Idiopathic inflammatory myopathies - The burden of disease: Cohort analysis focusing on damage and comorbidities.

INTRODUCTION/BACKGROUND: Idiopathic Inflammatory Myopathies (IIM) continue to be a major clinical challenge worldwide. The exact aetiopathogenesis of this chronic and disabling disease remains elusive, preventing the development of novel and effective therapeutic strategies and leading to a high incidence of damage. The complexity of treating these diseases is even greater due to the numerous comorbidities that affect these patients. METHODS: Retrospective review of the cohort of patients diagnosed with IIM and followed in a dedicated unit of a tertiary hospital between 1971 and December 2022, with particular attention to damage and comorbidities. Damage was assessed using the Myositis Damage Index. Comorbidities were recorded and analysed as a whole and also assessed using the Charlson Comorbidity Index. Health Assessment Questionnaire (HAQ) Disability Index (DI) was performed by phone call in December 2022, to all patients actively followed-up in the Unit. RESULTS: Analysis of 149 patients with a mean follow-up of 9 years (range 0-51) revealed >90% with damage and comorbidities. Most comorbidities were a consequence of the damage and were particularly related to prolonged steroid therapy. Cardiovascular damage, which occurred either as cardiovascular risk factors or as end-organ sequelae (cardiovascular disease and chronic kidney disease), was the main cause and a major contributor to death. Depression was also high on the list of associated comorbidities. Median HAQ was 2.09 representing high negative impact in quality of life. CONCLUSIONS: Although survival rates have increased in recent decades, patients with IIM carry a high burden of disease with poor quality of life, mainly caused by damage and comorbidities. While comorbidities accumulation is the major factor for poor quality of life, damage severity is the main predictor for mortality. Improved therapeutic strategies are needed to reduce the need for steroids and to introduce routine screening and management of comorbidities as an essential partner of immunosuppressive therapy, leading to comprehensive care of myositis patients and effective improvement of their quality of life.

Influence of Mesh Fixation on the Development of Postoperative Pain after Laparoscopic Inguinal Hernia Repair: A Single Surgeon Experience.

OBJECTIVE: Primary aim of the present article was to determine the relationship between mesh fixation methods and the occurrence of postoperative pain after laparoscopic inguinal hernia repair. Materials and Methods: 101 patients diagnosed with inguinal hernia benefited from elective laparoscopic treatment of the abdominal wall defect. Follow up was realized at one and three months after surgical intervention. The followed details contained clinical, surgical and pain-related data. Results: Multivariable analysis resulted young adults (OR=4.226; p=0.0467), recurrent hernia (OR=4.862; p=0.0415) and use of fixation requiring surgical mesh (OR=4.226; p=0.0467) as significant risk factors in the development of chronic postoperative pain. During the follow up period, patients who benefitted of mesh fixation complained about significantly higher pain sensation (pain index at one month: SG=10.27; CG=5.07; p=0.0080; pain index at three months: SG=5.02; CG=1.42; p=0.0406). Concerning chronic postoperative pain syndrome, six patients from SG (12.76%) and only a single patient from CG complained after three months about pain index greater than 18.5 points, concluding that mesh fixation significantly increases the possibility of chronic postoperative pain syndrome (p=0.0455). Conclusions: Mesh fixation methods during laparoscopic inguinal hernia repair seem to contribute to the development of chronic postoperative pain. Avoiding traumatizing mesh fixation methods could be a suitable option for surgeons.

Manifestaciones clínicas de pilomatrixoma en un paciente pediátrico / Clinical manifestations of pilomatrixoma in a pediatric patient

Introducción: El pilomatrixoma es un tumor benigno que afecta fundamentalmente a pacientes femeninas menores de 10 años. Se manifiesta como una masa sólida y encapsulada, situada profundamente en la dermis inferior y recubierto de piel normal; puede medir entre 3 y 30 milímetros. Objetivo: Informar las manifestaciones clínicas de este tumor que permiten llegar al diagnóstico de un pilomatrixoma. Presentación del caso: Se presenta el caso de un adolescente de 12 años de edad, que acude a consulta de dermatología del Hospital Andino de Chimborazo, con manifestaciones clínicas que permiten hacer el diagnóstico de pilomatrixoma. Conclusiones: El pilomaxitroma es un raro tumor que, aunque afecta frecuentemente a niñas menores de 10 años, también puede presentarse en pacientes mayores del sexo masculino. El estudio anatomopatológico resulta vital para realizar el diagnóstico de la enfermedad y una vez realizado dicho diagnóstico la excéresis del tumor es el procedimiento más adecuado(AU)

Introduction: Pilomatrixomais a benign tumor that mainly affects female patients under 10 years old. It manifests as a solid and encapsulated mass, located deep in the lower dermis and covered with normal skin; it can measure between 3 and 30 mm. Objective: To present the clinical manifestations that allow to reach the diagnosis of a pilomatrixoma. Case presentation: It is presented the case of a 12-year-old male adolescent, who attended the dermatology clinic in the Andean Hospital of Chimborazo, with clinical manifestations that allow the diagnosis of pilomatrixoma. Conclusions: Pilomaxitroma is a rare tumor that, although it frequently affects girls under 10 years of age, can also occur in older male patients. The anatomopathological study is vital to make the diagnosis of the disease and once performed the same exceresis of the tumor is the most appropriate procedure(AU)

[The effect of glucose level in blood on microbiocenosis of intestine and quality of life of people with predisposition to diabetes mellitus type II.]

The article presents analysis of results of examination of spectrum, rate of occurrence and number of microorganisms of large intestine in individuals with normal level of glucose in blood and with predisposition to diabetes mellitus type II. The psychodiagnostic study was carried out including estimate of particular psycho-physiologic and social psychological characteristics of personality reflecting characteristics of psychic and social development. It is established that in individuals with predisposition to diabetes mellitus type II microbiota of intestine altered sideway to dysbiosis degree I-II at the expense of increasing of number of opportunistic microflora up to several degrees. In control group normobiocenosis and intestine dysbiosis degree I are established. It is demonstrated that satisfaction with life-quality is approximately the same in both groups of study participants. However, adaptation possibilities are significantly higher in individuals with predisposition to diabetes mellitus type II.

Efficacy comparison of different operations in treatment of papillary thyroid carcinoma / 重庆医学

Objective To compare the operative efficacy of low collar incision and L-shaped incision plus cervical plexus preser-ving lymphadenectomy in treating papillary thyroid carcinoma.Methods 9 3 inpatients with papillary thyroid carcinoma were ran-domly divided into the low collar incision group (n=37)and the L-shaped incision group(n=56)according to the random number table.The low collar incision group underwent the low collar type cervical plexus preserving lymphadenectomy,while the L-shaped incision group received the L-incision cervical plexus preserving lymphadenectomy.The postoperative 24-month follow up was per-formed.Then the clinical efficacy and the life quality of the patient were evaluated and compared between the two groups.Results (1)1 case of lymph node recurrence in the district Ⅱ after 20 months was found in the low collar incision group,1 case of lymph node recurrence in the district Ⅰ after 12 months and 1 case of lymph node recurrence in the districtⅣ after 22 months was found in the L-shaped incision group;no case of distant metastasis in the low collar incision group occurred during the follow up period, but 1 case of pulmonary metastasis in postoperative 5 months and 1 case of bone metastasis in postoperative 24 months occurred in the L-shpaed incision group.The differences in the occurrence rates of postoperative recurrence and metastasis had no statistical sig-nificance (2.70%vs.7.14%).(2)The scores of neck shoulder pain and numbness,incision appearance satisfaction degree in the low collar incision group were significantly higher than those of the L-shaped incision group (P<0.05).Conclusion Compared wtih L-shaped incision cervical lymphadenectomy,low collar incision cervical plexus preserving cervical lymphadenectomy has simi-lar high clinical efficacy,can significantly reduce neck shoulder pain and numbness,meet aesthetic requirements and especially is suitable for the patients with higher demands of the neck function preserving and the neck appearance.