Actualización en taxonomía, diagnóstico y tratamiento de las dermatofitosis / Update on taxonomy, diagnosis and treatment

Los dermatofitos son un grupo de hongos responsables de las dermatofitosis o tiñas, pudiendo afectar piel, uñas y pelo. En la actualidad están constituidos por los géneros Epidermophyton, Trichophyton, Microsporum, Arthroderma, Paraphyton, Lophophyton y Nannizzia. El examen microscópico directo y el cultivo en agar siguen siendo el estándar de oro para la identificación, sin embargo, en ocasiones se requiere de la biología molecular para poder corroborar una determinada especie. Dependiendo de la localización, del número de lesiones y de la extensión, el tratamiento de las dermatofitosis puede ser tópico o sistémico. Trichophyton indotineae y T tonsurans pueden expresar resistencia a la terbinafina y azoles, respectivamente.

Dermatophytes are a group of fungi responsible for dermatophytosis or ringworm, which can affect the skin, nails and hair. Currently, they are assembled by the genera Epidermophyton, Trichophyton, Microsporum, Arthroderma, Paraphyton, Lophophyton and Nannizzia. Direct microscopic examination and culture on agar remain the gold standard for identification, however, molecular biology is sometimes required to confirm a certain species. Depending on the location, the number of lesions and the extension, the treatment of dermatophytosis can be topical or systemic. Trichophyton indotineae and T tonsurans can express resistance to terbinafine and azoles, respectively.

Clinicopathological study of epithelioid and spindle cell rhabdomysarcoma with EWSR1/FUS-TFCP2 fusion / 中华病理学杂志

Objective: To investigate the clinicopathological and genetic features of epithelioid and spindle cell rhabdomysarcoma with EWSR1-TFCP2 or FUS-TFCP2 fusion. Methods: The clinical, morphological and immunohistochemical features of 14 cases of epithelioid and spindle cell rhabdomysarcoma with EWSR1-TFCP2 or FUS-TFCP2 fusion diagnosed from January 2019 to December 2022 in the Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed. The cases were all subject to FISH or next generation sequencing for analysis of molecular genetic features. The literature was reviewed. Results: There were 5 males and 9 females, with the age at presentation ranging from 6 to 36 years (mean, 22 years). Tumors occurred in the head and neck (9 cases), pelvic region (2 cases), bladder (one case), right humerus (one case), and the abdominal wall, humerus and pubic at the same time (one case). Presenting symptoms varied by location but often included pain or discomfort. Most of the patients showed aggressive radiographic features with soft tissue extension. The tumors had a median size of 6.6 cm (range, 2-23 cm). The tumors were poorly defined and irregularly shaped. Microscopic examination showed diffuse proliferation of spindle or epithelioid cells. While morphologically high-grade tumors displayed obvious cytological atypia, a high mitotic count and tumor necrosis, low-grade tumors grew in sheets and fascicles composed of spindle, epithelioid cells with moderate or abundant amounts of eosinophilic cytoplasm, without pronounced cytological atypia. The tumor cells expressed Desmin, MyoD1, and Myogenin, as well as ALK, EMA, and CKpan. EWSR1/FUS-TFCP2 gene fusion was detected in 14 cases with next generation sequencing and confirmed by FISH. Six cases had EWSR1-TFCP2 fusions and 8 cases showed FUS-TFCP2 fusions. Follow-up information was available in 13 patients, ranged from 5 to 37 months. At the end of follow-up period, 7 patients died of the disease. Six patients were alive:two cases had local recurrences and metastases, two cases of recurrences, one case of metastasis and one case without recurrences and metastasis. Conclusions: Epithelioid and spindle cell rhabdomysarcomas with EWSR1-TFCP2 or FUS-TFCP2 fusion show a very aggressive clinical course, and more commonly occur in the head and neck. Their genetic hallmark is the presence of EWSR1/FUS-TFCP2 fusions. Familiarity with its clinicopathological characteristics is helpful in avoiding misdiagnoses.

Effect of nalbuphine hydrochloride combined with dexmedetomidine on post-operative recovery quality and pain in patients undergoing laparoscopic bariatric surgery / 实用医学杂志

Objective To investigate the effects of nalbuphine combined with dexmedetomidine on postop-erative recovery quality and pain in patients who undergoing laparoscopic bariatric surgery.Methods A total of 169 patients who underwent laparoscopic bariatric surgery at our hospital were included and divided into control group(group C),nalbuphine group(group N),dexmedetomidine group(group D),and nalbuphine combined with dexme-detomidine group(group ND)using randomised numerical table method.Group C received intravenous injection of saline,group N and group ND received intravenous injection of nalbuphine before the end of the surgery,and group D and group ND received pumping of dexmedetomidine before anesthesia induction and during surgery.Compare the postoperative recovery quality score(QoR-40),hemodynamics at different time points,visual analogue scale score(VAS),sedation-agitation scale(SAS),first time out of bed activity and exhaust time,and incidence of nausea and vomiting among four groups.Results The postoperative QoR-40 scores of patients in group ND were better than those in group C and group N(P<0.05),and the QoR-40 scores in group D were better than those in group C(P<0.05).MAP and HR were more stable during the awakening period in group ND and group D(P<0.05).Compared with group C,patients in all three groups had lower VAS scores and SAS scores(P<0.05)and consumed less remedial analgesic medication(P<0.05).In terms of adverse reactions,the incidence of postoperative nausea,vomiting and coughing in the group ND was lower than that in the group C(P<0.05).Conclusion The combination of nalbuphine and dexmedetomidine could improve the quality of postoperative recovery and pain in patients under-going laparoscopic bariatric surgery,reduce hemodynamic fluctuations during the patients′ recovery period,reduce the incidence of nausea and vomiting,and improve the patients′ prognosis.

Comamonas Testosteroni Emerging Gastrointestinal Pathogen

Comamonas testosteroni newly emerging microorganism previously known as Pseudomonas testosteroni is common environmental bacterium that is not known to be a part of the human commensal organism. Since its identification as a human pathogen in 1987, numerous reports have drizzled in, implicating this organism for various infections. Comamonas testosteroni are rare isolates in microbiology laboratories and have been infrequently reported as an infectious agent in routine clinical practice. Comamonas testosteroni has been rarely observed as an infectious agent in clinical practice. Comamonas testosteroni is rarely recognized as a human pathogen. Most of the reported cases are bloodstream infections. We report this pathogen from the stool of an immunocompromised 48-year-old male. The aim of this case report is to alert clinicians and laboratory physicians for the potential diagnosis and clinical approach of gastrointestinal infections caused by this organism.

Colesteatoma del conducto auditivo externo: Experiencia de 5 años Hospital del Salvador / External ear canal cholesteatoma: 5-year experience Hospital del Salvador

Introducción: El colesteatoma del conducto auditivo externo (CCAE) es una estructura quística revestida por epitelio escamoso estratificado queratinizado que tiene la capacidad de invadir y erosionar localmente al hueso temporal. Su incidencia es de 0,19 a 0,3/100.000 habitantes siendo 60 veces menos frecuente que el de oído medio. Objetivo: Describir las características epidemiológicas, clínicas, imagenológicas y tratamiento de los pacientes diagnosticados con CCAE en el Servicio de Otorrinolaringología Hospital del Salvador. Material y Método: Se presenta una serie de ocho casos clínicos recopilados durante el período 2017 y 2021. Se realizó revisión de fichas clínicas, biopsias y tomografías computadas de oídos (TC oídos). Se describen los hallazgos y tratamiento efectuado. Resultados: El promedio de edad fue de 65,6 años, correspondiente a 5 mujeres y 3 hombres con presencia de tabaquismo y diabetes en la mitad de los casos. Los síntomas y signos más frecuentes fueron otalgia e hipoacusia seguido de otorrea. 7 pacientes se presentaron con tímpano íntegro y el compromiso de la pared inferior del conducto se evidenció en 6 de 8 pacientes. La TC oídos mostró erosión ósea del conducto, con o sin compromiso de estructuras adyacentes, en todos los casos y el diagnóstico histológico fue efectuado en el 100% de los pacientes. Se privilegió el tratamiento conservador mediante curaciones óticas periódicas asociado a ácido salicílico al 3% y/o antibióticos tópicos en 6/8 pacientes. Conclusiones: El CCAE es una entidad poco frecuente sin signos ni síntomas patognomónicos por lo que el diagnóstico histológico junto con el estudio imagenológico es perentorio. El tratamiento conservador es una alternativa terapéutica válida que ofrece buenos resultados en pacientes con adecuada adherencia al tratamiento y posibilidad de seguimiento estricto.

Introduction: External ear canal cholesteatoma (EECC) is a cystic structure lined by keratinized stratified squamous epithelium that has the ability to locally invade and erode the temporal bone. Its incidence is 0.19 to 0.3 / 100,000 habitants, being 60 times less frequent than that of the middle ear. Aim: To describe the epidemiological, clinical, imaging and treatment characteristics of patients diagnosed with EECC in the Hospital del Salvador ENT department. Material and Methods: A series of eight clinical cases collected during the period 2017 and 2021 is presented. A review of clinical records, biopsies and computed tomography of the ear (ear CT) was carried out. The findings and treatment carried out are described. Results: The average age was 65.6 years corresponding to 5 women and 3 men with the presence of smoking and diabetes in half of the cases. The most frequent symptoms and signs were earache and hearing loss followed by otorrhea. 7 patients presented with an intact eardrum and compromise of the inferior wall of the canal was evidenced in 6 of 8 patients. Ears CT showed bone erosion of the canal with or without compromise of adjacent structures in all cases and the histological diagnosis was made in 100% of the patients. Conservative treatment with periodic ear dressings associated with 3% salicylic acid and / or topical antibiotics was favored in 6/8 patients. Conclusion: EECC is a rare entity without pathognomonic signs or symptoms, therefore the histological diagnosis together with the imaging study is peremptory. Conservative treatment is a valid therapeutic alternative that offers good results in patients with adequate adherence to treatment and the possibility of strict follow-up.

PREVALENCE AND RISK FACTORS OF NON–ALCOHOLIC FATTY LIVER DISEASE IN LEAN INDIVIDUALS: A HOSPITAL BASED STUDY.

Introduction: According to epidemiological studies, NAFLD affects 9% to 53% of India's general population, with a higher frequency among those who are overweight or obese, those who have diabetes, or those who have prediabetes. There is emerging evidence of NAFLD occurring in lean or normal weight individuals. Studies show that between 5 and 34% of lean people have NAFLD. The highest prevalence rates, which were above 30%, were seen in India. Furthermore, Asian men who are slender, healthy, and active have insulin resistance prevalence that is three to four times higher than that of men in the rest of the world. Aim: To access the prevalence and risk factors of NAFLD among lean individuals attending Gauhati Medical College & Hospital with diagnosed Fatty Liver Disease. Materials and methods: A Hospital based Cross sectional study was done. The Gastroenterology department was used to choose the study participants using a purposive sampling method. The sample was made up of all patients with fatty liver disease who visited the gastroenterology outpatient department. The study found that the prevalence of NAFLD in lean individuals is Result: 16.9%. Females are at higher risk (P=0.0313 OR: 0.08316) of developing NAFLD in lean patients. Diabetes (P=0.0260 OR: 3.667) and Hypertension (P=0.0149 OR: 4.189) are significant risk factors. Altered bilirubin levels (P=0.0035 OR: 5.829), lipid profile (P=0.0013 OR: 7.367) and AST/ALT (P=0.0166 OR: 4.321) levels is also associated with NAFLD in lean individuals. NAFLD affects 16.9% of lean Conclusion: people with a BMI under 23. Among the lean population, women have a higher chance of getting NAFLD than men. In the study population, important risk factors for NAFLD include diabetes and hypertension. Patients with NAFLD (BMI <23) are more likely to have abnormal lipid profiles, AST/ALT values and bilirubin levels than non-NAFLD fatty liver patients with BMI <23.

PATTERNS OF SEROPREVALENCE FOR TRANSFUSION-TRANSMISSIBLE INFECTIONS AMONG BLOOD DONORS IN A BLOOD CENTRE OF NORTHEAST INDIA

PATTERNS OF SEROPREVALENCE FOR TRANSFUSION-TRANSMISSIBLE INFECTIONS AMONG BLOOD DONORS IN A BLOOD CENTRE OF NORTHEAST INDIA Original Research Paper Okram Geet- chandra Singh* Associate Professor, Blood Centre, JNIMS, Imphal *Corresponding Author Introduction: Transfusion– Transmissible Infections (TTIs) are the infections resulting from the introduction of a pathogen into a person through blood transfusion. In an attempt to mitigate the inherent risk of TTIs, the demographic information of blood donors including knowledge on local prevalence of infections and its pattern in the donor population is important for formulating recruitment strategies and planning other precautionary measures. Materials & Methods: This cross-sectional study was conducted in the Blood Centre, Jawaharlal Nehru Institute of Medical Sciences, Imphal between January 2019 and December 2022. All donated blood units were tested for the mandatory TTI markers for HIV 1 & 2, Hepatitis B, Hepatitis C, Syphilis and Malarial parasite. The prevalence and patterns of seropositivity for TTIs were studied based on the donor demographic characteristics such as donation type, gender and age group. The Results: overall seroprevalence among blood donors (n=31,563) was 1.79%. The seroprevalence was lower among voluntary donors (1.08%) than the replacement donors (2.10%). Seropositivities among female and male donors were 0.79% and 1.93% respectively. The lowest TTI seropositivity was seen among female voluntary donors (0.59%) and highest among male replacement donors (2.24%). The seroprevalence for speci?c TTI markers among the blood donors were 0.15% for HIV; 0.57% for HBV; 0.93% for HCV; 0.14% for Syphilis and no donor was found positive for Malaria. The frequency of TTI seropositivity was increased with increase in the age groups of donors in both sexes. There were 9 (0.029%) donors who had co-infection of TTIs. The patterns of TTI markers for co-infections were HCV+HIV=3; HCV+HBV=3; HCV+Syphilis=2 and HIV+ Syphilis=1. Conclusion: The measures to provide safe blood may include collection of blood from the targeted low risk donor population, using more sensitive testing methods, implementing pathogen reduction technologies and other public health measures

TO STUDY THE ROLE OF PROBIOTICS IN PREVENTING NECROTIZING ENTEROCOLITIS IN PRETERM AND LOW BIRTH WEIGHT NEONATES

Introduction: Necrotising Enterocolitis (NEC) is the most common gastrointestinal emergency in NICU, it is a life-threatening disease that occurs primarily in premature infants.1 Probiotics are the live microbial dietary supplements that when administered in adequate amount promotes health.2 In premature infants they are thought to improve the positive balance of colonizing bacteria that facilitate development of mucosal immunity and prevent the excessive in?ammation associated with NEC.3 The present study is a Prospective Observational study Methods and Materials: conducted in the NICU at Prathima Institute Of Medical Sciences, Karimnagar,Telangana. During the period of 2 years between December 2020 and November 2022. Neonates of <37 weeks of gestation and with birth weight <1500 gms admitted into NICU are included in the study. The selected neonates would be administered probiotic 2 million spores of Bacillus clausii ampules per day along with expressed mother's own milk daily till they reach full feeds (150ml/kg/day). These neonates were observed clinically, investigated and studied during their period of admission in NICU for the development of Necrotising Enterocolitis and also the morbidity and mortality of such neonates was studied. : In the present study, out of 50 Results neonates, 11 (22%) preterms developed NEC while 39 (78%) of them did not. This was found to be statistically signi?cant (p=0.01). Out of the 11 preterms, 1 (2%) belonged to ELBW while 10 (90%) belonged to VLBW. Out of the 11 preterms who developed developed NEC, 4 (8%) developed stage I NEC, 5 (10%) developed stage II NEC and 2 (4%) developed stage III NEC. This was statistically signi?cant (p= 0.001) In our present study, 4 (8%) of the preterms developed with sepsis while 46 (92%) did not develop sepsis. This was statistically signi?cant (p=0.001) Necrotizing Enterocolitis is a worldwide problem in Conclusion: Preterms Low Birth Weight neonates. The present study has found that Probiotic supplementation has reduced both the 4incidence and severity of NEC in such neonates. Probiotic supplementation has also reduced the incidence of culture proven 5sepsis in preterm and Low Birth Weight neonates

Network pharmacology and molecular docking study of the active ingredients in Saptasaram kashayam for the treatment of Polycystic ovary syndrome-Supplemenntary data

Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorder in women of reproductive age characterized by hyperandrogenism (HA). Current treatment options for PCOS are either with adverse effects or ineffective. Saptasaram kashayam (SK), an ayurvedic formulation is often been a safe traditional alternative medicine to improve the PCOS symptoms as well as its pathological development. However, its principle phytoconstituents or underlying mechanisms have not been investigated. In order to achieve this, the current study systematically utilized computational tools, network pharmacology approaches and molecular docking studies. All identified phytoconstituents of SK were screened by QikProp ADME prediction and 47 were selected based on oral bioavailability and drug likeliness scores. Their 3D structures were submitted to three online target fishing webservers PharmMapper, ChemMapper and Swiss Target Prediction which produced 1084 biological targets for SK comprehensively. 350 known PCOS therapeutic targets were retreived as common targets from three different interrogative disease centric bioinformatic platforms DisGeNET, OMIM and GeneCards. Intersection of 1084 biological targets of SK and 350 PCOS therapeutic targets produced, 88 potential therapeutic targets of SK against PCOS. STRING PPI and Compound-Target-Pathway networks were constructed and analysed using Cytoscape software. GO & KEGG pathway enrichment analysis was performed using DAVID database. 15 PCOS therapeutic target proteins were short listed from network analysis report- PIK3CA, PDPK1, AKT1, PIK3R1, STAT3, MAPK1, MAPK3, EGFR, AR, ESR1, ESR2, SHGB, NOS3, F2 & CREBBP. Targets that were likely to be inhibited/modulated by SK for treatment of PCOS were docked against the screened phytoconstituents and their respective standard inhibitors using GLIDE-SP of Schrodinger suite, Maestro version- 13.0. Results showed that Quercetin, Catechin, Boeravinone J, Genistein, Protocatechuic Acid, Gentisic Acid, Xanthoarnol, Luteolin, Boeravinone F, Tyrosine, Kaempferol, Dalbergioidin, etc exhibited good binding affinities when compared to standard drugs and might be responsible for synergistic/additive protective effect of SK against PCOS. Meanwhile PI3K-Akt signaling pathway, Prolactin signaling pathway, AGE-RAG diabetic complications, HIF-1 signaling pathway and Estrogen signaling pathway were found to be involving the hub genes of interest and in this way, they might be intervened during treatment of PCOS by SK. Present study succeeded in identifying the drug like principle phytoconstituents, probable PCOS therapeutic targets and the underlying molecular mechanism of SK apart from providing reliable evidence for therapeutic potential of SK against PCOS. However further validation by in vitro and in vivo investigations is necessary.

Network pharmacology and molecular docking study of the active ingredients in Saptasaram kashayam for the treatment of Polycystic ovary syndrome

Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorder in women of reproductive age characterized by hyperandrogenism (HA). Current treatment options for PCOS are either with adverse effects or ineffective. Saptasaram kashayam (SK), an ayurvedic formulation is often been a safe traditional alternative medicine to improve the PCOS symptoms as well as its pathological development. However, its principle phytoconstituents or underlying mechanisms have not been investigated. In order to achieve this, the current study systematically utilized computational tools, network pharmacology approaches and molecular docking studies. All identified phytoconstituents of SK were screened by QikProp ADME prediction and 47 were selected based on oral bioavailability and drug likeliness scores. Their 3D structures were submitted to three online target fishing webservers PharmMapper, ChemMapper and Swiss Target Prediction which produced 1084 biological targets for SK comprehensively. 350 known PCOS therapeutic targets were retreived as common targets from three different interrogative disease centric bioinformatic platforms DisGeNET, OMIM and GeneCards. Intersection of 1084 biological targets of SK and 350 PCOS therapeutic targets produced, 88 potential therapeutic targets of SK against PCOS. STRING PPI and Compound-Target-Pathway networks were constructed and analysed using Cytoscape software. GO & KEGG pathway enrichment analysis was performed using DAVID database. 15 PCOS therapeutic target proteins were short listed from network analysis report- PIK3CA, PDPK1, AKT1, PIK3R1, STAT3, MAPK1, MAPK3, EGFR, AR, ESR1, ESR2, SHGB, NOS3, F2 & CREBBP. Targets that were likely to be inhibited/modulated by SK for treatment of PCOS were docked against the screened phytoconstituents and their respective standard inhibitors using GLIDE-SP of Schrodinger suite, Maestro version- 13.0. Results showed that Quercetin, Catechin, Boeravinone J, Genistein, Protocatechuic Acid, Gentisic Acid, Xanthoarnol, Luteolin, Boeravinone F, Tyrosine, Kaempferol, Dalbergioidin, etc exhibited good binding affinities when compared to standard drugs and might be responsible for synergistic/additive protective effect of SK against PCOS. Meanwhile PI3K-Akt signaling pathway, Prolactin signaling pathway, AGE-RAG diabetic complications, HIF-1 signaling pathway and Estrogen signaling pathway were found to be involving the hub genes of interest and in this way, they might be intervened during treatment of PCOS by SK. Present study succeeded in identifying the drug like principle phytoconstituents, probable PCOS therapeutic targets and the underlying molecular mechanism of SK apart from providing reliable evidence for therapeutic potential of SK against PCOS. However further validation by in vitro and in vivo investigations is necessary.

Impacto del programa "Enhanced Recovery After Surgery" en artroplastía de rodilla a nivel institucional / Impact of the "Enhanced Recovery After Surgery" program in knee arthroplasty at the institutional level

Resumen: Introducción: la artroplastía total de rodilla ha ganado popularidad sobre la disminución del dolor, restablecer la movilidad y mejorar la calidad de vida de los pacientes. A nivel institucional, no existe un modelo multidisciplinario en el tratamiento de nuestros pacientes y en nuestro medio la rehabilitación física se inicia de manera tardía, dificultando la reincorporación de los pacientes y el control analgésico. Material y métodos: se realizó un estudio clínico controlado, aleatorizado, prospectivo y longitudinal que incluyó 55 pacientes sometidos a artroplastía de rodilla, asignados a dos grupos de estudio: el grupo ERAS (Enhanced Recovery After Surgery) (n = 27) y el grupo habitual (n = 28). Los criterios de inclusión fueron pacientes con gonartrosis grado IV de Kellgren y Lawrence, edad comprendida entre 30-70 años y seguimiento de seis meses. La estadística descriptiva se realizó mediante medianas y rango intercuartílico, mientras la estadística inferencial mediante la prueba de Kruskal-Wallis. Resultados: los resultados obtenidos a los seis meses no mostraron diferencias estadísticas significativas de edad (p = 0.327) y género (p = 0.588). Los resultados obtenidos en las escalas de EVA, WOMAC e IKDC mostraron diferencia estadística significativa (p = 0.000). El grupo de recuperación rápida con una mediana de flexión de 120o y el grupo habitual con flexión de 90o, ambos grupos con extensión de 0o. Conclusiones: el programa de recuperación rápida en procedimientos de remplazo articular, mostró buenos resultados sobre el dolor, función, movilidad y complicaciones en comparación con los pacientes sometidos al manejo habitual.

Abstract: Introduction: total knee arthroplasty has gained popularity over decreasing pain, restoring mobility and improving patients' quality of life. At the institutional level, there is no multidisciplinary model in the treatment of our patients, and in our environment, physical rehabilitation starts late, making it difficult for patients to reincorporate and attain adequate pain control. Material and methods: a controlled, randomized, prospective and longitudinal study was conducted, 55 patients underwent total knee arthroplasty, assigned to two study groups: the ERAS (enhanced recovery after surgery) group (n = 27) and the usual group (n = 28). Inclusion criteria were patients with Kellgren-Lawrence classification grade 4 gonarthrosis, age between 30-70 years and follow-up for six months. Descriptive statistics were performed using medians and interquartile range, while inferential statistics were performed using the Kruskal-Wallis test. Results: the results obtained at six months showed no statistically significant differences in age (p = 0.327) and gender (p = 0.588). The results obtained in the scales of VAS, WOMAC and IKDC showed statistically significant difference (p = 0.000). The rapid recovery group with a 120o flexion median and the usual group with 90o flexion, both groups with 0o extension. Conclusions: the enhanced recovery after surgery pathway in joint replacement procedures showed good results on pain, function, mobility and complications compared to patients undergoing usual management.

Telbivudine-Induced Myopathy: Clinical Features, Histopathological Characteristics, and Risk Factors

Background@#and Purpose Oral nucleos(t)ide analogs (NAs) are the mainstay treatment for chronic hepatitis B (CHB). Myotoxicity is an important extrahepatic effect related to NA treatment. Telbivudine is the NA for CHB that is frequently associated with muscle-related side effects. The risk factors for telbivudine-induced myopathy (TIM) are not yet clear. @*Methods@#This study characterized the clinical, magnetic resonance images (MRI), and pathological features of 12 TIM cases. A group of telbivudine-tolerant (TT) patients with CHB who received regular telbivudine treatment during the same period without the occurrence of myopathy was collected. Demographic and clinical factors were compared between the patients with TIM and the TT controls. Factors independently associated with TIM were identified using logistic regression analysis. @*Results@#The patients with TIM (males/females: 7/5, mean age: 57 years) developed myopathy after using telbivudine for a median period of 19.5 months. Muscle histopathology revealed abnormal proliferation, subsarcolemmal or sarcoplasmic accumulations, and ultrastructural defects of mitochondria. When compared with TT cases, patients with TIM had a lower estimated glomerular filtration rate and were more frequently positive for hepatitis B e antigen (HBeAg). @*Conclusions@#Mitochondrial abnormalities are characteristic histopathological features, and impaired renal function and HBeAg positivity are risk factors for TIM. Telbivudine-induced mitochondrial dysfunction and immune activation related to mitochondrial damage and HBeAg serostatus changes may underlie TIM. Constant clinical surveillance of myopathy during telbivudine treatment is needed due to the significant latency of its development. Dose adjustment for impaired renal function does not eliminate the risk of TIM occurrence.

Understanding and assessment menthods of occupational burnout syndrome / Монголын эм зүй, эм судлал

Background@#As the trend of pharmaceutical care around the world shifts to client-centered care, there is a need for new pharmacists to improve their knowledge and skills, learn psychological skills, provide customers with health education, and improve the rational use of drugs and pharmacological services.@*Objective@#This study is based on the fact that no research has been conducted in Mongolia on factors that affect burnout syndrome and social-psychology of pharmacists.@*Literature review@#The following are internationally accepted methods of assessing sociopsychological risks to determine the socio-psychological factors associated with the work and occupation of workers and their impact on health and safety. These include:</br> Burnout Measue-BM, 1981 (Pines & Aronson 1988). A method of measuring burnout, physical and emotional fatigue, and mental exhaustion. (Bazarragchaa, 2020) </br> The Copenhagen Psychosociol Questionnaire COPSOQ (Christenson et al. 2005) focuses on socio-psychological factors, stress, personal health, well-being and individual factors (style, sense of mutual understanding, etc.). </br> The Copenhagen Burnout Inverntory (CBI, 2005) examines fatigue, exhaustion, and work-related burnout as well as customer-related burnout.@*Conclusion@#There are more than 40 definitions of “Burnout syndrome”. The “Maslach Burnout Inventory” has become the “Gold standard” for assessing the burnout of service workers. The Copenhagen Burnout Inverntory (CBI, 2005) studies fatigue, exhaustion, and individual, work-related and customer-related burnout.

Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection – A Rare Phenomenon: A Case Report

@#Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

A summary of the Malaysian Clinical Practice Guidelines on the management of postmenopausal osteoporosis, 2022

Objectives@#The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). @*Methods@#A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. @*Results@#This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. @*Conclusions@#The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.

Rapid metabolic fingerprinting with the aid of chemometric models to identify authenticity of natural medicines:Turmeric,Ocimum,and Withania somnifera study / 药物分析学报

Herbal medicines are popular natural medicines that have been used for decades.The use of alternative medicines continues to expand rapidly across the world.The World Health Organization suggests that quality assessment of natural medicines is essential for any therapeutic or health care applications,as their therapeutic potential varies between different geographic origins,plant species,and varieties.Classification of herbal medicines based on a limited number of secondary metabolites is not an ideal approach.Their quality should be considered based on a complete metabolic profile,as their pharmacological activity is not due to a few specific secondary metabolites but rather a larger group of bioactive compounds.A holistic and integrative approach using rapid and nondestructive analytical strategies for the screening of herbal med-icines is required for robust characterization.In this study,a rapid and effective quality assessment system for geographical traceability,species,and variety-specific authenticity of the widely used natural medicines turmeric,Ocimum,and Withania somnifera was investigated using Fourier transform near-infrared(FT-NIR)spectroscopy-based metabolic fingerprinting.Four different geographical origins of turmeric,five different Ocimum species,and three different varieties of roots and leaves of Withania somnifera were studied with the aid of machine learning approaches.Extremely good discrimination(R2＞0.98,Q2＞0.97,and accuracy=1.0)with sensitivity and specificity of 100％was achieved using this metabolic fingerprinting strategy.Our study demonstrated that FT-NIR-based rapid metabolic fingerprinting can be used as a robust analytical method to authenticate several important medicinal herbs.

Survival Outcome in True Carcinoma of Unknown Primary (tCUP) with p16 + Cervical Metastasis

Abstract Introduction Age and lymph node ratio have been attributed as independent predictors for survival and recurrence in carcinoma of unknown primary (CUP). Objective The purpose of this study was to analyze the prognostic value of p16 overexpression for CUP in the absence of true primary (TP). Methods The study involved 43 patients who underwent therapeutic lymph node dissection (LND) from 2000 to 2015 after all the diagnostic work up for CUP. Immunohistochemistry for p16 overexpression was performed. Cox proportional hazard regression analysis was used to analyze the prognostic impact on 5-year overall survival (OS) and recurrence-free survival (RFS). Results The male-to-female ratio was 5.1:1, with a median age of 62 years. The clinicopathological data, except for p16 overexpression, did not differ significantly in terms of 5-year OS and RFS. The Cox regression analysis proposed p16 positivity to be an independent prognosticator of regional recurrence-free survival (RRFS) (hazard ratio [HR] 6.180, p = 0.21). The median time to recurrence and death were 10 and 25 months, respectively. Conclusion Cervical metastasis with p16 overexpression is a significant prognostic factor of improved RFS after surgery in CUP. The prognostic significance of lymph node p16 positivity should be further studied.

Calcificaciones pulmonares metastásicas, 3 casos clínicos / Metastatic pulmonary calcifications: three clinical cases

Las calcificaciones pulmonares metastásicas, hacen referencia a una enfermedad metabólica, caracterizada por depósitos de calcio en tejido pulmonar sano. La etiología es amplia e incluye enfermedades malignas y benignas, siendo la falla renal la causa más frecuente. Es una condición, que, a pesar de ser frecuente, suele ser subdiagnosticada, por presentar pocos o ningún síntoma. Presentamos tres casos clínicos asociados a enfermedad renal crónica, pre y post trasplante.

Metastatic pulmonary calcifications refer to a metabolic disease, characterized by calcium deposits in healthy lung tissue. The etiology is broad and includes malignant and benign diseases, the kidney failure being the most frequent cause. It is a condition, which, despite being frequent, is usually underdiagnosed, because it presents few or no symptoms. We present three clinical cases associated with pre- and post-transplant kidney disease.

Significance of Laboratory Markers in Predicting the Severity of COVID-19 in the Central Reserve Police Force Front-line Workers with a Review of Literature

COVID-19 disease has variable clinical presentations, ranging from asymptomatic to mild symptoms to severe manifestation with pneumonia, acute respiratory distress syndrome, septic shock, disseminated intravascular coagulation, and/or multiple organ failure. The real?time reverse transcription–polymerase chain reaction is gold standard test for severe acute respiratory syndrome?coronavirus?2 detection. In the present study, we aimed to predict the significance of various hematological and biochemical markers for early identification of complications and assessing the severity of the disease. A total of cases were divided into two study groups, namely, severe and nonsevere based on clinical presentation. Out of 210 cases, 186 (88.5%) cases were nonsevere and 24 (11.5%) cases were severe. Among various hematological and biochemical markers studied, hemoglobin, total leukocyte count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, lactate dehydrogenase, C?reactive protein, ferritin, D?dimer, and interleukin?6 are found to have P < 0.05 and significantly correlated with the severity of disease.

Estudio retrospectivo en pacientes con Cáncer de Colon etapa III. ¿El tratamiento adyuvante es iniciado de forma oportuna?

Introducción: En Chile, el Cáncer colorrectal (CC) abarca el 11,5% de todas las neoplasias malignas. La cirugía es la piedra angular del tratamiento del cáncer de colon, y en pacientes en etapa III, la quimioterapia adyuvante forma parte del tratamiento estándar. Materiales y Métodos: Estudio descriptivo retrospectivo transversal, de centro único, de pacientes con cáncer de colon en estadio III patológico. Objetivo principal de este estudio es conocer si, en pacientes con cáncer de colon etapa III, la quimioterapia adyuvante se entrega de manera oportuna. Resultados: En el período comprendido entre abril de 2016 y abril de 2021 se operaron 35 pacientes con cáncer de colon en estadio III patológico. Se realizó quimioterapia adyuvante en un 80%, y en siete pacientes durante las primeras ocho semanas poscirugía. La dehiscencia de anastomosis ocurrió en un 11,4%, aumentando la mediana de hospitalización en 2,2 veces. Discusión: En nuestro estudio, la adyuvancia en cáncer de colon etapa III se administró a un alto porcentaje de los pacientes (80%), pero observamos un retraso importante, ya que sólo en un 25% se inició el tratamiento durante las primeras 8 semanas poscirugía, lo cual puede ser explicado por múltiples factores, siendo la dehiscencia de anastomosis un punto importante a considerar. Conclusión: En estadio III de CC la adyuvancia puede verse retrasada por múltiples factores, lo que puede repercutir en la sobrevida de los pacientes, por lo tanto, conocer las causas de este retraso podría ayudar a instaurar nuevas estrategias, como la neoadyuvancia, para mejorar los resultados oncológicos.

Introduction: In Chile, colorectal cancer covers 11.5% of all malignant neoplasms. Surgery is the cor- nerstone of colon cancer treatment and in stage III patients adjuvant chemotherapy is part of standard treatment. Materials and Methods: A descriptive, retrospective, cross-sectional study, single center, of patients with pathological stage III colon cancer. Main objective of this study is to know if in patients with stage III colon cancer adjuvant chemotherapy is delivered in a timely manner. Results: Between April 2016 and April 2021, 35 patients with pathological stage III colon cancer were operated on. Adjuvant chemotherapy was performed in 80%, and in seven patient during the first eight weeks after surgery. Anastomotic dehiscence occurred in 11.4%, the median hospitalization increased by 2.2 times. Discussion: In this study, adjuvant stage III colon cancer was administered to a high percentage of patients (80%), but we observed a significant delay, since only 25% began treatment during the first 8 weeks post-surgery, which can be explained by multiple factors, with anastomotic dehiscence being an important point to consider. Conclusion: In stage III CC, adjuvant treatment can be delayed by multiple factors, which may affect patient survival; therefore, knowing the causes of this delay could help to establish new strategies, such as neoadjuvant therapy, to improve oncological results.