Reports

Background: The objective of this study is to determine the relationship between publications and authors. In turn, the different areas of research on the ocular complications of myopia are also identified, and the most cited publication by citation networks is determined. Methods: The search for publications is carried out in the Web of Science database using the term “myopia OR nearsightedness AND retin* OR degenerat* OR detachment OR patholog* OR glaucoma OR cataract OR machulopathy OR “choroidal neovascularization” for the period between 1978 and December 2022. Publication analysis was performed using the Citation Network Explorer, VOSviewer and CiteSpace software. Results: A total of 9357 publications and 78,400 citation networks were found across the network, with 2021 being the year with the highest number of publications, 712. The most cited publication was “Myopia”, published in The Lancet journal in 2012 by Morgan et al. with a citation index of 1006. By using the clustering function, seven groups covering the different research areas in this field were found: axial growth of the eye; myopic maculopathy; ocular complications in patients with myopia after a surgery; glaucoma; retinal detachment; cataracts and retinopathy of prematurity. Conclusions: The citation network offers a quantitative and qualitative analysis of the main papers on ocular complications of myopia. The research on this field is multidisciplinary; however, the main topic studied is the axial growth of the eye. Full article

Idiopathic nephrotic syndrome (INS) is one of the chronic kidney diseases that occurs in childhood. Starting from a few case reports in the 1950s–1970s and up to the present, the relationship between idiopathic nephrotic syndrome (INS) and the occurrence of atopic disorders in these patients has been discussed in many medical publications. These publications show that in certain patients, mainly children and adolescents, but also in adults with INS, various clinical symptoms and laboratory indicators of an atopic allergic process may be present. This process has been shown to involve Th2 lymphocytes, to have an excessive production of interleukins (IL-4, IL-5, IL-13), and to have an increased serum level of immunoglobulin E (IgE). This leads to the development of a systemic allergic inflammatory process, of which the kidneys can also become the effector organ. The coexistence of an allergic process which may adversely affect the course of nephrotic syndrome may be confirmed by the increased serum IgE level and the hypersensitivity reaction of the patient’s body to various environmental allergens (through the presence of allergen-specific IgE /asIgE/ antibodies to food, pollen, mould, dust, or other allergens in the blood serum). High concentrations of IL-13 and other plasma mediators of this inflammation (e.g., histamine, bradykinin) structurally and functionally damage the renal filtration barrier, and in particular, the function of podocytes in the glomeruli. Podocyte dysfunction disturbs the physiological process of plasma filtration in the glomeruli, leading to excessive protein loss in the urine. These disorders initiate the development of idiopathic nephrotic syndrome in these patients. This publication presents the coexistence of an allergic process caused by allergy to cow’s milk proteins and hypersensitivity to other allergens in a child with idiopathic nephrotic syndrome. This publication also assesses whether treatment of the allergic process coexisting with INS with an elimination diet (milk-free, hypoallergenic) and anti-allergic drugs affected the course and treatment of INS in this child. Full article

The ingestion of foreign bodies is a common cause for presentation in the emergency department by pediatric, adult, or elderly psychiatric patients. Swallowed foreign bodies sometimes represent a great challenge for surgeons due to the obstruction or perforation of the digestive tube’s upper or lower segments. Occasionally, the foreign bodies detected in the lower parts of the digestive tube (colon and rectum) could be introduced through the anal route with the risk of perforation of the rectum or sigmoid colon. In this report, we describe a unique case of a foreign body located in the sigmoid colon, where it arrived due to backstabbing and was retained for 7 years without acute symptoms. The 43-year-old male patient came to the emergency department with pain in the left iliac fossa. Before his presentation, a computerized tomography (CT) scan examination had suggested a foreign body. A surgical approach was decided. The surgery started as an exploratory laparoscopy and was converted to a xiphoid-pubic incision to extract the foreign body (a piece of glass about 8 cm long) through a sigmoid colotomy followed by a double-layer sigmoidorrhaphy. The postoperative evolution of the patient was uneventful. As far as we know, this is the first case of a patient with a foreign glass body positioned in the sigmoid colon that got there by stabbing and not by ingestion or introduced per anum. In conclusion, we suggest that aggressive behavior and abdominal wall penetration by different sharp objects should be considered when foreign bodies are detected in the abdomen. Full article

The implementation of next-generation sequencing (NGS) in clinical oncology has enabled the analysis of multiple cancer-associated genes for diagnostics and treatment purposes. The detection of pathogenic and likely pathogenic mutations is crucial to manage the disease. Obtaining the mutational profile may be challenging in samples with low yields of DNA—reflected by the type of biological material, such as formalin-fixed paraffin-embedded tissue (FFPE), needle biopsies, and circulating free/tumor DNA, as well as a sparse tumor content. Moreover, standardized strict procedures for the extraction of DNA in a clinical setting might contribute to lower amounts of DNA per µL. The detection of variants in low-yield DNA samples remains a challenge in clinical diagnostics, where molecular analyses such as NGS are needed. Here, we performed vacuum centrifugation on DNA extracted from five FFPE tissue blocks, with concentrations below 0.2 ng/µL. Through NGS analysis, we found that low-yield DNA samples could be concentrated to sufficient levels, without compromising the mutational profile. Full article

Glioblastoma is the most aggressive malignant tumor overall and remains an incurable neoplasm with a median survival of 15 months. Since 2005, the gold standard treatment for glioblastoma has remained unchanged, and it is a common goal of the scientific community to work towards a better prognosis and improved survival for glioblastoma patients. Herein, we report a case of glioblastoma multiforme in a patient with a poor prognosis who, following partial removal of the neoplasm, refused conventional therapy consisting of a combination of radiotherapy and temozolomide-based chemotherapy due to personal serious side effects. The patient started an unconventional therapeutic path by alternating periods of oxygen–ozone therapy with concomitant administration of legal medical cannabis products (Bedrocan and Bedrolite) and melatonin. This approach resulted in a complete and durable remission of the disease and long survival. Indeed, the patient is still alive. The exceptional result obtained here encourages us to share and carefully investigate this unconventional treatment as a possible future direction in the management of glioblastoma. Full article

The aim of the current study is to examine the effect of epilepsy recovery on personality traits by analyzing data from a large representative cohort from the United Kingdom. This study used data from Understanding Society: the UK Household Longitudinal Study (UKHLS). A predictive normative modelling approach along with one-sample t-tests were used to analyze the personality trait differences between 190 current epilepsy patients (40% male) with a mean age of 43.95 ± 15.68 years and 102 previous epilepsy patients (45.1% male) with a mean age of 47.50 ± 15.27 years. People who recovered from epilepsy had lower Neuroticism but higher Openness, Conscientiousness, and Extraversion scores than people who did not recover from epilepsy after controlling for demographic covariates, which can be potentially explained by the psychophysiological pathways. Health professionals can make better post-discharge plans based on personality traits as a result of epilepsy recovery. Full article

In all regions of the world, musculoskeletal disorders are a significant contributor to the burden of chronic illnesses. The effectiveness of treatments, such as rehabilitation, may vary intersectionally across demographic and other categories. The present study examines this intersectionality with respect to a lack of improvement in health conditions after rehabilitation of patients in Germany. Routine data from 298,617 patients aged 18–65 years residing in Germany who received rehabilitation because of arthropathies, dorsopathies, or soft tissue disorders during 2006–2016 were included in the analysis. Odds of the outcome were compared across demographic groups and across diagnostic sub-groups by means of multivariable logistic regression. Interaction terms were included to examine intersectional differences across these groups and over time. Women were more likely than men to have an impairment despite treatment (adjusted odds ratio [aOR] = 1.11; 95%-CI = 1.08, 1.13). In addition, patients in semi-skilled/unskilled employment were at higher odds of a poor outcome compared to patients in skilled positions (aOR = 1.13; 95%-CI = 1.10–1.17). Nationality also affected health care outcomes, with Turkish nationals and nationals from a Yugoslav successor state having higher odds of a poor outcome than Germans (aOR = 1.56; 95%-CI = 1.45–1.67 and aOR = 1.52; 95%-CI = 1.41–1.65, respectively). The findings highlight the importance of an intersectional perspective in health research and practice and can support the development of strategies and measures that aim to reduce disparities in health care. Full article

A 75-year-old female with a history of stomach cancer and depression was referred to our hospital for left cervical lymphadenopathy. The biopsy of her left cervical lymph node revealed noncaseating granulomas with multinucleated giant cells. The positron emission tomography/computed tomography (PET/CT) indicated general lymphadenopathy (left supraclavicular left axillary, hepatic lymph nodes), except for the hilar lymph node. Both histology by transbronchial lung biopsy (TBLB) and analysis of broncho alveolar lavage fluid (BALF) were indicative of sarcoidosis. C-reactive protein (CRP) and soluble interleukin-2 receptor (sIL-2R) were increased in the sera. An alternative cause of granulomatous disease was ruled out, and on follow-up, she was diagnosed with sarcoidosis. Two years later, she was hospitalized for fever, anorexia, lymph node tenderness, and erythema nodosum with significant increases in CRP and sIL-2R. After admission, the repetitive axillary lymph biopsy showed the same histological findings as before, but the G-band staining showed clonal abnormalities. Bone marrow biopsy revealed abnormal lymphocytes with petal-like nuclei. Finally, she was diagnosed with malignant lymphoma infiltrating the bone marrow. After CHOP-based chemotherapy, her laboratory data, lymphadenopathy, and clinical findings improved, and she was discharged from the hospital on the 90th day. Careful medical treatment, including genetic analysis of the lymph node, is necessary in patients with sarcoidosis if lymphadenopathy is predominant. Full article

Immune checkpoint inhibitors (ICIs) enhance antitumoral immune mechanisms and are used to treat various types of solid tumors including those that are microsatellite instability (MSI)-high. Uterine endometrial cancer is one of the most frequent tumor types that shows MSI-high, and, consequently, opportunities to use ICIs for endometrial cancer treatment are increasing. While using ICIs, it is important to monitor and manage various immune-related adverse events (irAEs). Here, we report two cases of secondary adrenal insufficiency during treatment of endometrial cancer with pembrolizumab. Both cases showed appetite loss and general fatigue after the 6th or 12th cycle of pembrolizumab. They were admitted to our hospital because of remarkable hyponatremia. Both cases showed no adrenocorticotropic hormone (ACTH) or cortisol response to CRH loading tests. Other pituitary hormone levels were normal, and MRI revealed no sign of hypophysitis in either patient. They were diagnosed with secondary adrenal insufficiency due to isolated ACTH deficiency and recovered soon after the administration of hydrocortisone and hydration. Thus, we should be aware of irAEs with the use of ICIs. In particular, adrenocortical insufficiency is sometimes lethal without appropriate treatment. Because the clinical symptoms are fatigue, appetite loss, and nausea, patients might be misjudged to have symptoms related to cancer. Checking serum morning cortisol before ICIs use and monitoring serum sodium levels could provide clues to diagnose secondary adrenal insufficiency. Full article

Extracorporeal membrane oxygenation (ECMO) can be a life-saving intervention in cases of potentially reversible refractory respiratory failure. One such indication can be bleomycin-induced lung injury. However, in some cases, the injury can be so severe that it becomes irreversible and creates complex medical decisions regarding life support and the continuation of care when no additional therapeutic options are feasible, particularly in cases of patients who were young and fully functional prior to an acute illness. In cases of full pulmonary replacement with mechanical support and the degree of functionality that can be attained utilizing modalities such as ECMO can obscure the true severity of illness and make end-of-life decisions significantly harder for families and caregivers. Full article

Pediatric sarcomas are rare malignancies accounting for about 10% of solid tumors in childhood. Sarcomas represent a heterogeneous group of malignancies, especially they include Rhabdomyosarcoma (RMS) and Non-Rhabdomyosarcoma Type Sarcomas (STSNR). Therapeutic management of pediatric sarcomas is challenging. Multidisciplinary approach including chemotherapy, surgery and radiotherapy is the treatment of choice. The correct management of affected patients can be demanding, especially in terms of preserving a good quality of life (QoL). In the present study we described our experience with a series of patients diagnosed with head and neck non-metastatic sarcoma between January 1995 and December 2020, referred to Pediatric Oncology or to Maxillo-Facial Surgery of University Hospital of Modena and Reggio Emilia.The survivors were asked to complete questionnaires on health-related quality of life (HRQoL; PedsQL and EORTC QLQ-H&N 43). We found satisfactory results in terms of global HRQoL; although outstanding issues persist, such as deterioration in masticatory function, and speech. Long-term sequelae of multimodality treatment may lead to both significant aesthetic-functional and psychosocial implications that need to be further investigate during the whole the care pathway. Full article

Nasopharyngeal (NP) swab sampling is a simple procedure that has become extremely popular in the coronavirus disease 2019 (COVID-19) era, with hundreds of million specimens collected every day. However, rare but serious complications have been reported following NP swab acquisition. Here we present a case of paroxysmal atrial fibrillation associated with NP specimen collection in a healthy healthcare provider undergoing COVID-19 testing during departmental screening. This response may have been caused by an exaggerated vagal tone triggered by the trigeminocardiac reflex. Less invasive collection methods, such as saliva testing, may be warranted in predisposed individuals. Full article

Ovarian malignant germ cell tumors (OMGCTs) represent a rare type of malignant tumors composed of primitive germ cells that often originate from dysgenetic gonads and are frequently associated with hermaphroditism. Such tumors occur more frequently in adolescents or young adults, and their etiopathogenic mechanism is not well established. We report the case of a 20-year-old female with ovarian dysgenesis and female phenotype. A laparoscopic surgery was performed, and ovotestis was discovered. To achieve a histopathological examination, right oophorectomy was performed, which confirmed the diagnosis of dysgerminoma. In the case of hermaphroditism, mixed germ cell tumors can develop, leading to a more aggressive evolution with bilateral malignancy of the gonads, which requires the removal of both ovotestis. The patient was recalled. A histopathological examination revealed a seminoma, so laparoscopic left oophorectomy was performed. The management of this type of diagnosis primarily involves surgery, minimally invasive interventions being preferred. Not all pathologic conditions are readily identifiable by means of exploratory laparoscopy, as in our patient’s case. We consider that the optimal solution for these patients would be the preservation of fertility via egg donation and embryo transfer; the survival rate of such patients being 97–100%, if the tumor is diagnosed at an early age. Full article

Breast cancer is the leading cause of cancer-related death among women worldwide. It is the most common malignancy in middle-age and elderly women already suffering from other comorbidities, such as chronic kidney disease (CKD). Being a heterogeneous disease, it has variable subtype-specific outcomes and responses towards treatment. Patients with human epidermal growth factor receptor 2 (HER2) overexpression are treated with anti-HER2-targeted drugs. With the advent of newer drugs, the usage of HER2 blockade and chemotherapy in the neoadjuvant treatment of HER2-positive early breast cancer management helps to increase the probability of achieving pathological complete response. We herein present a case of a patient with breast cancer with long-standing CKD and on maintenance hemodialysis where treatment with conventional chemotherapy regimens was a concern and managed with an antibody–drug conjugate (ADC), namely T-DM1, in a neoadjuvant setting. The patient showed a favorable outcome, and the tolerance of T-DM1 in this patient was predictable. This is a first-of-its-kind case report, where T-DM1 was used in a neoadjuvant setting for a patient on simultaneous hemodialysis. Full article

This Institutional Review Board (IRB)-approved retrospective observational protocol aims to report the safety and efficacy of birth tissue allografts applied in 38 patients with treatment-resistant sacroiliac (SI) joint pain. The research methodology consisted of an observational recording of the Numeric Pain Rating Scale (NPRS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), which measure pain, stiffness, and physical function. No adverse events or adverse reactions were observed in the 38 patients. Statistically significant improvements in NPRS and WOMAC scores of the affected SI joint were reported after 90 days. The observational data suggests that Wharton’s jelly allograft applications are safe, minimally invasive, and efficacious. They may present an alternative to surgery for patients who fail conservative and procedural management of pain originating from chondral cartilage degeneration of the SI joint. Full article

A Cryptococcus subspecies, neoformans, represents the most pathogenic infection for humans, particularly in immunocompromised hosts (e.g., cancer patients, drug users). In the present study, we described a 67-year old woman with non-Hodgkin lymphoma who developed an infectious disease sustained by Cryptococcus neoformans. Biochemical data documented a decrease in lymphocytes count while clinical evaluation was suggestive on meningeal infection. The microbiological analysis of the serum, using a dilution pattern through the CrAg lateral flow assay (Immy, Norman, OK 73069, USA) detected the antigen of Cryptococcus (dilution 1/1280), and a treatment with liposomal amphotericin B (3 mg/kg id) plus flucytosine (100 mg/kg per day orally in four divided doses) were started, showing an improvement of symptoms. This case report suggests that an antigen dilution can be used to perform a rapid diagnosis and to quickly start the pharmacological treatment. Full article

65 consecutive patients with presumed microbial keratitis and negative culture tests for bacteria and fungi obtained by corneal curettage were evaluated. All patients had undergone local broad spectrum antibiotic therapy for at least 5 days with no clinical improvement. After 48–72 h of wash-out they underwent scraping of the superior tarsal conjunctiva for cytological examination of cellular morphology in Scanning Electron Microscopy (SEM). The presence of pathogenic microorganisms was detected with this method in 62 of these patients, towards which specific therapy was carried out. Clinical improvement and eradication of microorganisms previously detected by SEM examination were observed in all positive patients over a time between 10 and 49 days. In three patients, no microorganisms were detected, but the presence of inflammatory cells (eosinophils and mast cells) or dry eye findings. This method could be useful to detect the presence of non-isolated microorganisms at common culture tests. The resolution of the infectious keratitis and the eradication of the pathogens at the subsequent cytological examination of cellular morphology in Scanning Electron Microscopy support the validity of the proposed method. Full article

Background: Secondary PTSD is defined as the natural, consequential behaviors and emotions that result from knowledge about a traumatic event experienced by a significant other deriving from working with suffering individuals. Pediatric health providers with symptoms of PTSD report problems with relationships and general life dissatisfaction as well as and anxiety, depression and burnout syndrome. Aim: The aim of this systematic review was to estimate the risk of developing secondary PTSD among pediatric health care providers as well as all additional contributing factors. In more detail, we investigated the PTSD symptomatology between pediatric health care providers and the extent to which parameters such as the job, gender, department and other factors had an impact on the mental health status of pediatric health care providers. Methodology: We searched all published English papers in PubMed, Google Scholar and the Cochrane Library from September to November 2022. We excluded reviews, systematic reviews and meta-analyses as well as letters to editors. From a total of 748 papers, we included only 12 research articles that met the admission criteria. Results: According to our results, the prevalence of secondary PTSD ranges from 13% to 94%. Burnout, nurses, the female gender, intensive care units, past traumatic life events and a psychiatric history identified as factors contributing to the development of secondary PTSD. Conclusions: Health policy-makers should take the specificity in the working environment of the pediatric sector seriously into consideration, especially emergency departments. Full article

The major sites of metastasis in non-small cell lung cancer (NSCLC) are bones, the brain, adrenal glands, the liver, the contralateral lung, and distant lymph nodes. Solitary metastasis in an uncommon site is very rare; therefore, it has not often been reported. Identifying whether a solitary lesion is a metastatic lesion is important because it decisively influences the stage and treatment decisions. We report a series of cases of NSCLC diagnosis with uncommon solitary metastasis. (1) A 71-year-old man was diagnosed with poorly differentiated NSCLC after a bronchoscopic biopsy of a tumor in the bronchus of the right middle lobe. A hypermetabolic lesion was observed in the tail of the pancreas using positron emission tomography/computed tomography (PET/CT), and metastasis of NSCLC was confirmed using endoscopic ultrasound fine-needle aspiration (EUS-FNA). (2) A 77-year-old man was diagnosed with squamous cell carcinoma after a bronchoscopic biopsy of a tumor in the bronchus of the left upper lobe. A hypermetabolic lesion was observed in the bilateral lobes of the thyroid gland using PET/CT, and metastasis of the squamous cell carcinoma was confirmed by FNA and cytology. (3) A 79-year-old woman was diagnosed with adenocarcinoma by brushing cytology performed on the apicoposterior segmental bronchus of the left upper lobe. Hypermetabolic lesions were observed using PET/CT in the subcutaneous layer of the right back and the left breast, and metastases of adenocarcinoma were confirmed by biopsies in each lesion. These three patients were treated with platinum-based chemotherapy for stage IV lung cancer. With this case series, we recommend that, when a solitary lesion is observed in NSCLC patients, a tissue biopsy should be performed, even if the lesion is located in an organ where lung cancer metastasis is uncommon. Full article