Bioscientia Medicina - Journal of Biomedicine and Translational Research
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Surgical Management of Facial Basal Cell Carcinoma: A Case Report Emphasizing the Need for Individualized Margin Assessment
Get PDFBackground: Basal cell carcinoma (BCC) is the most common form of skin cancer, and its incidence is steadily increasing. While surgical excision remains a cornerstone of BCC treatment, achieving complete tumor clearance while preserving healthy tissue and ensuring optimal cosmetic outcomes can be challenging, particularly in the facial region. This case report underscores the importance of individualized margin assessment in BCC excision.
Case presentation: We present the case of a 52-year-old male with a nodular BCC on his left cheek. The lesion was excised with a 5mm margin under local anesthesia. Histopathological examination revealed incomplete excision, with residual tumor cells at the peripheral margin. The patient underwent a second excision with wider margins, achieving complete tumor clearance.
Conclusion: This case highlights the limitations of standard margin guidelines in BCC excision. Factors such as tumor subtype, location, size, and patient characteristics should be considered when determining appropriate surgical margins. The use of intraoperative margin assessment techniques and adjuvant therapies may be beneficial in select cases
The Impact of Infection Prevention Bundles on Neurosurgical Outcomes and Healthcare Costs: A Systematic Review
Get PDFBackground: Post-operative infections represent a significant challenge in neurosurgery, leading to increased morbidity, mortality, and healthcare costs. The implementation of infection prevention bundles, which encompass a set of evidence-based practices, has emerged as a potential solution to mitigate these adverse outcomes. This systematic review aims to evaluate the effectiveness of infection prevention bundles in improving neurosurgical outcomes and reducing healthcare costs.
Methods: A comprehensive search of electronic databases (PubMed, Scopus, Web of Science) was conducted to identify studies published between 2010 and 2023 that evaluated the impact of infection prevention bundles on neurosurgical outcomes and healthcare costs. The search strategy included keywords such as "neurosurgery," "infection prevention," "surgical site infection," "bundle," "outcomes," and "healthcare costs." Studies were included if they reported on at least one clinical outcome (e.g., surgical site infection rates, mortality, length of stay) and/or healthcare costs. Data extraction and quality assessment were performed independently by two reviewers.
Results: The search yielded 45 studies that met the inclusion criteria. The studies encompassed a variety of neurosurgical procedures, including craniotomies, spinal surgeries, and deep brain stimulation. The infection prevention bundles implemented varied across studies but commonly included preoperative antibiotic prophylaxis, skin antisepsis, and intraoperative measures. The pooled analysis demonstrated a significant reduction in surgical site infection rates and length of stay associated with the use of infection prevention bundles. Moreover, several studies reported cost savings, primarily attributed to reduced complications and shorter hospital stays.
Conclusion: The evidence suggests that infection prevention bundles are effective in improving neurosurgical outcomes and reducing healthcare costs. The implementation of these bundles should be considered a standard of care in neurosurgery to enhance patient safety and optimize resource utilization. Keywords: Neurosurgery, infection prevention, surgical site infection, healthcare costs, systematic review
Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy in Mesial Temporal Lobe Epilepsy: A Meta-Analysis of Seizure Control and Cognitive Outcomes
Get PDFBackground: Mesial temporal lobe epilepsy (MTLE) is a common form of drug-resistant epilepsy often necessitating surgical intervention. The choice between selective amygdalohippocampectomy (SelAH) and anterior temporal lobectomy (ATL) remains a subject of debate, with each procedure offering potential advantages and disadvantages in terms of seizure control and cognitive outcomes.
Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Springer databases to identify studies published between 2013 and September 2024 that compared SELAH and ATL in patients with MTLE. The primary outcomes of interest were seizure freedom rates and changes in cognitive function, particularly IQ scores. A meta-analysis was performed using a random-effects model to pool the results of included studies.
Results: The meta-analysis encompassed 5 studies involving 218 patients with MTLE (105 underwent SelAH, 113 underwent ATL). The pooled results demonstrated a statistically significant reduction in the odds of achieving seizure freedom following ATL compared to SelAH (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.24-0.81, p = 0.008). Regarding cognitive outcomes, no significant difference was observed in Performance IQ (PIQ) between the two groups. However, a trend towards improved Verbal IQ (VIQ) was noted in the SelAH group, although this did not reach statistical significance.
Conclusion: The findings suggest that SelAH may offer superior seizure control compared to ATL in patients with MTLE. While both procedures appear to have comparable effects on PIQ, SelAH may be associated with a trend towards better preservation or even improvement in VIQ. The choice between SelAH and ATL should be individualized based on patient-specific factors, including preoperative cognitive profile and the relative importance of seizure control versus cognitive preservation
Immunological Implications of Gold Weight Implantation for Lagophthalmos: A Systematic Review
Get PDFBackground: Gold weight implantation is a well-established surgical intervention for lagophthalmos, a condition characterized by incomplete eyelid closure. While generally safe and effective, gold implants can elicit immune responses, potentially leading to complications. This systematic review aims to comprehensively evaluate the immunological implications of gold weight implantation in lagophthalmos treatment.
Methods: A systematic search of PubMed and ScienceDirect databases was conducted, encompassing studies published from 2000 to June 2024. Keywords included "gold weight implant" and "gold implant AND eyelid." Studies reporting quantitative data on immune responses to gold implants were included. Data extracted included study design, patient demographics, implant characteristics, follow-up duration, complications, and long-term outcomes.
Results: Thirteen studies met the inclusion criteria, encompassing a total of 340 patients (370 eyelids). Reported complications included hypersensitivity reactions (11.9%), lymphoma (0.6%), infection (1.2%), extrusion (8.1%), and nonspecific inflammatory reactions (4.3%). Hypersensitivity reactions were mediated by T-cell and B-cell responses, leading to chronic inflammation. Lymphoma cases highlighted the potential for chronic inflammation to trigger lymphoproliferative disorders. Infections were infrequent but could necessitate implant removal. Extrusion rates varied, influenced by implant size and placement. Nonspecific inflammatory reactions were observed, often requiring implant removal or steroid treatment.
Conclusion: Gold weight implantation can trigger diverse immune responses, ranging from mild inflammation to severe hypersensitivity and lymphoma. Careful patient selection, meticulous surgical technique, and vigilant postoperative monitoring are crucial to minimize complications. Further research is warranted to elucidate the precise mechanisms underlying these immune responses and develop strategies for their prevention and management
Successful Management of Panuveitis and Associated Complications in a Patient with Clinical Stage III HIV: A Case Report
Get PDFBackground: Human immunodeficiency virus (HIV) infection can lead to a myriad of ocular complications, including panuveitis, an inflammatory condition affecting the entire uvea and surrounding structures. The management of panuveitis in HIV patients is complex, often requiring a multidisciplinary approach to address both the underlying immunodeficiency and the ocular inflammation.
Case presentation: We present the case of a 37-year-old male patient with clinical stage III HIV who presented with panuveitis in the right eye (OD) secondary to herpes zoster ophthalmicus (HZO). The patient also had post-herpetic neuralgia, oral candidiasis, and malnutrition. He reported a history of unprotected sexual encounters with multiple partners. The patient's CD4 count was critically low at 15 cells/µL, indicating severe immunosuppression. He was initiated on antiretroviral therapy (ART), prophylactic medications to prevent opportunistic infections, and pain management for post-herpetic neuralgia.
Conclusion: This case highlights the challenges in managing panuveitis and associated complications in patients with advanced HIV infection. Early diagnosis, prompt initiation of ART, and a multidisciplinary approach are crucial for successful management and improving patient outcomes
Is It a Tumor or Not? A Case of Focal Segmental Glomerulosclerosis Secondary to Type 2 Diabetes with a Concomitant Renal Pseudotumor
Get PDFBackground: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern of glomerular injury that can be primary or secondary to various conditions, including obesity, diabetes, and hypertension. Renal masses, often detected incidentally, can be benign or malignant, with renal cell carcinoma (RCC) being the most common. This case report presents a patient with FSGS secondary to type 2 diabetes and a concomitant renal pseudotumor, initially suspected to be RCC.
Case presentation: A 60-year-old woman presented with weakness, fever, and weight loss. Imaging revealed a renal mass, initially suspected to be RCC. A kidney biopsy revealed FSGS, and further evaluation confirmed type 2 diabetes. After controlling her diabetes and hypertension, the renal mass regressed, suggesting a pseudotumor.
Conclusion: This case highlights the importance of considering pseudotumors in the differential diagnosis of renal masses, especially in patients with comorbidities such as diabetes. A kidney biopsy can help avoid unnecessary invasive procedures like nephrectomy
Myopia Progression in Children: A Comparative Analysis of Pre-Pandemic and Pandemic Periods
Get PDFBackground: The COVID-19 pandemic brought about significant changes in children's lifestyles, including increased screen time and reduced outdoor activities due to school closures and lockdowns. These changes raised concerns about potential myopia progression in children.
Methods: This study compared the spherical equivalent (SE) measurements of children aged 8-17 years from two time visits: one before the pandemic (September 2019 - February 2020) and one during the pandemic (March 2020 - February 2022). Data on family history of myopia, screen time, and outdoor activities were also collected. Paired t-tests were used to analyze the differences in SE between the two visits.
Results: A total of 11 children participated in the study. The mean change in SE was -1.55 D, indicating a significant increase in myopia during the pandemic (p = 0.046). The average daily screen time was 201 minutes, while outdoor activity time was 42 minutes.
Conclusion: The findings suggest a potential corelation between increased screen time, reduced outdoor activities, and myopia progression in children during the pandemic. It is crucial to encourage healthy visual habits, including limiting screen time and promoting outdoor activities, to mitigate the impact of the pandemic on children's vision
A Rare Case of Antithyroid Drug-Induced Lupus Erythematosus, Graves' Disease, and Primary Infertility
Get PDFBackground: Drug-induced lupus erythematosus (DILE) is a rare autoimmune disorder that mimics idiopathic lupus erythematosus, triggered by certain medications. This case report presents a patient with DILE induced by methimazole, a commonly used antithyroid drug, along with Graves' disease and primary infertility.
Case presentation: A 41-year-old woman presented with palpitations, a history of Graves' disease treated with methimazole, and primary infertility. She developed lupus-like symptoms including fever, joint pain, and skin rash. Examination revealed tachycardia, tenderness of the right and left knee joints and limited range of motion. Laboratory investigations confirmed hyperthyroidism and autoimmune features consistent with DILE.
Conclusion: This case highlights the rare occurrence of DILE induced by methimazole, emphasizing the importance of recognizing and managing this condition in patients receiving antithyroid drugs
Pathophysiology and Management of Refractory Rheumatoid Arthritis: A Narrative Literature Review
Get PDFRefractory rheumatoid arthritis is rheumatoid arthritis that fails to achieve low levels of disease activity using 2-3 DMARDS treatment and at least one other first-line bDMARD. The definition of refractory action is based on the number of failed DMARDs, the scale of the problem, and risk factors for a refractory disease course. Until now, there has been no further research discussing the pathophysiology of refractory RA, but it is known that TNF-α, IL-6, and IL-1 are the most important mediators that enable cell migration and inflammation in RA. IL-6 in particular, acts directly on neutrophils, which then contribute to inflammation and joint destruction by secreting proteolytic enzymes. The main goal to be achieved in RA is remission, low disease activity and an alternative goal for those who fail to achieve therapy targets. Currently, there are several bDMARD agents that can be used as therapy for refractory RA, namely TNF alfa inhibitors, B cell depletion agents, T cell activity inhibitors, and cytokine inhibitors
The Significance of TGF-β Expression in Predicting Lymphovascular Invasion and Lymph Node Metastasis in Colorectal Cancer
Get PDFBackground: Colorectal cancer (CRC) is a major health burden globally. The prognosis of CRC is strongly influenced by the presence of lymphovascular invasion (LVI) and lymph node (LN) metastasis. Transforming growth factor-beta (TGF-β) is a cytokine with a complex role in CRC progression. This study aimed to evaluate the significance of TGF-β expression in predicting LVI and LN metastasis in CRC.
Methods: This cross-sectional study involved 50 patients diagnosed with CRC. The expression of TGF-β was assessed using immunohistochemical staining and the Allred scoring system. The relationship between TGF-β expression and the presence of LVI and LN metastasis was analyzed using the Chi-square test.
Results: High TGF-β expression was significantly associated with both LVI (p = 0.011) and LN metastasis (p = 0.012) in CRC. Patients with high TGF-β expression had a higher risk of LVI and LN metastasis compared to those with low TGF-β expression.
Conclusion: TGF-β expression is a significant predictor of LVI and LN metastasis in CRC. This finding has potential implications for risk stratification and treatment decisions in CRC patients