Navigating the Pitfalls of Lung Cancer Screening: A Case Study on the Risks and Costs of Negative Screenings.

Lung cancer is the leading cause of cancer-related deaths in the United States. Low-dose computed tomography is the preferred screening method for high-risk individuals. However, with a false-negative rate reaching 15%, this method can underestimate disease prevalence and delay necessary treatment. This case examines a 61-year-old female smoker with chronic obstructive pulmonary disease who initially received a negative result from screening. Her imaging findings were categorized as Lung Imaging Reporting and Data System (Lung-RADS) 2 but advanced to small cell lung carcinoma. This progression emphasizes the imperative of thoroughly evaluating screening results and patient history. False-negative results from screenings have profound implications, leading to delayed diagnoses, adversely affecting patient outcomes, and increasing healthcare costs. The necessity for vigilant follow-up enhanced diagnostic precision and transparent communication about limitations is paramount. An economic analysis emphasizes the significant financial impact of diagnosing lung cancer at advanced stages, highlighting the need for timely and accurate diagnostics. Comprehensive strategies, such as physician education, patient awareness, and stringent quality control, are crucial to improving the efficacy of lung cancer screening. Addressing the issue of false negatives is vital for enhancing early detection rates, decreasing healthcare expenses, and advancing patient care in lung cancer management. Continuous evaluation and adjustment of screening protocols are essential to reduce risks and optimize outcomes.

Uncommon Scurvy Manifestation: Solitary Skin Lesion in an Alcoholic Case.

Scurvy, characterized by vitamin C deficiency, typically manifests with various symptoms, most commonly skin lesions. However, the presentation of a solitary skin lesion is considered atypical. An elderly patient with a history of heavy alcohol consumption presented with a small skin lesion that developed rapidly into a solitary open wound without any preceding trauma. Laboratory analysis revealed severe vitamin C deficiency (<5 µmol/L). The patient showed significant improvement following high-dose vitamin C replacement therapy. This case underscores the potential for scurvy to present with a solitary lower body wound devoid of typical symptoms. It highlights the importance of prompt consideration of vitamin C replacement therapy, particularly in high-risk groups such as alcoholics, by healthcare providers.

Normal values for tissue velocity and strain rate imaging parameters of left and right atrial myocardium in normal subjects.

OBJECTIVE: To determine normal values for tissue velocity imaging (TVI) and strain rate imaging (SRI) in the left atrium (LA) and right atrium (RA) in normal subjects. METHODS: A total of 63 healthy volunteers (50.8% male, age: 20-50 years) prospectively underwent TVI and SRI. The peak systolic velocity (TVs), strain (STs) and strain rate (SRs), peak early and late diastolic velocities (TVe and TVa), strain (STe and STa), and strain rate (SRe and SRa) were measured in the base and mid of the LA and RA walls and roofs. RESULTS: By TVI, TVs and TVe of LA walls decreased significantly from basal to mid-level and from mid to the roof. Mean Tva of LA walls reduced significantly from basal to mid-level and to the roof. By SRI, mean STs and STe of LA walls increased remarkably from basal to mid-level and to the roof and also mean SRs, SRe and SRa increased significantly from basal to mid-level and to the roof. For SRe, the changes were also significant from mid-LA wall to the roof. Mean Tvs, Tve, and Tva of the RA walls reduced significantly from base to mid and then to the RA roof. RA systolic, early, and late diastolic ST and SR increased from base to mid and to the roof. CONCLUSION: Peak systolic and diastolic velocities of the LA and RA decreased from the base to the mid and to the roof, while systolic and diastolic ST and SR increased from the base to the mid to the roof.

Association between Traditional Risk Factors and Coronary Artery Ectasia: A Study on 10057 Angiographic Procedures among Iranian Population.

BACKGROUND: Whether coronary artery ectasia (CAE) is a unique clinical finding or results from other clinical entities is still unknown. We aimed to determine the CAE prevalence, investigate the relationship between CAE and patients' demographic and clinical characteristics, and assess the prognosis at follow-up in a sample of Iranian population. METHODS: Totally, 10057 patients who underwent coronary angiography were divided into three categories: normal coronary arteries without co-existing coronary artery disease; CAE without co-existing coronary artery narrowing < 50%; and coronary artery stenosis with > 50% luminal narrowing (CAS). RESULTS: The prevalence of CAE was 1.5%. Compared to the normal individuals, the CAE patients were older, were more frequently male, and had higher rates of myocardial infarction (MI). The CAE patients had a lower frequency of diabetes and MI than the CAS group. The CAE patients were largely focused between 40 to 60 years of age. The right coronary and left anterior descending arteries were the most involved arteries, and ectasia was located more frequently in the proximal part of these arteries. Patients with ectasia in the three main vessels had higher rates of MI. After a mean follow-up of 54.23 ± 18.41 months, chest pain and dyspnea on exertion remained the main complaint in more than 97% of the patients, leading to hospital admission in more than 14%. CONCLUSION: There was no relationship between the presence of ectasia and conventional risk factors. According to our study, pure CAE may be deemed a benign feature of atherosclerosis; however, it can lead to frequent hospital admissions because of the persistence of cardiovascular symptoms.

Monitoring of intraocular pressure and its correlation with systemic parameters before and after hemodialysis.

INTRODUCTION: End-stage renal disease and hemodialysis affect intraocular pressure (IOP). This study aimed to evaluate the effects of a one session of hemodialysis on IOP. MATERIALS AND METHODS: In this study, the IOP of 130 eyes of 65 hemodialysis patients (38 men and 27 women) was measured before and every 1 hour after the initiation of hemodialysis therapy. Patients with any glaucomatous conditions were excluded. Demographic information including age, gender, underling systemic or ocular diseases, hemodialysis duration and frequency, KT/V, and levels of blood pressure, body weight, blood urea, serum sodium, serum potassium, blood glucose before and after hemodialysis were recorded. RESULTS: The mean age of the patients was 60.3 +/- 16.7 years. The mean predialysis and postdialysis IOPs were 13.50 +/- 4.09 mm Hg and 12.73 +/- 4.07 mm Hg, respectively (P = .02). The mean IOP at the first and second hours (12.32 mm Hg and 11.83 mm Hg, respectively) of hemodialysis were significantly lower than the mean predialysis IOP (P < .001 for each). In nondiabetics, the mean IOP significantly decreased after hemodialysis. The mean predialysis and postdialysis blood glucose levels were significantly different between diabetics and nondiabetics, but were not significant in each group of diabetics and nondiabetics. There was a significant inverse relationship between IOP and blood glucose changes after hemodialysis (r = -0.180, P = .040). CONCLUSIONS: Increased blood glucose levels significantly decreases IOP in hemodialysis patients without glaucomatous features. Changes in other metabolic parameters do not affect IOP during hemodialysis.

Impact of hemodialysis on visual parameters in patients with end-stage renal disease.

INTRODUCTION: Patients with end-stage renal disease who receive hemodialysis are prone to visual disturbances. The aim of this study was to evaluate the effects of metabolic changes on visual parameters during hemodialysis sessions. MATERIALS AND METHODS: Demographic information including history of underlying diseases, wearing eyeglasses, any ocular diseases or surgeries, and hemodialysis duration and frequency were recorded in 65 hemodialysis patients. The best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution and spherical equivalent (SE) per diopter were measured before and after hemodialysis. Other systemic and metabolic parameters including systolic blood pressure, body weight, KT/V, and blood levels of glucose, urea, and sodium were recorded. RESULTS: A total of 130 eyes of 38 men and 27 women with ages ranged from 24 to 90 years (mean, 60.3 ± 16.7 years) were enrolled. The mean BCVA changed significantly after hemodialysis (0.29 ± 0.48 increased to 0.31 ± 0.49; P < .001). The mean SE changes were significant as well (-0.33 ± 0.31 D decreased to -0.40 ± 0.12 D; P < .001). There was a weakly positive correlation between the BCVA and blood glucose changes (P = .05, r = 0.166). There were significant associations between diabetic retinopathy and wearing of eyeglasses with BCVA and SE (P < .001 for both). CONCLUSIONS: Hemodialysis could influence on visual parameters such as BCVA and refractive status by means of changes in blood glucose or possibly other systemic parameters.