Introduction: Intraductal Papillary Neoplasm of the Bile ducts (IPNB) is a rare entity characterized by exophytic growth of the bile ducts.Case presentation: In this report, we present a 57-year-old male with no prior medical history consulted for upper right abdominal pain, jaundice and pruritus. Abdominal Ultrasound (US) and magnetic resonance imaging/Bili-magnetic resonance were performed. They revealed that the circumferential parietal thickening of the common hepatic duct had extended approximately 4 cm with moderate dilatation of the left intrahepatic bile ducts. Computed tomography showed no evidence of distant metastasis.Biopsy revealed a high-grade intraductal papillary neoplasm. After 40 days, the patient had left hepatectomy with resection of the main bile duct and the gallbladder. Macroscopic examination of the surgical specimen showed a dilatation duct at the hilum with thickening of their walls.The histopathology report revealed multiple intra-hepatic papillary neoplasms with high-grade dysplasia with an invasive carcinoma component in the left hepatic duct without extending to the biliary wall, classified as pT1N0.Conclusion: This premalignant lesion has the potential to transform into invasive carcinoma if not properly diagnosed.Our case illustrates how early identification can lead to potential surgical resection.

Cardiovascular diseases are the leading cause of mortality in the industrialized world. Among these diseases, aortic dissection affects the aorta wall and is a surgical emergency with a low survival rate. This pathology occurs when an injury leads to a localized tear of the innermost layer of the aorta. It allows blood to flow between the layers of the aortic wall, forcing the layers apart and creating a false lumen. Endovascular treatment seeks to obliterate the entrances to the false lumen with a covered stent. There are very few studies on the postoperative demonstration of blood flow phenomena in the aortic dissection endovascular treatment. It is crucial to study the hemodynamics of blood in the aorta after an intervention because the new geometrical configuration of the aorta with a stent leads to modifications in blood flow. For the surgeons, the procedure can only be performed empirically, using MRI-4D images to view the postoperative flow of the patient’s blood in the aorta with the stent.This paper aims to present a numerical tool developed from the open-source software FOAM- Extend®, allowing for multiphysics numerical simulations. Using MRI data, a bio-faithful model of the patient-specific case was built. Numerical simulations were performed to predict preoperative and postoperative (endovascular treatment) hemodynamics. The modifications of the flow in the aorta were analyzed focusing on the postoperative perfusions. The results were compared with the corresponding MRI data and have a good qualitative agreement. Biomarkers are calculated to localize possible zones of post-operative pathological developments and recommendations may be suggested to the surgeons.

Gliomas are known to be one of the most grievous malignant central nervous system (CNS) tumors and have a high mortality rate with a low survival rate severe disability and increase risk of recurrence. Aim of his study is to determine the diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low-grade and high-grade gliomas, taking histopathology as the gold standard. It is a Cross-sectional validation study conducted at the Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, Pakistan from 28th February 2022 to 27th August 2022.Materials and methods: A total of 215 patients with focal brain lesions of age 25-65 years of either gender were included. Patients with a cardiac pacemaker, breastfeeding females, de-myelinating lesions and malignant infiltrates, and renal failure were excluded. Then diffusion-weighted magnetic resonance imaging was performed on each patient by using a 1.5 Tesla MR system. The area of greatest diffusion restriction (lowest ADC) within the solid tumor component was identified while avoiding areas of peritumoral edema. Results of ADC were interpreted by a consultant radiologist (at least 5 years of post-fellowship experience) for high or low-grade glioma. After this, each patient has undergone a biopsy in the concerned ward, and histopathology results were compared with ADC findings. Results: Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low- and high-grade gliomas, taking histopathology as the gold standard was 93.65%, 87.64%, 91.47%, 90.70% and 91.16% respectively. Conclusion: This study concluded that apparent diffusion coefficient (ADC) is the non-invasive modality of choice with high diagnostic accuracy in differentiating low- and high-grade gliomas.

Introduction: The spread of SARS-CoV-2 cases grew exponentially. In Mexico, it focused mainly on containing the disease and adopting activities and actions to mitigate it. Hospital reconversion was a fundamental strategy in the management of care for patients with COVID-19.Objective: To know the clinical characteristics of patients admitted with respiratory disease and probable COVID-19 in the Zacatecas General Hospital “Luz González Cosío” México.Material and methods: Descriptive, cross-sectional, and analytical study, at the General Hospital, from March 2019 to September 2021; using data from the Respiratory Disease Surveillance System. Data from patients admitted with a diagnosis of some pathology of respiratory disease and probable COVID-19 were analyzed.Results: We included 2,678 diagnosed with respiratory disease and a mean age; of 47.6 ± 21.6 gender distribution was almost equal; women 1,344 (51.0%). positive result to COVID-19 by PCR; 1,654 negatives; 900 and 124 without result. 193 (7.0%) required mechanical ventilation. The presence of comorbidities was evaluated; type 2 diabetes mellitus, systemic arterial hypertension, obesity, alone and together. Also the association of the age factor, as well as the lethality index; was 531 (19.6%).Discussion: What has been published in other studies about comorbidities and their influence on the severity of COVID-19 is confirmed, disagreeing on the case fatality rate; 20.7% against what was reported; 17.6% in other countries for COVID-19 hospitalized. An age variable was used as a risk factor with a cut-off point > 45 years; (FRE), obtaining; RR 3.42 (95% CI 2.79 to 4.19) and an odds ratio of 4.015 in binary logistic regression analysis. Reported male mortality (OR = 1.45; 95% CI: 1.41–1.51) according to our OR results; 1,45.Conclusion: The present study shows how certain chronic diseases influenced respiratory disease to present a serious state, regardless of the positive or negative result of COVID-19.

Non-Hodgkin Lymphoma is rarely diagnosed as spinal cord compression syndrome. Caused by an epidural mass, this complication is often encountered in the late stage of the disease. We report two cases presenting symptoms of low thoracic spinal cord compression due to an epidural tumor on the MRI. Possible complications that may occur and how to prevent adverse events during surgery are essential. This case is of special interest for being a low-incidence pathology in a rare location. The case is of high interest because of the importance of resecting the lesion to prevent sequels and the complexity of its management and highlights the importance of considering the diagnosis of this event.

Pre-eclampsia is a pregnancy-associated condition, which is characterized by the onset of hypertension and proteinuria. It is one of the leading causes of maternal and neonatal mortality and this affliction has been recorded in around 8% of all pregnancies in the world. In addition to this, the etiopathology of this condition is very less understood and the resources available to diagnose and treat it are limited. Prior studies suggest more than a hundred possible diagnostic biomarkers that could be used to detect this disease early on. However, most of them are not feasible due to several reasons including stability, cost, safety, etc. Here two biomarkers HtrA3 (high-temperature requirement A3) and NGAL (Neutrophil Gelatinase Associated Lipocalin) are selected for the detection of pre-eclampsia, and we compare their efficacy in the detection of pre-eclampsia based on their specificity, ease of use, speed, stage of detection and source (invasiveness). We found that these two biomarkers are efficient under some parameters, and inefficient under others. The scoring system used in the current study suggests that NGAL is a superior biomarker. The results of this study help to develop a stronger understanding of both these biomarkers in the short and long term to classify the biomarkers more efficiently and understand the complicated pathologies of pre-eclampsia.

Cold atmospheric pressure plasma (CAPP) treatment is a highly effective method of protecting seeds, plants, flowers, and trees from diseases and infection and significantly increasing crop yields. Here we found that cold atmospheric pressure He-plasma jet (CAPPJ) can also cause side effects and damage to plants if the plasma exposure time is too long. Reactive oxygen and nitrogen species (RONS), electromagnetic fields, and ultraviolet photons emitted by CAPPJ can cause both positive and negative effects on plants. CAPPJ can interact with biological tissue surfaces. The plasma lamp has no visible side effects on Aloe vera plants, cabbage, and tomatoes. A plasma lamp and a cold atmospheric pressure plasma He-jet cause strong electrical signaling in plants with a very high amplitude with frequencies equal to the frequency of plasma generation. The use of plasma lamps for electrostimulation of biological tissues can help to avoid side processes in biological tissues associated with the generation of RONS, UV photons, and direct interaction with cold plasma. CAPP technology can play an important role in agriculture, medicine, the food industry, chemistry, surface science, material science, and engineering applications without side effects if the plasma exposure is short enough.

Background: Factors like emotions, lifestyle choices, and physical activities, including posture changes, have a significant impact on cardiovascular indicators like blood pressure and heart rate. The study aims to examine the cardiovascular reactions in individuals with type 2 diabetes while performing the head-down crooked kneeling (HDCK) or Sujood position, resembling poses found in hatha yoga. This position emphasizes relaxation, body awareness, and meditation. Those with type 2 diabetes who engage in yoga have reported enhancements in their management of blood sugar levels and insulin resistance. Methodology:  A cross-sectional study was conducted in different hospitals. The sample size was 312 which was calculated by using the Rao soft calculator. The participants were selected by non-probability convenience sampling technique. Inclusion Criteria were male and Female diagnosed with Type 2 DM, Subjects with a history of smoking, Cognitive Impairment, Sepsis, Cardiac pathology, Respiratory disorders, and Malignancy were excluded. Blood pressure and heart rate were monitored initially, during the Crooked Down Kneeling position, and after the Crooked Down Kneeling Position. A Digital Sphygmomanometer was used to measure blood pressure and a pulse rate-demographic Assessment form was used to collect data. Ethical consideration is maintained. Informed consent was taken from participants. Results: The result shows a significant effect of head down crooked kneeling position on cardiovascular response in type 2 diabetic patients (p < .001). Systolic, diastolic blood pressure, and heart rate before, during, and after HDCK were significantly increased (p < .001) as compared to the baseline value, and after 5 min returning to the upright position it reverted to the initial value. Conclusion: This study revealed a significant increase in systolic and diastolic blood pressures and an increase in pulse rate during HDCK. Also, our findings showed no significant gender difference in the effect of HDCK on all the other cardiovascular parameters except systolic bp.

Background and objectives: Periodontal disease, as an inflammatory pathology, induces hemodynamic changes that can be evaluated by different unbiased methods such as laser Doppler flowmetry. This clinical investigation assesses laser Doppler as a non-invasive procedure to monitor gingival vascularization and its potential relationship with the response to treatment of periodontal disease.Materials & methods: 45 sites of white Spanish patients with active periodontitis undertake a complete periodontal analysis. This included periodontal pathogens identification along with the monitoring of the gingival margin microvascularization using a Doppler laser at the points exhibiting the most periodontal damage. All assessments were performed before and after periodontal combined treatment PCT (scaling, root planing, and antibiotic therapy prescription) (n = 45 sites).Results: Parameters of periodontal disease showed a positive correlation with pathogen levels. Blood flow readings decreased significantly after PCT (p < 0,05), although this parameter was not statistically correlated with periodontal nor microbial assessments in a significant range.Conclusion: Laser Doppler is a complementary method of monitoring periodontal inflammation to traditional techniques of clinical periodontal evaluation. Further studies are necessary to determine its usefulness as a predictive method of periodontal disease evolution.

Amyotrophic lateral sclerosis (ALS) disease is characterized by degeneration of motor neurons and elevation of brain oxidative stress. Previous studies demonstrated the neuroprotective effects of Telomerase reverse transcriptase (TERT) from oxidative stress. We showed that increasing TERT expression in the brain of the Tg hSOD1G93A mouse ALS model attenuated the disease pathology and increased the survival of motor neurons exposed to oxidative stress. How TERT increased the survival of motor neurons exposed to oxidative stress is not yet clear. Here we investigated the consequence of TERT depletion in motor neuron cells under normal and oxidative stress conditions and in mouse brains of TERT knockout mice, on the expression and activity of SOD1 and catalase enzymes. Depletion of mouse TERT caused mitochondrial dysfunction and impaired catalase and SOD1 activity. Compensation with hTERT restored the activity of SOD1. SOD1 expression increased in the brain of TERT KO and in ALS mice and decreased in the brain of WT mice treated with telomerase-increasing compounds. We suggest that the ability of TERT to protect neurons from oxidative stress affects the expression and activity of SOD1, in a TERT-dependent manner, and supports the notion of TERT as a therapeutic target for neurodegenerative diseases like ALS.

Proteinuria is an easily quantified biomarker of kidney disease and often a sign of glomerular pathology. Significant proteinuria is uncommon in cystic kidney diseases and should be further evaluated to exclude the presence of another simultaneous kidney disease. While renal biopsy is a valuable part of the diagnostic evaluation of proteinuria, careful consideration of risks and benefits is necessary before proceeding in a patient with bilateral renal cysts. We report the case of a man with Polycystic Kidney Disease (PKD) who was found to have nephrotic-range proteinuria. An ultrasound-guided kidney biopsy revealed evidence of Focal Segmental Glomerulosclerosis (FSGS), which was attributed to hyperfiltration-related injury in the context of extensive kidney cysts. Genetic testing did not reveal a cause of FSGS and showed a variant of uncertain significance in PKD1. We use this case to highlight three important issues that are applicable to patients with PKD: the role of diagnostic evaluation for proteinuria in cystic kidney disease, the feasibility of kidney biopsy despite the presence of bilateral renal cysts, and the roles and limitations of genetic testing in cystic kidney disease and FSGS.

Distinguishing between fibroadenomas and phyllodes tumors is a challenge in breast surgery, despite advances in both radiology and pathology. In this case report, we analyze a patient presenting with a breast mass with multiple core needle biopsy results consistent with fibroadenoma, who underwent enucleation and was found to have phyllodes tumor on final pathology, thereby requiring surgical re-excision. This case report highlights the importance of patient clinical presentation in differentiating fibroadenomas and phyllodes tumors and explores how to achieve appropriate margins upon surgical re-excision after prior enucleation of phyllodes tumor via ultrasound localization of a seroma.

Background: Early-onset sarcoidosis is a rare systemic inflammatory granulomatous disease, distinguished by onset before the age of 4 and notably lacking pulmonary involvement. Unfortunately, the condition often shows clinical features similar to juvenile idiopathic arthritis, resulting in the misdiagnosis of numerous patients. This case report delves into the challenges associated with the delayed diagnosis of early-onset sarcoidosis, with a particular focus on the diagnostic methods employed to address this delayed recognition.Case presentation: A 15-year-old girl presented with a history of recurrent fever since infancy, accompanied by rash, arthritis, and joint deformity. Previously misdiagnosed with juvenile idiopathic arthritis, she underwent management with steroids and methotrexate, yielding no improvement. The diagnosis of early-onset sarcoidosis was made during adolescence based on serial examinations, comprehensive laboratory and radiological evaluations, and subsequent histopathology findings. Presently, the patient is receiving treatment with low-dose steroids and biologic therapy (Tocilizumab) and experiencing no disease progression.Conclusion: This case report underscores the importance of considering early-onset sarcoidosis in the differential diagnosis of pediatric patients exhibiting persistent arthritis from an early age. Early detection and treatment are crucial in averting complications and enhancing the overall quality of life. 

Background: Dysgerminomas, account for only 1% - 2% of all malignant ovarian neoplasms.Objective: This case report aims to present a rare occurrence of dysgerminoma in a pediatric patient, highlighting the clinical characteristics, diagnosis, and management.Case presentation: We present a case of dysgerminoma in a 12-year-old girl who presented with a three-week history of pelvic pain and progressive abdominal swelling. Physical examination revealed a distended abdomen with evident suprapubic fullness, and a palpable abdominopelvic mass measuring approximately 20 weeks in size. Imaging studies confirmed the presence of a solid heterogeneous mass originating from the pelvis. The patient underwent a right salpingo-oophorectomy without complications. Histological examination coupled with an immunohistochemical study confirmed the diagnosis of dysgerminoma. The patient had an uneventful postoperative course and was discharged without adjuvant treatment. Regular follow-up visits, physical examinations, ultrasound scans, and lactate dehydrogenase assays were initiated for monitoring. Conclusion: Prompt recognition and appropriate surgical intervention, followed by regular monitoring, are crucial for optimal outcomes in pediatric dysgerminoma cases.

With the increase in incidence and prevalence of myeloid neoplasms in India, it has become a necessity to understand its molecular mechanisms, acquisition of genomic alterations, and understand its primary and secondary resistance pathways which ultimately impact the decision of therapeutics. The objective of this review is to investigate the molecular aspects of this disease type and identify the biomarkers that help with diagnosis, risk assessment, prognosis, and selecting the best line of treatment for a specific myeloid neoplasm. Advancements and innovations in molecular technologies from simplest Real-Time PCR to high throughput next-generation sequencing have played a vital role in screening the most common mutations and fusions to the novel and rare. Molecular technologies have helped to enumerate the genomic landscape of myeloid malignancies. The understanding of both- the mechanisms and the technology is a strong combination as it has helped revolutionize precision oncology and helped in giving better therapeutic choices with better clinical outcomes. The importance of cellular morphology, clinical symptoms, and molecular pathology in assessing the risk of myeloid malignancies is emphasized and summarized in the review. The review concludes that understanding molecular pathogenesis can be improved by using clinical-pathological-molecular strategies for diagnosis and therapy decision-making.

The authors are searchers in psychopathology and communicate here about the dead wishes in relation to euthanasia. In Europe, the question comes regularly up to know if the law should be changed concerning the prohibition of euthanasia. The health system obeys progressively a modern idea of comfort and the “good life”. The authors are psychotherapists and their methodology is based mainly on phenomenological psychology, psychoanalysis, and psychopathology. Statistics of the French Ministry of Health will support their statements. Different clinical experiences with young patients, aging patients, or near-to-death patients are crossed and compared to those marked by heavy experiences like rape or amputation. The unbearable nature of their suffering makes them ask frequently to stop the pain. They would prefer being dead. This contribution examinates this kind of demand to find a helpful position for the caregiver and the patient. We should consider that near-death patients may often be at the climax of anxiety and depression is likely to switch over to dementia. In asking to finish with life, this purpose may change one day to another – sometimes it just highlights the wish to see things changed. The position of society and the medical staff has a high influence as well. Asking for euthanasia shows the variety of the same words that have different meanings from a medical, psychological, or psychopathological viewpoint. The purpose is to consider these aspects with the patient’s demand.

The Canadian healthcare system, grappling with issues like systemic and intelligently established structural anti-black racism, including indigenous nations; even within Pathology and Laboratory Medicine Communities: and deteriorating outcomes, sees potential in AI to address challenges, though concerns exist regarding exacerbating discriminatory practices. In clinical pathology, AI demonstrates superior diagnostic accuracy compared to pathologists in a study, emphasizing its potential to improve healthcare. However, AI governance is crucial to navigating ethical, legal, and societal concerns. The Royal College of Physicians of Canada acknowledges the transformative impact of AI in healthcare but stresses the need for responsible AI tools co-developed by diverse teams. Despite positive attitudes towards AI in healthcare, concerns about patient safety, privacy, and autonomy highlight the necessity for comprehensive education, engagement, and collaboration. Legal concerns, including liability and regulation, pose challenges, emphasizing the need for a robust regulatory framework. AI application in healthcare is categorized as high-risk, demanding stringent regulation to ensure safety, efficacy, and fairness. A parallel is drawn to drug regulation processes, suggesting a similar approach for AI. The lack of transparency in AI-based decision-making raises ethical questions, necessitating measures to address biases and ensure patient privacy. Social accountability is crucial to prevent AI from exacerbating health disparities and harming marginalized communities. In conclusion, while AI offers potential benefits in clinical pathology, a cautious approach with comprehensive governance measures is essential to mitigate risks and ensure ethical AI integration into healthcare.

Introduction: In the latest WHO classification of central nervous system tumors, Mitotic Index (MI) counted on Phosphohistone-H3 stained slides (pHH3-MI) has been suggested as a valid proliferative marker in various tumors including in the evaluation of meningioma grading.We aim to report our own experience in assessing the efficiency of the anti-pHH3 antibody as a grading tool for meningiomas.Methods: A retrospective study was conducted on a series of 40 meningiomas diagnosed from March 2020 to April 2021 at the Pathology Department of the Military Hospital of Tunis. We attempted immunohistochemistry and compared MI assessed on both pHH3 and HE-stained slides.Results: According to the HE-MI and pHH3-MI, the 40 cases of meningiomas were respectively divided into 35 versus 29 grade 1 cases, four versus eight grade 2 cases, and one versus three grade 3 cases. A highly significant correlation was found between pHH3-MI and HE-MI (p < 0.001). A significantly higher sensitivity in the pHH3 counting method was reported in our study. Discussion: we found, in accordance with the literature, that pHH3-MI is more reliable and accurate in mitotic counting, therefore exhibiting a high sensitivity in tumor grading, reported by an upgrade within 22,5% of the cases.Conclusion: PHH3-MI count facilitated a rapid reliable grading of meningiomas. However, molecular characteristics that could have a potentially significant impact on tumor progression should be the subject of further research.

Susceptibility-weighted imaging (SWI) is based on a 3D high-spatial-resolution, velocity-corrected gradient-echo MRI sequence that uses magnitude and filtered-phase information to create images. It SWI uses tissue magnetic susceptibility differences to generate signal contrast that may arise from paramagnetic (hemosiderin), diamagnetic (minerals and calcifications) and ferromagnetic (metal) molecules. Distinguishing between calcification and blood products is possible through the filtered phase images, helping to visualize osteoblastic and osteolytic bone metastases or demonstrating calcifications and osteoid production in liposarcoma and osteosarcoma. When acquired in combination with the injection of an exogenous contrast agent, contrast-enhanced SWI (CE-SWI) can simultaneously detect the T2* susceptibility effect, T2 signal difference, contrast-induced T1 shortening, and out-of-phase fat and water chemical shift effect. Bone and soft tissue lesion SWI features have been described, including giant cell tumors in bone and synovial sarcomas in soft tissues. We expand on the appearance of benign soft-tissue lesions such as hemangioma, neurofibroma, pigmented villonodular synovitis, abscess, and hematoma. Most myxoid sarcomas demonstrate absent or just low-grade intra-tumoral hemorrhage at the baseline. CE-SWI shows superior differentiation between mature fibrotic T2* dark components and active enhancing T1 shortening components in desmoid fibromatosis. SWI has gained popularity in oncologic MSK imaging because of its sensitivity for displaying hemorrhage in soft tissue lesions, thereby helping to differentiate benign versus malignant soft tissue tumors. The ability to show the viable, enhancing portions of a soft tissue sarcoma separately from hemorrhagic/necrotic components also suggests its utility as a biomarker of tumor treatment response. It is essential to understand and appreciate the differences between spontaneous hemorrhage patterns in high-grade sarcomas and those occurring in the therapy-induced necrosis process in responding tumors. Ring-like hemosiderin SWI pattern is observed in successfully treated sarcomas. CE-SWI also demonstrates early promising results in separating the T2* blooming of healthy iron-loaded bone marrow from the T1-shortened enhancement in bone marrow that is displaced by the tumor.SWI and CE-SWI in MSK oncology learning objectives: SWI and CE-SWI can be used to identify calcifications on MRI.Certain SWI and CE-SWI patterns can correlate with tumor histologic type.CE-SWI can discriminate mature from immature components of desmoid tumors.CE-SWI patterns can help to assess treatment response in soft tissue sarcomas.Understanding CE-SWI patterns in post-surgical changes can also be useful in discriminating between residual and recurrent tumors with overlapping imaging features.

Primary melanocytic neoplasms of the central nervous system are rare entities and can present in different clinical forms with mild and non-specific symptoms (such as headache and tinnitus) to severe and limiting symptoms (focal deficits and intracranial hypertension), mimicking the most diverse pathologies. In addition to the peculiar changes in imaging tests, diagnosis is always a challenge given the multitude of possible differential diagnoses, including aseptic meningitis. Given this, we bring here the case of a 59-year-old patient who attended care due to headache and vertigo followed by involvement of the cranial nerves and spinal cord, corroborated by physical examination and imaging study suggesting diffuse involvement of the meninges, which was subsequently confirmed by anatomopathological examination as a primary melanocytic neoplasm of the central nervous system but ended up dying due to complications resulting from late diagnosis. The objective of this work is to raise awareness about the possibility of this pathology as a differential diagnosis in these cases where there are often frustrating clinical manifestations but with changes in imaging tests, to enable an early diagnosis and consequently the possibility of a better therapeutic result, in addition to a brief review of the propaedeutic findings of this pathology.