Metastatic pattern of uterine leiomyosarcoma: retrospective analysis of the predictors and outcome in 113 patients

Objective: To describe metastatic pattern of uterine leiomyosarcomas (ULMS) and correlate it with clinical and histopathologic parameters. Methods: We included 113 women (mean age, 53 years; range, 29 to 72 years) with histopathology-confirmed ULMS from 2000 to 2012. Distribution of metastases was noted from imaging by two radiologists in consensus. Predictors of development of metastases were analyzed with univariate and multivariate analysis. Impact of various clinical and histopathologic parameters on survival was compared using Log-rank test and Cox proportional hazard regression model. Results: Distant metastases were seen in 81.4% (92/113) of the patients after median interval of 7 months (interquartile range, 1 to 21). Lung was most common site of metastases (74%) followed by peritoneum (41%), bones (33%), and liver (27%). Local tumor recurrence was noted in 57 patients (50%), 51 of whom had distant metastases. Statistically significant correlation was noted between local recurrence and peritoneal metastases (p<0.001) and between lung and other common sites of hematogeneous metastases (p<0.05). Age, serosal involvement, local recurrence, and the International Federation of Gynecology and Obstetrics (FIGO) stage were predictive factors for metastases. At the time of reporting, 65% (74/113) of the patients have died; median survival was 45 months. Stage, local recurrence, and age were poor prognostic factors. Conclusion: ULMS metastasizes most frequently to lung, peritoneum, bone, and liver. Local recurrence was associated with peritoneal spread and lung metastases with other sites of hematogeneous metastases. Age, FIGO stage and local recurrence predicted metastatic disease and advanced stage, older age and local recurrence predicted poor outcome

Hypoparathyroidism presenting with seizures and intracranial calcifications in a child

The most common potentially treatable cause of basal ganglia calcification is hypoparathyroidism. Case report: We present a case of incidentally detected basal ganglia calcification due to hypoparathyroidism in a child presenting with seizures and discuss the clinical features, imaging findings, and management of hypoparathyroidism. Conclusion: Prompt detection and treatment of hypoparathyroidism can prevent intracranial calcification and the risk of intracerebral haemorrhages in patients with intracranial calcification

Disease Spectrum and Triage Assessment among Children Presenting to the Paediatric Emergency Department at a Tertiary Care Centre in Telangana, India

Introduction: Triage is a sorting process to quickly assess patients upon their arrival in the emergency department which helps to stream them to an appropriate location and adequate treatment. Triage assessment helps in recognising the commonly presenting childhood emergencies to optimise quality of care delivered in the Paediatric Emergency Department. Priority attention can be given to the critically ill or injured patients as how long the patient can safely wait, is predicted by triage. Aim: To provide data on disease spectrum and triage assessment of children presenting to an exclusive Paediatric Emergency Department. Materials and Methods: This was a cross-sectional study which was conducted from October 2020 to September 2021 over a period of one year in the Paediatric Emergency Department at Niloufer Hospital, a tertiary care children hospital in Hyderabad, Telangana, India. All children in the age group of one month to twelve years triaged by five-level Canadian triage and acute scale were included in the study. Data was collected from the register maintained at the Emergency Department. Descriptive statistics was used to analyse the data. Micosoft excel sheets were used for recording data. Results: During the study period, 7986 children were admitted with 5718 (71.6%) males and 2268 (28.4%) females. A total of 4352 (54.5%) patients were less than one year age. Neurological emergencies, acute febrile illnesses, respiratory illnesses were most common reasons for emergency visits. The number of chidren presenting with triage level 1,2,3 were n=4369 (54.71%). Conclusion: Majority of the patients attending the Emergency Department were less than one year old and acute febrile illnesses and seizures were the most common causes for admissions. Triaging and priorisation of pediatric emergencies is strogly recommended for early recognition of life threatening illnesses and to improve outcomes. Specially trained nurses, healthcare professionals trained in Basic Life Support (BLS) and Paediatric Advanced Life Support (PALS) will go a long way in reducing morbidity and mortality