Process evaluation of a pragmatic feasibility trial on smokeless tobacco cessation intervention delivered in dental hospitals.

BACKGROUND: Article 14 of the WHO 'Framework Convention on Tobacco Control' recommends, that all oral healthcare providers provide support for tobacco cessation, to all patients. Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, implementation remains low in most high-burden countries like Pakistan. A pragmatic pilot trial of a dentist-delivered behavioural support intervention for smokeless tobacco (ST) cessation, was conducted in dental hospitals in Pakistan. This paper presents the findings of the process evaluation of the trial. METHODS: A mixed-method process evaluation of a multi-centre randomised control pilot trial of dentist-delivered behavioural support intervention ST cessation was conducted. The intervention included three sessions namely: pre-quit, quit and post-quit sessions. The process evaluation involved: semi-structured interviews with trial participants (n = 26, of which dental patients were n = 13 and participating dentists were n = 13 conducted from June-August 2022); and fidelity assessment of audio recordings of the intervention sessions (n = 29). The framework approach was used to thematically analyse the interview data. RESULTS: Overall the trial procedures were well accepted, however, young patients expressed uneasiness over revealing their ST use status. The intervention was received positively by dentists and patients. Dentists identified some challenges in delivering behavioural support to their patients. Of these, some were related to the contents of the intervention whereas, others were related to the logistics of delivering the intervention in a clinical setting (such as workload and space). Acceptability of the intervention resources was overall low amongst young patients as they did not take the intervention resources home due to fear of their family members finding out about their ST use. The intervention was successful in achieving the intended impact (in those who engaged with the intervention), i.e., change in the patients' ST use behaviour. Giving up ST with the aid of behavioural support also had an unintended negative effect i.e., the use of harmful substances (cannabis, cigarettes) to give up ST use. Patients' satisfaction with their dental treatment seemed to influence the intervention outcome. CONCLUSION: While there are many variables to consider, but for the participants of this study, behavioural support for abstinence delivered through dentists during routine dental care, appears to be an acceptable and practical approach in helping patients give up ST use, in a country like Pakistan, where negligible support is offered to ST users.

A massive malignant pleural effusion due to lung adenocarcinoma in an adult male: a case report.

A significant right-sided pleural effusion was seen on chest radiography in a 53-year-old adult male who complained of bilateral chest pain, shortness of breath, and other additional symptoms. The bloody pleural effusion was removed with a chest tube, and cytopathology analysis showed moderate cellularity. After performing a high-resolution computed tomography, it was discovered that the affected lung had a significant pleural effusion on the right side as well as collapsed and consolidated lung parenchyma. Upon further examination, the right lower lobe wedge biopsy cytology smear revealed mucinous adenocarcinoma. Adults rarely experience a severe malignant pleural effusion brought on by lung adenocarcinoma, particularly in the absence of risk factors.

Removal of an atypical ovarian dermoid cyst: a case report.

Ovarian dermoid cysts, also known as mature teratomas, are benign embryonal tumors with a slow growth rate. They are the consequence of ectodermal components becoming trapped along with their closure sites and account for the most common germinative ovarian tumor in reproductive-aged women. These patients may have a reduced risk of morbidity if they receive an accurate diagnosis and extensive follow-up care. These cysts are often evaluated using one of the following imaging techniques: computed tomography, magnetic resonance imaging, pelvic ultrasonography, or transvaginal ultrasound. Laparoscopy and laparotomy are the 2 surgical procedures typically used to remove persistent or exceptionally large cysts. Leakage of cyst contents during surgery is a common postoperative complication that can seldom, but occasionally, results in chemical peritonitis. We discuss a case of a significant dermoid cyst that developed in an older woman and was successfully removed via laparoscopic surgery. This instance is instructive for other physicians who may encounter a similar pathology.

An Infected Simple Renal Cyst at Each Pole of the Left Kidney and Its Management: A Case Report.

A simple renal cyst can become infected spontaneously due to various modes like direct cyst penetration during biopsy or surgical exploration, hematogenous spread of infection, and retrograde infection from the urinary tract. Managing such cases becomes challenging due to the risk of rupture of the cyst, causing sequelae of bacteremia and septic shock. Aspiration of cyst along with imaging modality can strengthen the diagnosis. However, nephrectomy coupled with antibacterial administration is an updated therapeutic intervention for an infected simple renal cyst. Our patient presented with a renal cyst at each pole of the left kidney complicated by infection, and after confirming the diagnosis on computed tomography, we performed a right-sided nephrectomy after proper informed consent. The patient responded well to treatment and improved her quality of life.

A Rare Case of Renal Cell Carcinoma With Inferior Vena Cava Invasion: A Life-Threatening Complication.

Renal cell carcinoma (RCC) arises from the renal tubular epithelial cells and comprises a group of heterogenous renal tumors. Renal tumors can metastasize to involve almost any body organ, the common sites being the lung, liver, bone, brain, adrenal gland, head, neck, and rarely, inferior vena cava (IVC), leading to lethal outcomes. We present a case of RCC with IVC invasion in a patient who presented with right-sided flank pain and gross hematuria. His routine biochemical and hematological parameters were unremarkable, and an abdominal examination revealed a complex renal mass with mild hydronephrosis. The patient underwent contrast-enhanced magnetic resonance angiography with venography, which showed a right renal upper polar mass lesion extending into the right vein obliterating it up to its junction with the IVC. Integrating examination and imaging findings were suggestive of right renal RCC. Our case highlights the importance of standard preoperative MRI imaging to assess IVC invasion and its morphologic features including vessel breach or complete occlusion of the IVC.

Recognizing sinonasal cancer in primary care: a matched case-control study using electronic records.

BACKGROUND: Cancers of the nasopharynx, nasal cavity, and accessory sinuses ("sinonasal") are rare in England, with around 750 patients diagnosed annually. There are no specific National Institute for Health and Care Excellence (NICE) referral guidelines for these cancers and no primary care research published. OBJECTIVE: To identify and quantify clinical features of sinonasal cancer in UK primary care patients. METHODS: This matched case-control study used UK Clinical Practice Research Datalink (CPRD) data. Patients were aged ≥40 years with a diagnosis of sinonasal cancer between January 1, 2000 and December 31, 2009 and had consulted their GP in the year before diagnosis. Clinical features of sinonasal cancer were analysed using conditional logistic regression. Positive predictive values (PPVs) for single and combined features were calculated. RESULTS: In total, 155 cases and 697 controls were studied. Nine symptoms and one abnormal investigation were significantly associated with the cancer: nasal mass; odds ratio, 95 (95% confidence interval 7.0, 1315, P = 0.001); head and neck lumps, 68 (12, 387, P < 0.001); epistaxis, 17 (3.9, 70, P < 0.001); rhinorrhoea, 14 (4.6, 44, P < 0.001); visual disturbance, 12 (2.2, 67, P = 0.004); sinusitis, 7.3 (2.2, 25, P = 0.001); sore throat, 6.0 (2.0, 18, P = 0.001); otalgia, 5.4 (1.6, 18, P = 0.007); headache, 3.6 (1.4, 9.5, P = 0.01); raised white cell count, 8.5 (2.8, 27, P < 0.001). Combined PPVs for epistaxis/rhinorrhoea, epistaxis/sinusitis, and rhinorrhoea/sinusitis were 0.62%. CONCLUSION: This is the first primary care study identifying epistaxis, sinusitis, and rhinorrhoea as part of the clinical prodrome of sinonasal cancer. Although no PPVs meet the 3% NICE referral threshold, these results may help clinicians identify who warrants safety-netting and possible specialist referral, potentially reducing the number of advanced-stage diagnoses of sinonasal cancer.

Sinonasal cancer occurs in the back of the nose or in the sinuses. It is rare in the United Kingdom, with most cases being diagnosed at an advanced stage. Delayed presentation and non-specific symptoms often lead to diagnosis at a later stage, with consequently poorer survival outcomes. Currently, there is no research describing the symptoms presented by these patients to their general practitioner (GP), nor referral guidelines for primary healthcare professionals. The aim of this study was to detect the symptoms of patients aged ≥40 years, diagnosed with sinonasal cancer in primary care. Three symptoms in the year before their diagnosis were linked with sinonasal cancer: nosebleeds, runny nose, and sinusitis. These symptoms may help GPs to identify possible sinonasal cancer patients earlier, though each symptom was low-risk on its own.

Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia.

Clinicians must be mindful of angiographic appearances in patients with spontaneous coronary artery dissection (SCAD) in the setting of fibromuscular dysplasia (FMD) for the timely management of these high-risk patients. The objective is to highlight the clinical diagnostic and treatment modalities in rare case presentations of patients presenting with concurrent SCAD and FMD presentation. A qualitative review of scholarly materials. Twenty-seven patients who presented with a combination of SCAD and FMD from January 1, 2009, to August 2019 were identified. Various demographics such as age, gender, FMD location, acute-phase treatment (i.e., percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) vs. conservative), treatment outcomes, and then grouped into two tables. The mean age >46 years and standard deviation (SD) were used to calculate the normal distribution and percentile used to calculate others for treatment. SCAD and FMD cases were collected from three search engines ranging between 2009 and 2019. 22% of the patients had coronary artery disease (CAD). Additionally, 44.4% representing 12 patients with ST-segment elevation acute myocardial infarction (STEMI), four patients 14.8% presented with a non-ST-segment elevation myocardial infarction (NSTEMI), and nine patients 33.33% offered with unstable angina. Besides, 13 patients were diagnosed with optical coherence tomography (OCT), while intravascular ultrasound (IVUS) diagnosed six patients. SCAD is still very rare compared to other causes of myocardial infarction. Data has shown that up to 25% of acute coronary syndrome (ACS) cases of women between 40 and 65 years are SCAD.

Autologous hematopoietic stem cell transplantation in a pediatric patient with aquaporin-4 neuromyelitis optica spectrum disorder.

We report on a child with an early and severe manifestation of an Aquaporin-4 (AQP-4) positive Neuromyelitis Optica Spectrum Disorder (NMOSD) who had a refractory disease course despite aggressive immunotherapy and underwent autologous hematopoietic stem cell transplant (AHSCT).

Aquaporin-4 neuromyelitis optica spectrum disorder in a 2-year-old girl: Diagnostic and treatment considerations.

We describe a case of an unusually early and severe manifestation of Aquaporin-4 (AQP-4) positive Neuromyelitis Optica Spectrum Disorder (NMOSD) in a two-year-old girl. We discuss learning points from her clinical presentation and highlight differences between pediatric and adult presentations of the disease. We argue that AQP-4 NMOSD should always be considered in the differential diagnosis for any child presenting with an acute neuroimmunological process given the morbidity associated with the condition and the importance of early diagnosis and treatment.