Utility of the Paris System in Urine Cytology for Improved Screening of High-Grade Urothelial Carcinoma in Bahrain.

BACKGROUND: Urothelial carcinoma, a prevalent and aggressive urological malignancy, necessitates early detection for improved prognosis. Urine cytology serves as a cost-effective screening tool, but inconsistencies in reporting due to the lack of standardized criteria limit its efficacy. The Paris System for reporting urinary cytology (TPS) was introduced to address this issue, aiming to improve diagnostic accuracy. This retrospective study investigates the effectiveness of urine cytology in detecting high-grade urothelial carcinoma (HGUC) using TPS classification, specifically focusing on atypical urothelial cells (AUC) categorized as TPS-III and suspicious for high-grade urothelial carcinoma (SHGUC) categorized as TPS-IV. METHODS: We reviewed 470 urine cytology samples collected over two years at a tertiary healthcare center in Bahrain. All samples were re-evaluated using TPS classification by two independent consultant cytopathologists blinded to the original cytology report. The analysis included only samples categorized as TPS-III or TPS-IV with corresponding histopathology reports from confirmatory biopsies performed within four months of urine collection. Biopsy results were categorized as either benign/low-grade urothelial carcinoma (non-HGUC) or malignant (HGUC). The positive predictive value (PPV) of urine cytology for HGUC detection was calculated for both TPS-III and TPS-IV categories. Statistical significance was assessed using Fisher's exact test. RESULTS: Among the 470 urine cytology samples, 40 (8.5%) were classified as TPS-III or TPS-IV. Within this subset, 16 patients underwent confirmatory biopsies. Histopathological analysis revealed HGUC in 12 (75%) patients and non-HGUC (benign or low-grade) in 4 (25%) patients. The PPV of TPS-III for HGUC was 50%, while TPS-IV demonstrated a higher PPV of 90%. However, the difference between these values was not statistically significant (p = 0.25). This study explored the utility of TPS classification in urine cytology for HGUC detection. While SHGUC (TPS-IV) exhibited a numerically higher PPV compared to AUC (TPS-III), the lack of statistical significance necessitates further investigation. Our findings highlight the potential of TPS to improve the accuracy of urine cytology. TPS implementation has been shown to reduce the number of inconclusive "atypical" diagnoses, leading to more targeted investigations. CONCLUSION: Our study suggests that SHGUC (TPS-IV) within TPS classification framework might hold promise as a more specific indicator for HGUC compared to AUC (TPS-III). However, further research with larger cohorts is necessary to definitively establish the clinical significance of this observation. This investigation paves the way for future studies exploring the potential of TPS, particularly the SHGUC category, as a reliable screening tool for HGUC, potentially leading to earlier diagnoses and improved patient outcomes.

IFT140 Mutation and End-Stage Renal Disease in Mainzer-Saldino Syndrome: A Case Report.

Mainzer-Saldino syndrome (MSS) or conorenal syndrome (CRS) is a rare autosomal recessive ciliopathy characterized by multiorgan affection, typically presents with a triad of nephronophthisis (NPHP), retinitis pigmentosa (RP), and cone-shaped epiphysis (CSE) with varying degrees of severity. A 20-month-old male is experiencing recurrent pneumonia attacks, an elevated serum creatinine level, proteinuria, and high anion gap partially compensated metabolic acidosis were incidentally discovered during one of his hospitalizations. A biopsy was performed, and the results supported the diagnosis of Alport syndrome. However, a subsequent genetic test suggests the presence of MSS. Aside from NPHP, RP and CSE tested positive. Based on the fact that MSS is not a common cause of end-stage renal disease (ESRD) in pediatrics, physicians should bear in mind genetic testing as a decisive tool. In this context, we highlighted a case of an accidentally discovered impaired renal function from first presentation to final diagnosis, with a valuable comparison with previously published similar cases.

Emergency Presentation of Invasive Cervical Cancer in Late Pregnancy: A Case Report and Literature Review.

Antepartum hemorrhage (APH) often prompts consideration of the presence of obstetric disorders. Here, we describe a case with active APH in which invasive cervical cancer was the cause. A 41-year-old woman, fifth gravida, fourth para (G5, P4), presented to the emergency department at 38 weeks of gestation with an acute severe attack of vaginal bleeding, which occurred immediately after a per-vaginal examination at another local institute. Despite initial stabilization measures and investigations to exclude common causes of APH, a protruding cervical mass was discovered during a Cusco speculum examination. The patient underwent an emergent cesarean section (CS). Postoperatively, the patient was referred to the gynecological oncology unit for further evaluation and management. Magnetic resonance imaging (MRI) confirmed the presence of a large cervical mass. A punch biopsy revealed squamous cell carcinoma (SCC) of the cervix. All these confirmed the condition as cervical carcinoma stage IB3. This case and literature review highlight the obstacles that might delay the diagnosis of cervical cancer and the importance of continuing the screening program strategies even during pregnancy to avoid complications of invasive cervical cancer. In addition, bleeding due to cervical cancer should always be considered one of the important differential diagnoses of APH even in full-term pregnancy.

COVID-19 vaccine breakthrough infection among fully vaccinated healthcare workers in Duhok governorate, Iraqi Kurdistan: A retrospective cohort study.

The aims of this study were: to determine the incidence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among vaccinated healthcare workers (HCWs), assess risk factors associated with the vaccine breakthrough (BT), and compare the effectiveness of vaccine manufacturers against SARS-CoV-2 variant of concern among HCWs in Duhok governorate. It is a multicenter retrospective cohort study, which enrolled 944 HCWs through March 2022. COVID-19 vaccinated HCWs aging 18 and above were included. A random sampling process was performed by asking the participants to fill out a standardized questionnaire by means of interviews or participant-completed surveys. Fully vaccinated HCWs with positive polymerase chain reaction tests were considered to have vaccine BT infection. Two hundred and eighty-four (30.1%) out of 944 vaccinated HCWs had SARS-CoV-2 infection postvaccination, of whom 241 (84.9%) were fully vaccinated, concluding that the incidence of BT infection is 25.5%. There were 422 (44.7%) males and 522 (55.3%) females. Most vaccine BT infections had developed in SARS-CoV-2 Omicron variant (53.5%). The majority of BT infections were mild to moderate (95.5%). Occupation, namely dentist was a significant risk factor, with a p value of 0.001. HCWs with a history of SARS-CoV-2 infection prevaccination were more prone to a vaccine BT infection (p value =0.002). Pfizer vaccine manufacturers revealed the highest effectiveness against BT infection (p value =0.0001). Paramedics showed a significant association with the disease severity (p value =0.02). The three available vaccine manufacturers in the Duhok governorate are effective against COVID-19 BT infections. Dentists and paramedics were significantly associated with poor COVID-19 outcomes.

Optimal Medical Therapy for Secondary Prevention of Acute Coronary Syndrome: A Retrospective Study from a Tertiary Hospital in Sudan.

Background: Five-medication regimen is recommended for patients after acute coronary syndrome (ACS) as a secondary prevention strategy at discharge to reduce recurrence and improve mortality. Objective: This study aimed to assess prescribing of optimal medical therapy (OMT) as five-medication regimens for secondary prevention at discharge after ACS in Sudan. Methods: A retrospective cohort study was performed at a tertiary hospital located in Wad Medani, Sudan, in the period between January and December 2019. Data were collected from patients' files. OMT was defined as a combination of five medications; aspirin and P2Y12 inhibitors, statins, beta-blockers (BBs), and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) or if a valid contraindication was documented. Results: Of the 619 patients throughout the study period, 591 were selected based on inclusion and exclusion criteria. The median age of patients was 60 years, and 58.9% of patients were male. Diabetes (44.5%) and hypertension (42%) were the most common risk factors. Most patients (58.4%) were diagnosed with ST-segment elevation myocardial infarction. About 99.7% of patients were on aspirin, 99.5% on statins, 97% on clopidogrel, 96.8% on dual antiplatelet therapy, 70.4% on BBs, and 57.9% on ACEIs/ARBs. OMT for secondary prevention was prescribed to 267 (45.2%) patients with ACS at discharge. Conclusion: Although prescriptions for all five guideline-recommended medications after ACS were suboptimal, the study showed a positive trend in prescribing most individual medications.

Review of Hmong-Related Health Problems: A Quick Guide for Healthcare Providers.

The people of Hmong descent are one of the largest resettled communities in the United States (US). The Central Valley of California is well known to be the home to the largest Hmong population in the US. However, despite the presence of such a large Hmong community in the Central Valley, our knowledge of their cultural perceptions of medicine is limited. Based on local Central Valley health providers' experiences and observations, the Hmong people have a number of health-related challenges that differ from those of the general population, and this should be considered when dealing with their healthcare needs. In this report, we present a quick guide about the Hmong community and their health-related issues. We hope this will help clinicians and researchers better understand the Hmong community, which in turn would help provide a better quality of healthcare to the Hmong people and stimulate intellectual curiosity among healthcare providers towards this unique Asian ethnicity.

How do Saudi diabetic patients perceive their illness? A multicenter survey using revised-illness perception questionnaire.

BACKGROUND: Illness perception questionnaires for various medical conditions have become more useful in recent years. However, very few have used this to address the issue of type 2 diabetes in Saudi Arabia. MATERIALS AND METHODS: This study was conducted among type 2 diabetic patients attending primary healthcare centers and Al Kharj Military Industries Corporation Hospital in Al Kharj, Saudi Arabia, during November 24, 2016, to April 24, 2017. SPSS used for analysis that included descriptive statistics, t-test, and a one-way analysis of variance (ANOVA). RESULTS: A total of 500 questionnaires were distributed, and 383 of them were returned; response rate about 77%. Majority of participants (80.4%) were educated, 69.5% were married, and 51% were females. About 57% were on OHA, and 57% had no other chronic disease. Most participants perceived that diabetes was hereditary (75%), and 62.4% thought it is due to diet or eating habits. About 80% participants believed that there is a lot they can do to control symptoms. About 73% participants believed they have the power to influence diabetes, whereas 78% think there is very little that can be done to improve diabetes and treatment can control diabetes. The Cronbach's alpha value for identity, timeline (cyclical), and emotional factors were relatively high, showing that these scales had a strong level of internal consistency. CONCLUSION: Saudis with type 2 diabetes mellitus had adequate knowledge of their disease. They agreed that diabetes was likely to be permanent and would have major consequences on their lives.

The accuracy of active shape modelling and end-plate measurements for characterising the shape of the lumbar spine in the sagittal plane.

The 2D shape of the lumbar spine in the sagittal plane can be determined from lordosis angles measured between the corresponding end-plates of the vertebral bodies or by using an active shape model (ASM) of the vertebral body outline. The ASM was previously shown to be a more efficient and reliable method, but its accuracy has not been assessed. The aim of this study was to determine the accuracy of an ASM for characterising lumbar spine shape and compare this to conventional measurements. Images of 25 different lumbar spine shapes were generated and measured, using both methods, by three independent observers. The accuracy of the ASM, determined from lordosis angles predicted by the model, was found to be better than conventional measurements.

New cadinene sesquiterpenoids from the Formosan soft coral Xenia puerto-galerae.

Six new cadinene sesquiterpenoids, xenitorins A-F (1-6), were isolated from the methylene chloride solubles of the Formosan soft coral Xenia puerto-galerae. The structures were elucidated by 1D and 2D NMR spectral analysis, and their cytotoxicity against selected cancer cells was measured in vitro.

New cytotoxic xenia diterpenoids from the Formosan soft coral Xenia umbellata.

Seven new cytotoxic xenicane-type diterpenoids, 9-deoxyxeniloide-E (1), 9-deoxy-7,8-epoxyxeniloide-E (2), xeniolide-G (3), 9-deoxyxenialactol-C (4), xenibecin (5), xeniolide-H (6), and xenitacin (7), were isolated from the methylene chloride solubles of the Formosan soft coral Xenia umbellata. The structures were elucidated by 1D and 2D NMR spectral analysis, and their cytotoxicity against selected cancer cells was measured in vitro.

New cytotoxic constituents from the Formosan soft corals Clavularia viridis and Clavularia violacea.

Three new cytotoxic prostanoids, claviridenone E-G (1-3), and three new cytotoxic steroids, stoloniferone E-G (4-6), were isolated from the methylene chloride solubles of the Formosan soft coral Clavulariaviridis. A cytotoxic cembranoid, claviolide (7), was isolated from the methylene chloride solubles of the Formosan soft coral Clavularia violacea. The structures were elucidated by 1D and 2D NMR spectral analysis, and their cytotoxicity against selected cancer cells was measured in vitro.

Novel terpenoids from the formosan soft coral Cespitularia hypotentaculata.

Four new cytotoxic diterpenes, cespitularins A-D (1-4), having the verticillane skeleton, a new cytotoxic norditerpene, cesputularin E (5), that possesses a novel norverticillane skeleton, and three new diterpenes, cespitularins F-H (6-8), possessing a novel carbon skeleton named cespitularane, were isolated from the methylene chloride solubles of the Formosan soft coral Cespitularia hypotentaculata. The structures of cespitularins A-H (1-8) were elucidated by 1D and 2D NMR spectral analysis, and their cytotoxicity against selected cancer cells was measured in vitro.