Nevin Manimala

J Neurosurg. 2024 Mar 22:1-9. doi: 10.3171/2024.1.JNS23730. Online ahead of print.

ABSTRACT

OBJECTIVE: Olfactory neuroblastoma (ONB) is a rare, malignant tumor of the sinonasal tract that arises from olfactory epithelium. Although surgery is the preferred first-line treatment, tumor involvement of adjacent structures may preclude the ability to achieve negative margins during initial resection. Herein, the authors examine the oncological outcomes of patients with positive margins after primary resection of ONB, with the aim of determining predictors of disease progression and patterns of recurrence.

METHODS: The authors performed an institutional review of 25 patients with positive-margin ONB after resection. Cox survival analyses were used to determine any statistically significant predictors of worse progression-free survival (PFS) and overall survival (OS).

RESULTS: A total of 93 patients who were diagnosed with ONB were identified, of whom 25 patients had positive margins following their primary resection. Eleven (44%) had a delayed finding of positive margins that were initially negative in the operating room but returned as positive on final pathology. Four patients had subtotal resection (STR), whereas the remaining patients underwent gross-total resection. Twenty-four patients received adjuvant radiotherapy (96%), and 15 additionally received adjuvant chemotherapy (60%). Fourteen patients (56%) experienced recurrence/progression at a median time of 35 months following resection (IQR 19-70 months). Local recurrence occurred in 10 patients (40%), regional in 9 (36%), and distant metastasis in 2 (8%). In Cox survival analyses, the 5-year PFS and OS were 55.1% and 79.2%, respectively. Kadish stage D was predictive of worse PFS in univariate (hazard ratio [HR] 15.67, 95% CI 3.38-72.61, p < 0.001) and multivariate (HR 15.46, 95% CI 1.45-164.91, p = 0.023) analyses. Hyams grade, adjuvant chemotherapy, and primary radiotherapy were not associated with PFS. Furthermore, Kadish stage D and STR were predictive of worse OS in univariate analysis (HR 12.64, 95% CI 2.03-78.86, p = 0.007; HR 7.31, 95% CI 1.45-36.84, p = 0.016; respectively). However, local and regional recurrence was not associated with worse OS.

CONCLUSIONS: Approximately half of patients with positive-margin ONB may experience disease recurrence. Patients with an advanced disease stage (Kadish D) may have a higher likelihood of developing recurrence/progression. Furthermore, patients with tumor burden following resection (STR and Kadish D) may have worse OS. However, in positive-margin ONB with no gross disease following initial resection, the presence of disease recurrence does not significantly alter survival when receiving salvage therapy.

PMID:38518294 | DOI:10.3171/2024.1.JNS23730

J Neurosurg. 2024 Mar 22:1-9. doi: 10.3171/2024.1.JNS231633. Online ahead of print.

ABSTRACT

OBJECTIVE: The influence of socioeconomic factors on racial disparities among patients with sporadic meningiomas is well established, yet other potential causative factors warrant further exploration. The authors of this study aimed to determine whether there is significant variation in the genomic profile of meningiomas among patients of different races and ethnicities and its correlation with clinical outcomes.

METHODS: The demographic, genomic, and clinical data of patients aged 18 years and older who had undergone surgery for sporadic meningioma between September 2008 and November 2021 were analyzed. Statistical analyses were performed to detect differences across all racial/ethnic groups, as were direct comparisons between Black and non-Black groups plus Hispanic and non-Hispanic groups.

RESULTS: This study included 460 patients with intracranial meningioma. Hispanic patients were significantly younger at surgery (53.9 vs 60.2 years, p = 0.0006) and more likely to show symptoms. Black patients had a higher incidence of anterior skull base tumors (OR 3.2, 95% CI 1.7-6.3, p = 0.0008) and somatic hedgehog mutations (OR 5.3, 95% CI 1.6-16.6, p = 0.003). Hispanics were less likely to exhibit the aggressive genomic characteristic of chromosome 1p deletion (OR 0.28, 95% CI 0.07-1.2, p = 0.06) and displayed higher rates of TRAF7 somatic driver mutations (OR 2.96 95% CI 1.1-7.8, p = 0.036). Black patients had higher rates of recurrence (OR 2.6, 95% CI 1.3-5.2, p = 0.009) and shorter progression-free survival (PFS; HR 2.9, 95% CI 1.6-5.4, p = 0.002) despite extents of resection (EORs) similar to those of non-Black patients (p = 0.745). No significant differences in overall survival were observed among groups.

CONCLUSIONS: Despite similar EORs, Black patients had worse clinical outcomes following meningioma resection, characterized by a higher prevalence of somatic hedgehog mutations, increased recurrence rates, and shorter PFS. Meanwhile, Hispanic patients had less aggressive meningiomas, a predisposition for TRAF7 mutations, and no difference in PFS. These findings could inform the care and treatment strategies for meningiomas, and they establish the foundation for future studies focusing on the genomic origins of these observed differences.

PMID:38518289 | DOI:10.3171/2024.1.JNS231633

Pol Merkur Lekarski. 2024;52(1):104-111. doi: 10.36740/Merkur202401116.

ABSTRACT

OBJECTIVE: Aim: To evaluate the influence of the degree of detail of the nature of the pathomorphological changes in the osteoligamentous structures on the tactics of treating the patients with the traumatic damage to the thoracolumbar junction.

PATIENTS AND METHODS: Materials and Methods: A retrospective analysis of the treatment tactics was carried out in 96 patients with a traumatic injury of the thoracolumbar junction, both those who underwent a surgical treatment and those who underwent a conservative therapy. The lesions were classified using F. Magerl and AOSpine classifications; the neurological status was assessed according to the ASIA scale, the nature of the damage was specified using the McCormack criteria. The statistical data processing was performed using the Random Forest machine learning algorithm.

RESULTS: Results: The nature of the injury makes it possible to unambiguously determine the optimal method of therapy when using the F. Magerl classification with a probability of 58.33%, while in relation to the AOSpine classification this figure is 55.21%. When building the models that include the nature of the damage, the level of the neurological disorders and the McCormack criteria, it was found that the use of the F. Magerl classification demonstrates an error in unambiguously determining the most effective treatment method at the level of 26.04%, while the use of AOSpine this figure was 21.88%.

CONCLUSION: Conclusions: The application of the AOSpine classification is more promising for the development of a multifactorial algorithm for the treatment of the traumatic injuries of the thoracolumbar junction.

PMID:38518241 | DOI:10.36740/Merkur202401116

Pol Merkur Lekarski. 2024;52(1):95-103. doi: 10.36740/Merkur202401115.

ABSTRACT

OBJECTIVE: Aim: The purpose of the research is to study trends in the dynamics of morbidity and mortality from arterial hypertension in the Republic of Kazakhstan for 2010-2019.

PATIENTS AND METHODS: Materials and Methods: Due to the interdisciplinary nature of the study, a set of methods was used: analytical, graph-analytical, statistical, sociological, clinical and economic analysis, organizational experiment.

RESULTS: Results: The survey of 318 hypertension patients highlighted a common profile: hypertensive men aged 45-59, smokers, alcohol drinkers, urban dwellers, married with children, industrially employed, physically active at their country house, and facing stress. Gender differences showed 74.4% of hypertensive women were over 50, while a fifth of men were under 45, with higher risk factors in men: smoking (1.87), alcohol (2.53), occupational hazards (2.76), and harsh climates (2.54).

CONCLUSION: Conclusions: The analysis findings reveal noteworthy trends within the hypertension patient population in Kazakhstan. Despite a decline in hypertension prevalence and initial occurrences, along with reduced relative hospitalization rates between 2010 and 2019, mortality linked to hypertension-related causes and the occurrence of heart attacks have remained relatively steady in recent times.

PMID:38518240 | DOI:10.36740/Merkur202401115

Pol Merkur Lekarski. 2024;52(1):79-86. doi: 10.36740/Merkur202401113.

ABSTRACT

OBJECTIVE: . Aim: To assess the effectiveness of monotherapy and complex treatment of patients with erectile dysfunction depending on its severity.

PATIENTS AND METHODS: Materials and Methods: Men with moderate and mild erectile dysfunction took part in the study, who, in turn, were divided into groups, depending on the treatment, with the evaluation of the results of the International Index of Erectile Function (MIEF-15), the state of cavernous hemodynamics and the function of the vascular endothelium before and after treatment.

RESULTS: Results: In patients with an average degree of severity, who received complex treatment including a course of low-energy shock wave therapy, against the background of taking sildenafil and L-arginine, the best results were obtained in the quality of erection and increased cavernous blood flow, which positively affected satisfaction with sexual intercourse and overall satisfaction. It has also been proven that the function of the endothelium was improved in patients receiving L-arginine, due to which there was a probable decrease in endothelin-1. A probable improvement of erectile function was obtained in the group of patients with a mild degree who received L-arginine, and there was no statistical difference from the indicators in the group who received sildenafil, which was confirmed by the data of dopplerography.

CONCLUSION: Conclusions: Patients with an average degree of erectile dysfunction require comprehensive treatment. The use of L-arginine can be an alternative to phosphodiesterase type 5 inhibitors in the treatment of mild erectile dysfunction.

PMID:38518238 | DOI:10.36740/Merkur202401113

Pol Merkur Lekarski. 2024;52(1):54-59. doi: 10.36740/Merkur202401109.

ABSTRACT

OBJECTIVE: . Aim: The purpose of the study was to identify the features of apoptotic and proliferative processes in experimental Staphylococcus aureus-infected radiation skin ulcer under conditions of photodynamic therapy and the use of platelet-rich plasma.

PATIENTS AND METHODS: Materials and Methods: An experimental study was conducted on 95 six-month-old male rats of the WAG population, which were divided into three groups. Group 1 included 25 animals that were simulated a radiation ulcer of the skin in the thigh area with subsequent application to its surface on the 7th day after irradiation with 0.2 ml of a suspension of the Staphylococcus aureus (ATCC 25923) reference strain (0.5 million microbial cells/cm2). Group 2 included 25 animals with Staphylococcus aureus-infected radiation skin ulcer, which were subjected to photodynamic therapy a day after infection. Group 3 included 45 animals with Staphylococcus aureus-infected radiation skin ulcers, which, 1 day after infection, received photodynamic therapy in the first half of the day, and in the second half of the day the periphery of the wound defect was injected with platelet-rich plasma. The material for the study was skin with underlying soft tissues from the area of radiation exposure. Histological, immunohistochemical, morphometric and statistical methods were used.

RESULTS: Results: In cases of simultaneous use of photodynamic therapy and platelet-rich plasma, compared with photodynamic therapy alone, the processes ofapoptosis and proliferation were more balanced, active, with a shift in the proliferative-apoptotic ratio towards proliferation processes and met the needs of the regenerative process. From the 10th to the 22nd day of the experiment these processes increased, which indicated active healing processes, that, during survey microscopy on the 22nd day, were manifested by the complete filling of the wound cavity with granulation and connective tissues with the presence of an epithelial layer on the surface of the regenerate. From the 22nd to the 45th day of the experiment, a decrease in the rate of regeneration was recorded, as evidenced by a decrease in the intensity of apoptotic and proliferative processes. The intensity of the latter was sufficient, which led to the healing of Staphylococcus aureus-infected radiation skin ulcer on the 45th day with complete restoration of the original structure of the skin.

CONCLUSION: Conclusions: Photodynamic therapy in combination with the use of platelet-rich plasma balancedly activates apoptotic and proliferative processes with a predominance of the latter in granulation and connective tissues filling the lumen of Staphylococcus aureus-infected radiation skin ulcer, which on the 45th day of the experiment leads to wound healing with complete restoration of the original structure of the skin.

PMID:38518234 | DOI:10.36740/Merkur202401109

Pol Merkur Lekarski. 2024;52(1):49-53. doi: 10.36740/Merkur202401108.

ABSTRACT

OBJECTIVE: Aim: To study and record the level of empathy and self-compassion of the medical and nursing staff of a general hospital in North Greece, and to investigate their connection to depression levels..

PATIENTS AND METHODS: Materials and Methods: The study sample consists of 88 people (66 women and 22 men), medical and nursing staff of the General Hospital of Kavala (northern Greece) who filled out a questionnaire. The questionnaire consists of 4 parts: 1) socio-demographic data; 2) the Toronto Empathy Questionnaire (TEQ); 3) Self- Compassion Scale (SCS), and 4) the Beck Depression Inventory (BDI). For the statistical processing of the data, SPSS v.25 software was used.

RESULTS: Results: The mean total value for TEQ indicates moderate high level of empathy (M = 40.5). For self-compassion the mean total value for SCS was moderate (M = 82.6) and the BDI shows a low level of depression (M = 28.7). A high level of empathy corresponds to a high level of self-compassion (ρ(88) = 0.263, p = 0013). Older ages correspond to a lower level of depression (ρ(88) = -0.218, p = .042).

CONCLUSION: Conclusions: Empathy is a key factor for the creation of the therapeutic relationship between the patient and the healthcare provider, while increasing the level of the health provider’s self-compassion. Increased levels of self-compassion and older age among providers may correspond to lower levels of depression.

PMID:38518233 | DOI:10.36740/Merkur202401108

Pol Merkur Lekarski. 2024;52(1):42-48. doi: 10.36740/Merkur202401107.

ABSTRACT

OBJECTIVE: . Aim: To study the stability of surface-modified dental implants, with the usage of sandblasting/acid modification vs. photoactivation.

PATIENTS AND METHODS: Materials and Methods: In the observation were included 164 patients with dental defects. All patients had digital impressions taken by scanning the oral cavity with an intraoral scanner 3Shape TRIOSR. Group A (80 subjects) included implants whose surface was modified with a combination of sandblasting and acid. Group B (84 subjects) – implants after modification with photoactivation. The implant stability quotient was recorded using an Osstell MentorTM device.

RESULTS: Results: The reliable effectiveness of the photoactivation method in complex treatment of the surface of dental implants in improving the stability of fixed dentures in the short and long-term periods of observation was proven. When assessing immediate clinical outcomes, there was no significant difference in the frequency of hyperemia, algesia, hyperthermia, soft tissue edema, regional lymphadenitis, depending on the classical method of treating the implant surface and the complex method with photoactivation. Of the long-term clinical outcomes with classical surface treatment, the absolute risk of implant failure was 1.2%, relative risk – 0,99 [CI%0,96-1,0]. The average value of the implant stability coefficient (ISQ) and the data of the Periotest study at the time of surgery probably did not differ in the observation groups, after 3 months, a higher index was proven in the treatment of the surface by the method of photoactivation and greater stability of the mandibular implants. At the time of implantation, there were no statistically significant differences in implant fixation between the groups, however, during prospective observation in group A, secondary stability indicators based on periotestometry results were significantly lower.

CONCLUSION: Conclusions: It was proved the reliable effectiveness of the photoactivation-method for surface modification in the short and long-term periods of observation for improving the results of orthodontically treatment.

PMID:38518232 | DOI:10.36740/Merkur202401107

Pol Merkur Lekarski. 2024;52(1):23-29. doi: 10.36740/Merkur202401104.

ABSTRACT

OBJECTIVE: Aim: The aim of the present published work is efficacy evaluation of the modified educational program in achieving the target levels of glycemia in children and adolescents with type 1 diabetes mellitus in pump insulin therapy in Almaty..

PATIENTS AND METHODS: Materials and Methods: This study involved 125 children and adolescents with type 1 DM and evaluated the effectiveness of a modified educational program at the School of Type 1 Diabetes Mellitus. Participants were divided into subgroups based on their method of glycemia evaluation. The program’s effectiveness was assessed through pre-and post-training questionnaires and measurement of glycohemoglobin levels. Statistical analysis was conducted using the Statistica application.

RESULTS: Results: The study evaluated the effectiveness of a modified educational program for children and adolescents with type 1 DM. The results indicated that those who participated in the modified program demonstrated significant improvements in their knowledge and ability to manage their diabetes. They were able to correctly answer 80-90% of the questionnaire questions six months to a year after the training. Additionally, those in the modified program exhibited better carbohydrate metabolism rates and achieved higher rates of their individual treatment goals, especially when using the FreeStyle Libre system for continuous monitoring of blood glucose levels. These findings suggest that a modified educational approach can significantly enhance diabetes management and treatment outcomes in children and adolescents.

CONCLUSION: Conclusions: The study concluded that a modified educational program leads to better target therapy levels in children and adolescents with type 1 diabetes mellitus, highlighting the importance of motivated parents and frequent blood glycemia measurements.

PMID:38518229 | DOI:10.36740/Merkur202401104

J Low Genit Tract Dis. 2024 Apr 1;28(2):164-168. doi: 10.1097/LGT.0000000000000796. Epub 2024 Jan 10.

ABSTRACT

OBJECTIVES: Lichen sclerosus (LS) is an inflammatory skin disease probably arising from an interplay of genetics, local irritation, and autoimmune processes. We identified potential risk factors for the disease using data from nationwide Finnish registries.

METHODS: We identified all women diagnosed with LS within specialized health care during 1998-2016 (n = 10,692) and selected 3 age-matched population control women for each case. We calculated odds ratios (ORs) for possible risk factors using conditional logistic regression.

RESULTS: Dermatological autoimmune conditions were strongly associated with LS (OR = 15.1, 95% confidence interval [CI] = 13.6-16.7 for morphea; OR = 10.3, 95% CI = 5.02-19.0 for lichen planus; OR = 6.86, 95% CI = 5.65-8.33 for alopecia; OR = 2.20, 95% CI = 1.88-2.56 for vitiligo). A diagnosis of Crohn or celiac disease increased the odds of LS (OR = 1.80, 95% CI = 1.71-1.89; OR = 1.49, 95% CI = 1.28-1.73, respectively) as did urge and stress incontinence (OR = 1.79, 95% CI = 1.71-1.87; OR = 1.28, 95% CI = 1.22-1.35, respectively).The odds of LS were lower in women after a diagnosis of type 1 diabetes (OR = 0.43, 95% CI = 0.41-0.45), coronary artery disease (OR = 0.41, 95% CI = 0.38-0.43), and rheumatoid arthritis (OR = 0.38, 95% CI = 0.36-0.41).Parous women had higher odds of LS (OR = 1.11, 95% CI = 1.04-1.17) than nulliparous ones, but increasing number of births decreased the risk. Lichen sclerosus was not associated with socioeconomic status nor the urbanicity level of the place of residence.

CONCLUSIONS: Certain autoimmune diseases and urinary incontinence were associated with LS.

PMID:38518214 | DOI:10.1097/LGT.0000000000000796