Prognostic Impact of Residual Moderate Mitral Regurgitation Following Valve-in-Valve Transcatheter Aortic Valve Implantation

ABSTRACT Introduction: The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI. Methods: We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison. Results: No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006). Conclusion: MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.

No Incidence of Liver Cancer Was Observed in A Retrospective Study of Patients with Aristolochic Acid Nephropathy / 中国结合医学杂志

OBJECTIVE@#To assess the risk of aristolochic acid (AA)-associated cancer in patients with AA nephropathy (AAN).@*METHODS@#A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014. Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer. The primary endpoint was the incidence of liver cancer, and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.@*RESULTS@#A total of 337 patients diagnosed with AAN were included in this study. From the initiation of taking AA to the termination of follow-up, 39 patients were diagnosed with cancer. No cases of liver cancer were observed throughout the entire follow-up period, with urinary cancer being the predominant type (34/39, 87.17%). Logistic regression analysis showed that age, follow-up period, and diabetes were potential risk factors, however, the dosage of the drug was not significantly associated with urinary cancer.@*CONCLUSIONS@#No cases of liver cancer were observed at the end of follow-up. However, a high prevalence of urinary cancer was observed in AAN patients. Establishing a direct causality between AA and HCC is challenging.

Retrospective cohort study on the factors influencing poor prognosis in young and middle-aged patients with pulmonary tuberculosis / 公共卫生与预防医学

Objective To conduct a retrospective cohort study on the influencing factors of poor prognosis of young and middle-aged patients with pulmonary tuberculosis. Methods Selecting 426 young and middle-aged patients who were diagnosed with pulmonary tuberculosis in our hospital from January to December 2018 as the research subjects. Collecting the social demography information of all patients and the information of potential factors affecting the prognosis (allergy history, smoking history, drinking history, BMI level, disease information, treatment information, etc.) and discussing the factors affecting the prognosis of young and middle-aged pulmonary tuberculosis patients and their effects. Results The average age of 426 patients was (41.93±5.17) years old, the average BMI of them was (21.97±3.15) kg/m2, and an average course of disease of them was (2.76±0.99) years. There was no significant difference in the basic sexual information between men and women. In this study, a total of 128 patients with poor prognosis were retrospectively followed up, including 90 males and 38 females. The detection rate of males was significantly higher than that of females (χ2=16.976, P2=18.850, P2=38.924, P2=127.207, P2=32.566, P2=16.715, P2=17.315, P2=16.976，P1 and P1 and P<0.05; Regular treatment still showed potential protective factors, with an HR of 0.408, P<0.05. Conclusion: Male, emaciated body type, disease course ≥ 5 years, smoking history, number of lung field lesions ≥ 3, presence of pulmonary cavities and comorbidities are potential risk factors, while regular treatment suggests potential protective factors. Conclusion More targeted disease control and management should be implemented for middle-aged and young patients with pulmonary tuberculosis based on the aforementioned influencing factors to improve their prognosis.

Genomic analysis and biomarker discovery of thymic cancer based on whole exome sequencing: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To examined gene mutations in thymic carcinoma (TC) patients and to explore prognostic correlates and potential targets for therapy. Methods We retrospectively included TC patients in Sichuan Cancer Hospital between January 2015 and Febuary 2021.Whole-exome sequencing was performed on tumor tissues from TC patients and their control peripheral blood samples, and the raw data were subjected to bioinformatics analysis and statistical analysis. Results We finally included 24 TC patients with 16 males and 8 females at a median age of 55 (42-74) years. The highest frequency of single nucleotide mutations in this cohort were in the TTN gene (42%), HSPG2 (29%), and OBSCN (29%). Higher frequency of copy number variations occurred in ZNF276 gene (54%, loss), BEND3 (50%, loss), DHODH (50%, loss), and VAC14 (50%, loss). Microsatellite instability (MSI) phenotype was found in 25% of the patients, and the mean tumor mutation burden (TMB) was 9.86. Conclusion This study is the first comprehensive analysis of the mutation profile of thymic carcinoma in China to date. The mutation frequencies of TTN, OBSCN, and ZNF276 genes were high. The biomarker analysis suggests that patients may benefit from immunotherapy and have a long effective survival.

Observation of the prophylactic use of prokinetic agents in patients after tricuspid valve replacement under cardiopulmonary bypass / 药学实践杂志

Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement （TVR） under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass （during June 2010 to December 2021） in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery （prevention group） and patients not taking prokinetic agents within three days after surgery （control group）. Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group （P<0.05）. The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group （P<0.05）. Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients.

Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

The Effect of Modified Shugan Dingji Decoction （疏肝定悸汤） on the Occurrence of Endpoint Events in Patients with Paroxysmal Atrial Fibrillation of Liver Constraint and Qi Stagnation： A Retrospective Cohort Study / 中医杂志

ObjectiveTo retrospectively analyze the effect of modified Shugan Dingji Decoction （疏肝定悸汤） on the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation. MethodsA retrospective cohort study was conducted using the electronic medical record database of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine to screen and include patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation from January 1st， 2018， to December 31th， 2021. The included patients were divided into an exposure group and a non-exposure group， each consisting of 100 cases， based on whether they received modified Shugan Dingji Decoction. General information of the patients including age， gender， body mass index， duration of illness and comorbidities， medication history， cardiac structure and function indicators such as left atrial diameter， left ventricular end-diastolic diameter， stroke volume and ejection fraction， and the occurrence of endpoint events assessed through 24-hour dynamic electrocardiography or electrocardiogram to determine the recurrence of paroxysmal atrial fibrillation were collected. Kaplan-Meier （K-M） curves and Log-Rank tests were used to conduct survival analysis on the occurrence of endpoint events in the two groups of patients. Univariate and multivariate Cox regression analyses were used to analyze the impact of various factors on entry into endpoint events. Additionally， a safety assessment was performed by comparing liver and kidney function indicators before and after treatment. ResultsIn the non-exposure group， a total of 49 cases （49.0%） experienced endpoint events， while in the exposure group， there were 26 cases （26.0%）. The Log-rank test indicated significant difference between the two groups （χ2=11.211， P=0.001）. Univariate Cox regression analysis showed that age， duration of illness， hypertension， diabetes， chronic heart failure， left atrial diameter， stroke volume， and the use of modified Shugan Dingji Decoction may be the influencing factors for the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation （P＜0.05 or P＜0.01）. Multivariate Cox regression analysis showed that the risk of endpoint events in the exposure group was significantly lower than that in the non-exposure group （P＜0.01）. Patients with a duration of illness ＞12 months had a significantly higher risk of endpoint events compared to those with a duration of illness ≤12 months （P＜0.01）. Patients without concomitant hypertension had a lower risk of endpoint events compared to those with hypertension （P＜0.05）. Patients with left atrial diameter ＞40 mm had significantly higher risk of endpoint events than those with left atrial diameter ≤40 mm （P＜0.01）. There was no statistically significant difference in liver and kidney function indicators between the two groups before and after treatment （P＞0.05）. ConclusionThe use of modified Shugan Dingji Decoction is a protective factor for patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation， which can help to reduce the recurrence and progression of atrial fibrillation. Long duration of illness， concomitant hypertension， and enlarged left atrial diameter are risk factors for patients to experience endpoint events.

Drug-resistant tuberculosis in Colombia, 2013-2018: Case-control study

Abtract Introduction. Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is difficult to control, has high morbidity and mortality, and demands priority public health intervention. In Colombia, MDR/RR-TB has been becoming more widespread annually. Before the COVID-19 pandemic, over an 8-year period, the number of cases of multidrug-resistant tuberculosis in Colombia was close to a thousand cases. Timely identification of the different risk factors for MDR/RR-TB will contribute fundamentally to the systematic management. Objective. To determine which risk factors were associated with the presentation of MDR in Colombia between 2013 and 2018. Materials and methods. A retrospective case-control study was carried out, for which the data from the routine surveillance of MDR/events in the country were used. Results. The cases of multidrug-resistant tuberculosis were mainly in young people, Afrodescendants, and males. Of the clinical conditions, comorbidities such as malnutrition, diabetes, and HIV, presence of at least one factor, such as drug dependence, taking immunosuppressive medications, belonging to the black race, afro, and living in an area of high disease burden were risk factors. Conclusion. In addition to the diagnosis and timely provision of MDR-TB treatment, it is necessary that public health programs at the local level pay special attention to patients with the identified risk factors.

Introducción. La tuberculosis multirresistente-resistente a la rifampicina (TB-MDR/RR) es difícil de controlar, tiene una alta morbilidad y mortalidad y exige una intervención prioritaria en salud pública. En Colombia, la TB-MDR/RR se ha ido extendiendo cada año. Antes de la pandemia de COVID-19, en un periodo de 8 años, el número de casos de TB-MDR/RR en Colombia se acercaba a los mil. La identificación oportuna de los diferentes factores de riesgo de TB-MDR/RR contribuirá de manera fundamental al manejo sistemático de la enfermedad. Objetivo. Determinar los factores de riesgo que se asociaron a la presentación de la TB- MDR/RR en Colombia entre 2013 y 2018. Materiales y métodos. Se realizó un estudio retrospectivo de casos y controles, para el cual se utilizaron los datos de la vigilancia rutinaria de eventos de TB MDR/RR en el país. Resultados. Los casos de TB MDR se presentaron principalmente en jóvenes, afrodescendientes y varones. De las condiciones clínicas, fueron factores de riesgo las comorbilidades como la desnutrición, la diabetes y el VIH, y la presencia de, al menos, un factor como la farmacodependencia, el consumo de medicamentos inmunosupresores, el ser de raza negra o afro y el vivir en una zona del país de alta carga de tuberculosis. Conclusiones. Además del diagnóstico y la provisión oportuna del tratamiento de la TB MDR, es necesario que los programas de salud pública a nivel local presten especial atención a los pacientes con los factores de riesgo identificados.

Respuesta tumoral a la quimioterapia neoadyuvante en subtipos moleculares de cáncer de mama en Medellín, Colombia. Estudio de cohorte retrospectivo / Tumor response to neoadjuvant chemotherapy in molecular breast cancer subtypes in Medellin, Colombia. Retrospective cohort study

Objetivos: Describir la frecuencia de la respuesta clínica y patológica, entre los diferentes subtipos moleculares de cáncer de mama, en pacientes que previamente recibieron quimioterapia neoadyuvante. Materiales y métodos: Cohorte retrospectiva, descriptiva. Se incluyeron mujeres mayores de 18 años, con diagnóstico histológico de carcinoma invasivo de mama, en estadios IIA, IIB, IIIA, IIIB y IIIC, con clasificación por subtipos moleculares, que hubieran recibido quimioterapia neoadyuvante, atendidas en una clínica de alto nivel de complejidad localizada en Medellín (Colombia), entre el 1 de julio de 2017 y el 30 de julio de 2019. Las variables recolectadas fueron edad, estadio clínico, características histológicas, clasificación molecular y la respuesta clínica y patológica completa por subtipo molecular. Se realizó análisis descriptivo. Resultados: 255 pacientes cumplieron con los criterios de inclusión. La edad media fue de 55,2 años; los estadios clínicos con mayor prevalencia fueron IIIB (28,6 %) y IIB (26,3 %), respecto al grado histológico, los más frecuentes fueron grado 3 (48,2 %) y 2 (37,3 %). La frecuencia por subtipos moleculares fue: luminal A (10,2 %), luminal B HER2 negativo (39,6 %), triple negativo (23,1 %), luminal B HER2 positivo (13,7 %), y HER2 puro (13,3 %). La respuesta clínica completa posquimioterapia por subtipo molecular fue: luminal A (26,9 %), luminal B HER2 negativo (37,6 %), luminal B HER2 positivo (48,6 %), HER2 puro (41,2 %), triple negativo (45,8 %); se logró respuesta patológica completa por subtipo molecular, así: luminal A (19,2 %), luminal B HER2 negativo (32,7 %), luminal B HER2 positivo (54,3 %), HER2 puro (50 %), triple negativo (42,4 %). Conclusiones: En la práctica clínica, la clasificación por subtipos moleculares en cáncer de mama permite hacer una aproximación a la respuesta de la quimioterapia neoadyuvante. Se requieren estudios prospectivos en la región para determinar la capacidad predictiva de la respuesta patológica completa respecto a la sobrevida global y libre de enfermedad.

Objectives: To describe the frequency of clinical and pathological response in different molecular subtypes of breast cancer, in patients receiving prior neoadjuvant chemotherapy. Materials and methods: Descriptive retrospective cohort. The study population consisted of women 18 years of age and older with a histological diagnosis of invasive breast cancer stages IIA, IIB, IIIA, IIIB and IIIC, with a classification by molecular subtypes, who had received prior neoadjuvant chemotherapy, seen at a high complexity clinic in Medellin (Colombia), between July 1, 2017, and July 30, 2019. We measured age clinical stage, histological characteristics, molecular classification, and complete clinical and pathological responses by molecular subtype. A descriptive analysis was conducted. Results: Overall, 255 patients met the inclusion criteria. Mean age was 55.2 years; the clinical stages with the highest prevalence were IIIB (28.6 %) and IIB (26.3 %), and the most frequent by histologic grading were grades 3 (48.2 %) and 2 (37.3 %). Frequency by molecular types was as follows: luminal A (10.2 %), HER2-negative luminal B (39.6 %), triple-negative (23.1%), HER2-positive luminal B (13.7 %), and pure HER2 (13.3 %). Complete clinical response following chemotherapy, by molecular type, was as follows: luminal A (26.9 %), HER2-negative luminal B (37.6 %), HER2-positive luminal B (48.6 %), pure HER2 (41.2 %), triple-negative (45.8 %). Complete pathological response by molecular subtype was achieved in the luminal A (19.2 %), HER2-negative luminal B (32.7 %), HER2-positive luminal B (54.3 %), pure HER2 (50 %) and triple-negative (42.4 %) subtypes. Conclusions: In clinical practice, breast cancer classification by molecular subtypes is a means to approach the assess the to neoadjuvant chemotherapy. Se requieren estudios prospectivos en la región para determinar la capacidad predictiva de la respuesta patológica completa respecto a la sobrevida global y libre de enfermedad.

25-Hydroxyvitamin D as a biomarker of vitamin D status in plaque psoriasis and other dermatological diseases: a cross-sectional study

ABSTRACT BACKGROUND: Hypovitaminosis D is a public health problem associated with several chronic inflammatory and immunological diseases, including psoriasis. OBJECTIVES: This study aimed to determine the prevalence of hypovitaminosis D in patients with plaque psoriasis. A comparison was made between vitamin D levels in patients with psoriasis and those with other non-inflammatory dermatoses without photosensitivity. In addition, it evaluated the effects of the patients' Fitzpatrick skin phototype and the season of the year on the serum levels of vitamin D. DESIGN AND SETTINGS: A retrospective cross-sectional study was conducted at an outpatient clinic in a university center in Juiz de Fora (MG), Brazil. METHODS: A review of dermatology patients' demographic data, including skin phototype and serum levels of 25-hydroxyvitamin D [25(OH)D], over 12 months in 2016. RESULTS: This study included 554 patients: 300 patients allocated to the plaque psoriasis group and 254 control patients with other dermatological diseases. Regarding the season of the year, 229, 132, 62, and 131 participants were evaluated in summer, autumn, winter, and spring, respectively. As for the skin phototype, 397, 139, and 18 patients had phototypes III, IV, and V, respectively. The serum levels of 25(OH)D were significantly lower in the psoriasis group (24.91 ± 7.16 ng/mL) than in the control group (30.37 ± 8.14 ng/mL). CONCLUSIONS: Hypovitaminosis D (< 30 ng/mL) was present in 76.66% of patients with psoriasis versus 53.94% of control patients. Vitamin D deficiency (< 20 ng/mL) was observed in 25% of the patients with psoriasis versus 8.66% in the control group (P < 0.001). The season and patient's skin phototype were independent predictors of serum vitamin D levels.

A STUDY ON RETROSPECTIVE ANALYSIS OF GASTROINTESTINAL STROMA TUMOURS.

Introduction:.Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract. They are believed to originate from the interstitial cells of Cajal (ICCs) or from the precursors of ICCs. Most GISTs show an activating mutation in either the c-kit or platelet-derived growth factor receptor alpha (PDGFRA) gene. Tumor size, mitotic rate, and anatomic location correlate with potential malignancy and recurrence rate. The aim of our study is to Aim & Objectivesobserve the demographic and clinical characteristics of GIST in our clinical environment.Method- 30 patients who are diagnosed with GIST managed during the period from Jun 2017 to July 2022 were reviewed in terms of demographics, clinical presentation, location of tumor, characteristics, management, histopathology, IHC analysis, post op follow up & recurrence.The risk stratification in terms of size, mitotic index, site of tumour was observed & classified using modified NIH classification. Results- Out of 30 cases male patient's- 73% (n- 22); female patients27%(n-8). Mean age was 60 years with a range of 44-81 years. Most common clinical presentation was abdominal mass, Abdominal pain. Commonly involved sites are stomach and small bowel.4 cases who underwent multiple organ resection 2 cases developed recurrence in which 1 underwent palliative Whipple's procedure and one was medically managed. GIST Conclusion- s are rare entities with a variety of clinical features, Common sites for GIST are stomach & small intestine. Surgery is the main stay of management in GIST. Neo adjuvant therapy will help in down staging the tumour. Wedge resection & resection &anastomosis will be adequate for stomach in small bowel GIST. En-bloc resection should be considered if adjacent structures are involved. Overall GIST has favourable prognosis if diagnosed early.

Maxillofacial Fractures in Pondicherry, India: An Eight?Year Single Centre Retrospective Study

Background: The purpose of the present study was to analyze the etiology, incidence, pattern, and treatment modalities of patients with maxillofacial fractures treated at the Department of Dentistry of a medical college in Pondicherry during the period between June 2011 and June 2019. Materials and Methods: A retrospective epidemiological study of 277 patients treated for maxillofacial fractures between June 2011 and June 2019 was performed. Data regarding age, gender, etiology, site of the fracture, time of injury, presence of associated injuries, treatment modalities, and complications were recorded. Results: A total of 491 maxillofacial fractures were seen in 277 patients. These were 261 males (94.2%) and 16 females (5.8%) with a male to female ratio of 16.3:1. Most of the patients 79.8% were in the age group of 11 to 40 years. Most common cause of injury was Road Traffic Collisions (RTCs; 62.1%), followed by fall (20.2%), assault (14.4%) and others (3.3%). Fractures of the mandible (52.3%) and zygomatic complex (18.9%) were the most common maxillofacial fractures reported in our study. 196 patients sustained associated injuries with a prevalence of soft tissue injury (61.2%). Majority of fractures were treated with open reduction and internal fixation (ORIF; 71.9%) of patients followed by closed reduction (17.7%) and observation only (10.4%). Postoperative complications were presented in 16.8% of the patients in the study. Conclusion: RTC is the commonest cause of maxillofacial injury with a male predominance in our study. Mandibular and zygomatic complex fractures were the most common. ORIF remains the preferred method of treatment.

HISTOPATHOLOGY OF GALLBLADDER SPECIMENS AFTER CHOLECYSTECTOMY: A RETROSPECTIVE STUDY

Background Current approach to detect the presence of gallbladder carcinoma involves a routine histopathological examination of all gallbladder specimens, regardless of the clinical characteristics of the patient or macroscopic aspect of the gallbladder. Available pathological reports were interpreted for the following parameters: age, gender, and pathological diagnosis. In addition, the demographic information and clinicopathologic characteristics of the patients with histopathologic findings were assessed in detail, and re-examination of the available specimens was done. Inpatient records of the Methods patients who had been operated for elective and emergency cholecystectomies in the hospital associated with Khaja Bandanawaz University – Faculty of medical Sciences; from January 2018 to November 2022, were retrospectively evaluated. Results A total of 661 gallbladder specimens submitted for histopathological examination during the study period were included in the study. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 535 (81%), acute cholecystitis in 46 (6.99%), cholesterolosis in 44 (6.5%) patients, Dysplasia was found in 34 (5.14%) patients, and gallbladder carcinoma was detected in 2 (0.30%) patients. Conclusion A strategy of selective approach for histopathological examination of gallbladder specimens may be safe in areas with very low incidence of gallbladder carcinoma. Such selective strategy is more cost-effective, reduces the workload of pathologists, and does not appear to compromise patient outcome.

Caracterización de la displasia broncopulmonar según dos definiciones en prematuros chilenos / Characterization of bronchopulmonary dysplasia in relation with two definitions in chilean preterm infants

Existen controversias en la definición de la displasia broncopulmonar, siendo las más utilizadas el requerimiento de O2 durante 28 días o a las 36 semanas de edad gestacional corregida (EGC). Nuestro objetivo fue determinar la incidencia y características clínicas de los prematuros nacidos antes de las 32 semanas (RNP≤ 32s) con requerimiento de O2 a los 28 días de vida (DBP28d) y a las 36 semanas de EGC (DBP36s) en una unidad neonatal de Santiago, Chile, entre los años 2012 y 2019. Es un estudio descriptivo, retrospectivo con componente analítico. La población estudiada incluyó 535 RNP≤ 32s, vivos a las 36 semanas o dados de alta después de las 34 semanas de EGC. De los 242 prematuros DBP28d, 203 (83,88%) fueron DBP36s; 16 de los 242 (6%) requirió O2 durante menos de 28 días consecutivos, de los cuales 7, aún lo requerían a las 36 semanas. Los predictores de DBP36s fueron: sexo masculino (OR 2,42, IC del 95%: 1,24-4,69), peso al nacer (OR 1, IC del 95%: 0,99-1), edad gestacional (OR 0,75, IC del 95%: 0,57-0,97), APGAR a los 5 min, (OR 0,01, IC del 95%: 0,003-0,05), el requerimiento de presión positiva continua o cánula nasal de alto flujo (OR 1,1, IC del 95%: 1,04-1,17) y días de ventilación mecánica invasiva (OR 1,1,95% IC: 1-1,2). Conclusiones: No encontramos una diferencia significativa en la incidencia de DBP entre las definiciones de DBP28d y DBP36s; y la mayoría de los RNP< 32s con diagnóstico de DBP36s se pudieron identificar a los 28 días de vida.

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in premature newborns. It is commonly defined as a need for supplemental O2 for 28 days or at 36 weeks postmenstrual age (PMA) (BPD36w). Our objective was to determine the incidence and clinical characteristics of premature neonates born at less than 32 weeks (PNB< 32w) with O2 requirement at 28 days of life (DBP28d) and DBP36w in a neonatal unit of Santiago, Chile, between 2012 and 2019. This is a descriptive, retrospective study with an analytical component. The study population included 535 PNB< 32w, alive at 36 weeks or discharged after 34 PMA. Of the 242 premature BPD28d, 203 (83,88%) were BPD36w; 16 (6%) required O2 for less than 28 consecutive days, of which 7 still required it at 36 weeks. The predictors of BPD36w were: male (OR 2.42, 95% CI: 1.24-4.69), birth weight (OR 1, 95% CI: 0.99-1), gestational age (OR 0.75, 95% CI: 0.57-0.97), APGAR at 5 min, (OR 0.01, 95% CI: 0.003-0.05), continuous positive pressure or high-flow nasal cannula requirement (OR 1.1, 95% CI: 1.04-1.17) and days of invasive mechanical ventilation (OR 1.1, 95% CI: 1-1.2). Conclusions: We did not find a significant difference in the incidence of BPD between the definitions of BPD28d and BPD36s; and the majority of PNB < 32w diagnosed with BPD36w can be identified at 28 days of life.

Adolescent Female Victims of Sexual Violence: Analysis of Loss of Follow-up after Emergency Care and Outpatient Follow-up / Meninas adolescentes vítimas de violência sexual: Análise da falta de atendimento de emergência e seguimento ambulatorial

Abstract Objective To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors. Methods This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%. Results A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR = 2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up. Conclusion Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.

Resumo Objetivos Avaliar a perda de seguimento de adolescentes vítimas de violência sexual após o atendimento de emergência, durante o seguimento ambulatorial e as variáveis associadas. Métodos Estudo retrospectivo com a revisão de prontuários de 521 mulheres de 10 a 18 anos, que buscaram atendimento de emergência em um serviço de referência em São Paulo, Brasil. As variáveis foram sociodemográficas; antecedentes pessoais; características do abuso, atitude de revelação e reações desencadeadas após o abuso (distúrbios físicos, mentais e mudanças sociais), necessidades de prescrição de psicotrópicos e momento do abandono: após atendimento de emergência e antes de completar 6 meses de seguimento ambulatorial. Para comparar os grupos de perda de seguimento em cada momento, foram utilizados os testes do qui-quadrado e exato de Fisher, seguidos de regressão logística múltipla com critério stepwise para seleção das variáveis associadas. Calculamos a razão de probabilidade com intervalo de confiança (RP, IC 95%). O nível de significância adotado foi de 5%. Resultados Um total de 249 (47,7%) das adolescentes descontinuaram o acompanhamento, 184 (35.3%) após o atendimento de emergência e 65 (12.4%) antes de completar o seguimento ambulatorial. As variáveis de viver com companheiro [RP = 5,94 (IC 95%; 2,49-14,20]; não ter religião [RP = 2,38 (IC 95%;1,29-4,38)], ter religião católica [RP = 2,11 (IC 95%; 1,17-3,78)] e não revelar o abuso [RP = 2,07 (IC 95%; 1,25-3,44)] foram associadas à perda de seguimento após o atendimento de emergência. Não necessitar de cuidados de saúde mental (RP = 2,72 [IC 95%; 1,36-5,46]) ou apoio social (RP = 2,33 [IC 95%; 1,09-4,99]) foram as variáveis associadas à perda do seguimento ambulatorial. Conclusão Medidas para melhorar a adesão ao seguimento devem ser direcionadas às adolescentes que vivem com parceiro e às que não revelam a violência sofrida.

Factors associated with the outcomes of older patients operated due to hip fractures / Fatores associados aos desfechos de pacientes idosos operados por fraturas do quadril

ABSTRACT Objective: Evaluating clinical factors associated with mortality in older patients who underwent surgical correction of hip fractures. Methods: This observational and retrospective study analyzed the medical records of 67 patients (aged older than 60 years), both men and women, who underwent surgical correction of hip fractures from 2019 to 2020 at Hospital São Paulo. The following variables were analyzed: age, sex, presence of comorbidities, affected hip region, and trauma mechanism. Statistical analyses were performed using the SPSS software. Results: The mean age of patients was 78.12 ± 9.80 years and 80.6% of the sample were women. The prevalence of hip fractures on the right side (52.2%), in the transtrochanteric region (53.7%), and due to fall on the same level (88.1%) was higher. Systemic arterial hypertension (77.6%), diabetes mellitus (37.3%), and dementia (16.4%) were frequent comorbidities. The prevalence of death after fracture was 17.9% and it was associated with longer hospital stay after surgery (p = 0.028). Conclusion: The prevalence of mortality of patients with hip fractures who underwent surgery was 17.9%. A longer hospital stay due to pre-existing comorbidities was the main factor related to this outcome. Level of Evidence III, Retrospective Study.

RESUMO Objetivo: Avaliar os fatores clínicos associados à mortalidade em pacientes idosos submetidos ao tratamento cirúrgico para correção de fraturas do quadril. Métodos: Estudo observacional e retrospectivo de análise de prontuários de 67 pacientes (idade superior a 60 anos). Foram incluídos indivíduos de ambos os sexos, submetidos ao tratamento cirúrgico para correção de fraturas do quadril, entre 2019 e 2020, no Hospital São Paulo. Foram analisadas as variáveis: idade, sexo, presença de comorbidades, região do quadril acometido e mecanismo de trauma. As análises estatísticas foram realizadas pelo software SPSS. Resultados: A idade média dos participantes foi de 78,12 ± 9,80 anos, e 80,6% da amostra era constituída por mulheres. Houve maior prevalência de fraturas do quadril no lado direito (52,2%), na região transtrocantérica (53,7%) e causada por queda sem desnível (88,1%). Hipertensão arterial sistêmica (77,6%), diabetes mellitus (37,3%) e demência (16,4%) foram frequentes. A prevalência de óbito após a fratura foi de 17,9%, sendo associada a maior tempo de internação hospitalar após a cirurgia (p = 0,028). Conclusão: A prevalência de mortalidade dos pacientes com fratura do quadril submetidos à cirurgia foi de 17,9%. O tempo prolongando de internação hospitalar por comorbidades pré-existentes foi o principal fator relacionado a este desfecho. Nível de Evidência III, Estudo Retrospectivo.

Acinic cell carcinoma of the oral and maxillofacial region: an international multicenter study

Abstract The aim of this study was to describe the prevalence, clinicopathological, and prognostic features of acinic cell carcinoma (AciCC) of the oral and maxillofacial region. AciCC cases were retrospectively retrieved from 11 pathology centers of three different countries. Medical records were examined to extract demographic, clinical, pathologic, and follow-up information. A total of 75 cases were included. Females (65.33%) with a mean age of 45.51 years were mostly affected. The lesions usually presented as an asymptomatic (64.28%) nodule (95.66%) in the parotid gland (70.68%). The association of two histopathological patterns was the most common finding (48.93%) and the tumors presented mainly conventional histopathological grades (86.11%). Surgical treatment was performed in the majority of the cases (59.19%). Local recurrence was observed in 20% of the informed cases, regional metastasis in 30.43%, and distant metastasis in 12.50%. The statistical analysis showed that the cases with a solid histopathological pattern (p=0.01), high-grade transformation (p=0.008), recurrence (p=0.007), and regional metastasis (p=0.03) were associated with poor survival. In conclusion, high histopathological transformation, presence of nodal metastasis, and recurrence were prognostic factors for AciCC of the oral and maxillofacial region.

Profile of gynecological cancers in a tertiary hospital, Eastern Nigeria

Introduction: there is a great diversity in the profile of cancers in the world. This study set out to analyze the profile of gynecological cancer in Federal University Teaching Hospital, Owerri, [FUTHO] (former Federal Medical Centre, Owerri, Imo state, Nigeria). Methods: this was a retrospective cross sectional descriptive study of the records of women admitted in the gynecological ward in FUTHO from January 2020 to November 2022. It was analyzed using SPSS version 23.0 and reported in simple percentages for categorical variables and measures of central tendency for quantitative variables. Results: a total of 1,378 gynecological patients were admitted into the Gynaecological ward of the hospital, out of which 242 (17.6%) were cancer cases. The most common cancer over the three years in review, was ovarian, 81(33.5%), followed by cervical, 66 (27.3 %), endometrial, 65 (26.8 %), choriocarcinoma, 22 (9.1%), vulvar, 6 (2.5%) and vagina, 2(0.8%). The most common gynecological cancers in this study is very different from previous reports from Nigeria and other African countries. The pattern looks like that seen in the developed countries where endometrial and ovarian cancers top the list. Conclusion: this report shows a possible change in lifestyle and improved access to cervical cancer prevention strategies. It is also assumed that all the facilities who have recorded cervical cancer as the most common cancer can actually have a similar result as ours if a more current review is done.

Treatment Outcomes in COVID-19 patients with comorbidities in Kaduna state, NorthwesternNigeria

Background: Severe COVID-19 disease has been reported among people with underlying conditions such as diabetes, chronic respiratory diseases, cancer, obesity, and cardiovascular disease. This study determined the outcomes of COVID-19 among patients with comorbidities in Kaduna state, where we have the highest incidence in northern Nigeria.Methods: This study was a retrospective, descriptive cross-sectional review of the clinical records involving all age groups of 902 COVID-19 patients admitted at the four isolation centers of the Kaduna State Infectious Disease Control Centre (IDCC) between March 27th2020 to December 31st2021. Data was analyzed with SPSS version 25 and STATA SE 12 with p <0.05.Results: Out of the 902 cases, 245(27.2%) had comorbidities, hypertension 206(22.8%) was the most recorded comorbidity, others were diabetes 77(8.5%), asthma 7 (0.78%), HIV 7(0.78%), sickle cell anemia 7 (0.78%) and PTB 3 (0.33%). Patients with comorbidities had prolonged mean duration of symptoms 8.36±3.5 days, compared to 7.2±2.7 days in those without comorbidities (p=0.001).Multivariate logistic regression analysis further shows that the odds for clinical recovery from the COVID-19 disease was significantly lower for patient with hypertension (AOR=0.13, 95%CI=0.06-0.27, p = <0.01), diabetic (AOR=0.20, 95% CI=0.10-0.40, p<0.01) and HIV comorbidities (AOR=0.1, 95%CI=0.01-0.98, p=0.05) compared to those without comorbiditiesConclusion: Hypertension and diabetes were the major comorbidities in this study. Most patients with comorbidities had severe presentations and fatal poorer outcome. There is a need for sustained public health education targeted at patients with chronic diseases to be screened and treated early for COVID 19 Disease

Efficacy Evaluation of Biejiajianwan in the Treatment of Primary Liver Cancer Based on Real-world Data of Traditional Chinese Medicine / 中国实验方剂学杂志

ObjectiveTo evaluate the efficacy and influencing factors of Biejiajianwan in the treatment of primary liver cancer based on real-world data of traditional Chinese medicine （TCM）. MethodClinical diagnosis and treatment data of patients with primary liver cancer admitted to five Grade-A tertiary hospitals in Henan Province from January 2015 to December 2020 were collected from the medical electronic database. The patients treated with Biejiajianwan for ≥30 days were assigned to the exposure group and those without treatment with Biejiajianwan or treated with Biejiajianwan for <30 days to the non-exposure group. The propensity score matching model was used to balance confounding factors between the two groups according to the 1∶1 genetic matching method. Kaplan-Meier method was used for survival analysis and survival curve plotting. Log-rank was used to test the difference in survival rate between the two groups. Univariate analysis of Biejiajianwan in the treatment of primary liver cancer was performed by Log-rank test combined with the Kaplan-Meier method. The factors with statistical significance （P<0.05） were combined with unbalanced factors by the propensity score matching model， and at the same time， clinical common sense and relevant prognostic factors by literature search were considered， which were subjected to multivariate analysis by Cox proportional hazards regression model. ResultA total of 2 207 electronic cases were collected，including 174 cases in the exposure group （Biejiajianwan group） and 2 033 cases in the non-exposure group. After propensity score matching， there were 174 cases in the exposure group and 174 cases in the non-exposure group. The Kaplan-Meier method was used for survival analysis on the matched data， and the Log-rank test results showed that the survival rate of patients with primary liver cancer in the Biejiajianwan group was higher than that in the control group （χ2=12.193， P<0.01）. Cox proportional hazards regression model analysis showed that the regression coefficient of Biejiajianwan was -0.916 4 with the hazard ratio （HR） ［95% confidence interval （CI）］=0.4 （0.239 5-0.668 0）， P<0.01， and the regression coefficient of radiofrequency ablation treatment was -0.976 5 with HR （95% CI）=0.376 6 （0.172 8-0.821 1， P<0.05）. Fibrinogen （FIB） abnormal regression coefficient was 0.481 4 with HR （95% CI）=1.618 4（1.022 0-2.562 9），P<0.05. ConclusionBiejiajianwan can prolong the survival period of patients with primary liver cancer. Radiofrequency ablation is an independent protective factor for Biejiajianwan in the treatment of primary liver cancer，while abnormal FIB are independent risk factors for Biejiajianwan in the treatment of primary liver cancer.