating these tools, hold the promise of delivering more precise and personalized predictions. Despite the inherent challenges, such as data standardization and genetic heterogeneity, the future offers opportunities for refinement, driven by precision medicine, artificial intelligence, and global collaboration. The goal is to empower healthcare providers to make informed treatment decisions, ultimately leading to improved survival outcomes and a brighter horizon for individuals facing this challenging disease.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical education is constantly evolving worldwide and facing various challenges. To cope with these, continuous and fruitful evaluation of an educational program is the need of the day. This study aims to know the purpose of evaluation, various theories related to program evaluation, and different models of curriculum and program evaluation. This will help educationists evaluate their programs fruitfully and effectively according to their needs and objectives. Different search engines including Medline's PubMed interface, Google Scholar, and Cochrane Review databases using keywords, curriculum evaluation, evaluation models, and evaluation strategies in education, were searched without any date restrictions, and 20 full-text articles were selected for review and data extraction. While reviewing the literature it was found that most of the modern educational program and curriculum evaluation models are based on the reductionist, system, and complexity theories of evaluation. The experimental/quasi-experimental model is based majorly on the linear approach and reductionism, but its drawback is that it is impractical for the whole curriculum and sometimes ethically unfavorable. Kirkpatrick's model, Philips' model, the CIPP model, and the logic model are based on the system and complexity theory and are more practical in medical education. Each of these models has its advantages and limitations. In this review, the authors discussed the important distinctive features of these evaluation theories and models and their applicability and usefulness in evaluating different programs and curricula.
{"title":"Curriculum and program evaluation in medical education: a short systematic literature review.","authors":"Himayat Ullah, Sarwat Huma, Ghulam Yasin, Muhammad Ashraf, Qazi Tahir-Ud-Din, Hossam Shabana, Junaid Sarfraz","doi":"10.1097/MS9.0000000000002518","DOIUrl":"10.1097/MS9.0000000000002518","url":null,"abstract":"<p><p>Medical education is constantly evolving worldwide and facing various challenges. To cope with these, continuous and fruitful evaluation of an educational program is the need of the day. This study aims to know the purpose of evaluation, various theories related to program evaluation, and different models of curriculum and program evaluation. This will help educationists evaluate their programs fruitfully and effectively according to their needs and objectives. Different search engines including Medline's PubMed interface, Google Scholar, and Cochrane Review databases using keywords, curriculum evaluation, evaluation models, and evaluation strategies in education, were searched without any date restrictions, and 20 full-text articles were selected for review and data extraction. While reviewing the literature it was found that most of the modern educational program and curriculum evaluation models are based on the reductionist, system, and complexity theories of evaluation. The experimental/quasi-experimental model is based majorly on the linear approach and reductionism, but its drawback is that it is impractical for the whole curriculum and sometimes ethically unfavorable. Kirkpatrick's model, Philips' model, the CIPP model, and the logic model are based on the system and complexity theory and are more practical in medical education. Each of these models has its advantages and limitations. In this review, the authors discussed the important distinctive features of these evaluation theories and models and their applicability and usefulness in evaluating different programs and curricula.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Montelukast is a leukotriene receptor antagonist that helps treat chronic asthma and allergic rhinitis by reducing inflammation and bronchoconstriction. However, oral montelukast's effectiveness in managing acute asthma attacks has yet to be completely identified.
Methods: This randomized, double-blind, placebo-controlled trial investigated the efficacy of oral montelukast in acute exacerbations of asthma. Seventy patients between 18 and 65 years of age with a primary diagnosis of asthma attack were included in the study and were randomly assigned to receive 10 mg of montelukast orally daily or placebo. Symptoms, signs, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEFR) were evaluated.
Results: Our findings showed a statistically significant difference between montelukast and placebo regarding FEV1 (78.05 ± 7.84 vs. 72.05 ± 12.00, P = 0.016), PEFR (322.86 ± 28.95 vs. 290.86 ± 44.21, P = 0.003), and wheezing (P = 0.022) on the fifth day of treatment. Additionally, FEV1 and PEFR values were compared in two subgroups of patients, ICS users (ICSU) and non-ICS users (NICSU), in both the montelukast and placebo groups. In the montelukast group, while PEFR improved significantly for day 5 in both the ICSU (P = 0.007) and NICSU (P = 0.027) subgroups, FEV1 only improved in the ICSU (P = 0.009) subgroup compared to placebo.
Conclusion: The present study demonstrated that oral montelukast administered in acute asthma exacerbation could lead to better values of PEFR and FEV1 on pulmonary function and improvement of wheezing in terms of symptoms.
{"title":"Effects of oral montelukast on pulmonary function and clinical symptoms in acute asthma exacerbations: a randomized, double-blind, placebo-controlled trial.","authors":"Masoud Aliyali, Siavash Abedi, Ali Sharifpour, Erfan Ghadirzadeh, Mahdie Fattahi, Jamshid Yazdani Charati, Hossein Mehravaran","doi":"10.1097/MS9.0000000000002507","DOIUrl":"10.1097/MS9.0000000000002507","url":null,"abstract":"<p><strong>Introduction: </strong>Montelukast is a leukotriene receptor antagonist that helps treat chronic asthma and allergic rhinitis by reducing inflammation and bronchoconstriction. However, oral montelukast's effectiveness in managing acute asthma attacks has yet to be completely identified.</p><p><strong>Methods: </strong>This randomized, double-blind, placebo-controlled trial investigated the efficacy of oral montelukast in acute exacerbations of asthma. Seventy patients between 18 and 65 years of age with a primary diagnosis of asthma attack were included in the study and were randomly assigned to receive 10 mg of montelukast orally daily or placebo. Symptoms, signs, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEFR) were evaluated.</p><p><strong>Results: </strong>Our findings showed a statistically significant difference between montelukast and placebo regarding FEV<sub>1</sub> (78.05 ± 7.84 vs. 72.05 ± 12.00, <i>P</i> = 0.016), PEFR (322.86 ± 28.95 vs. 290.86 ± 44.21, <i>P</i> = 0.003), and wheezing (<i>P</i> = 0.022) on the fifth day of treatment. Additionally, FEV<sub>1</sub> and PEFR values were compared in two subgroups of patients, ICS users (ICSU) and non-ICS users (NICSU), in both the montelukast and placebo groups. In the montelukast group, while PEFR improved significantly for day 5 in both the ICSU (<i>P</i> = 0.007) and NICSU (<i>P</i> = 0.027) subgroups, FEV<sub>1</sub> only improved in the ICSU (<i>P</i> = 0.009) subgroup compared to placebo.</p><p><strong>Conclusion: </strong>The present study demonstrated that oral montelukast administered in acute asthma exacerbation could lead to better values of PEFR and FEV<sub>1</sub> on pulmonary function and improvement of wheezing in terms of symptoms.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002505
Mohammadreza Emamhadi, Nooshin Zaresharifi, Zoheir Reihanian, Anita Khalili, Mohammad Taghi Ashoobi, Sama Noroozi Guilandehi, Iraj Baghi, Alireza Mehrvarz
Introduction and importance: Primitive neuro-ectodermal tumor (PNET) is a highly aggressive tumor composed of small round blue cells, mostly developing in children and young adults. Being a member of Ewing's Sarcoma Family of Tumors (ESFT); it has been discussed in two subcategories of central and peripheral PNET. PNETs of peripheral nerves are very uncommon pathologic findings, as to the best of our knowledge only 12 well-documented cases have been yet reported.
Case presentation: A 30-year-old male presented with progressive paresthesia of his right hand's little finger and painless swelling of the right axilla. Magnetic resonance (MR) neurography demonstrated a heterogeneous, high-signal, round mass within the right axilla fossa in proximity to the medial aspect of brachial plexus branches. The clinical and radiological study failed to an accurate diagnosis, thus surgical resection of the tumor was done for tissue evaluation. Histopathologic study of the lesion revealed a neoplasm comprising sheets of small, round, blue cells (Hematoxylin and Eosin stain), which immunohistochemically consisted with the diagnosis of PNET.
Clinical discussion: The differential diagnosis of axillary fossa masses, focusses on peripheral nerve tumors like Schwannoma and PNET. MR neurography aids in evaluation, but tissue diagnosis remains crucial. Treatment involves surgical resection, chemotherapy, and radiotherapy tailored to individual patients.
Conclusion: Although pPNET is not apparently the first differential diagnosis coming to mind when encountering a rapidly growing mass in the axillary fossa with peripheral nerve origin, its highly malignant behavior, makes it crucial to be considered in the differential diagnoses.
{"title":"Axillary lesion in a young adult ends up to a peculiar diagnosis: primitive neuro-ectodermal tumor (PNET) of ulnar nerve: a rare case report.","authors":"Mohammadreza Emamhadi, Nooshin Zaresharifi, Zoheir Reihanian, Anita Khalili, Mohammad Taghi Ashoobi, Sama Noroozi Guilandehi, Iraj Baghi, Alireza Mehrvarz","doi":"10.1097/MS9.0000000000002505","DOIUrl":"10.1097/MS9.0000000000002505","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Primitive neuro-ectodermal tumor (PNET) is a highly aggressive tumor composed of small round blue cells, mostly developing in children and young adults. Being a member of Ewing's Sarcoma Family of Tumors (ESFT); it has been discussed in two subcategories of central and peripheral PNET. PNETs of peripheral nerves are very uncommon pathologic findings, as to the best of our knowledge only 12 well-documented cases have been yet reported.</p><p><strong>Case presentation: </strong>A 30-year-old male presented with progressive paresthesia of his right hand's little finger and painless swelling of the right axilla. Magnetic resonance (MR) neurography demonstrated a heterogeneous, high-signal, round mass within the right axilla fossa in proximity to the medial aspect of brachial plexus branches. The clinical and radiological study failed to an accurate diagnosis, thus surgical resection of the tumor was done for tissue evaluation. Histopathologic study of the lesion revealed a neoplasm comprising sheets of small, round, blue cells (Hematoxylin and Eosin stain), which immunohistochemically consisted with the diagnosis of PNET.</p><p><strong>Clinical discussion: </strong>The differential diagnosis of axillary fossa masses, focusses on peripheral nerve tumors like Schwannoma and PNET. MR neurography aids in evaluation, but tissue diagnosis remains crucial. Treatment involves surgical resection, chemotherapy, and radiotherapy tailored to individual patients.</p><p><strong>Conclusion: </strong>Although pPNET is not apparently the first differential diagnosis coming to mind when encountering a rapidly growing mass in the axillary fossa with peripheral nerve origin, its highly malignant behavior, makes it crucial to be considered in the differential diagnoses.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002499
George Bashour, George Hneino, Zain Aldin Zaher, Ali Dway, Georges Michael, Zuheir Alshehabi
Introduction: Urachal carcinomas are uncommon malignant neoplasms comprising only 0.01% of all adult cancers. Most patients were aged from 58 to 64 years at diagnosis with 60 years being the median. It usually metastasizes to the lungs (22%), bones (22%), and liver (16%).
Presentation: We report a case of a 71-year-old female patient who initially presented with two large liver masses and a small nodule on the anterior side of the bladder. The symptoms were nonspecific with abdominal discomfort. The final diagnosis of urachal adenocarcinoma was finalized with a biopsy of the bladder mass. The patient initially received six doses of FOLFOX6 without improvement and then Gem-Carbo, showing improvement after six doses. Finally, the patient received two doses of FOLFIRI-B with no response and kept deteriorating and died after 19 months of treatment.
Discussion: About 90% of patients are symptomatic and hematuria is the most typical presenting symptom at diagnosis. The low incidence and the histopathologic similarities to adenocarcinoma from various sources pose a difficulty in recognizing the tumor. Our study presents the only case of a urachal carcinoma first manifesting with abdominal mass resulting from liver metastasis with no prior symptoms of urological origins. Also, our study presents the first attempt of using FLOFIRI-B to treat metastatic UraC.
Conclusion: This case highlights the necessity for clinicopathological correlation to make the correct diagnosis and the challenges in the treatment which urges the need for further research to identify more effective treatment strategies for this rare cancer.
{"title":"Urachal carcinoma initially presenting only as a liver metastasis, a diagnostic and therapeutic challenge: first case in literature.","authors":"George Bashour, George Hneino, Zain Aldin Zaher, Ali Dway, Georges Michael, Zuheir Alshehabi","doi":"10.1097/MS9.0000000000002499","DOIUrl":"10.1097/MS9.0000000000002499","url":null,"abstract":"<p><strong>Introduction: </strong>Urachal carcinomas are uncommon malignant neoplasms comprising only 0.01% of all adult cancers. Most patients were aged from 58 to 64 years at diagnosis with 60 years being the median. It usually metastasizes to the lungs (22%), bones (22%), and liver (16%).</p><p><strong>Presentation: </strong>We report a case of a 71-year-old female patient who initially presented with two large liver masses and a small nodule on the anterior side of the bladder. The symptoms were nonspecific with abdominal discomfort. The final diagnosis of urachal adenocarcinoma was finalized with a biopsy of the bladder mass. The patient initially received six doses of FOLFOX6 without improvement and then Gem-Carbo, showing improvement after six doses. Finally, the patient received two doses of FOLFIRI-B with no response and kept deteriorating and died after 19 months of treatment.</p><p><strong>Discussion: </strong>About 90% of patients are symptomatic and hematuria is the most typical presenting symptom at diagnosis. The low incidence and the histopathologic similarities to adenocarcinoma from various sources pose a difficulty in recognizing the tumor. Our study presents the only case of a urachal carcinoma first manifesting with abdominal mass resulting from liver metastasis with no prior symptoms of urological origins. Also, our study presents the first attempt of using FLOFIRI-B to treat metastatic UraC.</p><p><strong>Conclusion: </strong>This case highlights the necessity for clinicopathological correlation to make the correct diagnosis and the challenges in the treatment which urges the need for further research to identify more effective treatment strategies for this rare cancer.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002482
Pratik Adhikari, Nabin Bhujel
Background: Neurofibromatosis type I (NF1) is a genetic disorder characterized by the development of multiple benign tumors along nerves in the skin, brain, and other parts of the body. It is associated with a range of clinical manifestations, including skin lesions, neurofibromas, and ocular abnormalities, which can significantly impact a patient's quality of life. Management of NF1 is particularly challenging in resource-limited settings due to limited access to diagnostic and therapeutic resources.
Clinical presentation: A 62-year-old woman with a known history of NF1 presented with progressive visual impairment. Her condition began in childhood with multiple hyperpigmented skin macules, which developed into numerous cutaneous tumors over time. Examination revealed numerous neurofibromas, café-au-lait spots, and axillary freckling. Significant visual impairment was caused by large fibromas on her eyelids. Histological analysis confirmed benign nerve tissue tumors.
Clinical discussion: The management strategy in this resource-limited setting focused on regular monitoring, patient education, symptomatic treatment, and multidisciplinary care. Despite the limitations, the patient's condition was managed effectively through these adapted strategies. The importance of genetic testing for confirmation and further management was noted but not performed due to resource constraints.
Conclusion: This case highlights the complexities of managing NF1 in resource-limited settings, emphasizing the need for adaptable management approaches. Multidisciplinary care and patient education were crucial in improving the patient's quality of life. This case underscores the importance of early diagnosis and intervention to prevent complications like visual impairment.
{"title":"Managing neurofibromatosis type I and vision impairment in a resource-limited setting: a case study and multidisciplinary approach.","authors":"Pratik Adhikari, Nabin Bhujel","doi":"10.1097/MS9.0000000000002482","DOIUrl":"10.1097/MS9.0000000000002482","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type I (NF1) is a genetic disorder characterized by the development of multiple benign tumors along nerves in the skin, brain, and other parts of the body. It is associated with a range of clinical manifestations, including skin lesions, neurofibromas, and ocular abnormalities, which can significantly impact a patient's quality of life. Management of NF1 is particularly challenging in resource-limited settings due to limited access to diagnostic and therapeutic resources.</p><p><strong>Clinical presentation: </strong>A 62-year-old woman with a known history of NF1 presented with progressive visual impairment. Her condition began in childhood with multiple hyperpigmented skin macules, which developed into numerous cutaneous tumors over time. Examination revealed numerous neurofibromas, café-au-lait spots, and axillary freckling. Significant visual impairment was caused by large fibromas on her eyelids. Histological analysis confirmed benign nerve tissue tumors.</p><p><strong>Clinical discussion: </strong>The management strategy in this resource-limited setting focused on regular monitoring, patient education, symptomatic treatment, and multidisciplinary care. Despite the limitations, the patient's condition was managed effectively through these adapted strategies. The importance of genetic testing for confirmation and further management was noted but not performed due to resource constraints.</p><p><strong>Conclusion: </strong>This case highlights the complexities of managing NF1 in resource-limited settings, emphasizing the need for adaptable management approaches. Multidisciplinary care and patient education were crucial in improving the patient's quality of life. This case underscores the importance of early diagnosis and intervention to prevent complications like visual impairment.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002491
Shree Rath, Murtaja Satea Shafeea, Abbas F Abdul Hussein, Ahmed Shamil Hashim, Sara Hassanaien, Santiago Pastrana-Brandes, Bipin Chaurasia
Meningiomas, the most common tumors of the central nervous system (CNS), present significant challenges in treatment, particularly for atypical and anaplastic subtypes where standard therapies often fall short of therapeutic expectations. Chimeric antigen receptor (CAR) T-cell therapy, a groundbreaking immunotherapy approach, has demonstrated great success in hematological malignancies but faces obstacles in solid tumors, including CNS tumors like glioblastomas. This article provides a comprehensive review of the efficacy of CAR-T therapy in meningiomas, highlighting the tumor's immunogenic potential and the challenges associated with applying this therapy in clinical practice. Through an extensive literature review, the study explores potential antigens for CAR-T targeting in meningiomas, shedding light on the tumor-immune microenvironment interactions. Challenges such as tumor heterogeneity, blood-brain barrier penetration, off-target effects, and tumor recurrence are discussed, alongside potential strategies to overcome these obstacles. The study also investigates recent advancements in CAR-T therapy, including the identification of novel target antigens and the development of engineering approaches to enhance therapeutic efficacy. Furthermore, the article highlights the importance of ongoing research efforts in exploring the tumor-immune dynamics in meningiomas and underscores the urgent need for clinical trials to validate the safety and efficacy of CAR-T therapy in this context. By addressing these challenges, CAR-T therapy holds the promise of revolutionizing meningioma treatment, offering new hope for patients suffering from this disease.
{"title":"CAR-T-cell therapy in meningioma: current investigations, advancements and insight into future directions.","authors":"Shree Rath, Murtaja Satea Shafeea, Abbas F Abdul Hussein, Ahmed Shamil Hashim, Sara Hassanaien, Santiago Pastrana-Brandes, Bipin Chaurasia","doi":"10.1097/MS9.0000000000002491","DOIUrl":"10.1097/MS9.0000000000002491","url":null,"abstract":"<p><p>Meningiomas, the most common tumors of the central nervous system (CNS), present significant challenges in treatment, particularly for atypical and anaplastic subtypes where standard therapies often fall short of therapeutic expectations. Chimeric antigen receptor (CAR) T-cell therapy, a groundbreaking immunotherapy approach, has demonstrated great success in hematological malignancies but faces obstacles in solid tumors, including CNS tumors like glioblastomas. This article provides a comprehensive review of the efficacy of CAR-T therapy in meningiomas, highlighting the tumor's immunogenic potential and the challenges associated with applying this therapy in clinical practice. Through an extensive literature review, the study explores potential antigens for CAR-T targeting in meningiomas, shedding light on the tumor-immune microenvironment interactions. Challenges such as tumor heterogeneity, blood-brain barrier penetration, off-target effects, and tumor recurrence are discussed, alongside potential strategies to overcome these obstacles. The study also investigates recent advancements in CAR-T therapy, including the identification of novel target antigens and the development of engineering approaches to enhance therapeutic efficacy. Furthermore, the article highlights the importance of ongoing research efforts in exploring the tumor-immune dynamics in meningiomas and underscores the urgent need for clinical trials to validate the safety and efficacy of CAR-T therapy in this context. By addressing these challenges, CAR-T therapy holds the promise of revolutionizing meningioma treatment, offering new hope for patients suffering from this disease.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-10-01DOI: 10.1097/MS9.0000000000002474
Sebastian Mactaggart, Raheel Ahmed, Asma Riaz, Shehroze Tabassum, Kamleshun Ramphul, Maham Bilal, Yumna Jamil, Mansimran Singh Dulay, Alexander Liu, Mushood Ahmed, Hiroyuki Sawatari, Prince K Pekyi-Boateng, Alessia Azzu, Athol Wells, Vasilis Kouranos, Anwar Chahal, Rakesh Sharma
Background: The highly arrhythmogenic nature of cardiac sarcoidosis (CS) leads to high morbidity and mortality, the rates of which may be higher in COVID-19 patients. This study aimed to evaluate the outcomes of CS patients admitted to hospitals with COVID-19.
Methods: The study utilised the 2020-2021 National Inpatient Sample database, examining primary COVID-19 cases in adults aged older than or equal to 18 years. Those with CS were identified using ICD-10 code "D86.85" and compared with and without propensity matching (1:10) to those without CS for baseline characteristics and primary outcomes of acute kidney injury (AKI), use of mechanical ventilation, cardiac arrest and mortality.
Results: In total, 2 543 912 COVID-19 cases were identified. Before propensity matching, CS patients were more likely to be younger (58.0 vs. 64.0 years, P<0.01), male (64.0% vs. 52.6%, P=0.011), of Black ethnicity (60.0% vs. 15.9%, P<0.01), exhibit higher Charlson Comorbidity Index (CCI) scores (3.00 vs. 1.00, P<0.01) and had a higher incidence of in-hospital cardiac arrest (aOR 2.649, 95% CI 1.366-5.134, P=0.004). After propensity matching (CS, N=95; non-CS, N=875), those with CS were at a statistically significant reduced risk of AKI (aOR 0.484, P=0.01); however, the outcomes of death, cardiac arrest, mechanical ventilation, length of stay (LOS) and healthcare costs did not reach significance.
Conclusion: In a propensity-matched cohort admitted with COVID-19, CS patients had a reduced risk of AKI, but comparable LOS, rates of cardiac arrest, mechanical ventilator use, and mortality. Future research is warranted to develop evidence-based guidelines for managing COVID-19 in patients with CS.
{"title":"Clinical outcomes following hospitalization for COVID-19 in patients with cardiac sarcoidosis in the United States: a propensity-matched analysis from national inpatient sample database from April 2020 to December 2021.","authors":"Sebastian Mactaggart, Raheel Ahmed, Asma Riaz, Shehroze Tabassum, Kamleshun Ramphul, Maham Bilal, Yumna Jamil, Mansimran Singh Dulay, Alexander Liu, Mushood Ahmed, Hiroyuki Sawatari, Prince K Pekyi-Boateng, Alessia Azzu, Athol Wells, Vasilis Kouranos, Anwar Chahal, Rakesh Sharma","doi":"10.1097/MS9.0000000000002474","DOIUrl":"10.1097/MS9.0000000000002474","url":null,"abstract":"<p><strong>Background: </strong>The highly arrhythmogenic nature of cardiac sarcoidosis (CS) leads to high morbidity and mortality, the rates of which may be higher in COVID-19 patients. This study aimed to evaluate the outcomes of CS patients admitted to hospitals with COVID-19.</p><p><strong>Methods: </strong>The study utilised the 2020-2021 National Inpatient Sample database, examining primary COVID-19 cases in adults aged older than or equal to 18 years. Those with CS were identified using ICD-10 code \"D86.85\" and compared with and without propensity matching (1:10) to those without CS for baseline characteristics and primary outcomes of acute kidney injury (AKI), use of mechanical ventilation, cardiac arrest and mortality.</p><p><strong>Results: </strong>In total, 2 543 912 COVID-19 cases were identified. Before propensity matching, CS patients were more likely to be younger (58.0 vs. 64.0 years, <i>P</i><0.01), male (64.0% vs. 52.6%, <i>P</i>=0.011), of Black ethnicity (60.0% vs. 15.9%, <i>P</i><0.01), exhibit higher Charlson Comorbidity Index (CCI) scores (3.00 vs. 1.00, <i>P</i><0.01) and had a higher incidence of in-hospital cardiac arrest (aOR 2.649, 95% CI 1.366-5.134, <i>P</i>=0.004). After propensity matching (CS, <i>N</i>=95; non-CS, <i>N</i>=875), those with CS were at a statistically significant reduced risk of AKI (aOR 0.484, <i>P</i>=0.01); however, the outcomes of death, cardiac arrest, mechanical ventilation, length of stay (LOS) and healthcare costs did not reach significance.</p><p><strong>Conclusion: </strong>In a propensity-matched cohort admitted with COVID-19, CS patients had a reduced risk of AKI, but comparable LOS, rates of cardiac arrest, mechanical ventilator use, and mortality. Future research is warranted to develop evidence-based guidelines for managing COVID-19 in patients with CS.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}