Introduction. Spinal neurosarcoidosis is a rare disease that can manifest as myelopathy, radiculopathy, or cauda equine syndrome. Spinal epidural lipomatosis is also a rare condition resulting from overgrowth of epidural fat tissue causing compressive myelopathy. To our knowledge, there are no reports linking epidural lipomatosis and spinal neurosarcoidosis. Case Report. We describe a case of progressive myelitis in the presence of concomitant spinal neurosarcoidosis and epidural lipomatosis which was a challenging diagnosis with complete response to treatment after addressing both diseases. Both etiologies are inflammatory in nature and share similar expression of inflammatory factors such as TNF-α and IL-1β. Conclusion. The common inflammatory process involved in these two diseases might explain a pathophysiological interconnection between both diseases that may underlie their concomitant development in our patient. If these two diseases are interconnected, in their pathophysiological mechanism remains a hypothesis that will need further investigation.
Objectives:Motor neuron disease is a progressive neurodegenerative disease involving upper and lower motor neurons. Nonmotor symptoms (NMS) are part of disease manifestation. We aim to report the prevalence and severity of NMS in patients with motor neuron disease (MND) in Lebanon.
Methods:Fifty-eight patients diagnosed with MND at the American University of Beirut Medical Center were interviewed using the NMS Scale. The prevalence of these symptoms was assessed and correlated with disease progression.
Results:All our patients had at least 2 NMS with an average total score of 15.8. Symptoms reported in more than half of the patients were fatigue, depression, dysphagia, lack of motivation, pain, change in weight, anxiety, constipation, and lack of pleasure. A significant correlation was found between the total NMS score and Amyotrophic Lateral Sclerosis Functional Rating Scale score (P ¼ 0.002) and between the NMS score corresponding to mental health and Amyotrophic Lateral Sclerosis Functional Rating Scale score (P ¼ 0.012). Patients with bulbar symptoms had a significantly higher NMS score corresponding to gastrointestinal symptoms (P , 0.0001). It is important to note that NMS such as dysphagia could be related to motor neuron involvement.
Conclusions:NMS are commonly reported in patients with MND and seem to positively correlate with disease progression. Treating NMS is a critical aspect of the clinical care delivered to patients with MND to maintain a good quality of life.
Original Research Article Objective: Assessing the performance of European System for Cardiac Operative Evaluation (EuroSCORE) and EuroSCORE II. Method: 4145 patients who underwent cardiac surgery between 1 st January 2015 to 31 st December 2016 in Institut Jantung Negara (IJN) were included. The entire cohort and isolated coronary bypass graft (CABG) patients were analyzed by measuring the area under the receiver operating characteristic (ROC) curve for model discrimination and Hosmer-Lemeshow Chi-squared test for model calibration. Performance of both models was compared. Result: For the entire cohort, ROC curve for EuroSCORE was 0.679; EuroSCORE II was 0.615. For isolated CABG patients, ROC curve for EuroSCORE was 0.670; EuroSCORE II was 0.609. For the entire cohort, Hosmer-Lemeshow test showed no significant difference between expected and observed mortality according to EuroSCORE model (Chi-square = 5.284, P = 0.508) and EuroSCORE II model (Chi-square = 15.828, P = 0.050). For the isolated CABG patients, Hosmer-Lemeshow test showed no significant difference between expected and observed mortality according to EuroSCORE model (Chi-square = 5.365, P = 0.498) and EuroSCORE II model (Chi-square = 9.839, P = 0.276). For the entire cohort (Table 7), the observed and predicted mortality were 4.56% and 3.7% respectively for EuroSCORE; observed and predicted mortality were similar at 4.56% for EuroSCORE II. For isolated CABG patients (Table 8), the observed and predicted mortality were 3.62% and 3.36% respectively for EuroSCORE; the observed and predicted mortality were 3.62% and 3.97% respectively for EuroSCORE II. Conclusion: Despite poor discrimination under the ROC, the calibration of both models was good and acceptable to be used for risk prediction tools in our centre.
Objective
To evaluate factors that affect a gynecologist’s decision to remove an asymptomatic uterus at the time of removal of a presumed benign adnexal mass.
Methods
Retrospective chart review of hysterectomies conducted when removing presumed benign adnexal masses at a tertiary‐care academic center. Primary outcome was the final pathology of the adnexal mass to determine whether the hysterectomy was medically indicated. Secondary outcomes included the rate of postoperative complications.
Results
We included 185 out of 1415 charts. Most hysterectomies were performed by gynecologic oncologists (68.8%); 113 (61%) had a frozen section and of those, 76 (67.3%) were benign. Final adnexal pathology was benign in 135 (73%) cases. Using a bivariate analysis, menopausal status (P = 0.019), parity (P = 0.047), sonographic appearance of the mass (P = 0.049), and the physician’s preoperative suspicion for malignancy (P < 0.001) were significantly associated with the final adnexal pathology. At the multivariate level, only the physician’s suspicion for malignancy was significantly associated with the final adnexal pathology (P < 0.0001) with an odds ratio of 7.28 (95% confidence interval 3.11–17.02).
Conclusion
Despite gynecologists' capacity to predict the malignant nature of an adnexal mass, 135 of 185 (73%) hysterectomies were performed without a clear medical indication, at the time of removal of benign adnexal masses.
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