Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Tuesday, February 9, 2021

Role of argon plasma coagulation in treatment of esophageal varices.

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Role of argon plasma coagulation in treatment of esophageal varices.

World J Clin Cases. 2021 Jan 26;9(3):521-527

Authors: Song Y, Feng Y, Sun LH, Zhang BJ, Yao HJ, Qiao JG, Zhang SF, Zhang P, Liu B

Abstract
With the development of endoscopic therapy, argon plasma coagulation (APC) has been widely used by endoscopists. It has many advantages, such as simple to operate, low cost, and minimal invasiveness. Because of its capability of lesion ablation and hemostasis, APC has several indications in the gastrointestinal tract. One of them is esophageal varices. The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.

PMID: 33553390 [PubMed]

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Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury.

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Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury.

World J Clin Cases. 2021 Jan 26;9(3):528-539

Authors: Han MW, Wang M, Xu MY, Qi WP, Wang P, Xi D

Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has posed a serious threat to global public health security. With the increase in the number of confirmed cases globally, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Despite atypical pneumonia as the primary symptom, liver dysfunction has also been observed in many clinical cases and is associated with the mortality risk in patients with COVID-19, like severe acute respiratory syndrome and Middle East respiratory syndrome. Here we will provide a schematic overview of the clinical characteristics and the possible mechanisms of liver injury caused by severe acute respiratory syndrome coronavirus 2 infection, which may provide help for optimizing the management of liver injury and reducing mortality in COVID-19 patients.

PMID: 33553391 [PubMed]

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Circulating immune parameters-based nomogram for predicting malignancy in laryngeal neoplasm.

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Circulating immune parameters-based nomogram for predicting malignancy in laryngeal neoplasm.

World J Clin Cases. 2021 Jan 26;9(3):540-551

Authors: Chen M, Fang Y, Yang Y, He PJ, Cheng L, Wu HT

Abstract
BACKGROUND: Malignancy prediction remains important to preoperative diagnosis and postoperative follow-up in laryngeal neoplasm.
AIM: To evaluate the circulating immune population and develop a nomogram for prediction of malignancy in patients with laryngeal neoplasm.
METHODS: A primary cohort of 156 patients was divided into laryngeal benign lesion, premalignant lesion and malignant lesion groups. Peripheral blood from patients was measured by blood routine test and flow cytometry. A nomogram was developed and applied to a validation cohort containing 55 consecutive patients.
RESULTS: Age, gender and seven circulating immune parameters exhibited significant differences between laryngeal benign lesion and premalignant lesion. The nomogram incorporated predictors, including gender, age, smoke index, proportions of monocytes, CD8+ T cells, CD4+ T cells, B cells and CD4/CD8+ T cell ratio. It showed good discrimination between laryngeal premalignant lesion and malignant lesion, with a C-index of 0.844 for the primary cohort. Application of this nomogram in the validation cohort (C-index, 0.804) still had good discrimination and good calibration. Decision curve analysis revealed that the nomogram was clinically useful.
CONCLUSION: This novel nomogram, incorporating both clinical risk factors and circulating immune parameters, could be appropriately applied in preoperative individualized prediction of malignancy in patients with laryngeal neoplasm.

PMID: 33553392 [PubMed]

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Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure.

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Role of ammonia in predicting the outcome of patients with acute-on-chronic liver failure.

World J Clin Cases. 2021 Jan 26;9(3):552-564

Authors: Chiriac S, Stanciu C, Cojocariu C, Singeap AM, Sfarti C, Cuciureanu T, Girleanu I, Igna RA, Trifan A

Abstract
BACKGROUND: High venous ammonia (VA) values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis (LC) as well as acute hepatitis. Moreover, VA has been associated with poor prognosis and high mortality in these clinical settings. However, the role of ammonia in acute-on-chronic liver failure (ACLF) has not yet been clearly established.
AIM: To assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care center.
METHODS: We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites, hepatic encephalopathy (HE), upper gastrointestinal bleeding, or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver (APASL) criteria for ACLF. The study was conducted in "St. Spiridon" University Hospital, Iasi, Romania, a tertiary care center, between January 2017 and January 2019. The APASL ACLF Research Consortium (AARC) score was calculated and ACLF grade was established accordingly. West-haven classification was used for HE. Statistical analysis was performed using IBM SPSS version 22.0.
RESULTS: Four hundred and forty-six patients were included, aged 59 (50-65) years, 57.4% men. Child-Pugh, model for end-stage liver disease (MELD) and AARC scores were 11 (10-12), 19.13 ± 6.79, and 7 (6-8), respectively. 66.4% had ACLF grade I, 31.2% ACLF grade II, and 2.5% ACLF grade III. HE was diagnosed in 83.9%, 34% grade I, 37.2% grade II, 23.5% grade III, and 5.3% grade IV. Overall mortality was 7.8%. VA was 103 (78-148) μmol/L. Receiver operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score [Area under the curve (AUC) = 0.886], MELD score (AUC = 0.816), VA (AUC = 0.812) and a fair accuracy for the Child-Pugh score (AUC = 0.799). Subsequently, a cut-off value for the prediction of mortality was identified for VA (152.5 μmol/L, sensitivity = 0.706, 1-specificity = 0.190). Univariate analysis found acute kidney injury, severe HE (grade III or IV), VA ≥ 152.5 μmol/L, MELD score ≥ 22.5, Child-Pugh score ≥ 12.5, and AARC score ≥ 8.5 to be associated with in-hospital mortality. Multivariate analysis identified AARC score ≥ 8.5 and venous ammonia ≥ 152 μmol/L to be independent predictors of in-hospital mortality.
CONCLUSION: VA could be used as an inexpensive predictor of in-hospital mortality in patients with ACLF. Patients with both ACLF and VA > 152.5 μmol/L have a high risk for a poor outcome.

PMID: 33553393 [PubMed]

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Impact of different stereoisomers of inositol on insulin sensitivity of gestational diabetes mellitus patients.

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Impact of different stereoisomers of inositol on insulin sensitivity of gestational diabetes mellitus patients.

World J Clin Cases. 2021 Jan 26;9(3):565-572

Authors: He J, Zhang YL, Wang LP, Liu XC

Abstract
BACKGROUND: Inositol is a hexa-carbon polyol, a naturally soluble vitamin, often found in various foods.
AIM: To discuss the impact of different stereoisomers of inositol on insulin sensitivity of gestational diabetes mellitus (GDM) patients.
METHODS: Eighty GDM pregnant women were divided into four groups according to their treatment received: A group (placebo folic acid 400 μg/d), B group [myo-inositol (MI) 1500 mg, twice a day], C group [D-chiro-inositol (DCI) 250 mg, twice a day], and D group (inositol MI and inositol DCI 1500 mg/250 mg, twice a day). Each patient routinely used dietary guidance adjustments and did some safe and effective aerobic exercise in addition to receiving placebo or inositol from GDM diagnosis to delivery. Triglyceride, total cholesterol, fasting plasma glucose, oral glucose tolerance test postprandial glucose (2 h postprandial blood glucose), fasting insulin, fasting plasma glucose, and glycosylated hemoglobin levels and Homeostasis Model Assessment-insulin resistance (HOMA-IR) and Homeostasis Model Assessment-insulin sensitivity index (HOMA-ISI) scores were determined before treatment and 8 wk after treatment onset. Adverse maternal and infant outcomes, including hypoglycemia, exces sive amniotic fluid, premature infants, macrosomia, fetal distress etc., were also recorded.
RESULTS: There was no statistical difference in the baseline data of each group. The levels of 2 h blood glucose, glycosylated hemoglobin, fasting insulin, total cholesterol, and triglyceride in the B, C, and D groups were significantly lower than those in the control group (A group) after treatment (P < 0.05). Moreover, compared with the B group, the level of the above indexes in the C and D groups decreased more significantly, and the differences were statistically significant (P < 0.05). The HOMA-IR of B, C, and D groups decreased significantly, and the HOMA-ISI increased significantly compared with the A group, and the differences were statistically significant (P < 0.05), among which the decrease of HOMA-IR and the increase of HOMA-ISI were more significant in the C and D group compared with the B group (P < 0.05). The occurrence rate of adverse maternal and infant outcomes in the C and D group was significantly lower than that in the control group (A group), and the differences were statistically significant (P < 0.05).
CONCLUSION: Treatment with different inositol stereoisomers (inositol MI and inositol DCI) can improve insulin sensitivity and reduce insulin resistance in diabetic patients, and inositol DCI has a better curative effect than inositol MI.

PMID: 33553394 [PubMed]

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Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging.

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Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging.

World J Clin Cases. 2021 Jan 26;9(3):573-580

Authors: Ghali S, Katti G, Shahbaz S, Chitroda PK, V A, Divakar DD, Khan AA, Naik S, Al-Kheraif AA, Jhugroo C

Abstract
BACKGROUND: The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology. Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools, including ultrasonography (USG) and magnetic resonance imaging (MRI).
AIM: To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.
METHODS: Among 20 patients, 50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study. Fascial space infection involvement was examined by USG and MRI. Results were compared for both and confirmed by microbiological testing.
RESULTS: Ultrasonography identified 42 (84%) of 50 involved fascial spaces. Whereas MRI identified all 50 (100%). USG could stage the infections from edematous change to cellulitis to complete abscess formation.
CONCLUSION: MRI was superior in recognizing deep fascial space infections compared to USG. However, USG is a significant addition and has a definite role in prognosticating the stage of infection and exact anatomic location in superficial space infections.

PMID: 33553395 [PubMed]

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Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and meta-analysis.

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Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and meta-analysis.

World J Clin Cases. 2021 Jan 26;9(3):581-601

Authors: Xu YQ, Long X, Han M, Huang MQ, Lu JF, Sun XD, Han W

Abstract
BACKGROUND: Lung cancer is a major cause of death among patients, and non-small cell lung cancer (NSCLC) accounts for more than 80% of all lung cancers in many countries.
AIM: To evaluate the clinical benefit (CB) of COX-2 inhibitors in patients with advanced NSCLC using systematic review.
METHODS: We searched the six electronic databases up until December 9, 2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC. Overall survival (OS), progression free survival (PFS), 1-year survival rate (SR), overall response rate (ORR), CB, complete response (CR), partial response (PR), stable disease (SD), and toxicities were measured with more than one outcome as their endpoints. Fixed and random effects models were used to calculate risk estimates in a meta-analysis. Potential publication bias was calculated using Egger's linear regression test. Data analysis was performed using R software.
RESULTS: The COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS, progression free survival, 1-year SR, CB, CR, and SD. However, there was a difference in overall response rate for patients with advanced NSCLC. In a subgroup analysis, significantly increased ORR results were found for celecoxib, rofecoxib, first-line treatment, and PR. For adverse events, the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia, thrombocytopenia, and cardiovascular events.
CONCLUSION: COX-2 inhibitor combined with chemotherapy increased the total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.

PMID: 33553396 [PubMed]

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Delayed cardiac tamponade diagnosed by point-of-care ultrasound in a neonate after peripherally inserted central catheter placement: A case report.

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Delayed cardiac tamponade diagnosed by point-of-care ultrasound in a neonate after peripherally inserted central catheter placement: A case report.

World J Clin Cases. 2021 Jan 26;9(3):602-606

Authors: Cui Y, Liu K, Luan L, Liang P

Abstract
BACKGROUND: Peripherally inserted central catheters (PICCs) have been increasingly applied worldwide owing to many advantages. Even with these advantages, the related complications should not be ignored, especially in neonates. The available evidence about PICC-related thrombosis was manifold, but the cardiac tamponade, an emergency and life-threatening complication, has been rarely reported. Early recognized cardiac tamponade by ultrasound may reduce mortality.
CASE SUMMARY: A neonate weighting 2.8 kg was born at 40 wk of gestation. He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon. A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition. Three days later, the patient was still on total parenteral nutrition. Cardiac tamponade caused by PICC was found on ultrasound. The patient recovered spontaneously after an emergency pericardiocentesis.
CONCLUSION: Proficiency in the use of point-of-care ultrasound may save the life of patients, since it enables clinicians to treat patients faster, more accurately, and in a non-invasive way at the point of care.

PMID: 33553397 [PubMed]

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Facial microcystic adnexal carcinoma - treatment with a 'jigsaw puzzle' advancement flap and immediate esthetic reconstruction: A case report.

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Facial microcystic adnexal carcinoma - treatment with a "jigsaw puzzle" advancement flap and immediate esthetic reconstruction: A case report.

World J Clin Cases. 2021 Jan 26;9(3):607-613

Authors: Xiao YD, Zhang MZ, Zeng A

Abstract
BACKGROUND: Microcystic adnexal carcinoma (MAC) is a rare malignant tumor of the skin that is commonly found on the face. It grows slowly and has a low mortality rate. However, for various reasons, including strong histological invasiveness, clinical inexperience and inadequate procedure design, immediate or permanent facial deformity may occur after surgical operations.
CASE SUMMARY: This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip. She declined the recommended treatment plan, which included two-stage reconstruction, skin grafting, or surgery that could have resulted in obvious facial dysfunction or esthetic deformity. We accurately designed a personalized procedure involving a "jigsaw puzzle advancement flap" for the patient based on the lesion location and the estimated area of skin loss. The procedure was successful; both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.
CONCLUSION: This study suggests that when treating facial MAC or other skin malignancies, a surgical team should have sufficient plastic surgery-related knowledge and skills. An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.

PMID: 33553398 [PubMed]

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Nephrotic syndrome in syngeneic hematopoietic stem cell transplantation recipients: A case report.

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Nephrotic syndrome in syngeneic hematopoietic stem cell transplantation recipients: A case report.

World J Clin Cases. 2021 Jan 26;9(3):614-622

Authors: Bai MC, Wu JJ, Miao KR, Zhu JF, Mao HJ

Abstract
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is widely used in the treatment of hematological diseases. However, complications after transplantation, such as acute and chronic graft-vs-host disease (GVHD), still seriously affect the quality of life and even threaten the lives of patients. There is evidence that glomerular diseases can manifest as GVHD. However, GVHD should not occur as a result of syngeneic HSCT.
CASE SUMMARY: A 20-year-old male diagnosed with T lymphoblastic lymphoma (stage IIIA, aaIPI 1) in September 2013 was treated with six cycles of hyper-CVAD and achieved complete remission. He underwent syngeneic HSCT in June 2014, and had no kidney disease history before the transplant. However, nephrotic syndrome occurred 24 mo later in the patient after syngeneic HSCT. Renal biopsy was performed, which led to a diagnosis of atypical membranous nephropathy. After treatment with glucocorticoids combined with cyclophosphamide and cyclosporine, the nephrotic syndrome was completely relieved.
CONCLUSION: We report a case of delayed nephrotic syndrome after syngeneic HSCT. Antibody-mediated autoimmune glomerular disease may be the underlying mechanism. After treatment with immunosuppressive agents, the nephrotic syndrome was completely relieved but further long-term follow-up is still needed.

PMID: 33553399 [PubMed]

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Nephrotic syndrome in syngeneic hematopoietic stem cell transplantation recipients: A case report.

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Nephrotic syndrome in syngeneic hematopoietic stem cell transplantation recipients: A case report.

World J Clin Cases. 2021 Jan 26;9(3):614-622

Authors: Bai MC, Wu JJ, Miao KR, Zhu JF, Mao HJ

Abstract
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is widely used in the treatment of hematological diseases. However, complications after transplantation, such as acute and chronic graft-vs-host disease (GVHD), still seriously affect the quality of life and even threaten the lives of patients. There is evidence that glomerular diseases can manifest as GVHD. However, GVHD should not occur as a result of syngeneic HSCT.
CASE SUMMARY: A 20-year-old male diagnosed with T lymphoblastic lymphoma (stage IIIA, aaIPI 1) in September 2013 was treated with six cycles of hyper-CVAD and achieved complete remission. He underwent syngeneic HSCT in June 2014, and had no kidney disease history before the transplant. However, nephrotic syndrome occurred 24 mo later in the patient after syngeneic HSCT. Renal biopsy was performed, which led to a diagnosis of atypical membranous nephropathy. After treatment with glucocorticoids combined with cyclophosphamide and cyclosporine, the nephrotic syndrome was completely relieved.
CONCLUSION: We report a case of delayed nephrotic syndrome after syngeneic HSCT. Antibody-mediated autoimmune glomerular disease may be the underlying mechanism. After treatment with immunosuppressive agents, the nephrotic syndrome was completely relieved but further long-term follow-up is still needed.

PMID: 33553399 [PubMed]

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