Isolated Splenic Metastasis of Primary Lung Cancer Presented as Metachronous Oligometastatic Disease—A Case Report

Modern oncology practice and new antitumor drugs prolonged disease-free intervals in patients with lung cancer. Patients with distant metastatic disease are treated only with palliative intent. The International Association for the Study of Lung Cancer, in the 8th edition of the TNM classification, for the first time includes oligometastatic disease as a clinical state that describes the patients with distant metastasis, limited in number and organ sites, who may have more indolent biology. In this paper, we present a case of a 56-year-old man who was admitted to our clinic regarding a radiologically diagnosed splenic lesion of uncertain nature, and who underwent a left upper lobectomy for primary lung cancer 12 years before. After a detailed radiological diagnosis, it was concluded that it is highly suspected metastatic lesion of the spleen and the patient underwent a splenectomy. While no definitive protocols exist on the management of isolated splenic metastasis from lung cancer, splenectomy, in suitable patients, with reasonable survival expectations, improves patient disease-free survival and can prevent potentially life-threatening complications, such as splenic rupture. 18F-FDG PET has very high sensitivity and specificity for differentiating benign and malignant splenic lesions especially in patients who are in the follow up protocol due to primary malignancy.

Prediction and risk stratification from hospital discharge records based on Hierarchical sLDA

Background The greatly accelerated development of information technology has conveniently provided adoption for risk stratification, which means more beneficial for both patients and clinicians. Risk stratification offers accurate individualized prevention and therapeutic decision making etc. Hospital discharge records (HDRs) routinely include accurate conclusions of diagnoses of the patients. For this reason, in this paper, we propose an improved model for risk stratification in a supervised fashion by exploring HDRs about coronary heart disease (CHD). Methods We introduced an improved four-layer supervised latent Dirichlet allocation (sLDA) approach called Hierarchical sLDA model, which categorized patient features in HDRs as patient feature-value pairs in one-hot way according to clinical guidelines for lab test of CHD. To address the data missing and imbalance problem, RFs and SMOTE methods are used respectively. After TF-IDF processing of datasets, variational Bayes expectation-maximization method and generalized linear model were used to recognize the latent clinical state of a patient, i.e., risk stratification, as well as to predict CHD. Accuracy, macro-F1, training and testing time performance were used to evaluate the performance of our model. Results According to the characteristics of our datasets, i.e., patient feature-value pairs, we construct a supervised topic model by adding one more Dirichlet distribution hyperparameter to sLDA. Compared with established supervised algorithm Multi-class sLDA model, we demonstrate that our proposed approach enhances training time by 59.74% and testing time by 25.58% but almost no loss of average prediction accuracy on our datasets. Conclusions A model for risk stratification and prediction of CHD based on sLDA model was proposed. Experimental results show that Hierarchical sLDA model we proposed is competitive in time performance and accuracy. Hierarchical processing of patient features can significantly improve the disadvantages of low efficiency and time-consuming Gibbs sampling of sLDA model.

Observational Study: Application of Therapy with Equine Serum for Patients Diagnosed with COVID-19 in Tucumán, Argentina

Purpose: The objective of this work is to make an observational study of the usage in moderate or severe state COVID-19 patients of a new therapeutic commercial product obtained after immunization of horses: CoviFab® ELEA F(ab')2 fragmented equine immunoglobulins anti SARS-CoV2.Methods: Participant Centres depend on the Public Health System of Tucumán, Argentina were recruitment. Subjects were assigned to the Moderate Patient Group (MPG) and the Severe Patient Group (SPG), classified according to WHO criteria.In total, n = 84 were enrolled for this study. The subjects were divided into MPG and SPG. All participants were evaluated by physical examination and COVID-19 infection was diagnosed with positive RT-PCR. Each subject received two doses of 0.16 ml / kg, according to the subject's body weight. A generalized linear model with binomial distribution was adjusted for the number of symptoms. Data was analysed using proportion, bivariate and logistic regression. P-value was considered significant at the p< 0.05 threshold.Results: Both groups were similar in age, sex, and comorbidities. A higher proportion of patient with medical discharge was observed in MPG (91.4%) vs. SPG (55.3%) (p= 0.004). MPG showed 9 times more chance of receiving medical discharge than SPG (9.33 CI= [1.65, 52.81]; p= 0.012). Then, the chance to get medical discharge was independent of variables sex, age, and comorbidities. Conclusions: Treatment with Equine Serum in patients with moderate and severe disease of COVID-19 managed to slightly reduce hospitalization time. This treatment improved the clinical state to obtain medical discharge. The bivariate analysis showed 8 times more chance in MGP versus SGP to receive of medical discharge and this chance was independent of the pre-existent comorbidities.

Double-blind cross-over pilot trial protocol to evaluate the safety and preliminary efficacy of long-term adaptive deep brain stimulation in patients with Parkinson’s disease

IntroductionAfter several years of brain-sensing technology development and proof-of-concept studies, adaptive deep brain stimulation (aDBS) is ready to better treat Parkinson’s disease (PD) using aDBS-capable implantable pulse generators (IPGs). New aDBS devices are capable of continuous sensing of neuronal activity from the subthalamic nucleus (STN) and contemporaneous stimulation automatically adapted to match the patient’s clinical state estimated from the analysis of STN activity using proprietary algorithms. Specific studies are necessary to assess superiority of aDBS vs conventional DBS (cDBS) therapy. This protocol describes an original innovative multicentre international study aimed to assess safety and efficacy of aDBS vs cDBS using a new generation of DBS IPG in PD (AlphaDBS system by Newronika SpA, Milan, Italy).MethodsThe study involves six investigational sites (in Italy, Poland and The Netherlands). The primary objective will be to evaluate the safety and tolerability of the AlphaDBS System, when used in cDBS and aDBS mode. Secondary objective will be to evaluate the potential efficacy of aDBS. After eligibility screening, 15 patients with PD already implanted with DBS systems and in need of battery replacement will be randomised to enter a two-phase protocol, including a ‘short-term follow-up’ (2 days experimental sessions during hospitalisation, 1 day per each mode) and a ‘long-term follow-up’ (1 month at home, 15 days per each mode).Ethics and disseminationThe trial was approved as premarket study by the Italian, Polish, and Dutch Competent Authorities: Bioethics Committee at National Oncology Institute of Maria Skłodowska-Curie—National Research Institute in Warsaw; Comitato Etico Milano Area 2; Comitato Etico IRCCS Istituto Neurologico C. Besta; Comitato Etico interaziendale AOUC Città della Salute e della Scienza—AO Ordine Mauriziano di Torino—ASL Città di Torino; De Medisch Ethisch Toetsingscommissie van Maastricht UMC. The study started enrolling patients in January 2021.Trial registration numberNCT04681534.

Homeopathic treatment of vaginal leiomyoma in a dog: case report

The most common vaginal neoplasias in old dogs are leiomyoma and fibroma. Although surgical excision is the indicated treatment, it does not eliminate potential complications that may lead to death or poor quality of life. This paper reports the case of a 9 year-old female Doberman dog with vaginal leiomyoma attended by copious and recidivating colporrhagia homeopathically treated between March and December 2005. Homeopathic approach was the one designed at Homeopathic Unit of the Veterinary Hospital, Rural Federal University of Rio de Janeiro, Brazil. The progress of disease was assessed through clinical evaluation, laboratory exams and ultrasonography. Hemorrhage decreased while the general clinical state of the animal improved. After 7 months of homeopathic treatment, the tumor was spontaneously eliminated through violent abdominal contractions, which was followed by recovery of the animal’s state of health. Keywords: Homeopathy; Veterinary medicine; Tumors; Leiomyoma; Vaginal; Dogs.  Tratamento homeopático de leiomioma vaginal em cães: relato de caso Resumo As neoplasias vaginais mais comuns em cadelas velhas são o leiomioma e o fibroma. Embora a excisão cirúrgica é o tratamento indicado, não elimina complicações potenciais que podem levar ao óbito ou baixa qualidade de vida. O presente artigo relata o caso de uma cadela Doberman de 9 anos de idade, com leiomioma vaginal, apresentando colporragia copiosa e recidivante, tratada entre março e dezembro de 2005. A abordagem homeopática utilizada foi a desenvolvida na Unidade Homeopática do Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro, Brasil. A evolução da doença foi acompanhada através de avaliação clínica, testes de laboratório e ultrassonografia. A hemorragia diminuiu e o estado geral melhorou. Depois de 7 meses de tratamento homeopático, o tumor foi espontaneamente eliminado através de violentas contrações abdominais, seguido de recuperação do estado de saúde do animal. Palavras-chave: Homeopatia, Medicina Veterinária; Tumores; Leiomioma; Vaginal; Cães.  Tratamento homeopático de leiomioma vaginal en canino: relato de caso Resumen Las neoplasias vaginales más comunes en caninos ancianos son el leiomioma y el fibroma. Aunque la excisión quirúrgica es el tratamiento de elección, no elimina complicaciones potenciales que pueden llevar al deceso o pobre calidad de vida. Este artículo relata el caso de un canino Doberman femenino de 9 años de edad, con leiomioma vaginal acompañado de colporragia abundante y recidivante, tratado entre marzo y diciembre de 2005. El abordaje homeopático utilizado fue el desarrollado en la Unidad Homeopática del Hospital Veterinario de la Universidad Federal Rural de Río de Janeiro, Brasil. La evolución de la enfermedad fue estimada mediante evaluación clínica, exámenes de laboratorio y ecografía. Las hemorragias disminuyeron, con mejoría del estado general. Después de 7 meses de tratamiento homeopático, el tumor fue espontáneamente eliminado mediante violentas contracciones abdominales, seguido de recuperación del estado de salud del animal. Palabras-clave: Homeopatía, Medicina veterinaria; Tumores; Leiomioma; vaginal; Perros.  Correspondence author: Luiz Figueira Pinto. [email protected] How to cite this article: Ferreira MIC, Pinto LF. Homeopathic treatment of vaginal leiomyoma in a dog: case report. Int J High Dilution Res [online]. 2008 [cited YYYY Mmm DD]; 7(24):152-158. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/304/358. ÂÂÂ

Evaluation of the effectiveness of drug treatment in patients with arterial hypertension and insomnia

Objective: chronic sleep disturbance is a comorbid condition with arterial hypertension, often combined with affective disorders, anxiety, depression. Forced sleep deprivation in patients with hypertension indicates a high activity of the renin‑angiotensin‑aldosterone system (RAAS) and desynchronosis of biological rhythms caused by a probable deficit in melatonin secretion during the night. Timely elimination of any pathological process associated with insomnia and arterial hypertension (AH) in the early stages of its development is a prerequisite for the effectiveness of therapy. Therefore, initial therapy should help neutralize the adverse effects of RAAS and improve the 24‑hour blood pressure (BP) profile. The aim of this study was to determine the therapeutic effect of monotherapy with an angiotensin converting enzyme (ACE) inhibitor, As well as in combination with a synthetic analogue of melatonin, on the course of hypertension and parameters of systemic hemodynamics in patients with first degree hypertension with insomnia at the onset of the disease. Combined therapy with an ACE inhibitor and a synthetic analogue of MT in patients with hypertension and insomnia was accompanied by an improvement in the clinical state, achievement of the target blood pressure level in most patients, positive dynamics of central blood pressure parameters and indicators reflecting the rigidity of peripheral arteries.

Voices 2: Improving Prosodic Recognition in Schizophrenia With an Online Rehabilitation Program

Introduction: Emotion recognition of voices may play an important role in interpersonal communication and patients with schizophrenia present alterations in this regard. Several on-line rehabilitation tools have been developed for treatment in this area. Voices is an on-line prosodic recognition program consisting of identifying different emotional tones in neutral phrases, in different sessions of gradually increasing difficulty. This training tool has previously reported benefits, and a new version has been created called Voices 2. The main aim of this study is to test the capacity of the Voices 2 program to improve emotion recognition through prosody for adults with schizophrenia. Secondly, it seeks to observe durability effects 1 month after intervention.Method: A randomized, single-blind, multicenter clinical trial was conducted with 44 outpatients diagnosed with schizophrenia or schizoaffective disorder. The intervention group (also called Voices) was treated with Voices 2, whereas the control group was treated with auditory training that was not related to emotions. Sociodemographic and clinical data, clinical state (PANSS), Intelligence Quotient and prosodic recognition (RMV-SV) were measured at baseline. After intervention, RMV-SV and PANSS were assessed. One month later, the RMV-SV measure was repeated.Results: The control group (n = 19) and the Voices group (n = 22) did not differ on χ2, t or U tests in sociodemographic, clinical and psychometric variables at baseline or post-intervention (all p-values &gt; 0.05). In the Voices group, statistically significant differences were observed in the RMV-SV scale applied post-intervention vs. that applied pre-intervention (Z = 2.47, p = 0.013). Similar results were observed in the 1-month follow-up RMV-SV vs. the pre-intervention RMV-SV (Z = 1.97, p = 0.049). PANSS scale was also assessed with no significant differences between pre vs. post measures in both groups. Lastly, Voices 2 was rated relatively higher, based on its ease of understanding, entertainment value, usefulness and the appropriateness of use of its emotional glossary.Discussion: Improvements were observed in prosodic recognition following intervention with Voices 2 in the Voices group. Although these results are similar to other clinical trial rehabilitation programs, specific research on the matter remains scarce. Certain aspects, such as the durability of effects or adherence should be thoroughly studied and clarified.Clinical Trial Registration: [https://doi.org/10.17605/OSF.IO/G95C4].

Clustering Treatment Outcomes in Women with Gambling Disorder

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Case Report on Guillain-Barre Syndrome (GBS) in Adult

Introduction: Guillain-Barre-syndrome is when the immune system attacks the peripheral nervous system were disease progresses to trembling and muscle weakness in both hands and legs, which progress to upper body and arms. Clinical Findings: High grade intermittent fever, low back pain, B/L LL weak, urinary incontinence which is intermittent in nature. Diagnostic Evaluation: Neurological examination- revealed B/L UL and LL weakness, acute onset of quadriparesis. X-Ray – revealed normal sinus rhythm. CSF examination – revealed No RBC; No pus cell; No Organism seen. Lab investigation – Hb% 10%, total RBC count 4.45, total WBC 10400, total platelet 2.33, SGOT 226 SGPT 83, Peripheral Smear RBCs - Normocytic Normochromic platelets adequate smear no Haemoparasite seen. Blood Culture: revealed Growth of Acinetobacter species. Therapeutic Intervention: Inj. Optineurone 1gm, Inj.Pantop 40mg, Tab.PCM,Inj. Tramadol 500mg, Immunoglobin (Ig) 100ml , physiotherapy and supportive therapy. Outcome: The symptoms and clinical state of the patient improved over time. The patient's weakness began to improve after 5 days of IV-Ig therapy. Conclusion: The patient was hospitalised to the neurosurgery ICU AVBRH on 05/06/20 with the known case of guillain-barre syndrome-(GBS). After receiving therapy, she showed significant progress.

How to avoid the problem of erythrocyte alloimmunization in sickle cell disease

Erythrocyte alloimmunization is a major barrier to transfusion in sickle cell disease (SCD) because it can lead to transfusion deadlock and the development of life-threatening hemolytic transfusion reactions (HTRs). Several risk factors have been identified, such as blood group polymorphism in these patients of African ancestry frequently exposed to antigens they do not carry and an inflammatory clinical state of the disease. The most important preventive measure is prophylactic red blood cell antigen matching, and there is a consensus that matching for Rh (D, C, E, c, e) and K antigens should be performed for all SCD patients. However, some patients are high responders and more at risk of developing antibodies and HTRs. For these patients, the extension of matching to other blood groups, including variant antigens of the RH blood group, the use of genotyping rather than serology to characterize significant blood groups, and the prophylactic administration of immunosuppressive treatments remain a matter of debate due to low levels of certainty concerning their effects and the difficulty of determining which patients, other than those already immunized, are at high risk. These issues were recently addressed by a panel of experts established by the American Society of Hematology. Here, we review and stratify the various interventions for preventing alloimmunization, based on the literature and our experience and taking into account the obstacles to their implementation and any future developments required.