Mediastinal malignant rhabdoid tumor in an infant: A rare case report.

Mediastinal malignant rhabdoid tumor (MRT) is an exceedingly rare and aggressive neoplasm, particularly uncommon in infants. We present the case of a previously healthy 7-month-old male infant with mediastinal MRT. The patient initially presented with left eyelid ptosis and was otherwise asymptomatic. Initial investigations, including brain MRI, yielded unremarkable results, and the infant was discharged with vitamin B supplements. However, he was readmitted a week later with prolonged fever, poor feeding, diarrhea, and respiratory distress. Despite an initial diagnosis of bronchiolitis/viral respiratory tract infection, the patient's condition rapidly deteriorated. Subsequent evaluation revealed mediastinal MRT as the underlying cause. This case underscores the diagnostic challenges associated with mediastinal MRT in infants and highlights the importance of considering rare neoplastic etiologies in atypical clinical presentations.

Development of a Scoring Method Based on a Chest CT Scan to Determine the Outcomes of COVID-19 Patients.

Introduction As COVID-19 shifts from pandemic urgency to endemic management, healthcare systems are faced with the evolving challenge of providing optimized care and adept resource allocation in this evolving landscape of the disease. However, the timely management and accurate assessment of disease severity remains a cornerstone of effective treatment. This study presents a pioneering scoring system, based on the primary chest CT scan findings, to predict patient outcomes and to equip clinicians with a tool that can expedite decision-making. Method A retrospective cohort study was conducted involving 406 confirmed COVID-19 cases referred to two of our hospitals in Tehran, between February and April 2020. Radiographic and CT scan data were sourced from the imaging archive system and evaluated by a certified radiologist. We devised distinct severity scores for CT findings, demographic factors, and clinical indicators. These were synthesized into a comprehensive severity score to forecast critical patient outcomes, such as mortality, ICU admission, intubation, or extended hospitalization. Of the total cases, 161 (39.7%) were classified as severe, while 245 (60%) fell into the low or moderate severity category. Results The mean score of demographic, CT scan, and clinical characteristics was significantly higher for those in the severe COVID-19 than the non-severe group. The cutoff score for predicting the outcomes in COVID-19 patients for demographic, clinical, and chest CT scan factors was 2.5, 9.5, and 8.5, respectively. Multivariate analysis indicated that each unit increase in these scores elevated the odds of fatal outcomes by 24%, 2.8%, and 12%, respectively. Then, using the comprehensive severity score, which is the sum of the above scores, we further predicted the disease severity. Conclusion The findings suggest that our innovative scoring system, based on initial chest CT scan findings, serves as a robust predictor of COVID-19 outcomes.

Ruptured splenic abscess as an extremely rare cause of pneumoperitoneum: A comprehensive review with a case report.

Splenic abscess leading to rupture and pneumoperitoneum is a very rare condition that is limited to a few case reports. In this study, we first introduced a case of an adolescent girl with a medical history of diabetes mellitus who presented with left upper quadrant abdominal pain and fever. Ultrasound revealed an abscess in the spleen and a computed tomography (CT) scan of the abdomen revealed evidence of pneumoperitoneum secondary to the rupture of this abscess. The patient underwent splenectomy without postoperative complications. Secondly, we reviewed and discussed the current literature on this topic which predominantly denotes that the pneumoperitoneum following splenic abscess rupture mostly occurs in the immunocompromised status, without a specific predominant infectious agent but the culprit is a gas-forming organism, acute abdomen ensues if the diagnosis is delayed, diagnosis is via abdominal CT when there is hemodynamic stability otherwise exploratory laparotomy uncovers the diagnosis, and splenectomy with broad-spectrum antibiotic therapy is the mainstay of treatment.

Outcome of Second Line Treatment of Recurrent High- Grade Glioma by re-Irradiation or Bevacizumab-based Chemotherapy: A Cross Sectional Study.

INTRODUCTION: Currently, there is no standard of treatment for the management of the recurrent high-grade glioma. Re-resection, re-irradiation, and chemotherapy are among main treatment options without any proven efficacy. AIM: To compare the outcome of second line treatment of recurrent high-grade glioma by re-irradiation or bevacizumab-based chemotherapy. METHODS: Retrospectively, patients with the recurrent high-grade glioma treated by re-irradiation (ReRT group) (34 patients) or bevacizumab-based chemotherapy (Bev group) (40 patients) as the first-file after the first recurrence were compared in term of first-line progression free survival (PFS), second-line PFS, and overall survival (OS). RESULTS: Both groups were similar in term of gender (p=0.859), age (=0.071), type of first-line treatment (p=0.227), and performance status (p=0.150). With a median follow-up of 31 months (m), mortality rate was 41.2% and 70% in the ReRT and Bev groups, respectively. In the Bev and ReRT groups, median OS was 27 m (95% confidence interval (CI) 20-33.9 m) vs. 132 m (95% CI 52.9-211 m) (p<0.0001), median first-line PFS was 11 m (95% CI 7.14-28.7 m) vs. 37 m (95% CI 8.42-65.75 m) (p<0.0001), and median second-line PFS was 7 m (95% CI 3.9-10 m) vs. 9 m (95% CI 5.5-12.4 m) (p=0.564), respectively. CONCLUSION: The PFS is similar after the second line treatment of recurrent primary central nervous system malignancies either by re-irradiation or bevacizumab-based chemotherapy.

Torsion of epididymal Cyst as a cause of acute Scrotum in a child.

Epididymal cyst is commonly seen in adults and sometimes in children. In most cases of the epididymal cyst, there are no symptoms and the diagnosis is made incidentally during ultrasonography. However, in rare circumstances, such as infection, trauma, or torsion, an epididymal cyst could become painful and require surgical or medical intervention. We report the case of an 11-year-old boy admitted to our hospital with acute right scrotal pain and treated surgically for epidydimal cyst torsion. Torsed epididymal cysts may cause symptoms exactly like testicular torsion. Therefore, It should be considered a differential diagnosis of testicular torsion in pediatrics.

Therapeutic effect of turmeric on radiodermatitis: A systematic review.

Radiodermatitis (RD) occurs in 95% of cancer patients undergoing radiation therapy. At present, there is no effective treatment for the management of this complication of radiotherapy. Turmeric (Curcuma longa) is a polyphenolic and biologically active natural compound with various pharmacological functions. The aim of this systematic review was to determine the efficacy of curcumin supplementation for reducing RD severity. This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive literature search was conducted in Cochrane library, PubMed, Scopus, Web of Science, and MEDLINE databases. A total of seven studies comprising 473 cases and 552 controls were included in this review. Four studies demonstrated that curcumin supplementation had a beneficial effect on RD intensity. These data provide evidence for the potential clinical use of curcumin in supportive cancer care. Further large prospective and well-designed trials are warranted to exactly determine the "real effective extract, supplemental form and dose of curcumin" for RD prevention and treatment of patients receiving radiotherapy.

Giant pedunculated hepatoblastoma mimicking neuroblastoma in a 4-month-old infant: a case report.

BACKGROUND: Hepatoblastoma is the most common primary malignancy of hepatic origin in children, with an estimated incidence of 0.5-1.5 per million children. Hepatoblastoma classically has an intraparenchymal location, and pedunculated hepatoblastoma is a relatively rare entity. Accurate diagnosis can be challenging due to its extrahepatic location and possibly its thin peduncle, which is not easily identified in imaging. CASE PRESENTATION: Here, we report a case of asymptomatic giant palpable hepatoblastoma in the LUQ of a four-month-old male infant, initially suspected of neuroblastoma based on abdominal ultrasound findings. The final diagnosis of giant pedunculated hepatoblastoma was made based on the abdominal CT scan and the diagnosis was confirmed by percutaneous biopsy. Due to the size of the tumor, complete removal of the tumor was not initially possible. Therefore, the patient was treated with several courses of chemotherapy. The tumor was shrunk and then completely removed. The patient was treated, and no complications were found in the 6-month follow-up. CONCLUSION: Pedunculated hepatoblastoma is rare but should be considered as a possibility in the case of a perihepatic mass in a pediatric patient that can be confused with other upper abdominal masses such as an adrenal mass. Therefore, in such cases, we must look for the vascular pedicle in the imaging and keep the AFP check in mind.

Esophageal lung misdiagnosed as tracheoesophageal fistula: A case report.

An esophageal lung is a subtype of communicating bronchopulmonary foregut malformation (CBPFM) where the lung, often right side, communicates with the esophagus, which causes hypoplastic and consolidated diseased lung, and is usually diagnosed late in its clinical course. Clinical suspicion based on patient history, signs, and symptoms should lead to this opinion. A chest CT scan combined with esophagography is highly recommended for suspicious cases. Here, we describe the case of a 3-month-old female infant who was referred to our hospital because of respiratory distress. The diagnosis of the congenital esophageal lung was made following a chest CT scan and esophagography. This is a very rare case that is misdiagnosed as a tracheoesophageal fistula. CBPFMs are rare abnormalities caused by an abnormal connection between the respiratory tract and the gastroesophageal system. Early diagnosis and differentiation of these abnormalities from sequestration and tracheoesophageal fistula could improve the outcome.

Clinical Manifestations Laboratory Tests Abdominal Ultrasonic Findings and In-hospital Prognosis of COVID-19 in 185 Pediatric Cases in a Tertiary Center.

BACKGROUND: Despite the COVID-19 pandemic, there is little information about the different clinical aspects of COVID-19 in children. In this study, we assessed the clinical manifestations, outcome, ultrasound, and laboratory findings of pediatric COVID-19. METHODS: This retrospective study was conducted on 185 children with definitive diagnosis of COVID-19 between 2021 and 2022. The patients' information was retrieved from hospital records. RESULTS: The average age of the patients was 5.18 ± 4.55 years, and 61.1% were male. The most frequent clinical manifestation was fever (81.1%) followed by cough (31.9%), vomiting (20.0%), and diarrhea (20.0%). Mesenteric lymphadenitis was common on ultrasound and found in 60% of cases. In-hospital death was identified in 3.8% of cases. The mean length of hospital stay was 8.5 days. Mandating intensive care unit (ICU) stay was found in 19.5% and 5.9% of cases were intubated. Acute respiratory distress syndrome (ARDS), lower arterial oxygen saturation, higher white blood cell (WBC) count, and higher C-reactive protein (CRP) were the main determinants of death. Lower age, respiratory distress, early onset of clinical manifestations, lower arterial oxygen saturation, lower serum hemoglobin (Hb) level, and higher CRP level could predict requiring ICU admission. CONCLUSION: We recommend close monitoring on CRP, serum Hb level, WBC count, and arterial level of oxygenation as clinical indicators for potential progression to critical illness and severe disease. Mesenteric lymphadenitis is a common sonographic finding in pediatric COVID-19 which can cause abdominal pain. Ultrasound is helpful to avoid unnecessary surgical interventions in COVID-19.

Corrigendum to "Bilateral Botryoid Wilms tumor presented with acute renal failure" [Radiology Case Reports 16 (2021) 166-170].

[This corrects the article DOI: 10.1016/j.radcr.2020.10.055.].

Erratum to "Bilateral Botryoid Wilms Tumor presented with acute renal failure" [Radiology Case Reports 16 (2021) 166-170].

[This corrects the article DOI: 10.1016/j.radcr.2020.10.055.].

Kisspeptin levels in relation to sex hormone profile among PCOS patients.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common endocrine disease among women in the reproductive age that is associated with consequences such as insulin resistance and hyperandrogenemia. This study was aimed to assess the association of sex hormone profile and kisspeptin levels in PCOS women in Gorgan, Iran. METHODS: In this case-control study, 43 women with diagnosed PCOS between the ages of 15 and 37 years and 40 healthy demographically matched controls were recruited. Sex hormone profile and kisspeptin levels were measured in these subjects using ELISA assay kits. RESULTS: Follicle stimulating hormone (FSH), sex hormone binding globulin (SHBG), and kisspeptin levels were significantly lower in cases than in controls. Luteinizing hormone (LH), free-testosterone (FT), 17-OH-progesterone (17-OH-P), dehydroepiandrosterone sulfate (DHEA-S), estradiol (E2), and free androgen index (FAI) were higher in PCOS significantly. There was a significant positive correlation between kisspeptin levels and LH and E2 in cases (p = 0.037 and p = 0.024, respectively). The results of the regression analysis have shown a significant association between the LH and kisspeptin concentrations in PCOS group (r = 0.275, p = 0.037). CONCLUSION: PCOS patients had lower plasma kisspeptin level that was positively correlated with LH and estradiol levels. Also, higher levels of free androgens were demonstrated in these patients. It is suggested that kisspeptin may be involved in complex interactions of the sex hormone endocrine system of PCOS.

Acute gastric volvulus following rapid and incomplete chewing of vegetables: A case report.

One of the rare but serious causes of acute abdomen is gastric volvulus. It is considered an emergent surgical condition when it takes place acutely due to the risk of gastric strangulation, gangrene, and perforation. In this study, we introduce a case of a previously healthy young adult patient who presented with sudden severe epigastric and left upper quadrant abdominal pain along with nausea and retching following insufficient mastication and rapid swallowing of large amounts of vegetables. Radiological studies with chest and abdominal X-rays were in favor of acute gastric outlet obstruction and finally, laparotomy confirmed the diagnosis of acute, primary mesenteroaxial gastric volvulus. We postulated a probable justifying mechanism of the presence of a flaccid gastrocolic ligament (found through the laparotomy) besides rapid entrance of great pieces of vegetables into the stomach precipitated instant gastric rotation.

Predictors of critical COVID-19 in an Iranian population: Age and disabilities play a special role.

Background: Ever since coronavirus disease 2019 (COVID-19) has emerged as a global public health problem, risk factors for severe disease have been reported in studies from Western countries. However, apart from studies of Chinese origin, few reports are available on COVID-19 severity among the Asian population. This study investigates potential risk factors for development of critical COVID-19 in an Iranian population. Methods: In this retrospective cohort study, we included all adults with COVID-19 from 2 tertiary centers in Iran who had been diagnosed between February 20 and April 1, 2020, in either inpatient or outpatient settings. "Critical COVID-19" was proposed when a hospitalized patient was scheduled for admission to intensive care unit, assisted by mechanical ventilation, or pronounced dead. We used univariable and multivariable logistic and linear regression models to explore the potential risk factors associated with critical COVID-19, admission to hospital, and length of hospital stay. Results: Of the 590 recruited patients, 427 (72.4%) were hospitalized, 186 (31.5%) had critical COVID-19, and 107 (18.2%) died. In the multivariable regression analysis, age >60 years and physical/mental disabilities were associated with critical COVID-19 (odds ratio (OR), 2.33 and 7.03; 95% CI, 1.51-3.60 and 2.88-17.13, respectively); and history of renal, heart, or liver failure was associated with both COVID-19 hospitalization (OR, 4.13; 95% CI 1.91-8.95; p<0.001) and length of hospital stay (Beta 1.90; 95% CI, 0.76-3.04; p=0.001). Conclusion: Age >60 years and physical/mental disabilities can predict development of critical COVID-19 in the Iranian population. Also, the presence of renal, heart, or liver failure might predict both COVID-19 hospitalization and length of hospital stay.

Opium poisoning following self-medication of radiation-induced dermatitis with topical use of opium latex traditional extract; a teaching case.

Despite Radiation-induced dermatitis is a self-limiting complication, it can be complicated if inappropriate self-medications have been used such as opium latex traditional extract.

Bilateral Botryoid Wilms Tumor presented with acute renal failure.

Botryoid Wilms tumors are intrapelvic polypoid masses that are uncommon feature of Wilms tumor. The authors reported a rare case of bilateral botryoid Wilms tumor in a 19-month-old boy who admitted to hospital with acute renal failure secondary to hydronephrosis caused by bilateral botryoid Wilms tumor with ureteral extension. The patient was successfully treated with chemotherapy and bilateral nephron sparing surgery in 2 separate operations. During 15 months follow-up, no evidence of recurrence or metastasis was found.

A case of dystonia with polycythemia and hypermanganesemia caused by SLC30A10 mutation: a treatable inborn error of manganese metabolism.

BACKGROUND: Manganese is a critical trace element that not only has antioxidant properties, but also is essential for various metabolic pathways and neurotransmitters production. However, it can be toxic at high levels, particularly in the central nervous system. Manganese intoxication can be acquired, but an inherited form due to autosomal-recessive mutations in the SLC30A10 gene encoding a Mn transporter protein has also been reported recently. These mutations are associated with significant failure of manganese excretion and its storage in the liver, brain (especially basal ganglia), and other peripheral tissues, resulting in toxicity. CASE PRESENTATION: A 10-year-old boy from consanguineous parents presented with a history of progressive truncal instability, gait difficulty, and frequent falls for 2 months. He had dystonia, rigidity, ataxia, dysarthria, bradykinesia and a plethoric skin. Investigations showed polycythemia, low serum iron and ferritin levels, and increased total iron binding capacity. A brain MRI revealed symmetric hyperintensities in the basal ganglia and dentate nucleuses on TI images that were suggestive of brain metal deposition together with clinical manifestations. Serum calcium and copper levels were normal, while the manganese level was significantly higher than normal values. There was no history of environmental overexposure to manganese. Genetic testing showed a homozygous missense mutation in SLC30A10 (c.C1006T, p.His336Tyr) and Sanger sequencing confirmed a homozygous state in the proband and a heterozygous state in the parents. Regular treatment with monthly infusions of disodium calcium edetate and oral iron compounds resulted in decreased serum manganese and hemoglobin levels to normal values, significant resolution of MRI lesions, and partial improvement of neurological symptoms during 6 months of follow-up. CONCLUSION: The syndrome of hepatic cirrhosis, dystonia, polycythemia, and hypermanganesemia caused by SLC30A10 mutation is a treatable inherited metal deposition syndrome. The patient may only have pure neurological without hepatic manifestations. Although this is a rare and potentially fatal inborn error of metabolism, early diagnosis and continuous chelation therapy might improve the symptoms and prevent disease progression.

Association of Perforin and Granzyme-B Levels with Hyperandrogenism in Polycystic Ovary Syndrome: A Case-Control Study.

BACKGROUND AND OBJECTIVE: Polycystic ovary syndrome (PCOS) is shown to be associated with hyperandrogenemia and has some features such as cytotoxic T-cells activation and release of perforin and granzyme-B. Present work was aimed to investigate the relation of perforin and granzyme-B to androgenic state in PCOS. MATERIALS AND METHODS: Forty three PCOS and 40 control women were recruited. After recording demographic data, sex hormone status and cardiovascular disease (CVD) risk factors were evaluated. Perforin and granzyme-B levels were measured using sandwich ELISA kits. RESULTS: Sex hormone binding globulin (SHBG) levels were lower in patients. Luteinizing hormone (LH), free testosterone (FT), dehydroepiandrosterone sulfate (DHEA-S), free androgen index (FAI), perforin and granzyme-B values were higher in PCOS group. Perforin and granzyme-B were positively correlated with FT and FAI and with each other in PCOS group. In patients, granzyme-B and perforin were related with FT and FAI, respectively. CONCLUSION: The results of present study together with evidences about the release of pro-inflammatory cytokines in insulin resistance, CVD and PCOS suggest that perforin/granzyme-B may be involved in interactions of sex hormones system in PCOS patients.

Low variable rate stimulation strategy for cochlear implants using temporal cues and electrophysiological factors.

BACKGROUND: The performance of a cochlear implant (CI), especially in conveying pitch depends on its electrical stimulation strategy. OBJECTIVE: The present study proposes a variable-rate stimulation algorithm which improves speech emotion perception by using temporal fine-structure cues and electrophysiological parameters of the patient. METHODS: This method is based on the coding of the phase information at the peak time intervals of the band-passed signals. The stimulation pulse is generated at the time of peak occurrence, which is able to excite the number of fibers with a discharge probability above a threshold. Calculating the discharge probability is based on the excitable fiber model and taking into account the biological characteristics of the patient, such as the fiber threshold and the distribution of remaining intact fibers. RESULTS: The results of the emotion detection test on selective reconstructed sentences from the Persian emotional speech database (Persian ESD) indicated that the listeners have been able to detect the emotion by an average of 83.82% using the proposed stimulation algorithm while it was 75% and 48.03% for the zero-crossing and the continuous interleaved sampling (CIS), respectively. Furthermore, the number of pulses compared to the zero-crossing and the CIS has decreased by 76.3% and 75.4%, respectively. CONCLUSIONS: In this paper, a stimulation method was proposed for cochlear implants by considering the patient's biological parameters. It has been successful in transmitting speech emotion despite the reduction of stimulating pulses. This has some advantages such as reducing the interaction of current fields between electrodes during stimulation and reducing battery usage.