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Determination of 1p/19q co-deletion status is important for the classification, prognostication, and personalized therapy in diffuse lower-grade gliomas (LGG). We developed and validated a deep learning imaging signature (DLIS) from preoperative magnetic resonance imaging (MRI) for predicting the 1p/19q status in patients with LGG. The DLIS was constructed on a training dataset (n = 330) and validated on both an internal validation dataset (n = 123) and a public TCIA dataset (n = 102). The receiver operating characteristic (ROC) analysis and precision recall curves (PRC) were used to measure the classification performance. The area under ROC curves (AUC) of the DLIS was 0.999 for training dataset, 0.986 for validation dataset, and 0.983 for testing dataset. The F1-score of the prediction model was 0.992 for training dataset, 0.940 for validation dataset, and 0.925 for testing dataset. Our data suggests that DLIS could be used to predict the 1p/19q status from preoperative imaging in patients with LGG. The imaging-based deep learning has the potential to be a noninvasive tool predictive of molecular markers in adult diffuse gliomas. The authors developed a deep learning model predictive of 1p/19q status from preoperative imaging in 555 lower-grade gliomas (LGG), and achieved an area under the curve (AUC) of 0.983 in the testing dataset. They reveal that developing deep learning imaging signatures could be a noninvasive tool for predicting molecular markers in LGG.

Background: Obesity and metabolic syndrome (MetS) are growing problems in type 1 diabetic patients; these can influence clinical complications and also treatment regimens. Visceral adipose tissue i...

Background: Well controlled blood pressure (BP) is associated with decreased risk of kidney disease progression, cardiovascular events and death. Patients with chronic kidney disease (CKD) are frequently seen to have low rates of BP control. This study aimed to find out the proportion of adult type 2 diabetic CKD patients with hypertension achieving the goal of target blood pressure. Methods: This cross-sectional study included 105 hypertensive subjects having type 2 diabetes and CKD at the outpatient department of Nephrology, BIRDEM General Hospital in Dhaka, Bangladesh from May to August, 2012. Results: The mean age was 55.6 years and maximum numbers of patients were in the age group of 39-66 years. Among 105 subjects, 52.3% were male and rest 47.7% were female. The mean duration of diabetes, CKD and hypertension were 6.73 (±3.22), 3.12 (±2.47) and 3.1 (±1.77) years respectively. The study revealed that ischemic heart disease (30.5%), dyslipidemia (56.1%) and stroke (13.3%) were associated comorbidity along with diabetes and CKD. Mean estimated glomerular filtration rate was 52.19 ml/min. Mean serum creatinine level was 3.4 mg/ dl. It was observed that majority (49.5%) of the study subjects were prescribed at least two drugs to control hypertension. Three anti-hypertensive medications were given in 35.2% subjects. Among 105 study subjects, 25.7% were found to have high systolic blood pressure and 8.8% high diastolic blood pressure. It was observed that only 40% subjects achieved target systolic blood pressure and 68.6% reached the target diastolic pressure for CKD with diabetes. In correlation analysis, it was observed that both systolic and diastolic blood pressure was significantly correlated with age of the subject, duration diabetes and duration of HTN. Conclusion: From the present study it was seen that both the target systolic and diastolic blood pressure were correlated with numbers of medications used for controlling hypertension but only diastolic blood pressure control was significantly correlated with number of medication used in this present study. BIRDEM Med J 2021; 11(3): 212-217

Background Type 2 diabetes mellitus (T2D) has become a global health challenge. Diabetic peripheral neuropathy (DPN) is one of the common comorbidities of T2D that may affect the ability to perform diabetes self-care. Purpose To compare self-care practices between adult T2D patients with and without comorbid DPN and identify factors predicting self-care practices. Methods In this cross-sectional study, conducted at tertiary hospitals in Ethiopia, a total of 216 (108 with DNP and 108 without DNP) participants completed an interviewer-administered questionnaire including measures of diabetes self-care practices, self-evaluated peripheral neuropathy, self-efficacy, diabetes knowledge, and social support. Results Adult T2D patients with comorbid DPN had lower dietary (P< 0.001), exercise (P< 0.001), blood glucose testing (P = 0.001), and foot (P = 0.007) self-care practice than those without DPN. Social support is a significant predictor of dietary self-care in both groups while predicting foot self-care and blood glucose testing in those with comorbid DPN. Moreover, occupation, education, and having a glucometer are significant predictors of diabetes self-care practice in both groups. Conclusion This study found that adult T2D patients with comorbid DPN have poorer diabetes self-care practice than those without comorbid DPN. Interventions should focus on addressing social support and access to a glucometer in order to improve diabetes self-care practices in adult T2D patients with comorbid DPN.

Background Annular pancreas (AP) is a rare congenital abnormal rotation of the pancreas. AP rarely occurs in adults. Pancreatic tumors and ampullary tumors are related to AP, so the discovery and treatment of AP are essential. Case summary This study investigated the clinical manifestations, imaging features, complications, and treatment of six patients diagnosed with AP at the Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University from January 2010 to June 2020. There were four males and two females, with an average age of 56.00 ± 9.86 years old. In this study, abdominal pain and jaundice were the main clinical manifestations. Imaging can show the "crocodile jaw sign" or "double bubble sign". Conclusion For patients with duodenal or biliary obstruction, physicians should give priority to AP when imaging examinations suggest that the duodenum is wrapped with tissue similar to the density of the pancreas. Symptomatic patients should actively undergo surgical treatment.

OBJECTIVE To examine childhood BMI, fasting glucose, and insulin in relation to incident adult type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We used data from the International Childhood Cardiovascular Cohort (i3C) Consortium. Data included childhood (age 3–19 years) measurements obtained during the 1970s–1990s; a health questionnaire, including self-report of adult T2DM (occurrence age, medication use) obtained at mean age 40 years; and a medical diagnosis registry (Finland). RESULTS The sample included 6,738 participants. Of these, 436 (6.5%) reported onset of T2DM between ages 20 and 59 (mean 40.8) years, and 86% of them reported use of a confirmed antidiabetic medication. BMI and glucose (age and sex standardized) were associated with incident T2DM after adjustment for cohort, country, sex, race, age, and calendar year of measurement. Increasing levels of childhood BMI and glucose were related to an incrementally increased risk of T2DM beginning at age 30 years, beginning at cut points CONCLUSIONS Childhood BMI and glucose are predictors of adult T2DM at levels previously considered to be within the normal range. These easy-to-apply measurements are appealing from a clinical perspective. Fasting insulin has the potential to be an additional predictor.

Background and objectives This study aims at examining the potential survival benefits of primary versus secondary surgery of children diagnosed with advanced infantile (iFS) and adult-type fibrosarcoma (aFS). Methods Treatment and outcome of 89 children with FS treated within prospective Cooperative Studiengruppe (CWS) trials (1981–2016) were analyzed retrospectively. Results Localized disease (LD) was diagnosed in 87 patients: 64/66 patients with iFS (≤ 2 years) and 23 with aFS (> 2 ≤ 18 years). Two patients (iFS) had metastatic disease. Resection was the mainstay of therapy of patients with LD resulting in microscopically complete (R0, IRS group I) (n = 29/87, 33%), microscopically incomplete (R1, IRS group II) (n = 17/87, 20%) and macroscopically incomplete (R2, IRS group III) (n = 41/87, 47%). Advanced LD (IRS group III) was present in 32/64 (50%) patients with iFS and in 9/23 (39%) with aFS. Chemotherapy was added predominantly in patients with advanced disease and an assessable objective response to CHT was seen in 71% iFS and 75% aFS. The 5-year event-free survival (EFS) of patients with iFS and aFS was 81% (± 10, 95% CI) and 70% (± 19, 95% CI) (p = 0.24); the 5-year overall survival (OS) was 98% (± 3, 95% CI) and 82% (± 16, 95% CI) (p = 0.02). Primary resection was no prognostic factor. Secondary R0/ R1 resection in patients with advanced disease improved 5-year EFS and OS in aFS (p = 0.002 and p = 0.000) but not in infants. Conclusions Secondary resection improves outcome in advanced aFS but not in infants. Mutilating surgery in infants should be avoided. Type of study and level of evidence Treatment study: patients were enrolled in five prospective studies and one registry, prognosis study: retrospective study. Level of evidence II/ III. Mini-abstract Fibrosarcoma is a very rare malignant tumor. Little is known about differences of local treatment of advanced infantile and adult-type. Data of 89 patients registered in five prospective trials and one registry of the Cooperative Weichteilsarkom Studiengruppe (CWS) (1981–2016) were analyzed.

Hydrocele is a collection of fluid within the tunica vaginalis. Based upon the etiology and the pathophysiology, it is divided into, the primary and secondary. The primary hydrocele includes the neonatal or the congenital, the communicating and the non-communicating or the closed or the adult type. The secondary hydrocele can develop in the substrate of a pre-existing disease. After systematic and thorough systematic and thorough research of the relevant literature, we aim at describing all the aspects of this entity, with specific emphasis on the issues that remain unanswered from the scientific community.

In type 2 diabetic patients, blood lipids and lipid ratios have been provento beassociated with atherosclerosis risk; however, results about the effect of gender differences had not been fully conclusive.In thistransversal comparative study, a total of 129 adult type 2 diabetic patients (54 men and 75 women), from north western Algeria, was included to highlight the impact of gender differences on atherosclerosis risk (assessed by lipid ratios) according to their diabetic profile. Comparing between the two genders, no significant differences (p>0.05) were notedon diabetes duration, central obesity, body mass index and blood pressures. Moreover, the basic biochemical parameters of both glycaemic and lipid metabolism were not meaningfully divergent. However, higher significant values (p

Highlights • Triorchidism with incarcerated hernia was a rare occurrence. • Management of patients having concomitant pathology on exploration was a subject of dilemma. • All supernumerary testes that end up blindly without having communication with vase deferens must be removed. • Patients with undescended adult type polyorchidism with contralateral normal testis can safely undergo orchiectomy., Introduction Polyorchidism is a rare congenital malformation with about 200 cases reported in literatures. Triorchidism and left side occurrence are the most common presentation. This case report was aimed to report the rare presentation of polyorchidism which was on the right side and along with incarcerated inguinal that make it by far the least encountered presentation. The intraoperative management for the polyorchidism was an issue of dilemma but adult type can be excised safely. Presentation of the case A 43 year old farmer presented with right side inguino-scrotal mass and recent failure to reduce to abdomen. He used to have pain lower abdominal pain with slight pressure since childhood but didn’t get any medical evaluation. He has completed his family number and didn’t complain any sexual problem. Physical examination showed that there was non-tender irreducible soft right side inguino-scrotal mass. The right side testis was not appreciated. Discussion Triorchidism is one of the commonly occurring variant of supernumerary testes that diagnosed incidentally during investigations or interventions for other pathologies. Incarcerated inguinal hernia masks its detection on physical examinations, so its diagnosis is more of intraoperative making a one time management for both pathologies at single operation especially if the operation undertake with general anesthesia. This patient was operated for incarcerated inguinal hernia with incidental finding of right side type B1 polyorchidism. Both of the right side testes were atrophic and excision was done. Conclusion Patients who present at a late adulthood age with polyorchidism and undescended testis can be successfully treated with surgical removal of the atrophic supernumerary testes.

Introduction: The circle of Willis is the major source of collateral blood flow between the carotid and vertebrobasilar system. Its potential depends on the presence and size of arteries that vary greatly among normal individuals and therefore their adequate observation by a radiologist is necessary. Aim: Determine the type of the circle of Willis and their frequency. Determine the type, frequency and localization of anatomical variants of arteries, as well as their average diameter. Compare these variables according to the age and gender of the examinees. Material and methods: A retrospective study was performed at the Center for Radiology of the Clinical Center Nis during 2017. All subjects underwent CT or MR angiography according to a standard endocranial protocol. The anterior and posterior parts of the circle were specially observed, with an emphasis on the presence or absence of anatomical variants of the arteries, with the measurement of their diameter. The obtained data were classified into variants of the front or rear part of the ring as well as the type of ring according to integrity. The frequency of these variables and their comparison by sex and age were measured. Results: The research included 92 examinees. According to the configuration of the Willis arterial ring, the adult type was the most often represented (71.7%). The most common type in terms of integrity was partially complete. The most common anatomical variants obtained in our work was aplasia of AcoA (27.2%) and aplasia of one or both PCoA (21%). PcoA hypoplasia was occured in women with a frequency of 13.5% while in men it was not present. Conclusion: Adequate understanding of the morphology of the circle of Willis by radiological methods is a good guide for neurosurgical and radiological intervention procedures. In this way, potentially significant neurological complications and the risk of morbidity and mortality could be reduced.

BACKGROUND India is emerging as worlds’ diabetic capital. The cases of diabetic retinopathy are also increasing. We wanted to determine whether contrast sensitivity can be used as early indicator in diabetic retinopathy and also to measure and compare the contrast sensitivity in adults with type 2 diabetes mellitus with retinopathy and post-laser photocoagulation and correlate the contrast sensitivity in patients without diabetic retinopathy. METHODS This cross-sectional study included 50 diabetic patients with and without retinopathy and also 30 patients who had undergone laser photocoagulation who were above 30 years. Detailed history was obtained; ocular examination, and measurement of contrast sensitivity with Pelli Robson E and alphabet chart were done. Statistical analysis was done using Spearman’s coefficient of correlation, analysed using Epi Data / SPSS. RESULTS Contrast sensitivity was found to be reduced in post laser photocoagulation group and retinopathy group when compared to no retinopathy group. CS value between ‘No Retinopathy’ and ‘Post Laser’ groups, the p value by unpaired t test was found be statistically significant (p

Aims: To analyze prevalence and clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a public health system real-world sc...

Introduction: Anterior cruciate ligament (ACL) injuries represent a quarter of high school knee injuries. Adult-type ACL reconstruction (ACL-R) is the treatment of choice for skeletally mature adolescent patients with a complete ACL tear. Graft choice is individualized to the patient, taking into account the patient’s anatomy, activity level, and athletic participation. This subset of patients is at perhaps the highest risk of failure due to demands on the reconstruction after surgery. Hypothesis/Purpose: The purpose of this study was to evaluate outcomes including graft rupture between bone-patellar tendon-bone (BTB) versus hamstring autograft in adolescent patients undergoing adult-type ACL reconstruction. Methods: A retrospective review of patients under the age of 21 undergoing primary adult-type ACL-R by a single surgeon using BTB or hamstring autograft between 2011 and 2019 was performed. Patient demographics, athletic participation, concomitant injuries, graft utilized, graft size, femoral and tibial fixation devices, compliance with rehabilitation protocol, complications, and rates of revision surgery were evaluated. Factors associated with graft failure were compared using Fisher’s exact test with statistical significance < 0.05. Results: 269 patients with an average age of 16.5 years (range 12.4-20.6) and an average follow-up of 2.1 years (range 0.4-6.6 years) were included. 52.5% of the patients were female. The overall graft rupture rate was 4.8%. There was no difference in average age, sex, compliance, and participation in high risk sports between graft type groups. Graft size was larger in patients with BTB autograft than patients with hamstring autograft (9.0 vs. 8.3; pConclusion: Rates of graft tear after ACL-R did not differ with BTB versus hamstring autograft. Rates of compliance and participation in high risk sports did not significantly differ in patients with and without graft tear. Many patients had a change in surgical provider for revision surgery.

T1D accounts for 10% of all diabetes and DKA accounts for 8.1 per 1,000 hospitalizations. Glycemic outcomes have not been reported for adults with specifically T1D. We describe hospital glycemic outcomes for patients with T1D with and without DKA. Individual-level data from the Glytec Inpatient Database was examined for glycemic outcomes based on pre-specified target blood glucose (BG) ranges (Table 1). All patients were treated with Glucommander IV. Data was extracted from 154 hospitals located in 17 different states in the United States (2015-2020). T1D was determined based on ICD E10.XX. The DKA group (n=4592) included patients with age > 18 years met criteria for DKA: bicarbonate 250 mg/dl, and anion gap >12 mEq/L. The non DKA group (n=10,886) included patients who did not meet the DKA criteria. Prevalence of hypoglycemia and time to target (TTT) BG were stratified by target BG ranges. In patients with DKA, % BG This largest descriptive analysis of adult T1D patients with DKA and without DKA showed that Glucommander IV can safely get patients into prespecified target range, with minimal rates of hypoglycemia. Disclosure J. Messler: Employee; Self; Glytec, LLC. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. B. W. Bode: Advisory Panel; Self; Eli Lilly and Company, Consultant; Self; Bigfoot Biomedical, Inc., Companion Medical, Lexicon Pharmaceuticals, Inc., Medtronic, Novo Nordisk Inc., Zealand Pharma A/S, Research Support; Self; Abvance Therapeutics, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Dompe, Eli Lilly and Company, Eyenuk, Inc., Insulet Corporation, Jaeb Center for Health Research, Medtronic, Nova Biomedical, Novo Nordisk, Provention Bio, Inc., REMD Biotherapeutics, Sanofi, Senseonics, Viacyte, Inc., vTv Therapeutics, Xeris Pharmaceuticals, Inc., Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk, Sanofi, Stock/Shareholder; Self; AgaMatrix, Aseko, Inc., Glytec, LLC. R. Booth: Employee; Self; Glytec, LLC. J. Clarke: Employee; Self; Aseko, Inc., Stock/Shareholder; Self; Aseko, Inc.

The aim of this study is to assess the effect of meal size on glycemic control for T1D patients equipped with Diabeloop’s DBLG1 Closed Loop System[1], based on data from DBLG1 System Commercial Launch. The Soft Launch dataset comprises 34 adult type 1 diabetes patients with an average duration of 206 days for a total of 7011 days of treatment. Only days with ≥70% available CGM data were included in the analysis (97.3 % of total). To assess the effect of patient meal size (the daily sum of CHO declared by each patient on his device) on glycemic control, we compute the difference in percentage point between patient daily value and patient daily mean value of both Time In Range (TIR) (Figure 1) and Time In Hyperglycemia (TIHYPER) and plot it against each daily CarboHydrates (CHO) as a percentage of the mean daily CHO for this patient. This way we can observe the effect of bigger and smaller than average meals and determine if they tend to increase or decrease TIR and TIHYPER. As presented on Figure 1, days with increased CHO consumption are not linked to a drop in TIR. We observe no correlation between the TIR and the daily amount of CHO ingested (r=0.01), nor between the TIHYPER and the daily amount of CHO ingested (r=-0.12). In conclusion, Diabeloop’s DBLG1 Closed Loop System’s performance is not altered by the variations in daily amount of carbohydrates ingested by T1D patients. Disclosure P. Gimenez: Employee; Self; Diabeloop SA. S. Lachal: Employee; Self; Diabeloop SA. Y. Tourki: Employee; Self; Diabeloop SA. S. Franc: Advisory Panel; Self; Diabeloop SA, Board Member; Self; Novo Nordisk, Other Relationship; Self; Abbott Diabetes, Research Support; Self; Merck Sharp & Dohme Corp., Stock/Shareholder; Self; Diabeloop SA. C. Amadou: Other Relationship; Self; AstraZeneca, Diabeloop SA, Lilly Diabetes. A. Penfornis: Board Member; Self; Medtrum Technologies, Merck Sharp & Dohme Corp., Mundipharma International, Sanofi-Aventis, Other Relationship; Self; Medtrum Technologies, Speaker’s Bureau; Self; Amgen Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi-Aventis. G. Charpentier: Other Relationship; Self; Diabeloop. P. Y. Benhamou: Consultant; Self; Diabeloop SA, Eli Lilly and Company, Insulet Corporation, Other Relationship; Self; Abbott Diabetes.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome (BWGS) is a rare variant of the congenital anomalies of the coronary arteries. Two forms, the infantile (most common) and the adult types (rare) of these syndromic manifestations have been reported in the literature. Affected infants present with myocardial infarction and congestive heart failure. Few of them survive the first year of life, without appropriate surgical intervention. Adult type ALCAPA syndrome is one of the important causes of malignant cardiac arrhythmias, acute coronary syndromes, valvular pathologies and sudden cardiac death in young adults and adults. Asymptomatic adult type ALCAPA is uncommon, much more so its coexistence with bicuspid aortic valve (BAV). We present a 65-year-old patient with ALCAPA and BAV, who was largely asymptomatic. She had ligation of the ALCAPA, and aortic valve replacement, with a very good outcome.

Oxidative stress has been postulated as an underlying pathophysiologic mechanism of diabetic retinopathy (DR), the main cause of avoidable blindness in working-aged people. This review addressed the current daily clinical practice of DR and the role of antioxidants in this practice. A systematic review of the studies on antioxidant supplementation in DR patients was presented. Fifteen studies accomplished the inclusion criteria. The analysis of these studies concluded that antioxidant supplementation has a IIB level of recommendation in adult Type 1 and Type 2 diabetes mellitus subjects without retinopathy or mild-to-moderate nonproliferative DR without diabetic macular oedema as a complementary therapy together with standard medical care.

Objective: Islet autoantibodies at diagnosis are not well studied in older-adult onset (>30years) type 1 diabetes due to difficulties of accurate diagnosis. We used a type 1 diabetes genetic risk score (T1DGRS) to identify type 1 diabetes aiming to evaluate the prevalence and pattern of autoantibodies in older-adult onset type 1 diabetes. Methods: We used a 30 variant T1DGRS in 1866 white-European individuals to genetically confirm a clinical diagnosis of new onset type 1 diabetes. We then assessed the prevalence and pattern of GADA, IA2A and ZnT8A within genetically consistent type 1 diabetes across three age groups ( 30years (n=588)). Findings: In autoantibody positive cases T1DGRS was consistent with 100% type 1 diabetes in each age group. Conversely in autoantibody negative cases, T1DGRS was consistent with 93%(56/60) of 30years having type 1 diabetes. Restricting analysis to genetically consistent type 1 diabetes showed similar proportions of positive autoantibodies across age groups (92% 30years)[p=0.87]. GADA was the most common autoantibody in older-adult onset type 1 diabetes, identifying 95% of autoantibody positive cases versus 72% in those

Gaucher disease (GD), the most common lysosomal storage disorder (LSD), is caused by autosomal recessive mutations of the glucocerebrosidase gene, GBA1. In the majority of cases, GD has a non-neuropathic chronic form with adult onset (GD1), while other cases are more acute and severer neuropathic forms with early onset (GD2/3). Currently, no radical therapies are established for GD2/3. Notably, GD1, but not GD2/3, is associated with increased risk of Parkinson’s disease (PD), the elucidation of which might provide a clue for novel therapeutic strategies. In this context, the objective of the present study is to discuss that the evolvability of α-synuclein (αS) might be differentially involved in GD subtypes. Hypothetically, aging-associated PD features with accumulation of αS, and the autophagy-lysosomal dysfunction might be an antagonistic pleiotropy phenomenon derived from αS evolvability in the development in GD1, without which neuropathies like GD2/3 might be manifested due to the autophagy-lysosomal dysfunction. Supposing that the increased severity of GD2/3 might be attributed to the decreased activity of αS evolvability, suppressing the expression of β-synuclein (βS), a potential buffer against αS evolvability, might be therapeutically efficient. Of interest, a similar view might be applicable to Niemann-Pick type C (NPC), another LSD, given that the adult type of NPC, which is comorbid with Alzheimer’s disease, exhibits milder medical symptoms compared with those of infantile NPC. Thus, it is predicted that the evolvability of amyloid β and tau, might be beneficial for the adult type of NPC. Collectively, a better understanding of amyloidogenic evolvability in the pathogenesis of LSD may inform rational therapy development.

A 43-year-old male patient complained with atypical chest pain and dyspnea on exertion since six months ago. In heart physical examination, S1, S2, and III/VI systolic murmur in left sternal border was detected. In transthoracic echocardiography, mild LV enlargement with severe systolic dysfunction, EF=30% was reported. Patient was candidate for selective coronary angiography. Based on coronary angiography, Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome was confirmed and referred to cardiac surgeon to manage his condition.

Background: Ovarian granulosa cell tumors that originate from the sex cord-stromal cells represent 2% to 5% of all ovarian cancers. These tumors constitute two subgroups according to their clinical and histopathological features: juvenile granulosa cell tumors (JGCT) and adult granulosa cell tumors (AGCT). Granulosa cell tumor (GCT) is considered to be a low-grade malignancy with a favorable prognosis. Methods: This case series includes four patients who admitted to our university hospital and had an MRI examination within 5 years. Results: The histopathological subtype of granulosa tumor was the adult type in 3 patients and juvenile type in 1 patient. Even though it is extremely rare, bone metastases were present in one of our patients. Liver metastases were also detected in one patient. The MRI examination of tumors revealed a heterogeneous solid mass that contained cystic components in 3 patients. In one of our patients, the tumor had a multiseptated cystic feature, and all of the tumors were ovoid or round with smooth margins. T1 signal hyperintensity, not suppressed on fat saturation sequences, was observed in 3 patients, which represents its hemorrhagic content. Conclusion: Even though granulosa cell tumor shows a wide spectrum in terms of tumor appearance, some common findings have been shown and especially a hemorrhagic content could be a clue for us. The tumor is known to have a good prognosis, but it may have an unpredictable clinical course, so close follow-up is greatly important.

Lactose intolerance (LI) is characterized by the presence of symptoms, mainly gastrointestinal, due to the colonic fermentation of lactose not absorbed by lactase enzyme deficiency. Lactase deficiency can be primary, congenital, or adult type lactase deficiency, and secondary to other pathologies that involve a loss of enzyme activity. The prevalence of adult type lactose malabsorption varies depending on ethnicity and geographic location. In Europe it is related to the presence of two single nucleotide polymorphisms (SNP C / T-13910 and G / A-22018). What is the best technique for its diagnosis, especially with what dose the provocation should be done and for how long it should be performed, is still under discussion. The clinical symptomatology in lactose intolerance is modified by the load of the lactose substrate, the activity of the lactase enzyme, the speed of intestinal transit, the rate of gastric emptying and colonic compensation. Some LI do not present symptoms after usual amounts of milk intake, mainly of yogurt and cheese. In addition, the intestinal microbiota will also modify the presence and severity of symptoms. So the modification of this with biotics could be a possibility of treatment and to promote dairy products consumption.

Background Depression is associated with chronic physical illnesses and negatively affects health outcomes. However, it often goes undiagnosed and untreated. We investigated the prevalence of depression among adult type 2 diabetes mellitus (T2DM) patients attending non-communicable diseases (NCD) clinics in Lilongwe, Malawi, and estimated the level of routine detection by NCD clinicians. This study set out to determine the prevalence of major depression and its detection among adult type 2 diabetes mellitus (T2DM) patients attending NCD clinics in Lilongwe, Malawi. Methods In a cross-sectional study design, 323 T2DM patients aged ≥ 18 years were screened for depression with the Patient Health Questionnare-9 (PHQ-9) followed by diagnostic assessment with the Structured Clinical Interview for DSM-IV (SCID). We analysed the association between presence of major depression and sociodemographic factors using logistic regression. Results Three quarters of the participants (76%) were females. The participants’ ages ranged from 21–79 years. Of the 323 participants, 58 (18%) met criteria for DSM-IV major depression. None of the cases of major depression had been identified by the NCD clinicians. Major depression was found not to be significantly associated with any of the sociodemographic factors. Conclusions We found that depression is common among NCD clinic attendees with T2DM in Malawi, and poorly detected by NCD clinicians. Given the high prevalence and challenges in clinical identification, integration of depression screening with a standardized validated tool should be a high priority so as to link patients to appropriate services.

Amaç: Türkiye’de Çocukluk Çağı Ulusal Bağışıklama Programının kapsayıcılığı yüksektir; bu programda yer almayan rotavirüs, human papilloma virüs, meningokok, influenza ve erişkin tip boğmaca aşılarının uygulaması bağışıklama ile ilgili uzmanlar tarafından önerilmesine rağmen yaygın değildir. Bu çalışmada bu aşıların uygulanma oranının ve nedenlerinin belirlenmesi hedeflendi.Yöntemler: Ankete dayalı kesitsel bir çalışma olarak planlanan bu çalışma Orta Kuzey Anadolu’da küçük bir il merkezinde aile hekimleri ile yürütüldü. Katılımcılar tarafından elektronik posta veya telefon görüşmeleri ile sosyodemografik ve mesleki özelliklerini, Çocukluk Çağı Ulusal Aşı Programı dışındaki aşılar konusunda tutumlarının sorulduğu anket formları dolduruldu. Bulgular: Çalışmaya 108 aile hekiminin 78’i (%72) katıldı. Rotavirus aşısı hem günlük çalışma hayatında, hem de Ulusal Aşı Takvimi’ne dahil edilme önerisi konusunda en yaygın aşı idi. Tdab her iki durumda da en az önerilen aşı idi. Takvimde olmayan aşıların uygulanmaması konusunda en sık neden olarak hekimlerin konuyla ilgili bilgi ve deneyimlerinin yetersiz olması saptandı.Sonuç: Aşılar enfeksiyon hastalıklarından korunmanın en güvenilir ve ucuz yoludur, bu hizmetlerin sahada yürütülmesini sağlayan kaptanlar aile hekimleridir. Onların bağışıklama ile ilgili güncel bilgi ve gelişmelere ulaşmasını sağlamak için eğitim programları düzenlenmelidir. Çocuk sağlığı izlemelerinde Sosyal Pediatri hekimleri bağışıklama konusunda danışmanlık verebilir. Ek olarak, bu aşılar sosyal güvenlik sisteminin geri ödeme kapsamına alınmalıdır., Aim: The National Immunization Schedule (NIS) of Childhood has high coverage, but the administration of non-NIS vaccines (rotavirus, human papilloma virus, meningococcal, influenza, adult type pertussis vaccines [Tdap]) is not widespread in Turkey, despite recommendations by immunization experts. This report intended to explore the administration rates of these vaccines and their reasons in this province. Methods: This questionnaire based cross-sectional study was conducted in a small city in middle northern Turkey. The target population was the family physicians of this city. The participants filled a survey containing questions about their sociodemographic and professional features and attitudes about non-NIS vaccines via email or telephone interviews.Results: Seventy-eight (72%) of 108 physicians were enrolled in the study. The most and least recommended vaccines in daily practice and for addition to NIS were rotavirus and Tdap vaccines, respectively. The main reason of not administrating non-NIS vaccines was lack of knowledge and experience.Conclusion: Vaccination is the safest and cheapest way of protecting from infectious diseases. Family physicians are the leaders of these procedures in the field. Education should be provided to help them reach current knowledge regarding immunizations. Community pediatricians can provide expert consultation. These vaccines should be covered by social security.

Hypertension (HPT)is most common co-morbidity among type-2 diabetes mellitus (T2DM) patients which ominously increased their morbidity and mortality from cardiovascular disease (CVD)

Introduction: Although childhood obesity is related to incident adult type 2 diabetes (T2DM), whether other childhood risk factors relate to T2DM is not clear and no childhood risk score has been established to help with prediction of T2DM. Methods: We examined childhood risk factors in The International Childhood Cardiovascular Cohort (i3C) Consortium with a goal of developing a risk score for predicting adult T2DM. The pooled datasets included childhood measurements during the 1970s to 1990s. Participants were re-contacted at mean age 40 yr and completed a health questionnaire including self-report of adult T2DM (occurrence age, medication use). Results: N = 4,425 i3C participants with measurements during ages 3-19 yr. 225 (5.1%) reported onset of T2DM between ages 20-55 (mean 38.4) years (82% reported use of a valid antidiabetic medication). After stepwise regression, age-sex standardized deviates (mean of all repeated measures during ages 3-19 yr) of body mass index (BMI), glucose and ln(insulin) were associated with incident T2DM; the unadjusted risk curves visibly steepened at about 0.75 standard deviates (Figure, top panel). In multivariable models, BMI, glucose and ln(insulin) in a single model were associated with adult T2DM after adjustment for sex, race, cohort, and individual mean childhood age and calendar year. Prediction of incident T2DM was directly related to the number of the three risk factors with levels above +0.75 standard deviates (0: 3.2% (96/2966), 1: 6.2% (63/1,012), 2: 14.3% (56/392), 3:18.2% (10/55); the corresponding adjusted HR (95%CI) for the counts were 1 (reference), 1.8 (1.3, 2.4), 4.7 (3.3, 6.5), and 6.7 (3.5, 13.1), respectively). The +0.75 standard deviates in natural units are given in the Figure (bottom panel), e.g. about 92 mg/dL for glucose at age 12-14. Conclusion: The study suggests that a childhood risk score composed of BMI, glucose and insulin is a strong predictor of adult T2DM. Provisionally suggested cutpoints are lower than currently defined normal.

Purpose Patients with diabetes and health care professionals (HCPs) play important roles in effective application of injectable antidiabetic therapies (IATs). However, their concerns and opinions on IATs are rarely investigated in China. This study aims to assess unmet medical needs of IATs regarding patient concerns, patient satisfaction, aspects that need improvement, and training burden from patient and HCP perspectives. Methods This cross-sectional survey was conducted in 12 representative Chinese cities from December 2018 to January 2019. Patients with adult type 2 diabetes who were receiving IAT currently and had received IAT continuously for at least 1 month before the survey, endocrinologists with ≥5 years of experience and prescribing IAT in the past 1 month, and nurses with ≥3 years of experience and providing IAT training in the past 1 month were eligible participants. The patient survey assessed concerns of initiating IAT, satisfaction with IAT, aspects of IAT that need improvement, and IAT training received. The HCP survey evaluated patient concern of initiating IAT, aspects of IAT that need improvement, experience of providing IAT training, and self-reported burden of training. Descriptive statistical analysis was performed. Findings In total, 500 patients, 200 endocrinologists, and 100 nurses were surveyed. The mean (SD) age of patients was 55.1 (11.8) years, with a disease duration of 7.6 (6.4) years. Of all patients, 391 (78.2%) were insulin users and 109 (21.8%) were glucagon-like peptide 1 receptor agonist users. Of the top 4 concerns about initiating IAT, both patients and endocrinologists reported inconvenience of daily injection (58.0% of patients and 68.5% of endocrinologists), worries about insulin dependence (42.6% of patients and 62.5% of endocrinologists), and fear of injection (37.0% of patients and 66.5% of endocrinologists). Medical expenses, convenience of drug portability and storage, and injection site reactions were the top 3 aspects that need improvement according to both patients and HCPs. High injection frequency was also one of the most urgent aspects for improvement (mean urgency score, 3.8 for physicians and 4.0 for nurses). A typical IAT training session took a mean (SD) of 14.1 (9.7) minutes. Both patients and HCPs considered injection operation after dose is set and symptoms and treatment for adverse effects as the 2 most time-consuming training contents. In addition, 97.1% of endocrinologists who provided training and 97.0% of nurses thought a more user-friendly IAT would reduce their training burden. Implications Study results indicate that the IATs with more convenient drug portability and storage, fewer injection site reactions and adverse events, less injection frequency, more user-friendly design, and fewer steps for injection might help improve patient experience with self-injection and reduce HCPs’ training burden.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare cardiac malformation accounting for 0.25% of congenital heart diseases with reported incidence of 1 in 300,000 live births. It frequently occurs as an isolated defect and is associated with early infant mortality and sudden death in adults. Surgical repair is the treatment of choice and should be done soon after diagnosis. We report the case of a 38-year-old female, presenting as cardiac arrest and being finally diagnosed as adult ALCAPA. Successful surgical repair was performed using the trap door technique. The patient had an uneventful recovery.

Bakground and objective: To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. Patients and methods: Multicentre, prospective, randomized, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140 mmHg without relevant renal disease were randomized to one of two follow-up strategies: (1) standard follow up, with a clinic BP target

Background and aim The aims of this study were to establish consensus on service delivery models for management of Type III intestinal failure (IF) and home parenteral nutrition (HPN) within the Australian health-care system and to identify barriers and enablers in moving towards this ideal model. Methods A modified Delphi methodology was utilized to survey experts working in Type III IF HPN. The panel comprised physicians, dietitians, nurses, and pharmacists from 18 of the 20 adult Type III IF HPN centres across Australia. The study consisted of two rounds of email administered questionnaires developed around four key areas of health service delivery: access to services, clinical care, service guidance, and models of care. Open-ended responses were evaluated via an inductive thematic approach to identify areas of consensus. Experts reviewed the final report to consolidate consensus and validity. Results There was >80% consensus that an ideal team should consist of a physician, nurse, dietitian, pharmacist, and access to psychological support. Consensus supported the need for updated guidelines (75%) and a hub and spoke model of care (82%). However, further consultation is required in order to establish consensus around the use of HPN in the palliative oncology setting (69%). Conclusions This consensus provides a framework within which health professionals, managers, policy-makers, and consumer groups can move towards optimal management for Type III IF HPN patients. Advocacy and a review of service delivery across Australia are now required to facilitate the ideal model of care identified.