Cerebrospinal fluid 2-hydroxyglutarate (2-HG) as a monitoring biomarker for IDH-mutant gliomas.

D-2-hydroxyglutarate (D-2-HG) is a well-established oncometabolite of isocitrate dehydrogenase (IDH) mutant gliomas. While prior studies have demonstrated that D-2-HG is elevated in the cerebrospinal fluid (CSF) of patients with IDH-mutant gliomas 1,2 , no study has determined if CSF D-2-HG can provide a plausible method to evaluate therapeutic response. We are obtaining CSF samples from consenting patients during their disease course via intra-operative collection and Ommaya reservoirs. D-2-HG and D/L-2-HG consistently decreased following tumor resection and throughout chemoradiation in patients monitored longitudinally. Our early experience with this strategy demonstrates the potential for intracranial CSF D-2-HG as a monitoring biomarker for IDH-mutant gliomas.

The Spectrum of Postoperative Complications and Outcomes After Pancreaticoduodenectomy: A Retrospective Outlook From a Developing Country.

Background Pancreaticoduodenectomy is an extremely complex surgical procedure that mandates aggressive postoperative management. Unfortunately, in developing countries, the limited resources and poor postoperative care lead to multiple complications and abysmal outcomes. Therefore, our study aimed to evaluate the spectrum of postoperative complications and outcomes among patients undergoing pancreaticoduodenectomy. Methods This retrospective study involved a total of 97 patients who underwent pancreaticoduodenectomy for ampullary, periampullary, or pancreatic tumors. Patients with advanced metastasis and unresectable tumors were excluded from the study. Patients were studied for various parameters including the demographic details, postoperative outcomes, characteristics of the tumor, and postoperative complications. Results Out of 97 patients, 59 (60.8%) patients were males. The mean age of the study participants was 53.43 ± 17.89 years. Jaundice and abdominal pain were the most common presenting symptoms among the study participants. Of the 97 patients, 58 (59.8%) had malignant tumors. A total of 49 patients developed various postoperative complications including surgical site infections (10.3%), anastomosis leakage (9.27%), pancreatic fistula (9.27%), cholangitis (7.2%), and biliary leakage (4.1%). A total of 29 (29.9%) patients expired due to postoperative complications. Conclusions Surgical site infections, anastomosis leakage, pancreatic fistula, cholangitis, and biliary leakage are common but preventable postoperative complications after pancreaticoduodenectomy. These lead to morbidity and mortality, especially in the setting of a resource-deprived developing country. Aggressive postoperative management, improved surgical technique, better intraoperative hemostasis management, and a multi-disciplinary approach for the management of such patients can help in preventing postoperative complications and improving the postoperative outcomes.

The Spectrum of Postoperative Complications and Outcomes After Open Adrenalectomy: An Experience From a Developing Country.

Background Open adrenalectomy is an invasive surgical procedure that is commonly performed for adrenal gland neoplasms in developing countries. Due to its complexity, the patients are predisposed to a number of complications and dismal outcomes. The objective of our study is to assess different characteristics of patients undergoing open adrenalectomy, including their histology, postoperative complications, and outcomes. Methods This retrospective cross-sectional study included 107 patients undergoing open adrenalectomy for primary adrenal gland neoplasms. Patients with bilateral involvement, metastatic disease, or unresectable tumors were excluded. Patients were evaluated for different features that included demographic data, tumor properties, postoperative outcomes, and complications. Results Out of 107 patients, 45 (42.1%) were females. The mean age of the patients was 47.53 ± 8.45 years. Abdominal pain and severe headaches were the most common presenting complaints. A total of 96 (89.7%) tumors were benign, while 11 (10.3%) were malignant. Upon the histopathological examination of the resected specimen, adrenal adenoma was present in 49 (45.8%) cases, while adrenal pheochromocytoma was present in 41 (38.3%) cases. A total of 51 patients developed different postoperative complications including surgical site infections (22.4%), atelectasis (11.2%), deep venous thrombosis (7.5%), and retroperitoneal hematoma (5.6%). In-hospital mortality occurred in three (2.8%) patients. Conclusion Surgical site infections, atelectasis, deep venous thrombosis, and retroperitoneal hematoma were frequent postoperative complications after open adrenalectomy. These complications increase morbidity and mortality, especially in developing countries. Improved surgical techniques, intraoperative hemostasis, and multidisciplinary approach can yield favorable postoperative outcomes.

Clinical Characteristics and Etiological Spectrum of Pancytopenia in Pediatric Age Group: A Cross-Sectional Outlook From a Developing Country.

Background The etiologies of pancytopenia in the pediatric age group remain exceedingly ubiquitous and warrant extensive hematological and interventional investigations like bone marrow biopsy. It varies widely from benign nutritional disorders to fatal malignancies. The present study aims to delineate the prevalence of various causes of pancytopenia in the pediatric population. Methods The present cross-sectional study included 96 patients between the age of one month till 15 years with pancytopenia. Study participants were evaluated for various parameters including their demographical details, clinical features, immunization history, and nature of the disorder. The prevalence of various etiologies (nutritional, neoplastic, infectious, autoimmune, and others) of pancytopenia was ascertained. Results Of the 96 patients, 42 (43.75%) were males with a mean age of 69.47 ± 7.12 months. Fever was present in 71.87%, arthralgias in 56.25%, weight loss in 35.41%, and failure to thrive in 18.75% of patients. The bone marrow examination revealed aplastic changes in 36 (37.50%), hyperplastic changes in 21 (21.87%), and normal cellularity in 40.62% of patients. Megaloblastic anemia was the most common nutritional cause of pancytopenia present in 21.85% of cases. Acute lymphoblastic leukemia (ALL) was the most prevalent neoplastic etiology present in 19.79% of patients. Aplastic anemia, miliary tuberculosis, parvovirus B19, and hemolytic anemia were other notable etiologies. Conclusion Megaloblastic anemia and infections like tuberculosis were common treatable etiologies of pancytopenia among the pediatric age group. ALL was the most common neoplastic etiology. Bone marrow biopsy remains crucial in elucidating the various neoplastic and nutritional etiologies of pancytopenia in children.

Sleep Quality and Compliance to Medical Therapy Among Hemodialysis Patients With Moderate-to-Severe Depression: A Cross-Sectional Study.

Background Depression is a fairly common finding among end-stage renal disease (ESRD) patients and is an independent risk factor for morbidity and mortality. The psychiatric manifestations of the disease may affect their compliance to medications and alter sleep quality that is often overlooked. This translates into poor quality of life and poorer disease prognosis. Our study aims to assess the prevalence of depression and its association with compliance to medical therapy and sleep quality among ESRD patients on hemodialysis. Methodology In this cross-sectional study, a total of 288 hemodialysis patients with a confirmed diagnosis of ESRD were evaluated for depression using Patient Health Questionnaire-9 (PHQ-9) scale. Only patients with moderate-to-severe depressive symptoms on PHQ-9 were further evaluated for sleep quality and compliance to medications using Pittsburgh Sleep Quality Index (PSQI) and Drug Attitude Inventory-10 (DAI-10), respectively. The characteristics of ESRD patients with depression were also assessed. Median PHQ-9, DAI-10, and PSQI scores were calculated, and the correlation between study variables was assessed using Spearman's correlation. Results Of the 288 included participants, 188 (65.27%) had depression as evaluated via PHQ-9. Of these 188 patients, 114 were males while 74 were females. A total of 113 (60.01%) of depressed patients had poor compliance to medication while 137 (72.87%) patients had poor sleep quality. Higher PHQ-9 scores were positively correlated with disease duration, dialysis years, and time between diagnosis and therapy (r = 0.41, 0.39, and 0.43, respectively) and negatively with marital and employment status (r = -0.32 and -0.49, respectively). Spearman's correlation showed a significant negative correlation of PHQ-9 scores with DAI-10 scores but a significant positive correlation with PSQI scores. The correlation between DAI-10 and PSQI was a significant negative correlation. Conclusions This study indicated a high prevalence of moderate-to-severe depression among ESRD patients on hemodialysis. Poor sleep quality and non-adherence to medications are frequent among ESRD patients with depression. These psychiatric components must be considered to optimize medical treatment and improve the quality of life in this subset of patients. More studies should be conducted to assess the risk factors of depression in patients with ESRD.

MR Product as a Novel Diagnostic Indicator for Chronic Secondary Mitral Regurgitation.

Background Chronic secondary mitral regurgitation (SMR) is a common form of valvular heart disease. Its diagnosis through echocardiography is challenging and dependent on subjective interpretations. The subjective error to diagnose SMR can be reduced by developing accurate predictive quantitative parameters that support echocardiographic interpretations and clinical manifestations. The present study aims to develop a new diagnostic indicator for chronic SMR. The new indicator called MR product is the product of left atrial diameter (LAD) and left ventricular internal dimension at end-systole (LVIDs). Materials and Methods An analytical, case-control study was conducted from transthoracic echocardiography (TTE) reports of 720 patients performed according to the guidelines of the American Society of Echocardiography. The LAD and LVIDs were measured using the standard M Mode TTE. Out of the 720 patients who underwent TTE, 300 patients were diagnosed with chronic SMR by experienced clinicians. Only 115 of those 300 patients met the inclusion criteria for chronic SMR.  Results The MR product was significantly associated with chronic SMR (rho = 0.83) and predicted it with an odds ratio of 1.014 (p < 0.001). The MR product was able to diagnose SMR with a sensitivity of 94.8% and a specificity of 92.2%, respectively, for a cut off value of 1,045 mm2. Conclusion A new parameter called MR product (LAD multiplied with LVIDs) has very high sensitivity and specificity for SMR. Therefore, it can aid in establishing its diagnosis, along with other diagnostic modalities. The new parameter may also potentially increase the diagnostic accuracy of the disease.

Gauging the Risk Factors for Asymptomatic Bacteriuria in Type-2 Diabetic Women: A Case-Control Study.

Background There is conflicting literature pertaining to the risk factors of asymptomatic bacteriuria (ASBU) in diabetic women. ASBU is a well-established risk factor for frequent urinary tract infections (UTIs), and the risk factors that predispose diabetic women to ASBU should, therefore, be evaluated.  Objectives This study aims to discern these aforesaid risk factors in type-2 diabetic women, define a population subset at particularly high risk for ASBU, and gauge the efficacy inherent in adhering to an antibiotic regimen in combatting ASBU.  Methods An analytical, case-control study was conducted at the Diabetic Clinic of the Holy Family Hospital (HFH), Rawalpindi, Pakistan. The participants included were type-2 diabetic women reporting to the clinic for routine follow-up. Six hundred and sixty-seven urine samples from these type-2 diabetic women were evaluated. Positive cases were those in which patients were diagnosed with ASBU according to the guidelines, while those with no ASBU constituted the control group. Common risk factors for UTI were excluded in both groups. Age, socioeconomic status, hygiene practices, and contraceptive use were matched between cases and controls.  Results Nineteen percent of type-2 diabetic women presented with ASBU in our study. The significant risk factors for ASBU were a higher HbA1c level (OR 1.97), more years since the initial diagnosis of diabetes (OR 1.49), a prior UTI history (OR 2.49), excessive antibiotic use (OR 2.72), sodium-glucose cotransporter-2 (SGLT2) inhibitor use (OR 1.75), and proteinuria (OR 1.88) in the multivariate model. Body mass index (BMI), age of the patients, pyuria, and voiding dysfunction manifested no association with ASBU. Antibiotic use was significantly associated with the type of bacterial species precipitating the ASBU.  Conclusion The clinicians must keep in mind the association between the various patient parameters and ASBU, especially in prescribing antibiotics to diabetic women. More studies are needed to further elaborate on these risk factors and revise the patient management in at-risk cases for ASBU and UTIs.