Current Issue (Volume 3, Issue 1), 2025

Introduction

Thoracic outlet syndrome is a group of disorders arising from compressive forces on the neurovascular bundle in that region due to different etiologies. This study aims to present a case with an intractable cough as a complication of the surgery and its management.

Case presentation

A 41-year-old woman had a 15-year history of bilateral upper limb pain and numbness. The pain worsened over the last two months. Tests and imaging confirmed thoracic outlet syndrome. Physiotherapy had no effect. She underwent thoracic outlet decompression (TOD) under general anesthesia via a supraclavicular incision. Post-surgery, she developed uncontrollable cough that didn't respond to medication. Two days after the operation, a bupivacaine (5%) injection near the phrenic nerve resolved the cough.

Literature review

The literature review identified several cases of TOD complications, including right phrenic nerve paralysis resolving in 3-6 months, unilateral right diaphragm dysfunction, and lung herniation successfully treated with thoracoscopic reduction. These cases underscore the diverse presentations and outcomes of TOD complications, highlighting the importance of early diagnosis and tailored management strategies.

Conclusion

A possible complication of surgical decompression for thoracic outlet syndrome is an intractable cough that can be relieved by the injection of local anesthesia into the area of the phrenic nerve.

Introduction

Sacrococcygeal teratoma (SCT) is a rare embryonal tumor that occurs in the sacrococcygeal region, with an incidence of about 1 in 35,000 to 40,000 live births. This study presents a systematic review of giant SCT greater than 10 cm.

Methods

A systematic review of published studies regarding giant SCT in infants was conducted. The studies included met the following criteria: 1) the teratoma was situated in the sacrococcygeal region; 2) all case reports involved infants with a teratoma larger than 10 cm, and 3) the size of the teratoma was verified to exceed 10 cm through diagnostic methods.

Results

The current study included 31 studies that met the inclusion criteria. The studies included patients aged 6.1 to 9.3 months, with a median age of 7.6 months, predominantly female (72.7%). Diagnoses were primarily made in the first and second trimesters (39%) or after birth (33.3%), with cesarean delivery being the most common method (66.7%). Tumors weighed between 1.5 and 5 kg, with an average diameter of 15.6 cm. Surgical resection was performed in 93.9% of cases. The most common complication was respiratory failure (30.3%), and histopathology revealed that 39.4% of tumors were immature teratomas, while 33.3% were mature teratomas. The overall survival rate was 66.7%, with 18.2% of survivors experiencing tumor recurrence. Most complications occurred in the second trimester; however, no significant associations were found concerning the timing of diagnosis. Additionally, tumor size did not significantly impact outcomes.

Conclusion

Routine ultrasound and MRI are essential for the antenatal diagnosis of SCT. Due to the high risk of morbidity with larger tumors, cesarean delivery is advised for tumors over 10 cm. Coccygectomy is the most effective approach to prevent recurrence, highlighting the importance of timely surgical intervention and ongoing follow-up.

Introduction

 Microwave ablation (MWA) has emerged as a minimally invasive treatment for patients with inoperable non-small cell lung cancer (NSCLC). However, whether it is more effective as a standalone treatment or in combination with chemotherapy warrants further investigation. This systematic review assesses the efficacy and safety of MWA as a standalone treatment and in combination with chemotherapy in managing NSCLC.

Methods

Studies were included if MWA was used either as a standalone treatment or combined with chemotherapy for managing NSCLC, regardless of whether chemotherapy was administered before or after MWA.

Results

The patient cohort included 928 patients. In 63.8% of the cases, MWA was used alone, and in 36.2% with chemotherapy. Complications from MWA alone were higher (59.29% vs. 32.74%). The tumor stage in 52.36% of the cases who underwent MWA alone was stage I; however, it was the IV stage in 82.44% of the cases who underwent MWA combined with chemotherapy. Patients with available data and treated with MWA alone experienced higher local progression (26% vs. 18.5%), distant recurrence (51.5% vs. 38.5%), and both local and distant recurrence (10.8% vs. 2.6%). Reported complete response was 88.6% among cases that underwent MWA alone. While it was 78.0% in those who underwent combined MWA and chemotherapy. The median overall survival was higher in the MWA alone group (24.9 to 69.6 months vs. 21.3 to 23.90 months).

Conclusion

MWA combined with chemotherapy may represent a more effective option, with a slightly similar treatment response, reducing the risk of recurrence and minimizing complications.

Introduction

Cancer patients face a venous thromboembolism (VTE) risk that is up to 50 times higher compared to individuals without cancer. In 2010, direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and edoxaban were introduced, consequently becoming the controversial oral anticoagulants for VTE therapy. This study is a meta-analysis of randomized clinical trials (RCTs) evaluating the use of edoxaban for treating VTE in cancer patients over different treatment durations.

Methods

Using Google Scholar, a systematic search for RCTs on edoxaban for cancer-associated VTE was performed. The data extracted covered patient numbers, age, gender, BMI, cancer type, edoxaban dosage, treatment duration, comorbidities, major bleeding, recurrent VTE incidence, and deaths. Statistical significance was set at 0.05.

Results

Out of 52 studies, nine with 3,190 cases met the inclusion criteria. The mean age was 66.68 years, with 1,604 females (50.28%). Major bleeding occurred in 192 patients (7.66%) in the 6- or 12-month group and 57 (8.35%) in the 3-month group (p=0.573). Recurrent VTE was observed in 145 patients (5.78%) in the 6- or 12-month group and 95 (13.91%) in the 3-month group (p<0.001). Deaths from any cause totaled 548 (21.86%) in the 6- or 12-month group and 165 (24.16%) in the 3-month group (p=0.110).

Conclusion

Cancer patients receiving edoxaban for six or 12 months experience a lower recurrence rate of VTE compared to those on a 3-month treatment. The incidence of major bleeding appears to be similar between the two treatment durations.

Introduction

Fibroadenoma is the most common benign breast lesion; however, it carries a potential risk of malignant transformation. This systematic review provides an overview of the presentation, management, and outcome of carcinomas arising within fibroadenomas.

Methods

A systematic search on Google Scholar was conducted for English-language studies on breast carcinoma within fibroadenomas. Studies on fibroadenomas with no malignant components, review articles, pre-prints, incomplete data, and those published in suspicious journals were excluded.

Results

On ultrasonography, 28 masses (36.8%) appeared benign, and 20 (26.3%) were suspicious, with ultrasonographic data unavailable for the remaining tumors (36.8%). Mammography data were available for 50 tumors, revealing 27 benign lesions (54%) and 23 suspicious lesions (46%). Among the 17 lesions with available magnetic resonance imaging data, five were benign lesions (29.4%), and 12 were suspicious (70.6%). Cytology evaluation among 46 tumors revealed that 20 (43.5%) were benign, 24 (52.2%) were malignant, and two (4.3%) were suspicious. The most commonly performed surgery was wide local excision (50.7%), followed by mastectomy (32.9%). On histopathology, 11 tumors exhibited more than one pathology. Ductal carcinoma in situ was the most frequent finding (40.8%), followed by invasive ductal carcinoma (28.9%) and lobular carcinoma in situ (28.4%). Recurrence was observed in one case (1.4%), and metastasis occurred in two cases (2.8%).

Conclusion

Although rare, carcinomas arising within fibroadenomas may present considerable challenges in preoperative diagnosis, whether through imaging or cytology. Therefore, clinicians may find it necessary to approach fibroadenomas with increased caution.

Introduction

Transfusion medicine promotes the safety of blood transfusions by rigorously testing to eliminate risks of infection and hemolytic. The efficacy (to correct and identify antibodies) of a modified cross-matching method that excludes the use of anti-human globulin (AHG) bovine serum with that of the immediate spin crossmatch was assessed.

Material and Methods

This multi-center study was performed at two medical centers in Iran and Iraq. Over seven years, consecutive participants received two different blood cross-matching methods: one with AHG and bovine serum and another without it.

Results

The study included 31240 participants. About 18526 (59.3%) were males and 12714 (40.7%) were females. The ages of participants ranged from 23 through 57 years, with the average age of 39 years. Only 45 (1.4%) participants blood cross match incompatible in both spin cross match and cross match without AHG, bovine serum the same resultThe study found that all detected antibodies correlated with potential blood incompatibility, and there remained 100% safety between the two testing methods.

Conclusion

Omitting AHG and bovine serum in cross-matching might be safe. At least it can be used in emergency situations and in resource-limited settings. 

Introduction

There has been a notable rise in antibiotic resistance among enterobacteria. This issue is primarily attributed to the emergence of extended-spectrum beta-lactamases (ESBLs), which present a significant concern for public health worldwide. This study investigates the prevalence of ESBL production, antibiotic resistance profiles, and molecular identification of the blaTEM gene in Klebsiella pneumoniae isolates.

Methods

The samples were randomly collected from several medical facilities in Erbil city. The VITEK 2 system was used for bacterial identification, antibiotic susceptibility, and ESBL production testing. The Double Disc Synergy Test (DDST) confirmed ESBL production. Polymerase chain reaction was conducted on all DNA samples, and the amplified DNA was analyzed using agarose gel electrophoresis to detect the blaTEM gene.

Results

A total of 43 samples were collected, of which the majority were urine (56%), followed by sputum (28%), blood (9%), and wound (7%). Klebsiella pneumoniae isolates exhibited the highest prevalence of resistance against ceftazidime (72%), ceftriaxone (70%), ciprofloxacin (63%), amoxicillin-clavulanic acid (60%), amikacin (58%), cefotaxime/tazobactam (56%), and gentamicin (53%). The DDST results indicated positive ESBL production in 15 isolates (35%), as evidenced by an increase or distortion in the inhibition zone toward the amoxicillin-clavulanate disc. Of the 43 isolates, 34 (79%) carried the blaTEM gene.

Conclusion

The study area shows a significant level of antibiotic resistance in ESBL-producing Klebsiella pneumoniae isolates, which, if not adequately addressed, could soon lead to severe health and therapeutic consequences.

Introduction

Hospitals are high-risk environments for infections. Despite the global recognition of these pathogens, few studies compare microorganisms from community-acquired and hospital-acquired infections (HAIs). This study compares these microorganisms and explores their relationship with patients' comorbidities and socio-demographic factors.

Methods

This retrospective cross-sectional study was conducted at Smart Health Tower, Iraq, from January to December 2023, focusing on patients with community-acquired infections and HAIs. Data were extracted from microbiology laboratory records, including blood cultures, urine samples, and other body fluids, with patients classified based on CDC and IDSA guidelines. Bacterial identification combined conventional methods and the BD Phoenix™ M50 system, while antibiotic susceptibility was tested using the Kirby-Bauer method and the same automated system. Statistical analysis of resistance patterns utilized SPSS version 25, with significance set at p ≤ 0.05.

Results

In this study of 2,157 participants, 1,303 (60.4%) were male, with microbial growth observed in 1,177 cases (54.6%). Notably, 41.1% of females and 52.1% of males showed no growth (p < 0.001). The mean age was 43.62 ± 23.3 years. Wound samples had the highest growth rate (91.2%), while body fluids had the lowest (33.0%) (p < 0.001).  The overall multidrug resistance rates were 62.5% for community-acquired infections and 79.3% for HAIs. Patients with pre-existing comorbidities demonstrated significantly higher rates of hospital-acquired infections (p < 0.05).

Conclusion

Multidrug-resistant isolates are more prevalent in HAIs than in community-acquired infections, highlighting the need for enhanced surveillance to optimize antibiotic use and control HAIs through early detection of resistance.

Introduction

Due to indeterminate cytology, Bethesda III is the most controversial category within the Bethesda System for Reporting Thyroid Cytopathology. This study examines the characteristics and malignancy rates of thyroid nodules (TNs) classified as Bethesda III.

Methods

Data were collected by reviewing electronic medical records, encompassing demographic details, medical history, chief complaint, laboratory tests (including thyroid function tests), preoperative imaging, cytology results, management, and histopathology diagnosis.

Results

The majority of the cases were female (84.7%). Patients’ ages ranged from 15 to 71 years, with a mean of 42.9 ± 10.5 years. Regarding goiter grading, 37 cases (21.8%) were classified as G0, 62 (36.5%) as G1, 55 (32.3%) as G2, and seven (4.1%) as G3. Thyroid Imaging Reporting and Data Systems scoring categorized the nodules as TI-RADS 2 (5.3%), TI-RADS 3 (40%), TI-RADS 4 (38.2%) and TI-RADS 5 (9.4%).  The size of TNs on ultrasound ranged from 0.3 cm to 7.8 cm, with a mean size of 2.06 ± 1.3 cm. Adenoma was the most common diagnosis (40%), followed by thyroiditis (16.5%), papillary thyroid carcinoma (15.9%), and papillary thyroid microcarcinoma (15.9%). The nodules were predominantly benign (64.7%), while 35.3% were malignant. Patients with malignant nodules were younger than those with benign nodules (p=0.044). Benign nodules were significantly larger than malignant ones (p-value = 0.003).

Conclusion

One of three TNs with indeterminate cytology may be malignant. Patients with malignant nodules tend to be younger than those with benign nodules, and benign nodules are likely larger than malignant ones.