An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma. CASE PRESENTATION: We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx. CONCLUSION: To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.

An accidental finding of a retroperitoneal desmoid tumor: case report and review of the literature.

Retroperitoneal desmoid-type fibromatosis is a rare benign mesenchymal neoplasm that develops as a result of fibroblastic proliferation within the musculoaponeurotic stroma. The authors present the case of a 41-year-old male patient who was referred for a retroperitoneal neoplasm. A mesenteric mass core biopsy was done, and it revealed a low-grade spindle cell lesion consistent with desmoid fibromatosis.

Long segment Rosai-Dorfman disease-causing spinal cord compression: A case report.

INTRODUCTION AND IMPORTANCE: Rosai-Dorfman disease is a rare, histiocytic lymphoproliferative disease of unknown etiology. It manifests mainly as painless cervical lymphadenopathy, with very few cases reported extranodal involvement in the central nervous system. Isolated spinal Rosai-Dorfman disease is sporadic. CASE PRESENTATION: This case report documents a rare instance of an isolated long-segment spinal Rosai-Dorfman disease (C4-D6) along with the review of relevant literature. A 33-year male presented with progressive quadriparesis and urinary retention. A magnetic resonance scan (MRI) revealed a long segment epidural lesion from C4-D6 levels that led to the displacement of the cord. A core biopsy of the spinal tumor revealed characteristic histiocytic emperipolesis and confirmational immunocytohistochemistry markers, confirming the diagnosis. Surgical resection and laminoplasty were performed. CLINICAL DISCUSSION: The following histopathology and immunocytohistochemistry findings showed the presence of histiocytes positive for S100 and CD68 positive. Therefore, it was diagnosed to be a case of Rosai-Dorfman disease. The patient had a smooth postoperative recovery and displayed marked motor improvement in the ensuing days. This is a rare case that posed an intriguing challenge to approach. CONCLUSION: To our knowledge, we have encountered one of the most prolonged segmental lesions in isolated spinal Rosai-Dorfman diseases, where surgical management (surgical resection and laminoplasty) has proven to bring about remarkable improvement.

Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia.

PURPOSE: To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia. DESIGN: Retrospective claims-based cohort study. PARTICIPANTS: A 20% representative sample of Medicare beneficiaries, 2006-2015. METHODS: Dementia was identified from diagnosis codes on or prior to each beneficiary's first-eye cataract surgery. For each surgery, we identified setting, routine vs complex coding, anesthesia provider type, duration, and any postoperative hospitalization. We evaluated 30- and 90-day complication rates-return to operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, glaucoma, or choroidal detachment-and used adjusted regression models to evaluate likelihood of surgical characteristics and complications. Complication analyses were stratified by second-eye cataract surgery within 90 days postoperatively. RESULTS: We identified 457,128 beneficiaries undergoing first-eye cataract surgery, 23,332 (5.1%) with dementia. None of the evaluated surgical complications were more likely in dementia-diagnosed beneficiaries. There was also no difference in likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization. Dementia-diagnosed beneficiaries were more likely to have surgeries coded as complex (15.6% of cases vs 8.8%, P < .0001), and surgeries exceeding 30 minutes (OR = 1.21, 95% CI = 1.17-1.25). CONCLUSIONS: Among US Medicare beneficiaries undergoing cataract surgery, those with dementia are more likely to have "complex" surgery" lasting more than 30 minutes. However, they do not have greater likelihood of surgical complications, higher-acuity setting, advanced anesthesia care, or postoperative hospitalization. This may be influenced by case selection and may suggest missed opportunities to improve vision. Future research is needed to identify dementia patients likely to benefit from cataract surgery.

Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia.

PURPOSE: To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries. DESIGN: Retrospective, claims-based analysis. PARTICIPANTS: A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015. METHODS: Dementia was identified from diagnosis codes documented in a beneficiary's first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities. MAIN OUTCOME MEASURES: Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters). RESULTS: A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69-0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55-0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62-0.63) and less likely to receive a cataract diagnosis (18% vs. 82%). CONCLUSIONS: US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care than those without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value to patients with dementia, and implement measures to improve access to appropriate eye care.

Bioaccumulation and heavy metal concentration in tissues of some commercial fishes from the Meghna River Estuary in Bangladesh and human health implications.

Despite the beneficial aspect of aquatic food's consumption, bioaccumulation of toxic metals in fish can enhance the health risk for the consumers. Heavy metals were measured from editable tissues of some commercial fish species like Latis calcarifer, Silonia silondia, Clupisoma garua, Planiliza subviridis, Otolithoides pama, Tenulosa ilisa, Rhinomugil corsula, and Aila coila in the Meghna river estuary in Noakhali district. Heavy metals such as As, Pb, Cd, Cu, and Cr were detected by ICP-MS, which were significantly different (p ≤ 0.01), and the hierarchy of all mean concentrations were: Cu (5.14 mg/kg) > Pb (3.79 mg/kg) > As (1.08 mg/kg) > Cr (0.78 mg/kg) > Cd (0.12 mg/kg). The mean concentration of Cu (6.62 mg/kg) imparted to the maximum level in L. calcarifer, which slightly exceeded the Bangladesh food safety guideline. The mean BAFs of the contaminants were found as: Pb (1042.29) > Cr (1036.47) > As (934.84) > Cd (832.77) > Cu (772). Further, L. calcarifer, S. silondia, C. garua, and P. subviridis showed the bioaccumulative status. To assess the health risk effects, estimated daily intake (EDI), target hazard quotient (THQ) and carcinogenic risk (CR) were conducted. THQs for both adult and children consumers were <1, indicating that, consumers would not experience the non-carcinogenic health effects. Although children were more susceptible than adults, CR for all the consumers was found in the acceptable range (10-6 to 10-4).

Differences in Cataract Surgery Rates Based on Dementia Status.

BACKGROUND: Cataract surgery substantially improves patient quality of life. Despite the rising prevalence of dementia in the US, little is known about use of cataract surgery among this group. OBJECTIVE: To evaluate the relationship between dementia status and cataract surgery. METHODS: Using administrative insurance claims for a representative sample of 1,125,387 US Medicare beneficiaries who received eye care between 2006 and 2015, we compared cataract surgery rates between patients with and without dementia via multivariable regression models to adjust for patient characteristics. Main outcome measures were annual rates of cataract surgery and hazard ratio and 95% confidence interval (CI) for receiving cataract surgery. RESULTS: Cataract surgery was performed in 457,128 patients, 23,331 with a prior diagnosis of dementia. 16.7% of dementia patients underwent cataract surgery, compared to 43.8% of patients without dementia. 59 cataract surgeries were performed per 1000 dementia patients annually, versus 105 surgeries per 1000 nondementia patients. After adjusting for patient characteristics, dementia patients were approximately half as likely to receive cataract surgery compared to nondementia patients (adjusted HR = 0.53, 95% CI 0.53-0.54). Among the subset of patients who received a first cataract surgery, those with dementia were also less likely to receive second-eye cataract surgery (adjusted HR = 0.87, 95% CI 0.86-0.88). CONCLUSION: US Medicare patients with dementia are less likely to undergo cataract surgery than those without dementia. This finding has implications for quality of care and dementia progression. More information is necessary to understand why rates of cataract surgery are lower for these patients, and to identify conditions where benefits of surgery may outweigh risks.

Intraperitoneal injection of JNK-specific inhibitor SP600125 inhibits the expression of presenilin-1 and Notch signaling in mouse brain without induction of apoptosis.

Presenilin-1 (PS1) is a multifunctional protein involved in many cellular functions including the processing of type 1 membrane proteins such as ß-amyloid precursor protein (APP) and Notch 1 receptor. PS1 acts as the catalytic subunit of the γ-secretase complex, and participates in Notch 1 processing to release Notch intracellular domain (NICD) in the cytoplasm. NICD subsequently migrates to the nucleus and causes Notch signaling by increasing the expression of the Hes1 gene. We have previously shown that inhibition of basal activity of c-jun-NH2-terminal kinase (JNK) with JNK-specific inhibitor SP600125 represses the expression of PS1 and γ-secretase activity by increasing p53 level in SK-N-SH cell line in vitro (Lee and Das, 2008, 2010). However, it is largely unknown whether PS1 can be effectively suppressed in vivo in adult mouse brains. In this report we showed that intraperitoneal (i.p) injection of JNK-specific inhibitor SP600125 decreased p-JNK level, and reduced PS1 expression by increasing p53 level in adult mouse brains. We also showed that suppression of PS1 expression by SP600125 reduced γ-secretase activity which decreased Notch 1 processing to reduce NICD in mouse brains. Furthermore, inhibition of Notch 1 processing by SP600125 decreased Notch 1 signaling by reducing the expression of the NICD target Hes1 gene in mouse brains without induction of apoptosis. These results provide insights for further study on PS1-mediated reduction of Notch 1 and APP processing for the treatment of Alzheimer's disease.

Morphogenesis and maintenance of the 3D thymic medulla and prevention of nude skin phenotype require FoxN1 in pre- and post-natal K14 epithelium.

Expansion of thymic epithelial cysts represents disruption of an organized three-dimensional (3D) thymic epithelial cell (TEC) meshwork, which is crucial for T-lymphocyte development. Although the FoxN1-null mutant develops a rudimentary two-dimensional (2D) cystic thymus, 2D thymic cyst lining resulting from a dGUO culture was reported to be FoxN1-independent; thus, it is unclear whether loss of FoxN1 facilitates cyst formation and whether FoxN1 regulates the morphogenesis and maintenance of the 3D thymic microstructure. Using the loxP-floxed-FoxN1 mouse model, we demonstrated that specific deletion of FoxN1 in keratin (K)-14 promoter-driven TECs induced the loss of 3D thymic medullary structure by producing a large number of morphologic pulmonary alveolar-like 2D epithelial cysts, which increased with age. The cystic lining was positive for differential polarized keratins and had strong claudin-3,4, but reduced MHC-II, expression. However, an increased percentage of claudin-3,4(+) TECs, which are presumptive precursors of UEA-1(+) and Aire(+) mature medullary TECs, failed to promote the development of these mature descendants. Meanwhile, the K14Cre-mediated FoxN1 deletion alone was sufficient to induce a complete hair follicle defect, causing a nude phenotype in the skin, but was not sufficient to cause a complete loss of the thymus. All these changes to occur require deletion of FoxN1 in both prenatal (Cre-recombinase from parents during fertilization) and postnatal (Cre-recombinase from offspring themselves after fertilization) life. These findings provide new insights into FoxN1 regulation of 3D thymic epithelial morphogenesis and maintenance, the distinct impacts of FoxN1 in the K14 epithelial subset of the thymus and skin, and its postnatal requirement.