Top Medical Bulletin 31/May/2022

Here are the top medical news for today:

A Healthy Lifestyle in Men at Increased Genetic Risk for Prostate Cancer

A study in European Urology examined whether men at an increased genetic risk of prostate cancer can offset their risk of disease or disease progression by adhering to a healthy lifestyle. Findings suggest thata genetic predisposition for prostate cancer is not deterministic for a poor cancer outcome. Maintaining a healthy lifestyle may provide a way to offset the genetic risk of lethal prostate cancer.

Study prospectively followed 12 411 genotyped men in the Health Professionals and the Physicians Health Study. Genetic risk of prostate cancer was quantified using a polygenic risk score (PRS). A healthy lifestyle with weight, vigorous physical activity, not smoking, and a healthy diet.

A total of 3005 overall prostate cancer and 435 lethal prostate cancer events were observed. The polygenic risk score enabled risk stratification not only for overall prostate cancer, but also for lethal disease with a four-fold difference between men in the highest and lowest quartiles 4.32. Among men in the highest PRS quartile, adhering to a healthy lifestyle was associated with a decreased rate of lethal prostate cancer 0.55, compared with having an unhealthy lifestyle, translating to a lifetime risk of 1.6% among the healthy and 5.3% among the unhealthy. Adhering to a healthy lifestyle was not associated with a decreased risk of overall prostate cancer.

These findings suggest that a genetic predisposition for prostate cancer is not deterministic for a poor cancer outcome. Maintaining a healthy lifestyle may provide a way to offset the genetic risk of lethal prostate cancer concluded the authors.

Lingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture

Management of a long proximal ureteral stricture is challenging. Lingual mucosal graft ureteroplasty is a novel minimally invasive technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. Study evaluated the long-term effectiveness of lingual mucosal graft ureteroplasty for managing long, complex proximal ureteral strictures in a multi-institutional cohort of patients. The findings of the study are published in European Urology.

This retrospective study involved data for 41 patients treated with lingual mucosal graft ureteroplasty was performed using either an onlay ureteroplasty in which the diseased ureter was incised ventrally and repaired with a lingual mucosal graft (LMG) to widen the ureteral lumen, or an augmented anastomotic technique in which the obliterated segment of the ureter was excised and reanastomosed primarily on dorsal side, and an lingual mucosal graft was placed on the ventral side.

A total of 41patients, 40 were operated with laparoscopic procedures and one with a robot. Twenty-four (59%) patients underwent an onlay ureteroplasty, and 17 (41%) underwent an augmented anastomotic ureteroplasty. The reconstructed ureter was wrapped with omentum in 90% of cases. The median (range) stricture length was 4.8 cm (2.0–8.0), operative time was 166 min (98–306), and estimated blood loss was 65 ml (15–220). No open conversions and intraoperative complications occurred. At a median follow-up of 35 mo (range 13–80), the overall success rate was 97.6% (40/41).

Lingual mucosal graft ureteroplasty is a safe, feasible, and effective long-term technique for managing long, complex proximal ureteral strictures, concluded the researchers.

Cardiac disorders worsen the final outcome in myasthenic crisis undergoing non-invasive mechanical ventilation

A recent study was performed to evaluate the impact of cardiological disorders on the outcome of myasthenic crisis requiring ventilation. Study threw some light on the fact that  hypertensive cardiopathy,  atrial fibrillation and ischaemic heart disease increased the risk of non-invasive ventilation failure in myasthenic crisis receiving ventilation. The study is published in Acta myologica journal. The study included 90 cases admitted to the Neurology Unit of Modena, Italy. All patients were eligible for a non-invasive ventilationtrial. The effect of cardiac comorbidities on the outcomes was analyzed, which were the need of invasive ventilation, the risk tracheostomy for weaning failure and the duration of intensive care unit (ICU) stay Females were 58.9% and males 41.1%.

Patients were classified as early or late, 34.4 and 65.6% respectively, according to age above or below 50; 85% of patients were anti- acetylcholine receptors (AChR) antibody positive. Hypertension and cardiac diseases occurred at the diagnosis in 61 and 44.4%, respectively. Invasive mechanical ventilation (MV) was needed in 34% of cases. Nine subjects (10%) underwent tracheostomy because of weaning failure. Independent predictors of non-invasive ventilationtrial failure were atrial fibrillation (AF), either parossistic or persistent, hypertensive cardiopathy and ischaemic heart disease. Hypertension (HT) had no statistical effect on the outcomes. Hypertensive cardiopathy was a predictor of weaning failure. Researchers concluded that study shows that hypertensive cardiopathy,  atrial fibrillation and ischaemic heart disease increase the risk of non-invasive ventilation failure in myasthenic crisis receiving ventilation.

Methanol-induced parkinsonism and cerebral vasculopathy due to perfume inhalation

The most common cause of methanol poisoning is through ingestion of adulterated alcohol; however, other routes of poisoning may also occur including cutaneous exposure and, rarely, inhalation. A case report in BMJ Neurol Open represents an unusual presentation of incidental methanol intoxication through inadvertent inhalation while manufacturing homemade perfume. It also highlights an additional, yet unrecognised finding of cerebral artery spasms as a squeal of methanol poisoning.

A woman in her 30s living in a rural area of Saudi Arabia was referred to our tertiary care facility for the management of sudden vision loss and parkinsonism. The patient makes a living by manufacturing local perfumes at home, and to compensate for increased demand for her product, she admitted to using adulterated alcohol from a different local vendor. She was admitted to her local hospital as a case of encephalopathy with optic neuritis, and she required intubation.

She was misdiagnosed as having autoimmune encephalitis, for which she received a course of pulse methyl prednisolone followed by intravenous immunoglobulin G (IVIG). The brain MRI showed bilateral and symmetrical areas of bright T2 sight. The frontal and occipital lobes showed bilateral, symmetrical, subcortical, hyperintense T2 signals with heterogeneous contrast enhancements in addition to enhancement of the optic nerves bilaterally.

There was significant rigidity and bradykinesia. A sensory examination was unremarkable to all modalities as well as cerebellar examination. Her gait revealed a decreased arm swing bilaterally with a shuffling gait and mild postural instability. The estimated unified Parkinson's disease rating scale (UPDRS) III was 50.

The preliminary diagnosis was methanol toxicity due to the nature of her disease progression and typical radiological imaging. As the patient denied any history of alcohol intake, results showed to have found a high concentration of methyl alcohol. Symptomatic therapy consisting of carbidopa–levodopa and pramipexole was started with a gradual increase in the dosages.

Parkinsonian symptoms resulting from methanol poisoning were managed by the use of dopaminergic agents, as was the case with the patient who showed a fair response to levodopa–carbidopa and pramipexole.