Prognostic Impact of the SARC-F Score in Gastrointestinal Advanced Cancers

We sought to elucidate the prognostic impact of the SARC-F score among patients with gastrointestinal advanced malignancies (n = 421). A SARC-F score ≥ 4 was judged to have a strong suspicion for sarcopenia. In patients with ECOG-PS 4 (n = 43), 3 (n = 61), and 0–2 (n = 317), 42 (97.7%), 53 (86.9%) and 8 (2.5%) had the SARC-F score ≥ 4. During the follow-up period, 145 patients (34.4%) died. All deaths were cancer-related. The 1-year cumulative overall survival (OS) rate in patients with SARC-F ≥ 4 (n = 103) and SARC-F < 4 (n = 318) was 33.9% and 61.6% (p < 0.0001). In the multivariate analysis for the OS, total lymphocyte count ≥ 1081/μL (p = 0.0014), the SARC-F score ≥ 4 (p = 0.0096), Glasgow prognostic score (GPS) 1 (p = 0.0147, GPS 0 as a standard), GPS 2 (p < 0.0001, GPS 0 as a standard), ECOG-PS 2 (p < 0.0001, ECOG-PS 0 as a standard), ECOG-PS 3 (p < 0.0001, ECOG-PS 0 as a standard), and ECOG-PS 4 (p < 0.0001, ECOG-PS 0 as a standard) were independent predictors. In the receiver operating characteristic curve analysis on the prognostic value of the SARC-F score, the sensitivity/specificity was 0.59/0.70, and best cutoff point of the SARC-F score was two. In conclusion, the SARC-F score is useful in patients with gastrointestinal advanced malignancies.

Perforated Duodenal Ulcer in a Young Nepalese Girl: An Infrequent Diagnosis for Age

Perforated duodenal ulcer (PDU) is exceedingly uncommon in children. In a child with acute abdomen and pneumoperitoneum, an appendiceal etiology is more often suspected as a likely cause. Failure or delay to diagnose a PDU can result in significant morbidity and even mortality. We report a case of acute abdomen in a girl with PDU with a successful outcome. A 12-year-old school girl presented to emergency room (ER) with acute generalized abdominal pain for 2 days. Clinical examination revealed florid peritonitis, and abdominal radiographs showed free peritoneal air. At emergency laparotomy, PDU was noted with general peritoneal contamination. Omental patch repair and continued supportive care resulted in gradual improvement. PDU is an uncommon cause of peritonitis in children and poses significant challenges in management. Strong suspicion and prompt appropriate intervention is necessary to avoid untoward outcomes.

FH ALERT: efficacy of a novel approach to identify patients with familial hypercholesterolemia

Diagnosis rates of familial hypercholesterolemia (FH) remain low. We implemented FH ALERT to assess whether alerting physicians for the possibility of FH impacted additional diagnostic activity. The study was conducted from SYNLAB laboratory Weiden (Bavaria). Beyond common reporting of LDL-C or TC, 1411 physicians covering approximately a population of 1.5 million people were eligible to receive an alert letter (AL) including information on FH, if laboratory results exceeded thresholds as follows: adults LDL-C ≥ 190–250 mg/dl (to convert into mmol/l multiply with 0.0259), TC ≥ 250 to ≤ 310 mg/dl (probable suspicion); LDL-C > 250 mg/dl and TC > 310 mg/dl (strong suspicion). Persons below 18 years were alerted for LDL-C 140 mg/dl and TC ≥ 200 mg/dl (strong suspicion). Patients above 60 years were excluded. Our readouts were characteristics of involved physicians, rate of ALs issued, acceptance, and subsequent diagnostic activity. Physicians were mainly general practitioners in ambulatory care. 75% of the ordered tests were for TC, 25% for LDL-C. We issued 3512 ALs (~ 5% of tests) triggered by 2846 patients. 86% of eligible physicians stayed with the initiative, 32.7% were alerted, and 70% were positive upon call-center survey. We registered 101 new visitors of www.fhscore.eu and sent out 93 kits for genetics. Thereof, 26 were returned and 5 patients were positive for FH. Physicians were in general open to our approach. Although genetic testing was taken up with caution, this 3-months pilot examination resulted in a greater rate of patients with FH diagnosed than previous screening projects. Further education on FH in primary care is required to improve FH detection in the community.

Distal Patellar Tendon Avulsion Associated with an ACL Tear in a Teenager: A Case Report and Review of the Literature

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

Retrospective Diagnosis of Ankylosing Spondylitis after Spinal Fractures: A Review of 3 Cases and Clinical Implication

Ankylosing spondylitis (AS) is an underdiagnosed inflammatory condition in the initial stages of disease that can cause vertebral fractures in young adults after trivial trauma. Hence, low-energy spinal fractures in young patients must be carefully evaluated to exclude AS as the treatment protocol (fixation levels, period of immobilization) may change drastically if AS is diagnosed. Here, we present cases of 3 patients who presented at emergency after low-velocity spinal trauma and diagnosed as AS during workup for fracture management. This cases series indicates underdiagnosis of AS in general population as well as importance of strong suspicion of AS in low-energy spinal fractures in the younger age-group.

The Development of the Tarekat among the Madurese Population until the Beginning of the 20th Century

In its development, the number of tarekat found in Madura was three, namely the tarekat Qadiriyah, the tarekat Qadiriyah Wa Naqshabandiyah, and the tarekat Tijaniyah. In addition, the tarekat Syatariyah, which had a lot of contact with the traditions of the local Madurese community, had also been influential, even though it was not so big. In this case it is known that starting from the development of the performing arts among the Madurese population called rateb, or from the Arabic language ratib which is similar to the debus performances in Banten and Aceh, there is a strong suspicion that the tarekat Samaniyah has also developed in Madura since the 18th century. In its journey, the popularity of the tarekat Sammaniyah, especially in Madura, was replaced by the Qadariyah wa Naqsabandiyah. This tarekat in its development has replaced the fame of the tarekat Sammaniyah in the archipelago. The description from the sketch shows that in reality, we are often faced with local Islamic sketches, in the form of rituals, such as tarekat, tahlilan, salvation, and so on. The approaches used to telescope this are textual-contextual and structural-functional approaches. From the analysis, it is found that the patterns of understanding and attitudes of the majority of rural communities, especially Madurese, practice Islamic teachings in the form of rituals that are independent, walk alone, without recognizing the relationship between students and sheikhs or murshids.

KONSEP KEADILAN DALAM POLIGAMI MENURUT AGAMA ISLAM

<p><em>This article focuses on the discussion of the Kagian Islam on justice in polygamy, namely; what are the requirements for polygamy according to the priests of the mazhab, how the arguments and laws of the priests of the mazhab allow polygamy, and how is it relevant to polygamy according to the contemporary context in Indonesia. This research is a library research (Library Reserach), which is a method of collecting data such as the books of the priests of the mazhab and books that are relevant to the issues discussed. This research is a descriptive analysis, which describes, studies and analyzes the opinions of the Imam of the Schools in terms of being fair in polygamy. The results showed that in Islam it is permissible for a husband to practice polygamy on the condition that he believes or has a strong suspicion that he is able to do justice to his wives. as indicated by the al-Qur'an in the letter al-Nisa "verse 3:" then if you are afraid that you will not be able to act fairly, then marry only one wife ". This permissibility for polygamy is not a recommendation but one of the solutions given in special conditions to those (husbands) who really need and fulfill certain conditions. The meaning of justice as a condition for polygamy is not in the inner meaning of justice (such as love and affection) but justice for things that are material and measurable. As indicated by verse 129 of the letter al-Nisa 'and the sociological background because of the verse polygamy (verse 3 al-Nisa'). What is meant by the fairest distribution is in terms of: income, clothing, place to live, and time of turn</em></p>

Intestinal obstruction with oral pigmentation: a clue to Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder, which manifests as mucocutaneous hyperpigmentation and, intestinal and extraintestinal polyps. The classic triad of abdominal pain, mass and jam-like stools are not found commonly. On clinical examination, a strong suspicion of PJS should be made if patients below 18 years, present with mucocutaneous hyperpigmentation and intestinal obstruction. We report a case of a 16-year-old woman who presented to the surgical emergency with a 1-day history of acute pain in abdomen, in right iliac fossa and features of intestinal obstruction. A thorough history and clinical examination supported by diagnostic imaging should be done in suspicious cases for prompt diagnosis and appropriate treatment.

Een patiënte gered door alcohol

A patient saved by alcohol The medical history of a 43-year-old female patient with auto-intoxication of ethylene glycol is reported. Ethylene glycol is a toxic alcohol leading to severe complications if not treated early. Ethylene glycol itself is relatively nontoxic, however life-threatening toxicity appears after metabolization in the liver. These toxic metabolites lead to metabolic acidosis, renal failure, multiple organ failure and death. A quick diagnosis and therapeutic management are important to avoid formation of the metabolites. Serum drug levels give certainty regarding diagnosis, but are rarely available in time to guide management. There is often a strong suspicion or clear history of auto-intoxication. Shortly after large ingestions, patients may present with sedation or inebriation and have a large osmolar gap, but minimal acidosis. After several hours a profound metabolic acidosis with high anion gap will be present. Management involves supportive care, administration of sodium bicarbonate to correct systemic acidosis, inhibition of the enzyme alcohol dehydrogenase with either fomepizole or ethanol, haemodialysis and treatment with cofactors to optimize nontoxic metabolic pathways. Methanol poisoning is also discussed in this article, as methanol is another toxic alcohol with a similar therapeutic management.

Chronic obstructive Eustachian tube dysfunction: CT assessment with Valsalva maneuver and ETS-7 score

Chronic obstructive Eustachian tube dysfunction (ETD) is a common disorder of the middle ear. In recent years, two main diagnostic tools have become available: Eustachian tube score (ETS-7) and computed tomography (CT) combined with Valsalva maneuver. The aim of this study is to evaluate the outcomes of ETS-7 and CT in a group of patients affected by middle ear atelectasis with a strong suspicion of ETD. Three males and nine females, affected by middle ear atelectasis with retraction of the TM were enrolled. Each patient underwent to Eustachian tube dysfunction evaluation adopting the ETS-7 score and a temporal bone CT with Valsalva maneuver. The ears analyzed at steady state were divided into 2 groups: ETS<7 group and ETS≥ 7 group. The same division was applied for the ears analyzed after the Valsalva maneuver: ETS<7 group and ETS≥ 7 group. ETs were categorized as “well defined” (WD) and “not defined” (ND). The results of the analysis of the ETS-7 score in all 24 ears showed that 42% presented ETS ≥7, while 58% had ETS <7, indicating a diagnosis of ETD. In the ETS<7 group after Valsalva, ET was visualized in 33% of patients. In the ETS≥7 group it was WD in 29% after the Valsalva manoeuver. In both groups the comparison between the visualization of the ET before and after the Valsalva manoeuver did not present a statistical difference. No correlation emerged between ET evaluation with CT scan during Valsalva maneuver and ETS-7 score. It confirms that there is not a gold standard for the study of ET dysfunction.