Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report

Background Symptomatic pituitary metastasis is rare; furthermore, it can result in diabetes insipidus and panhypopituitarism. Since diabetes insipidus is masked by concurrent panhypopituitarism, it can impede the diagnosis of pituitary dysfunction. Case presentation A 68-year-old Japanese female suffering from pituitary and thalamic metastases caused by untreated breast cancer, underwent a biopsy targeting the thalamus, not the pituitary. She lacked prebiopsy pituitary dysfunction symptoms; however, these symptoms unexpectedly occurred after biopsy. Diabetes insipidus was masked by corticosteroid insufficiency, and she showed normal urinary output and plasma sodium levels. Upon commencement of glucocorticoid replacement therapy, the symptoms of diabetes insipidus appeared. Conclusions In this case, thalamic biopsy, as opposed to pituitary biopsy, was performed to preserve pituitary function. However, pituitary dysfunction could not be avoided. Caution is necessary for asymptomatic patients with pituitary metastases as invasive interventions, such as surgery, may induce pituitary dysfunction. Moreover, with respect to masked diabetes insipidus, there is a need to carefully consider pituitary dysfunction to avoid misdiagnosis and delayed treatment.

Access to healthcare during COVID-19 among ageing population in Latvia

Medical staff has worked tirelessly throughout the COVID-19 pandemic to test and treat coronavirus patients. However, the focus on the virus has caused huge disruption to healthcare services, resulting in delayed treatment for patients with other serious conditions. Additionally, the reasons for forgoing or abstaining healthcare could also relate to individual decisions. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), where the respondents aged 50 and older of the Wave 8, version 0, were asked to answer, among other, questions on delayed, postponed or denied healthcare services during the first wave of COVID-19 pandemic in Latvia. For comparative reasons also Estonian and Lithuanian data were included in the study with 2 473 627 valid weighted cases in total. Due to the large sample size, in order to evaluate statistically significant result for Pearson’s chi-square test, strength of association (f) was provided. The results show that 12.7% of the respondents forwent and 14% postponed medical treatment in Latvia. Appointment was denied to 5.5% of the respondents. Generally, older people in Latvia had better access to health care services compared to the average in the Baltic countries. We found significant age and gender differences, but they varied depending on the type of treatment and reason for not receiving it. However, further studies are necessary to analyse how limited access to the healthcare for other reasons has affected health of the ageing population. Also, more knowledge is needed about how to maintain public health and wellbeing for the growing part of the ageing society.

A Clinical Study on the Incidence and Visual Outcome after Surgical Management of Lens-Induced Glaucoma

Aims and Objectives: To determine 1) the incidence of lens-induced glaucoma. 2) the more prevalent type of LIG. and 3) Visual outcome following surgical management of LIG. Material and Methods: 50 patients of lens-induced glaucoma, who presented in OPD of Regional Institute of Ophthalmology, were included in the study. All patients were admitted and managed in indoor wards. Informed and written consents were taken. A detailed history and a thorough ocular examination was done. Surgical correction was done by SICS or Phacoemulsification or triple procedures operations. Results: A standardized proforma was used to compile data and it was analyzed statistically using Chi-square test and Probability value. The incidence of LIG was found to be 0.174 among all OPD attendees. Phacomorphic glaucoma (58%) was found to be the highest followed by phacolytic glaucoma (32%). No significant association with respect to sex and age of the cases was found. The presenting symptoms varied in severity and were directly proportional to the degree of rise of IOP. 38% of cases in our study achieved best corrected visual acuity of 6/9 and 28% achieved 6/12 acuity at the end of 6 weeks. Visual outcome was found to be better for cases with early detection and treatment. Conclusion: The mainstay to prevent and treat LIG is early diagnosis and treatment of cataract. Delayed treatment of LIG may result in poor visual outcome. Keywords: LIG, IOP, Phacomorphic glaucoma, Phacolytic glaucoma, SICS, Phacoemulsification.

Disparities in Access to Cranial Remodeling Orthosis for Deformational Plagiocephaly

Objective Moderate to severe cases of deformational plagiocephaly (DP) may be treated with cranial remolding orthoses (CRO). This study investigated the socioeconomic disparities in access to care for CRO for DP correction. Design This was a retrospective review of medical records from a single CRO company in Connecticut from 2014 to 2020. Methods Demographic variables were collected from all patients. Univariable logistic regressions were used to identify differences for presenting age at consultation, whether CRO was pursued, and length of CRO treatment by insurance payor and household income quartile. Results Of the 5620 patients identified, 4100 (73.0%) received CRO, with 674 (12.0%) receiving a second helmet. Of those receiving CRO, 1536 (37.5%) had Medicaid insurance while 2558 (62.4%) were commercially insured. Patients on Medicaid were 1.30 times more likely to have delayed presentation ( P = .017), while patients from the lowest income quartile were 1.26 1.50 ( P < .001) and 1.58 ( P < .001) times more likely to have a delayed presentation relative to those in the highest and second-highest income quartiles, respectively. Patients in the highest and second-highest income quartiles were also 1.55 ( P < .001) and 1.45 ( P < .001) more likely, respectively, to receive CRO after consultation than those from the lowest income quartile. Conclusions Lower income and Medicaid-insured patients had delayed presentation for CRO consultation. Those from the lowest income quartile were more likely to never receive CRO than those from wealthier backgrounds. Low socioeconomic status and Medicaid insurance, which can have more restrictive coverage policies for CRO, may result in the delayed treatment of DP.

The effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis patients

Aim. To assess the effect of late diagnosis on survival and risk of vascular complications in Takayasu's arteritis (TA) patients. Methods. 183 patients with TA who were treated at the Sverdlovsk Regional Clinical Hospital No. 1 during the period from 01.01.1979 to 31.04.2018 were examined. There were 139 women and 44 men included, median age at the time of diagnosis being 35 [24; 44] years in females and 34 [26.5; 42] years in males and a median interval from the first symptoms onset to the diagnosis of 3 [1; 7] and 4 [1.5; 8] years respectively. The diagnosis of TA met the ACR criteria (1990).Results. During the follow-up period, 31 deaths were observed (18 in males and 13 in females). The median age of death for women was 36 [32-44] years, for men - 50 [40-57] years. Cardiovascular complications were recorded in 72 patients (27 men and 45 women). Vascular complications and namely acute cerebrovascular accident observed in 31 (43%) patients, including ischemic stroke in 24 (35%), transient ischemic attack in 3 (3%) and hemorrhagic stroke in 4 (6%) were the most frequent. Arterial thromboses were registered in 32 (44%) cases. In 162 (88.5%) patients, the diagnosis was established more than six months after the appearance of the first symptoms.At the primary physician visit in 71 (39%) patients, the initial diagnosis was erroneous. The most common symptoms they had were regarded as a manifestation of arterial hypertension (in 18% cases). 4 years or more interval from the onset of TA symptoms to diagnosis was associated with a significant cardiovascular events odds increase (OR=1.8; 95% CI: 1.07-3.34) and premature death by the 5th year of follow-up (OR=2.9; 95% CI: 1,27-6,55).Conclusion. In the retrospective TA cohort setting, late diagnosis verification and delayed treatment initiation were associated with an increased risk of premature death and severe vascular complications, described earlier in other samplings. Timely diagnosis and as early as possible appropriate treatment administration can prevent the disease progression and disabling complications occurrence.

Workplace Violence Against Doctors in Bangladesh: A Content Analysis

Workplace violence in healthcare settings is a common global problem, including in Bangladesh. Despite the known presence of workplace violence in healthcare environments of developing countries, there is limited understanding of factors that lead to hospital violence in Bangladesh. This study aims to explore factors that influence incidents of violence against healthcare professionals in Bangladesh, as reported by doctors via social media forum. Content analysis was conducted on 157 reported incidents documented on “Platform,” the online social media most used by medical students and doctors in Bangladesh. Posts by doctors detailing experiences of physical or verbal violence at their workplace between July 2012 and December 2017 were included in this study. The majority of reported incidents were reported by male doctors (86%) and from government hospitals (63.7%). Findings showed that primary healthcare centers experienced more violence than secondary and tertiary facilities. This may largely be due to insufficient human and other resources in primary care settings to meet patient demand and expectations. Most of the events happened at night (61%), and as a result, entry-level doctors such as emergency duty doctors and intern doctors were commonly affected. Six themes were identified as vital factors in workplace violence against doctors: patients’ perspectives, delayed treatment, power practice, death declarations, extreme violence, and care-seeking behaviors. Most incidents fell under the categories of delayed treatment and power practice at 26.8 and 26.1%, respectively. This study identified possible factors for reported violence in hospital settings. To address and reduce these incidents, hospital administrators should be aware of risk factors for violent behavior and design appropriate measures to prevent workplace violence. Further qualitative and quantitative research is needed to appropriately address the consequences of violence on healthcare workers and implement measures to mitigate these events.

Comparing the performance of linear regression versus deep learning on detecting melanoma skin cancer using apple core ML

Melanoma is a type of deadly skin cancer. The survival rate of the patients can fall as low as 15.7% if the cancer cell has reached its final stage. Delayed treatment of melanoma can be attributed to its likeness to that of common nevus (moles). Two machine learning models were developed, each with a different approach and algorithm, to detect the presence of melanoma. Image classification is using the regression algorithm, and object detection is using deep learning. The two models are then compared, and the best model is determined according to the achieved metrics. The testing was conducted using 120 testing data and is made up of 60 positive data and 60 negative data. The testing result shows that object detection achieved 70% accuracy than image classification’s 68%. More importantly, linear regression’s 43% false-negative rate is noticeably high compared to convolutional neural network’s (CNN) 25%. A false-negative rate of 43% means almost half of sick patients tested using image classification will be diagnosed as healthy. This is dangerous as it can lead to delayed treatment and, ultimately, death. Thus it can be concluded that CNN is the best method in detecting the presence of melanoma.

Multi-Omics Advancements towards Plasmodium vivax Malaria Diagnosis

Plasmodium vivax malaria is one of the most lethal infectious diseases, with 7 million infections annually. One of the roadblocks to global malaria elimination is the lack of highly sensitive, specific, and accurate diagnostic tools. The absence of diagnostic tools in particular has led to poor differentiation among parasite species, poor prognosis, and delayed treatment. The improvement necessary in diagnostic tools can be broadly grouped into two categories: technologies-driven and omics-driven progress over time. This article discusses the recent advancement in omics-based malaria for identifying the next generation biomarkers for a highly sensitive and specific assay with a rapid and antecedent prognosis of the disease. We summarize the state-of-the-art diagnostic technologies, the key challenges, opportunities, and emerging prospects of multi-omics-based sensors.

Giant, Bleeding, and Ulcerating Proliferating Trichilemmal Cyst, With Delayed Treatment Due to Coronavirus Outbreak: A Case Report and Review of the Literature

We report a case of a large, ulcerating proliferating trichilemmal cyst in a 76-year-old woman, with clinical, radiological, macroscopic, and microscopic correlation. The outbreak of the Coronavirus pandemic delayed her treatment. We review the literature on proliferating trichilemmal cysts, which are relatively rare tumors, which, generally, are considered benign. However, we found a high rate of malign cases, which stresses the importance of rapid surgical excision and histological diagnosis. Even though our proband had delayed treatment, the tumor did not transform into a malignant form.