Kobari General Hospital

Opportunistic infections (OIs) play a crucial role in the morbidity and mortality of HIV-infected individuals. Despite the increasing use of antiretroviral therapy, there remains a lack of comprehensive data on the incidence of OIs to provide a clearer national picture. Therefore, this systematic review and meta-analysis aim to determine the pooled incidence and identify the predictors of OIs among people living with HIV in Ethiopia. A systematic search was conducted across multiple electronic databases to identify relevant studies. The degree of heterogeneity across studies was assessed using the I 2 statistic. Subgroup analyses were conducted to explore sources of heterogeneity. A funnel plot and Egger's test were used to assess publication bias. Adjusted hazard ratio with 95% CI was used to assess the relationship between predictors and OIs occurrence. In total, 24 studies met the inclusion criteria and were analyzed. The pooled incidence rate of OIs among people living with HIV in Ethiopia was found to be 6.96 per 100 person-years (95% CI: 5.14-8.78) based on a random-effects model. The meta-analysis identified predictors of OIs among people living with HIV, including poor adherence (pooled AHR 1.42, 95% CI: 1.12, 1.80), CD4 count < 200 cells/mm3 (AHR 1.49, 95% CI: 1.25, 1.78), being bedridden (AHR 1.45, 95% CI: 1.10, 1.90), and advanced WHO clinical stage (AHR 1.57, 95% CI: 1.24, 1.98). The burden of OIs continues to be a major health concern among people living with HIV/AIDS. Low CD4 count, poor adherence to ART, being bedridden, and advanced clinical stage were significantly associated with the occurrence of OIs.

72歳男性，扁平上皮癌cT1cN0M0に対し右肺下葉切除ND2a-1を施行，術後23日目に胸痛・息切れを自覚，定期受診時に右胸水と炎症を認めた．入院でドレナージ・抗生剤加療したが間欠熱持続と胸水培養でグラム陰性桿菌を認め，無瘻性膿胸の診断で胸腔鏡下膿胸腔掻把術を施行した．手術は急性膿胸を認め，初回手術で縦隔脂肪を被覆した気管支断端が視認でき，断端内腔は膿性付着物に覆われ，断端瘻による膿胸が疑われたが，明らかな気瘻は確認できず．術直後から持続性気瘻があり，CTで被覆脂肪内に気管支断端瘻を認めた．ドレナージで経時的に改善を得たため，術後1ヵ月で退院，術後2ヵ月でドレーンを全て抜去し，現在再燃なし．気管支断端瘻の程度や経過は様々で，治療法を迷う症例にも遭遇する．また断端被覆の効能は様々だが，今回は気管支断端への被覆脂肪内の気瘻減衰が保存加療継続の決め手となった．当方の過去被覆例や文献を踏まえ断端瘻保存加療を考察した．

IntroductionThe purposes of this study were to clarify whether non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) gene mutation have a higher incidence of cancer-associated venous and arterial thrombosis/thromboses (CATs) than EGFR-negative patients, and whether patients who develop CATs have a significantly poorer survival.Material and methodsThe relationship between EGFR mutation and the development of CATs was evaluated retrospectively in 1,891 patients with NSCLC, including 381 who were EGFR-positive. Propensity matching and logistic regression analysis were performed.ResultsAmong 1,891 patients with NSCLC, 37 patients (2.0%) developed CATs. After propensity matching, the incidence of CATs was 3.9% in EGFR-positive patients and 0.9% in EGFR-negative patients (p = 0.011). Therefore, the risk of developing CATs was higher in EGFR-positive than EGFR-negative patients. In EGFR-positive patients, the most common time to develop CATs was at the time of lung cancer diagnosis, but there were some patients who developed CATs during second-line treatment or later when EGFR-tyrosine kinase inhibitors were no longer effective. In advanced EGFR-positive patients, there was no significant difference in overall survival depending on the presence or absence of CATs, but the development of CATs impaired the long survival expected in EGFR-positive patients.ConclusionsEGFR-positive patients are currently treated with tyrosine kinase inhibitors and are expected to have a certain long-term prognosis. However, there is concern that overall survival might be shortened if CATs develop. Therefore, the possibility of developing CATs in EGFR-positive NSCLC patients must be addressed.

An 89-year-old woman was referred to our hospital This article is protected by copyright. All rights reserved.

Introduction: Diffuse large B-cell lymphoma is the largest subtype of non-Hodgkin's lymphomas, and is characterized by frequent extranodal presentation. The most common extranodal locations of non-Hodgkin's lymphomas are: stomach, bone, liver and testis. Simultaneous detection of multiple extranodal involvements during consultation is quite uncommon, and the majority of cases are characterized by gastric or intestinal localization. Case Report: This study has found an extranodal involvement of tonsil and testis by diffuse large B-cell lymphoma. Symptoms of tonsil lymphoma were seen one year before the same type of lymphoma appeared in the testis. Conclusion: The clinical course, similarity in the histological findings and the immunoprofile between the two organs suggested a possibility of metastatic diffuse large B-cell lymphoma from the tonsil to testis, which would be the first reported case. Diffuse large B-cell lymphoma (DLBCL) constitutes approximately 30% of all non-Hodgkin's lymphomas (NHLs) and typically presents as a rapidly enlarging symptomatic mass which is mostly due to nodal enlargement. The overall percentage of NHLs coded as being of extranodal origin is between 25% and 35% in most countries. Frequently, the origin of primary extranodal NHL can be ascribed to one given organ system or site, with most common extranodal sites being the stomach, skin, and small intestine. The breast, thyroid, lung, heart, liver, genitourinary tract, adrenal glands and bone could also be primarily affected. This report details a patient with an unusual presentation of DLBCL, characterized by tonsil and testicular involvement, which was associated with symptoms and signs of primary involvement of both organs.

Biochemical markers of cartilage and bone degradation are becoming increasingly important in the evaluation of knee osteoarthritis (OA). To clarify the correlation between radiological knee OA and urine CTX-II (C-terminal crosslinking telopeptide of collagen type II) or urine NTX-I (N-terminal crosslinking telopeptide of type I collagen), we conducted a cross-sectional study in the cohorts of the epidemiological knee survey at the Matsudai district in Niigata Prefecture, Japan. Urine specimens were collected from 296 subjects, and CTX-II and NTX-I were measured using ELISA. Standing knee AP X-rays were obtained and graded according to the Kellgren-Lawrence classification. The subjects were then divided by gender, age (40- to 59-year-old group and 60- to 79-year-old group), and the X-ray grade (Grade 0, 1, Grade 2, and Grade 3, 4). In non-OA (Grade 0, 1) subjects, the 60- to 79-year-old group had significantly higher CTX-II values than the younger group only in females. The subjects of both genders aged over 60 years of age with OA Grade 3, 4 had significantly higher CTX-II values than the Grade 0, 1 group or the Grade 2 group. For NTX-I, there were no significant differences between each OA grade although the Grade 3, 4 group females from 60 to 79 years of age had higher values than the Grade 2 group. In addition, in the 60- to 79-year-old subjects of both genders, a positive correlation was observed between the urine CTX-II and urine NTX-I. For the subjects ranging from 60 to 79 years of age in both genders, the urine CTX-II values indicate the progression of OA. In addition, the weak but positive correlation between urine CTX-II and urine NTX-I in the subjects ranging from 60 to 79 years of age in both genders suggests that bone resorption and cartilage degradation appear to develop in parallel.