Khalili Hospital

Seborrheic keratosis is a common benign epidermal neoplasm, typically arising on the trunk, face, and extremities. Auricular involvement is rare, and posterior auricular presentation is particularly uncommon, with few cases reported. We describe a 68-year-old Iranian woman presenting with a 3 cm × 2 cm posterior auricular mass that had slowly enlarged over 5 years. The lesion was firm, nontender, and fixed to underlying tissue, raising concern for malignancy. A preoperative biopsy was performed, and histopathology confirmed seborrheic keratosis. Given the lesion's size and atypical location, complete surgical excision was undertaken. Reconstruction of the resulting defect was achieved using a bilobed flap, executed in seven operative steps, utilizing mastoid and lateral neck skin to provide tension-free closure while preserving the retroauricular sulcus. Microscopic evaluation revealed acanthosis, papillomatosis, hyperkeratosis, and horn cysts without evidence of atypia or malignant transformation. The postoperative course was uneventful, with no complications or recurrence observed at 3-month follow-up. Both aesthetic and functional outcomes were satisfactory. This case highlights the rarity of posterior auricular seborrheic keratosis and underscores the importance of histopathological confirmation in lesions with indeterminate clinical features. The bilobed flap provided reliable coverage for a relatively large auricular defect, achieving favorable cosmetic and functional results. Documentation of such uncommon cases contributes to improved diagnostic accuracy and supports evidence-based surgical management of auricular tumors.

We aimed to conduct a systematic review of the epidemiology of Escherichia coli in bloodstream infections (BSI) of hematopoietic stem cell transplantation patients. For a comprehensive search of studies that reported the prevalence of E. coli and antibiotic resistance in bloodstream infections from 2000 to January 1, 2024, databases such as PubMed, EMBASE, Google Scholar, Scopus, and Web of Science were searched. The main keywords used were: Escherichia coli, epidemiology, bloodstream infection, microbial resistance, antibiotic resistance, hematopoietic malignancy, hematopoietic stem cell transplantation. After applying eligibility criteria, and quality assessment of studies, data analysis was done by comprehensive meta-analysis (CMA) software. The prevalence of bacterial bloodstream infections amongst different studies varied between 8-51%. Also, bloodstream infections caused by E. coli varied between 2.5-57%. Prevalence of extended-spectrum β-lactamases (ESBLs) of Escherichia coli in bloodstream infections varied between 15-80%. As well, the mortality rate caused by Escherichia coli strains in bloodstream infection varied between 6.7-27.3%. Resistance to ciprofloxacin, cefepime, third- and fourth-generation cephalosporins, was reported to be the highest (prevalence of 100%), and the lowest was against amikacin, with a prevalence between 13-38%. The high prevalence of Escherichia coli-related BSI, and subsequent mortality, especially by multidrug resistance and ESBL strains, in patients undergoing hematopoietic stem cell transplantation, requires essential measures to prevent the spread of microbial resistance.

Long noncoding RNAs (lncRNA) ANRIL and its genetic polymorphisms are shown to be associated with the risk of several cancers. However, the single nucleotide polymorphisms (SNPs) of lncRNA ANRIL are not thoroughly assessed in oral squamous cell carcinoma (OSCC) which is the most prevalent cancer in the head and neck area. Thus, this study aimed to assess the association of SNP of lncRNA ANRIL rs4977574 in patients with OSCC. 106 blood samples from the patients with OSCC were obtained with a gender- and age-matched control group to evaluate the SNP of rs4977574 of lncRNA ANRIL. The DNA was extracted using the salt-out technique and DNA genotyping was undertaken using specific primer pairs in the tetra-primer ARMS-PCR technique. Eventually, the frequency of wild-type (A) and the mutated allele (G), as well as the genotypes were estimated between the groups of patients with OSCC and healthy individuals. The results of our study indicated no statistically significant difference in the frequency of rs4977574 A/G of lncRNA ANRIL among the patients with OSCC and healthy individuals (p > 0.05). Likewise, no significant difference was found in the genotypes' frequencies (p > 0.05). Nevertheless, the marked association of GG with smaller tumor size and the high level of differentiation of OSCC cells in the presence of AA or AG genotypes were interesting outcomes of this study (p < 0.05). Similarly, all the genotypes AA, AG, and GG were correlated with the site of the occurrence of OSCC. Furthermore, the association of the genotypes with the lymph node metastasis and the tumors stage was not found to be significant (p > 0.05). The results of our study indicate that rs4977574 A/G and its genotypes do not have any direct correlation with the presence of OSCC; however, its association with the smaller tumor size and the level of the cancer cells differentiation could imply its possible indirect role.

Um melhor aproveitamento dos benefícios proporcionados pelo turismo cinematográfico depende de planejamento de longo prazo envolvendo as organizações de gestão de destino e as film commissions, organizações criadas para atração e apoio de produções audiovisuais. Este estudo focou nestas últimas, com objetivo de apresentar um panorama abrangente das film commissions brasileiras de atuação municipal e suas relações com o turismo cinematográfico. Para tanto, buscou-se analisar a estrutura institucional dessas organizações, além de ações de fomento ao turismo cinematográfico e sinergias com os atores do turismo. A pesquisa assumiu um caráter exploratório-descritivo, com abordagem quantitativa no tratamento dos dados, por meio da estatística descritiva. O universo consistiu nas film commissions brasileiras com atuação municipal, o qual totalizava dezesseis entidades em 2022. A coleta de dados foi realizada por meio da aplicação de uma survey, obtendo-se um retorno de dez comissões. Os achados da pesquisa mostram que as film commissionspossuem natureza pública, com equipes enxutas e baixos orçamentos. Verificou-se que elas concentram seus esforços mais no apoio às produções audiovisuais e menos em ações específicas de turismo cinematográfico. Orçamentos restritos e equipes pequenas foram considerados fatores limitantes à consecução da sua missão principal e ainda mais limitantes às ações de turismo cinematográfico.

Objective: To evaluate the outcome of laparoscopic Intra-abdominal Ventral Hernia Repair with Tissue Separating Mesh. Methodology: Patients aged 18-60 years old with documented ASA grade I or II, ventral hernias &gt;5 cm in size (clinically assessed by palpable expansile cough impulse and as abdominal wall defect on ultrasound), and no general contraindications to laparoscopy (such as bleeding disorders, low platelet counts, or prolonged clotting times) were excluded. Patients' permission was obtained after they were fully informed of the risks and benefits. Name, age, gender, and contact details were also recorded. After that, laparoscopic ventral hernia repair was performed. These surgeries were performed under general anaesthesia by a single surgical team led by a senior doctor with at least three years of expertise in laparoscopic surgery. The moment of incision served as the starting point. Tissue-separating mesh was inserted intraoperatively, and the operational time was recorded once again during closure. The patients were sent to the ward for further observation. Discharge documentation revealed a patient's postoperative hospital stay. Results: Mean age of the patients was calculated as 37.03+11.32 years. The gender breakdown reveals that men as majority, with 51 (51%) compared to 49 (49%) females. The outcome of laparoscopic intra-abdominal ventral hernia repair using tissue Separating Mesh showed that the mean operation time was 116.21+8.27 minutes, and the length of hospital stay was documented as 2.4+0.38 days. Conclusion: We concluded that outcome of laparoscopic Intra-abdominal Ventral Hernia Repair with Tissue Separating Mesh with regards to duration of operation and post operative hospital stay is feasible in our population Keywords: Intra-abdominal Ventral Hernia Repair, Tissue Separating Mesh, outcome, post-operative hospital stay, duration of operation

To measure the rate of unnecessary antimicrobials (UAU), and the effect of the infectious disease consultation. A 17-week multicenter study, patients’ records were reviewed for antimicrobials. A predefined UAU definition was developed. Excluded patients were those on prophylaxis and less than 1-year-old. The outcome is the UAU rate. Confounders were adjusted by Charlson index and APACHE 2 score. The analysis was by Χ² and Fischer's Exact Tests and multivariate analysis as appropriate. 662 records were reviewed: 169 qualified the necessary antimicrobial use (NAU) and 493 in the UAU categories. The rate of the UAU was 74.5%. The age means differed (53.85 years for the NAU versus 46.48 years for the UAU, P<0.001) without gender difference (P=0.285). The patients in the UAU category were represented more in UTI, SSTI, BSI, and no infection (P<0.05). The commonest UAU subcategory were non-infectious non-febrile conditions 36.71%, influenza-like illnesses, and viral syndromes 20.08%, combination therapy 17.6%. An infectious disease consultation was significantly associated with less UAU (P ≤ 0.004), and less mortality (P<0.05). In conclusion: UAU rate was high, and an infectious disease consultation significantly reduced the UAU rate and mortality.