Background and objectives. Brain-derived neurotrophic factor (BDNF) is a crucial neurotrophic protein involved in the development, maintenance, and function of the nervous system. However, the relationship between BDNF levels and vascular function in patients with Parkinson’s disease (PD) remains unclear. We aimed to investigate the association between BDNF and related factors and vascular function in PD. Materials and methods. In this cross-sectional study, 24 patients with PD were included. Their clinical characteristics were recorded, and disease severity was evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS). Cognitive function was measured using the Thai Mental State Examination (TMSE), whereas quality of life was assessed using the Parkinson’s Disease Questionnaire-8 (PDQ-8). Vascular function was assessed using brachial-ankle pulse wave velocity (baPWV) and flow-mediated dilation (FMD) of the popliteal artery. Linear regression analysis was performed to explore the relationships between the variables. Results. The average age of the 24 patients with PD was 64 years; the mean duration of PD was 4 years, with a mean levodopa dose of 450.58 mg/day. A significant positive correlation was observed between BDNF levels and FMD (B = 0.002, p = 0.003). However, no significant association was observed between BDNF levels and baPWV, nor was there any association between vascular function and TMSE, PDQ-8, or UPDRS scores or other related factors. Conclusions. The positive correlation between BDNF and popliteal artery FMD suggests an association between higher BDNF levels and better endothelial function in PD. Future research should investigate the complex relationships among neurotrophic support, vascular function, and cognitive decline in PD, particularly through longitudinal and interventional studies.
Background. Early identification of intracranial lesions in mild traumatic brain injury (mTBI) remains challenging, particularly when clinical presentation is subtle. Blood-based biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) have emerged as potential tools to support diagnostic decision-making. Methods. This cross-sectional study included 102 patients with mTBI (GCS 13–15) who underwent head CT and 21 healthy controls. The diagnostic performance of GFAP and UCH-L1 was evaluated to differentiate CT-positive and CT-negative mTBI cases, while controls were used to establish baseline biomarker levels. Results. Intracranial lesions were detected in 65 of 102 mTBI patients (63.7%). GFAP demonstrated excellent diagnostic performance (AUC 0.988; 95% CI: 0.968–1.000), with a sensitivity of 97.9% and a specificity of 100%. UCH-L1 showed good performance (AUC 0.889; 95% CI: 0.814–0.963), with a sensitivity of 87.6% and a specificity of 80.0%. Biomarker levels were markedly elevated in CT-positive patients compared with CT-negative patients and the control group. Conclusion. GFAP and UCH-L1 provide strong diagnostic value for detecting intracranial lesions in mTBI, with GFAP showing very high diagnostic accuracy. These biomarkers may support more accurate and timely imaging decisions in clinical practice.
Introduction. Laryngopharyngeal reflux disorder (LPRD) is a common extra-esophageal manifestation of gastroesophageal reflux that presents with diverse throat and voice-related symptoms. The reflux symptom index (RSI) and reflux finding score (RFS) are widely used tools for subjective symptom assessment and objective laryngoscopic evaluation, respectively. However, the degree of correlation between patient-reported symptoms and endoscopic findings in LPRD remains variable. Aim. To evaluate the correlation between RSI and RFS to better understand their clinical relationship in the assessment of LPRD. Methodology. The study was conducted in an ENT unit of a tertiary care hospital. Ninety-seven patients were included based on the inclusion and exclusion criteria. After informed consent was obtained, participants completed the reflux symptom index (RSI) questionnaire, followed by standardized 70° video laryngoscopy, with findings scored using the reflux finding score (RFS). Data were recorded prospectively and analyzed. Results. The mean RSI score was 14.05 ± 1.47, with most scores between 13 and 15. The majority of patients had an RFS of 8 (60.8%). A moderate positive correlation was observed between RSI and RFS (r = 0.598, p < 0.001). Common symptoms were throat clearing and globus sensation, while erythema and vocal fold edema were frequent findings. RSI showed high sensitivity (100%) but poor specificity (14.29%), limiting its standalone diagnostic utility. Conclusion. The study results support the complementary use of RSI and RFS in the diagnosis and evaluation of laryngopharyngeal reflux disorder.
Background and objectives. Chronic kidney disease is a global health issue affecting a significant portion of the population, with various complications such as osteopenia and osteoporosis. This study aimed to investigate the relationship between bone mineral density (BMD) and chronic kidney disease, with a focus on different skeletal regions and the impact of kidney function on bone health. Materials and methods. This study utilized secondary data extracted from medical records at a tertiary hospital in Surabaya, Indonesia, between January 15, 2025, and July 1, 2025. The sample comprised 66 adult patients diagnosed with chronic kidney disease (ICD-10 code N18.9). Various statistical analyses, including one-sample t-tests, goodness-of-fit tests, chi-square tests, and linear regression analysis, were performed to explore the relationship between eGFR and BMD at key skeletal sites. Scatter plots were also generated to visualize these relationships. Results. The sample included 28 males (42.42%) and 38 females (57.58%). Significant differences were observed in height (p = 0.0027) and weight (p = 0.0057), with a mean BMI of 22.60 ± 4.19 kg/m² (p < 0.001). The mean eGFR was 56.02 ± 7.02 mL/min/1.73 m² (p < 0.001), indicating kidney dysfunction, and the average hemodialysis time was 92.87 ± 42.32 days (p < 0.001). Significant reductions in BMD were observed in lumbar vertebrae (L1 to L4) with p-values < 0.001. Laboratory results showed that BUN (p < 0.001) and serum potassium (p < 0.001) were significant, while total calcium was not (p = 0.3371). The prevalence of osteopenia and osteoporosis was high, particularly at the femoral neck and lumbar spine. Osteopenia at the femoral neck was observed in 37.88%, with osteoporosis at 34.85% (p = 0.015), and osteopenia at the lumbar spine was observed in 34.85% (p = 0.023). Osteoporosis at the lumbar spine was found in 27.27% of the total sample (p = 0.013). These findings highlight a significant bone mineral density loss in patients with chronic kidney disease, particularly in critical skeletal sites like the femoral neck and lumbar spine. Conclusions. The results underline the high prevalence of reduced bone mineral density in patients with chronic kidney disease, particularly at the femoral neck and lumbar spine, and highlight the need for monitoring bone health in chronic kidney disease management. Although some weak correlations between eGFR and BMD were observed, other factors likely contribute to bone loss in these patients, suggesting a need for further studies to identify these influences.
Prostate cancer is a common malignancy, but cases with neuroendocrine differentiation are rare and often clinically aggressive. Objectives. To describe a rare case of de novo prostatic adenocarcinoma with neuroendocrine differentiation presenting as acute paraplegia from vertebral metastases. Case presentation. A 65-year-old man presented with progressive lower limb weakness, back pain, and urinary incontinence. Examination revealed paraplegia below T4. MRI showed a T2 vertebral compression fracture with spinal cord compression; PET-CT identified a prostatic lesion and widespread bone metastases. Biopsies revealed high-grade acinar adenocarcinoma (Gleason 4+5=9) in the right lobe and a neuroendocrine component (Gleason 5+5=10) in the left. Immunohistochemistry showed PSA and AR positivity in both components, with synaptophysin and chromogranin expression in the solid areas, and a Ki-67 index of ~30%. Outcome. The patient was diagnosed with de novo high-grade prostatic adenocarcinoma exhibiting neuroendocrine differentiation. His condition deteriorated despite supportive and palliative interventions, leading to death approximately three months post-diagnosis. Conclusions. Early recognition through histopathological and immunohistochemical analysis is essential for diagnosis and management. The patient died within three months of diagnosis, underscoring the aggressive nature and poor prognosis of this disease.
Gestational diabetes mellitus affects villous development and placental vascular behavior. The present study aimed to characterize placental histomorphological alterations and CD34-based endothelial patterns in gestational diabetes mellitus and to explore their association with maternal glucose levels. This prospective observational study examined histological changes and CD34-based endothelial patterns in 50 placentas from pregnancies complicated by gestational diabetes. Placental tissue was processed for routine histopathology, and immunohistochemistry for CD34 was used to assess endothelial expression and villous capillary patterns. The prevalence of key lesions was recorded, and associations with maternal oral glucose tolerance test (OGTT) values were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Villous immaturity (84%), syncytial knots (80%), fibrinoid necrosis (70%), stromal fibrosis (48%), and villous edema (56%) were the predominant alterations. CD34 immunostaining showed strong endothelial positivity in 74% of samples. Maternal OGTT values ≥140 mg/dL demonstrated a significant association with villous immaturity, syncytial knots, villous edema, stromal fibrosis (p < 0.001 to p = 0.005), and strong CD34 expression (p = 0.010). These findings indicate that higher maternal glucose levels are accompanied by marked structural injury and increased villous capillary density. Taken together, the observed combination of villous immaturity, stromal injury, and enhanced endothelial CD34 expression supports the concept of compensatory vascular remodeling in gestational diabetes. The results provide a clear representation of placental remodeling in gestational diabetes and underline the relevance of CD34 as a marker of vascular adaptation.
Toxic epidermal necrolysis (TEN) is a rare but life-threatening dermatologic emergency characterized by widespread epidermal detachment and mucosal involvement. Drug-induced TEN is most commonly associated with medications such as antiepileptic drugs, including phenytoin. While leukocytosis is typically observed as part of the systemic inflammatory response, this case report describes an uncommon presentation of TEN associated with significant leukopenia in a 54-year-old male. The patient had a recent history of head trauma requiring decompression craniotomy and was initiated on phenytoin for seizure prophylaxis in the immediate postoperative period, which was continued daily. Approximately 3–4 weeks after initiation of phenytoin, he developed an erythematous rash that rapidly progressed to widespread epidermal detachment with mucosal involvement over the subsequent 48–72 hours. Laboratory evaluation revealed a marked decline in total leukocyte count. Although the precise mechanism underlying leukopenia could not be established and no direct evaluation of bone marrow function was performed, leukopenia has been described in the literature in association with severe cutaneous adverse drug reactions. The patient was managed with intensive supportive care, including wound care, nutritional support, and empiric antimicrobial therapy. This case highlights the importance of early recognition of TEN and draws attention to leukopenia as an uncommon but clinically relevant associated finding in phenytoin-induced TEN.
Background. Vitiligo is a chronic depigmenting disorder with variable therapeutic outcomes. PUVA is a well-established treatment, whereas KUVA has been reported in only a few small studies, and its comparative efficacy and safety remain insufficiently investigated. Objectives. To compare the clinical efficacy, repigmentation rates, and safety profiles of PUVA versus KUVA in patients with generalized vitiligo. Methods. One hundred patients with generalized vitiligo were randomly assigned into two equal groups: PUVA (n = 50) and KUVA (n = 50). Patients were aged 12–50 years (mean age, 24.4 ± 3.4). Treatments were administered for 18 months. Clinical photographs, ophthalmologic assessments, and laboratory investigations – including liver function tests – were performed every 6 months. Repigmentation was quantified using the Vitiligo Area Scoring Index (VASI), and adverse events were systematically recorded. Results. After 18 months, very good to excellent repigmentation was achieved in 26 patients (52%) in the KUVA group compared with 16 patients (32%) in the PUVA group (p = 0.012). No patients in the KUVA group showed poor response, whereas one patient (2%) in the PUVA group demonstrated poor repigmentation. Side effects differed markedly between groups: KUVA, 14 patients (28%) and PUVA, 48 patients (96%). Nausea and itching were the most common adverse effects in both groups but were significantly more frequent and severe among PUVA patients. No abnormal liver function tests were observed in KUVA-treated patients throughout the study. Conclusion. Both therapies were effective; however, KUVA demonstrated superior outcomes, with higher repigmentation rates, markedly fewer side effects, and improved patient satisfaction compared with PUVA. Although PUVA remains effective, its high adverse-effect burden and long-term risks (e.g., photocarcinogenesis, photoaging) limit its desirability. KUVA may represent a safer and better-tolerated alternative for the management of generalized vitiligo
Background and objectives. Heart failure poses a major challenge for healthcare systems. Although left ventricular ejection fraction (LVEF)-based classification guides current therapeutic decisions, it fails to capture the complexity of the syndrome. This narrative review aimed to analyze alternative approaches that integrate comorbidity profiles, biomarker data, and machine learning-based subgroup identification to achieve a more accurate and clinically relevant framework. We focused on adult patients with chronic heart failure and literature published between 2015 and 2025, identified primarily through PubMed, Web of Science, and other indexed scientific databases. Materials and methods. We conducted an extensive narrative review of recent literature on heart failure phenotyping strategies, focusing on comorbidity profiles, biomarker integration, and machine learning-based subgroup identification. As this is a narrative review, the selection of sources may be subject to selection bias. Results. New classification models provide more nuanced stratification of heart failure patients by identifying clinically meaningful subgroups. Comorbidity clusters can reveal distinct trajectories and therapeutic responses. In addition, phenotype-based models, often derived using unsupervised machine learning, reveal latent structures associated with prognosis and risk prediction. Conclusions. A dual-axis model – comorbidity-based subgroups crossed with biologically and clinically defined phenotypes – enhances LVEF-based classification for risk stratification and may guide individualized therapy.
A 39-year-old man of Asian descent was referred by his general practitioner (GP) due to persistent frontal headaches and generalized abdominal pain. His systolic blood pressure was 205 mmHg on admission to ambulatory care. Blood tests revealed elevated serum creatinine (141 µmol/L) and reduced eGFR (55 mL/min/1.73 m²), indicating acute kidney injury (AKI). Computed tomography (CT) of the abdomen and pelvis was requested to evaluate abdominal tenderness and showed features suggestive of vascular pathology involving both renal arteries. Differential diagnosis included large-vessel vasculitis (Takayasu arteritis) and fibromuscular dysplasia (FMD). FMD can have serious vascular complications, including spontaneous coronary artery dissection [1]. The initial management plan included antihypertensive therapy, a short course of high-dose steroids pending further evaluation, and multidisciplinary input from rheumatology, nephrology, and vascular services. The mainstay of treatment was blood pressure control and renal function monitoring. This case illustrates a diagnostic dilemma, as FMD is more common in females, yet it is a rare cause of AKI and hypertension in young men. Prompt vascular imaging and multidisciplinary management are critical to obtain the diagnosis and avoid irreversible renal damage.
Background. Pneumosiderosis, or welder’s lung, is a rare occupational lung disease caused by chronic inhalation of iron dust. Clinical and imaging findings often overlap with other interstitial lung diseases (ILDs), making diagnosis challenging. While the gold standard is histopathological identification of iron-laden macrophages from lung tissue or bronchoalveolar lavage (BAL) fluid, this is not always feasible in resource-limited settings. Fourier transform infrared (FTIR) spectroscopy is a reagent-free, non-destructive technique that can serve as an adjunct to detect iron oxide deposits when histopathology is unavailable. Case. A 43-year-old man, a container welder with over 20 years of welding fume exposure, presented with progressive dyspnea and productive cough. Chest imaging revealed features suggestive of ILD. Laboratory tests showed elevated ferritin and positive antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) titers without systemic autoimmune manifestations. FTIR spectroscopy performed on the BAL sample detected Fe–O bond peaks consistent with iron oxide particles. Differential diagnoses, including hypersensitivity pneumonitis, silicosis, asbestosis, and post–COVID-19 sequelae, were considered and excluded based on clinical, radiological, and laboratory findings. The patient was treated with inhaled bronchodilators and corticosteroids, advised to stop welding exposure, and referred for pulmonary rehabilitation. Conclusion. This case demonstrates the potential role of FTIR spectroscopy as a rapid, non-invasive adjunctive tool for diagnosing pneumosiderosis when histopathology is not available. It also emphasizes the importance of integrating advanced spectroscopic methods into the diagnostic work-up of occupational lung diseases in resource-limited settings.
Background. Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice, with a substantial socioeconomic burden, morbidity, and mortality. In contrast to Western nations, rheumatic heart disease (RHD) remains a common etiological factor in India and frequently manifests at a younger age. Objective. To clinically and echocardiographically examine AF patients, determine underlying causes, assess severity, and record associated complications. The study also aimed to determine the prevalence of valvular vs. non-valvular AF and their echocardiographic characteristics. Materials and methods. This cross-sectional study included 103 adult patients with AF diagnosed by 12-lead ECG. Clinical presentation, etiology, AF type, comorbidities, and echocardiographic parameters (LA size, smoke, thrombus) were analyzed. Statistical tests included t-test and chi-square. Results. The mean age was 44.15 ± 14.18 years, with 53.4% females. Breathlessness (76.7%) and palpitations (64.1%) were the most common presenting symptoms. Permanent AF predominated (87.4%). RHD was the leading cause (68.9%), followed by ischemic heart disease (8.7%). Congestive heart failure was the most frequent complication (58.3%). LA smoke (6.8%) and thrombus (11.7%) were observed exclusively in valvular AF. A significant association was found between valve lesions – particularly mitral stenosis – and enlarged LA size (>3.5 cm) (p < 0.05). In patients with isolated mitral stenosis, LA size correlated moderately with mitral valve area (r = –0.424, p < 0.05). Conclusion. In the Indian setting, AF is largely linked to RHD and often affects younger people. A comprehensive clinical and echocardiographic evaluation is crucial for accurate diagnosis and management. The significant correlation between mitral stenosis severity and LA enlargement highlights the importance of early echocardiographic assessment. Appropriate use of anticoagulants and preventive measures against RHD may reduce AF-related complications.
Background. Parry–Romberg syndrome (PRS), or progressive hemifacial atrophy (PHA), is an uncommon disorder of unclear etiology, characterized by slowly progressive unilateral wasting of craniofacial soft tissues, musculature, bone, and cartilage. This case report presents a distinctive pediatric case of PRS with temporal association to prior paramyxovirus infection (mumps). Case report. An 11-year-old boy presented with right-sided facial hemiatrophy and intraoral changes following a documented mumps infection in 2017. Clinical examination revealed hyperpigmentation, localized alopecia, palatal hemiatrophy, soft-tissue thinning of the tongue and lips, and malocclusion on panoramic radiography. MRI demonstrated multiple T2-hyperintense lesions in the right frontotemporoparietal white matter without diffusion restriction, while skin biopsy showed epidermal atrophy with perivascular lymphocytic infiltrate. Serology confirmed prior mumps exposure, while autoimmune panels were unremarkable. No disease-specific therapy was initiated, and the patient was subsequently lost to follow-up, limiting assessment of long-term progression and treatment response. Conclusion. While the temporal relationship raises the possibility of a post-viral trigger, this single case does not establish causation between mumps infection and PRS. The absence of targeted treatment and lack of longitudinal follow-up represent important limitations. Further studies are needed to elucidate potential viral contributions to PRS pathogenesis and to guide management strategies.
Background. Apheresis donation, particularly platelet apheresis, exposes donors to citrate anticoagulant, which can cause hypocalcemia and potentially stimulate parathyroid gland activity, measurable through calcium-sensing receptor (CaSR) levels. Additionally, hypocalcemia may trigger bone calcium release, increasing the risk of osteopenia and osteoporosis, detected through tartrate-resistant acid phosphatase 5b (TRACP 5b) levels. This study aims to examine the relationship between apheresis donation frequency and CaSR and TRACP 5b levels in donors. Methods. A cross-sectional study was conducted on 57 male apheresis donors from the Blood Transfusion Service of Ngoerah General Hospital and the Indonesian Red Cross in Bali. CaSR and TRACP 5b levels were measured using ELISA. Statistical analysis was performed using SPSS version 25.0 for Windows to determine the correlation between donation frequency and these biomarkers. Results. The study included 57 male donors with a mean age of 42 years. The median donation frequency was 3 (range: 2–104). Median CaSR and TRACP 5b levels were 10.59 ng/mL (0.43–39.01 ng/mL) and 4.83 U/L (1.0–16.80 U/L), respectively. Statistical analysis showed no significant correlation between donation frequency and CaSR (p = 0.439) or TRACP 5b (p = 0.084). Conclusion. There is no significant relationship between apheresis donation frequency and CaSR or TRACP 5b levels. These findings suggest that regular apheresis donation does not significantly impact parathyroid function or bone resorption markers in donors. The absence of a significant correlation may be influenced by the small sample size and unmeasured confounding factors. Future studies should include female donors and account for lifestyle and dietary factors.
Background and objectives. Mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P-LCR) are cost-effective markers of platelet activation and morphology. Their diagnostic relevance in differentiating quantitative platelet disorders requires better clinical validation. Objective. To compare platelet indices in thrombocytopenia and thrombocytosis and identify distinct patterns among their etiological subtypes. Materials and methods. A cross-sectional study was carried out at Sree Balaji Medical College and Hospital, Chennai, from November 2022 to April 2024. Ninety adults were included: thrombocytopenia (n = 45) and thrombocytosis (n = 45). Thrombocytopenia cases were subclassified into hyperdestructive (n = 30) and hypoproductive (n = 15). Thrombocytosis cases were subclassified into primary (n = 9) and reactive (n = 36). Platelet indices were measured using the Mindray BC-6000 analyzer on day 1 and day 3. Statistical analysis was performed using SPSS v25, with p < 0.05 considered significant. Results. Hyperdestructive thrombocytopenia was most often linked to dengue fever (56.7%). Hypoproductive thrombocytopenia was commonly associated with iron deficiency anemia (26.7%). Primary thrombocytosis included cases of chronic myeloid leukemia and polycythemia vera, whereas reactive thrombocytosis was mainly secondary to iron deficiency anemia and infection. MPV, PDW, and P-LCR were significantly higher in hyperdestructive thrombocytopenia and primary thrombocytosis (p < 0.05). PCT was initially low in thrombocytopenia but increased significantly by day 3. Conclusion. Platelet indices support the differentiation of hyperdestructive versus hypoproductive thrombocytopenia and primary versus reactive thrombocytosis. Incorporating these parameters into routine testing may guide clinical decisions while reducing the need for invasive investigations.
Background. Diabetes mellitus is a serious endocrine disorder and remains one of the greatest public health challenges of the current century. Obesity and type 2 diabetes mellitus are frequently accompanied by insulin resistance and dyslipidemia. Irisin, a myokine released by skeletal muscle, has been proposed as a metabolic regulator involved in energy homeostasis and glucose–lipid metabolism; however, circulating irisin findings in diabetes remain inconsistent across studies. Objectives. This study aimed to estimate serum irisin levels and selected biochemical parameters in obese women with type 2 diabetes and compare them with healthy women. Methods. Ninety blood samples were collected from women and divided into 60 samples from obese women with type 2 diabetes and 30 samples from healthy women. Participants were stratified by age: 24–44 years (30 patients, 15 controls) and 45–65 years (30 patients, 15 controls). Serum irisin was measured using an immunoassay, and body mass index (BMI), fasting glucose, glycated hemoglobin (HbA1c), and lipid profile parameters (total cholesterol [TC], triglycerides [TG], high-density lipoprotein [HDL], low-density lipoprotein [LDL], and very low-density lipoprotein [VLDL]) were assessed. Group comparisons were performed using appropriate statistical tests; p ≤ 0.05 was considered statistically significant. Results. Serum irisin levels and BMI were significantly higher (p ≤ 0.05) in obese women with type 2 diabetes in both age groups than in controls. Patients also showed significantly higher glucose and HbA1c levels. Lipid profile analysis demonstrated significantly higher TC, TG, LDL, and VLDL, together with significantly lower HDL concentrations, in patients compared with controls in both age groups (p ≤ 0.05). Conclusions. Serum irisin levels were elevated in obese women with type 2 diabetes and were accompanied by adverse glycemic indices and dyslipidemia, supporting an association between higher irisin levels and metabolic disturbance in this population.
Background. Pulmonary embolism (PE) is a life-threatening condition that may cause respiratory failure and hemodynamic instability. Recognized risk factors include immobility, malignancy, surgery, and hormonal therapy such as oral contraceptive use. Early diagnosis and risk-based management are critical for reducing morbidity and mortality. Case presentation. A 50-year-old woman with no history of hypertension or myocardial infarction presented to the emergency department with shortness of breath and sudden, pleuritic chest pain. Notably, the patient had been using oral contraceptives for six months. Initial diagnostic workup included lower-extremity venous ultrasonography, which did not reveal evidence of deep vein thrombosis. However, the patient’s electrocardiogram (ECG) was remarkable for an S1Q3T3 pattern, including deep S waves in lead I, Q waves, and inverted T waves in lead III, suggesting right ventricular overload. Subsequently, computed tomography pulmonary angiography (CTPA) revealed the presence of pulmonary arterial thrombi. Furthermore, there was evidence of right ventricular dilation and contrast reflux into the hepatic veins, indicating right-sided pressure overload. Discussion. Echocardiography revealed right atrial and right ventricular dilation with pulmonary hypertension, and CTPA showed extensive thromboembolism in the setting of hypotension, consistent with high-risk PE. This case highlights the importance of early diagnosis in patients presenting with pulmonary embolism in the absence of detectable deep vein thrombosis, a particularly rare and clinically challenging scenario. It also underscores the role of prompt reperfusion therapy in achieving a favorable clinical outcome.
Background/aims. Initial assessment of liver cirrhosis patients upon hospital admission is crucial to estimating prognosis. This study aims to develop a scoring model for 90-day mortality in patients with liver cirrhosis. Methods. We conducted a retrospective cohort study on liver cirrhosis patients at Ngoerah Hospital. Receiver operating characteristic analysis determined laboratory cutoffs, while multivariate logistic regression identified independent predictors of 90-day mortality. Scores were assigned to each significant variable using the (B/SE)/lowest B/SE formula, showing strong discrimination power. Results. A total of 185 hospitalized patients with liver cirrhosis were included in this study. Significant variables identified were alanine transaminase >34.5 U/L (score 1), albumin <2.65 g/dL (score 1), neutrophil-to-lymphocyte ratio >5.6 (score 2), presence of chronic kidney disease (score 1), hepatocellular carcinoma (score 1), and hepatic encephalopathy (score 2). These significant variables predicted 90-day mortality in liver cirrhosis patients. The probabilities were 3%, 8.4%, 21.2%, 44.1%, 69.9%, 87.2%, 95.2%, 98.3%, and 99.4% for total scores of 0, 1, 2, 3, 4, 5, 6, 7, and 8, respectively. The scoring model demonstrated an area under the curve (AUC) of 0.897 (95% CI: 0.851–0.943), with a sensitivity of 78% and a specificity of 86.2%. The Child-Turcotte-Pugh score demonstrated an AUC of 0.810 (95% CI: 0.750–0.871), with a sensitivity of 73.6% and specificity of 73.4%, while the Model for End-Stage Liver Disease score had an AUC of 0.788 (95% CI: 0.723–0.852), with a sensitivity of 71.4% and specificity of 69.1%. Conclusion. The novel scoring model has remarkable accuracy in predicting 90-day mortality among liver cirrhosis patients. It suggests its potential for immediate risk stratification and guiding early clinical decision-making upon admission.
Background. Liposarcomas are rare malignant adipocytic tumors that often arise in the retroperitoneum and may attain a large size before detection due to nonspecific symptoms. They often show vague symptoms like abdominal pain and distension, which makes diagnosis difficult because they can get massive before they are discovered. Case report. We describe a rare case of a very large myxoid retroperitoneal liposarcoma in a 46-year-old man presenting with progressive abdominal distension and discomfort. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a multilobulated mass with mixed fat and soft-tissue components displacing adjacent organs. Complete surgical excision was achieved, and histopathology confirmed a grade 2 liposarcoma with myxoid features. Conclusion. This case illustrates that the diagnosis of liposarcomas requires imaging and histological examination. Complete surgical excision remains the cornerstone of treatment and requires a multidisciplinary approach to improve outcomes.
Background. Erythroderma is a rare but serious dermatologic emergency that is often drug-induced and poses a greater risk in HIV-positive individuals due to altered immune responses. Case report. A 47-year-old HIV-positive male developed diffuse erythema and scaling involving more than 90% of the body surface area after starting a tenofovir–lamivudine–dolutegravir regimen. A presumptive diagnosis of dolutegravir-induced erythroderma was made based on the temporal association. Differential diagnoses included erythrodermic psoriasis, eczema flare, and Sézary syndrome. No skin biopsy, peripheral blood smear, or immunologic testing was performed due to clinical considerations. Management included immediate drug withdrawal, topical emollients and corticosteroids, systemic antihistamines, fluid therapy, and adjustment of antiretroviral therapy. The patient showed progressive clinical improvement during follow-up after discontinuation of the suspected agent. Conclusions. Clinicians should maintain vigilance for drug-induced erythroderma in HIV-infected individuals, particularly following antiretroviral therapy modification, as early recognition and prompt intervention are essential to prevent severe complications.
