aging

Cancer metastasis to the pituitary gland is rare, but in most cases, it originates from a late-stage breast tumor or lung cancer. The most common symptoms of metastasis to the pituitary gland are diabetes insipidus and visual disturbance. The common site of metastasis is the posterior portion of the pituitary gland because it is highly vascularized. Metastases to this site represent 1% of all tumors [1]. Metastasis to the pituitary gland is difficult to diagnose by hormonal analysis and magnetic resonance imaging of the brain and requires biopsy for confirmation [2].

Background: Myxedema is an extreme manifestation seen in patients with untreated hypothyroidism. It is a lethal endocrine emergency, which arises when a precipitating cause overwhelms the compensatory mechanisms of the hypothyroid state.Objectives: This case report aims to present a case of myxedema coma secondary to cretinism. It also aims to discuss how hypothyroidism leads to hypoventilation and eventually respiratory failure, as well as to discuss the epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of a child with myxedema coma.Case presentation: This is a case of a 7-year-old female, diagnosed with congenital hypothyroidism at 5 months of age, but eventually was lost to follow-up. She came back after 7 years presenting with difficulty of breathing. She was seen hypothermic, obtunded, and in severe respiratory distress. She was severely stunted and underweight with coarse facial features. Initial laboratory work-up showed elevated Thyroid Stimulating Hormone (TSH) as well as decreased tri-iodothyronine (FT3) and thyroxine (FT4). She was immediately started on levothyroxine, with noted resolution of the edema and improvement in sensorium. There was also noted improvement in the patient’s ventilation and was sent home on Continuous Positive Airway Pressure (CPAP) while asleep.Conclusion: This case highlights the importance of having a high index of suspicion of its clinical manifestations, which could lead to earlier intervention thereby preventing further complications. A multidimensional approach is essential in managing this case, as various organ systems are involved in this condition.

The incidence of heart failure with preserved ejection fraction (HFpEF) continues to rise, and obesity continues to be a predominant comorbid condition affecting patients with HFpEF. Recent research sheds light on the important pathophysiologic role that obesity plays in the development of HFpEF, with many areas of opportunity existing for future developments in understanding the etiology and management of the disease. Crucial in these pathophysiologic developments are studies that clearly characterize the obesity phenotype in HFpEF and compare it to presentations of HFpEF in patients without obesity. This paper reviews the existing literature on the obesity phenotype within HFpEF and discusses some of the prevailing ideas behind the pathophysiologic interplay between the conditions, as well as the existing treatments demonstrating improved outcomes in HFpEF.

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.

In the realm of dental surgery, implants are essential for replacing missing teeth. To facilitate implant placement, techniques such as bone grafting and sinus lifts are utilized to augment the volume of atrophied alveolar bone in candidates for dental implants. Typically, patients undergo a period of recovery following bone grafts before proceeding with implant placement. This study investigates the efficacy of Cone Beam Computed Tomography (CBCT) in measuring the residual bone volume and assessing bone quality after the healing phase. A texture analysis was conducted on CBCT scans from 42 patients requiring maxillary sinus lift reconstruction. These patients were categorized into two groups based on the type of grafting material used: Xenograft or allograft. The study analyzed the distribution of various texture parameters and conducted a Mann-Whitney U test to identify significant statistical differences between the groups. Results indicated non-normal distributions for specific variables such as Area_S(1,0) and S(1,0)SumOfSqs, while others like S(1,0)Entropy displayed normal distributions. The findings revealed no significant statistical differences in the primary outcomes between the xenograft and allograft groups. However, the average values of the gray shades of pixels in the allograft group were statistically significantly higher compared to the xenograft group, suggesting differences in bone texture post-procedure.

Purpose of the study:  To evaluate the performance of Best Practice Recommendation (BPR) compliance in reporting abdominal aortic aneurysm findings on imaging, comparing the results before and after its deployment.Methods: Best Practice Recommendations for AAA were deployed in 2020 at a large radiology practice site. Reports between January 2018 through October 2022 were reviewed, representing studies read prior to and subsequent to the implementation of the reporting standards. Cases of abdominal aortic aneurysms ≥ 2.6 cm were counted by year. Adherence to the BPR for each year was calculated as [total number of confirmed cases of ≥ 2.6 cm AAAs with compliant reports] * 100 / [the total number of confirmed ≥ 2.6 cm AAAs]. A secondary analysis was performed to determine whether there was a statistically significant difference in the proportion of BPR-compliant reports for AAA cases before (from 2018 to 2019) and after (from 2020 to 2022) BPR deployment using a chi-square test. Results: From January 2018 to December 2022, there were 8,693 reports referencing AAA. After excluding cases of suspected AAA (N = 2,131), confirmed AAAs with indeterminate sizes (N = 103), and confirmed AAAs with sizes < 2.6 cm (N = 85), the number of AAA cases ≥ 2.6 cm in size was 6,374. Concordance with the BPR standards for the remaining cases with sizes ≥ 2.6 cm were 1.6% and 4.1% in 2018 and 2019, respectively. Post-implementation of BPRs, there was a substantial improvement in guideline adherence to 32.1%, 84.3%, and 83.6% in 2020, 2021, and 2022, respectively. In general, the proportion of BPR-compliant reports of AAA cases in the pre-deployment (3.6%) period statistically differs (p - value < 0.0001) from those in the post-deployment period (73.9%)Conclusion: Adherence to reporting standards increased after the BPR deployment in 2020. The inclusion of management recommendations in the radiology report when AAA is identified is a simple and cost-effective way of improving outcomes for patients with AAAs through appropriate follow-up treatment.

Venous Thromboembolism (VTE) is a major public health concern, affecting approximately 900,000 people annually in the United States. In rare cases, a Patent Foramen Ovale (PFO) may allow a venous thrombus to cross into the arterial circulation, causing a paradoxical embolism. This case report presents a 46-year-old male who developed left renal artery stenosis after a paradoxical embolism, likely triggered by a prolonged flight and binge alcohol consumption. The patient was found to have a moderate-sized PFO and renal infarction, confirmed by imaging studies. Despite initial anticoagulation therapy and a planned stenting procedure, intraoperative findings revealed only mild stenosis, leading to cancellation of the stent placement. The patient ultimately underwent PFO closure with an Amplatzer Talisman device. This case underscores the diagnostic challenges in managing paradoxical embolism and the need for individualized treatment, particularly concerning anticoagulation duration, the decision for PFO closure, and post-procedural antithrombotic therapy. Further research is required to establish optimal management strategies for cryptogenic embolic events.

Cardiovascular Diseases (CVDs) remain a major global health concern, necessitating accurate and comprehensive diagnostic techniques. Traditional medical imaging modalities, such as CT angiography, PET, MRI, and ultrasound, provide crucial but limited information when used independently. Image fusion techniques integrate complementary modalities, enhance visualization, and improve diagnostic accuracy. This paper presents a theoretical study of advanced image fusion methods applied to cardiovascular imaging. We explore wavelet-based, Principal Component Analysis (PCA), and deep learning-driven fusion models, emphasizing their theoretical underpinnings, mathematical formulation, and potential clinical applications. The proposed framework enables improved coronary artery visualization, cardiac function assessment, and real-time hemodynamic analysis, offering a non-invasive and highly effective approach to cardiovascular diagnostics.MSC Codes: 68U10,94A08,92C55,65T60,62H25,68T07.

Aim: This study aims to determine the current status for estimation of radiation dose to blood vessels and components from medical imaging procedures.Methodology: A database search on internet via PubMed and Google Scholar was performed to find published papers in estimation of radiation dose to blood vessels and components from medical imaging procedures. Results: Few published papers were found; namely two published papers. Radiation dose to blood vessels and components were assumed to be included in total radiation dose estimation for organ or tissue, without considering different in radiosensitivity. Conclusion: It seems that effect of radiation on blood vessels and components is underestimated, in ICRP 60 and 103 recommendations reports. Recommendation: It is recommended to conduct more studies to estimate radiation dose for blood vessels and components from medical imaging procedures and revise the value of tissue weighting factor for bone marrow.

Purpose: To determine trends in breast imaging services utilization among privately and government-insured patients at a national radiology practice.Method: Monthly breast imaging volume data from January 2019 to September 2022 were analyzed across five insurance types: three commercial carriers (Com1-Com3), Medicaid, and Medicare. Primary analysis involved calculating quarterly volumes and standard errors of the mean, followed by a joinpoint regression to identify trend inflection points and quarterly percentage changes (QPC). In the secondary analysis, the entire period trend was obtained and measured as the average quarterly percentage change (AQPC).Results: Between 2019 Q1 and 2022 Q3, a total of 4,640,619 breast imaging services were accessed, including 2,034,833 2D screening mammograms, 1,640,689 screening digital breast tomosynthesis, 497,592 diagnostic mammograms, 452,549 breast ultrasounds, and 14,956 breast MRIs. AQPC values for imaging modalities varied across insurance types. Medicare and Medicaid patients showed the highest rates of utilization increases, particularly for modalities other than screening breast tomosynthesis, where private insurers dominated. Variations were observed between different commercial payors.Conclusion: Breast imaging utilization increased among patients insured by Medicare and Medicaid from 2019 to 2022, outpacing that of those with private insurance. These findings contrast previous research suggesting better access and utilization among privately insured individuals, highlighting increased access for government-insured patients in this study.

Iatrogenic ureteral injury is an uncommon but potentially severe complication of abdominopelvic surgery. When not identified intraoperatively, it may present days to weeks later with flank pain, fever, urinary tract infection, and imaging evidence of obstruction. Early recognition and timely urinary diversion are essential to prevent sepsis and preserve renal function.A 65-year-old patient underwent elective resection of an abdominal mass; pathology confirmed schwannoma. On postoperative day 15, the patient developed left flank pain and fever. Laboratory tests showed leukocytosis (WBC 15,000/mm³) and elevated C-reactive protein (150 mg/L); urine culture grew Escherichia coli. Contrast-enhanced CT demonstrated left hydronephrosis without stones, suggesting postoperative ureteral obstruction. Retrograde double-J stenting was attempted but failed. Urgent percutaneous nephrostomy achieved decompression with clinical improvement under targeted antibiotics. Definitive exploration revealed a 1 cm stricture of the lumbar ureter, managed by segmental resection and tension-free spatulated termino-terminal ureteroureterostomy over an internal stent. Postoperative recovery was uncomplicated; the stent was removed after 3 weeks. Follow-up ultrasound showed no persistent pelvicalyceal dilatation.Delayed ureteral obstruction should be suspected in postoperative patients presenting with flank pain, fever, and hydronephrosis. When retrograde stenting fails in the setting of infection, percutaneous nephrostomy provides rapid decompression and source control, allowing delayed definitive reconstruction. For short-segment proximal or mid-ureter strictures, ureteroureterostomy remains a reliable option when performed according to reconstructive principles.

Intravaginal erosion of synthetic mesh after laparoscopic promontofixation(sacrocolpopexy) is an uncommon but clinically relevant late complication. When mesh becomes exposed within the bladder, it may function as a persistent foreign body, encouraging chronic inflammation, bacterial colonization, recurrent lower urinary tract symptoms, and progressive encrustation that can culminate in bladder stone formation. We report a 60-year-old woman with a history of laparoscopic promontofixation using standard polypropylene mesh performed approximately five years earlier. She presented with progressive urinary symptoms. Bladder ultrasound demonstrated an intravesical calculus, and diagnostic cystoscopy confirmed a bladder stone developing on exposed intravesical mesh fibers, consistent with intravesical mesh erosion. Endoscopic management was performed with cystolithotripsy followed by section/resection and removal of the exposed intravesical mesh to eliminate the lithogenic nidus, with a favorable outcome. In women with prior promontofixation presenting with bladder stones, recurrent urinary tract infections, hematuria, or persistent irritative urinary symptoms, intravesical mesh erosion must be considered. Cystoscopy is essential for diagnosis because imaging may identify the stone but not the underlying foreign-body etiology, and definitive treatment requires both stone clearance and elimination of intravesical foreign material to prevent recurrence.

Psoas abscess is a rare but potentially life-threatening condition with non-specific clinical manifestations. The condition may be primary or secondary, depending on whether it has an underlying cause. The condition may be diagnosed with the help of imaging studies, especially contrast-enhanced computed tomography (CT).A 55-year-old female patient with a history of treated hypertension presented with a 15-day history of fever and left-sided low back pain. Her laboratory parameters showed a high leukocyte count of 22,000 cells/mm³ and elevated levels of C-reactive protein (367 mg/L). Her renal functions were within normal limits, and the urine culture was negative. Contrast-enhanced CT revealed a large left-sided intra-abdominal fluid collection extending from the diaphragm to the left iliac fossa, measuring 66 x 305 mm with air bubbles. The collection also showed a left-sided intramuscular psoas collection of 66 x 50 x 131 mm. The patient received intravenous broad-spectrum antibiotics (third-generation cephalosporin, aminoglycoside, and metronidazole). The patient underwent mini-lumbotomy, and nearly 1 liter of pus was drained. The patient’s postoperative course was satisfactory with complete resolution of symptoms. The histopathological examination showed non-specific changes.Psoas abscess should be suspected in patients with febrile low back pain and inflammatory syndrome. Contrast-enhanced CT scans are essential for diagnosis and assessment of the extent of disease. In complicated cases with large abscess formation, early surgical drainage along with appropriate antibiotics will provide the best outcome.This case highlights the importance of early diagnosis and adapted management for successfully navigating the complexities associated with this condition.

Background: Bladder exstrophy is a rare congenital abnormality that is usually managed with multiple surgical interventions. Long-term consequences include recurrent urinary tract infections, bladder stones, fistulae, and metaplastic changes with malignant potential.Case Presentation: We present a case of a 21-year-old male with a history of failed childhood surgeries for bladder exstrophy who presented with a vesicocutaneous fistula and a 7 cm bladder stone. He underwent an open cystolithotomy with bladder augmentation and creation of a Benchekroun continent valve. However, the patient developed recurrent fistulae due to poor tissue quality. Histopathological examination confirmed early squamous metaplasia in the bladder mucosa. After discussion in a multidisciplinary meeting, the patient underwent a radical cystectomy with ileal conduit urinary diversion using the Bricker technique. He is doing well at 3 months with no evidence of any complication.Conclusion: This case illustrates the difficulties encountered in managing adult patients with bladder exstrophy and failed reconstructions. The presence of squamous metaplasia, poor bladder tissue, and recurrent complications all contributed to the decision for radical cystectomy. It is important to recognize these changes and address them appropriately in a timely manner to prevent further complications and possible malignant changes.

Obesity represents a significant public health challenge on a global scale, with its prevalence increasingly linked to socio-economic factors, most notably family income. This study investigates the relationship between family income and several obesity measures specifically, the Body Shape and Size Index (BSSI), Body Mass Index (BMI), Body Surface Area (BSA), Ponderal Index (PI), Weight/Body Mass (BM), and Height within a sample of 9,906 respondents from Pakistan. Utilizing descriptive statistics and p - values, the analysis aims to provide a comprehensive understanding of how variations in income affect these obesity indicators, ultimately informing potential public health interventions. The findings reveal a complex, variable association between family income levels and obesity measures that differs by the specific obesity index examined. For BSSI, individuals in the lowest income bracket demonstrated higher values (indicating greater adiposity), while for BMI and weight, higher income brackets showed elevated values. These mixed findings suggest that the direction of association depends critically on which obesity measure is analysed. The study reveals that lower-income families are more likely to face barriers in accessing nutritious food, engaging in physical activity, and achieving favourable health outcomes. This situation is often exacerbated by economic constraints that drive families toward caloric-dense, nutrient-poor food choices. The implications of this research are far-reaching, emphasizing the need for targeted public health strategies to address obesity, particularly among economically disadvantaged populations. The study advocates for policies that enhance food security, improve access to health-promoting resources, and create supportive environments for physical activity. Through a nuanced exploration of these relationships, the research aims to contribute valuable insights to the field of public health, promoting equity in health outcomes and addressing the root causes of obesity in Pakistan.

Background: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are two common conditions in aging men. Their association exceeds mere age-related coincidence and involves shared vascular, neurological, endocrine-metabolic and psychosexual mechanisms. Objective: To evaluate the prevalence of ED in patients followed for symptomatic BPH, to identify factors associated with its severity, and to analyze the evolution of erectile function after medical treatment. Methods: A prospective cross-sectional study conducted at the Urology Department A of Ibn Sina Hospital, Rabat, from August 1 to November 30, 2021. After excluding 37 records, 100 male patients aged 50 to 80 years followed for BPH were included. LUTS were assessed using the IPSS score and erectile function using the IIEF-5 score. Sociodemographic, clinical, biological, ultrasonographic, cardiovascular and therapeutic data were analyzed. The significance threshold was set at p < 0.05. Results: Mean age was 66 ± 15 years. The overall prevalence of ED was 72%, with 30% mild, 33% moderate, and 27% severe forms among interpretable cases. Only 25% of patients had spontaneously reported their sexual dysfunction. Factors significantly associated with ED were age (p < 0.001), LUTS severity by IPSS (p < 0.001), obesity (p < 0.001), and history of prostatic surgery (p < 0.01), arterial hypertension (p < 0.02) and nocturia (p < 0.05). Alpha-blocker–tadalafil combination therapy improved the IIEF-5 score by +4.3 to +5.2 points. Alpha-blockers alone did not significantly improve erectile function. Conclusion: ED is common and largely under-reported in patients with BPH. LUTS severity, particularly nocturia, is closely linked to erectile impairment. Systematic sexual assessment should be an integral part of BPH management, and the alpha-blocker–PDE5i combination represents a relevant therapeutic strategy in patients with associated ED.