Giant Cell Tumour (GCT) of bone is a benign, locally aggressive neoplasm. GCT of the foot is rare, comprising of about 5% of cases of all GCTs. GCT of Calcaneus is exceedingly rare, comprising of 1.2% of all calcaneal tumours. Due to its uncommon occurrence at this site, diagnosis can be delayed. In this report, we present the case of a Campanacci Grade 3 GCT of calcaneus in a 43-year-old female patient with 8 months history of worsening pain and disability. We treated her successfully by resection of Oscalcis and reconstruction with a femoral head allograft and K-wire fixation, a relatively cheaper and technically lesser challenging method of reconstruction. Three years’ postsurgery, she remains disease free, and her graft has healed. She continues to walk independently and remains disease free clinically and radiologically. We discuss a comparison with other reported cases where surgeons have opted for detailed intra-lesional curettage (DILC) and cementoplasty to fill the defect for a Grade 2 disease, some have even used a sural for soft tissue coverage with a maximum follow-up of two years. While in our patient we went for Calcanues resection and reconstruction with allograft because of a Grade 3 disease that poses greater risk of local recurrence with just DILC. Our patient has a three-year follow-up where she remains disease free

Hepatitis D virus （HDV） infection， the most severe form of viral hepatitis， remains underrecognized in the Asia due to inconsistent screening and limited surveillance. This systematic review （1970—2025） stratified HDV prevalence by population subgroups： community， hospital-based， and high-risk.Community studies showed high prevalence in Pakistan， Kazakhstan， and Kyrgyzstan； hospital cohorts revealed hyperendemicity in Mongolia and Uzbekistan； high-risk populations showed concentrated transmission in ［Hong Kong， China］， ［Taiwan， China］， Vietnam， and Sultanate of Oman. Many countries and regions lacked subgroup-specific data.The uneven， population-dependent burden underscores HDV as a major driver of advanced liver disease in Central and South Asia. Routine HDV screening and RNA-based diagnostics are essential to define burden and advance WHO 2030 elimination targets.¹

INTRODUCTION: Testicular tumours in childhood have diverse characteristics for different age ranges. This study aimed to describe the pattern, presentation and outcomes of primary testicular tumours in a paediatric population. METHODS: A retrospective study was conducted from January 2010 to December 2020 on children (≤18 years) with a diagnosis of primary testicular tumour. Baseline demographics, clinical characteristics, pathology, treatment and outcomes of these patients were analysed. The data were entered into IBM SPSS Statistics version 20.0. Chi-square test and Fisher's exact test were applied to find the statistical significance, which was set at P value ≤ 0.05. RESULTS: The study included 115 males, with 85 (73.9%) patients in the prepubertal age range with a mean age of 2.53 ± 2.06 years and 30 (26.1%) patients in the postpubertal group with a mean age of 15.73 ± 1.25 years. Yolk sac tumour was the most common (62.6%) histological subtype. Majority (46.1%) of patients had stage I disease on presentation, while 29.6% had stage IV disease. All patients underwent upfront high inguinal radical orchiectomy, which was followed by platinum-based adjuvant chemotherapy in 67% of the patients. The five-year event-free survival and overall survival for all patients were 75% and 91%, respectively. CONCLUSION Primary testicular tumours follow a bimodal age distribution pattern. Majority of patients can be cured with platinum-based chemotherapy despite having advanced disease at presentation.
Humans ; Male ; Testicular Neoplasms/mortality* ; Retrospective Studies ; Adolescent ; Child ; Child, Preschool ; Orchiectomy/methods* ; Chemotherapy, Adjuvant ; Treatment Outcome ; Neoplasm Staging ; Infant ; Endodermal Sinus Tumor/therapy* ; Neoplasms, Germ Cell and Embryonal

Major depressive disorder (MDD) affects people all over the world, and yet, its etiology is complex and remains incompletely understood. In this review, we aim to assess recent advances in understanding depression and its regulation, as well as its interaction with circadian rhythms. Circadian rhythms are internalized representations of the periodic daily light and dark cycles. Accumulating evidence has shown that MDD and the related mental disorders are associated with disrupted circadian rhythms. In particular, depression has often been linked to abnormalities in circadian rhythms because dysregulation of the circadian system increases susceptibility to MDD. The fact that several rhythms are disrupted in depressed patients suggests that these disruptions are not restricted to any one rhythm but rather involve the molecular circadian clock core machinery. The sleep-wake cycle is one rhythm that is often disrupted in depression, which often leads to disturbances in other rhythms. The circadian disruptions manifested in depressed patients and the effectiveness and fast action of chronobiologically based treatments highlight the circadian system as a key therapeutic target in the treatment of depression. This review assesses the evidence on rising depression rates and examines their contributing factors, including circadian misalignment. We discuss key hypotheses underlying depression pathogenesis, potential etiology, and relevant animal models, and underscore potential mechanisms driving depression's growing burden and how understanding these factors is critical for improving prevention and treatment strategies.
Humans ; Circadian Rhythm/physiology* ; Depressive Disorder, Major/therapy* ; Animals ; Sleep/physiology* ; Depression/therapy*

Background: The mortality of severe dengue infections is approximately 23%. In the management of dengue shock syndrome (DSS), aggressive fluid resuscitation is recommended. The primary objective of our study was to assess the factors associated with 30-day mortality in DSS patients. Methods: Adult patients >18 years old, who were admitted with DSS were included. DSS was diagnosed in patients who required vasopressors or had lactic acidosis >4 mmol/L. Patients were divided into three different groups based on cumulative fluid balance at death or extubation: group I (<3.5 L), group II (3.5–8.0 L), and group III (>8.0 L). Results: A total of 135 patients with DSS was included, with an overall 30-day mortality of 74.8%. The average Sequential Organ Failure Assessment (SOFA) score on intensive care unit admission was 12.2. Mechanical ventilation was required in 112 patients (83.0%), with 61 patients (45.2%) being intubated without a noninvasive ventilation trial. Respiratory failure was the most common reason for requiring intubation (65 patients, 48.2%). In survivors, the median cumulative fluid balance was 1,493 ml (interquartile range [IQR], 0–4,501 ml), whereas that in the mortality group was 7,797 ml (IQR, 3,700–13,600 ml). On multivariate analysis, SOFA score (odds ratio [OR], 1.220; 95% CI, 1.011–1.472; P=0.038) and having received >8.0 L cumulative fluid balance (OR, 6.682; 95% CI, 1.808–24.689; P=0.004) were associated with increased risk of mortality. Conclusions DSS patients have high mortality rates. High SOFA scores and >8.0 L cumulative fluid balance may indicate worse outcomes.

Background: Laparoscopic cholecystectomy has been associated with moderate to severe intensity pain, especially in the early postoperative period. Among pain modalities, the transversus abdominis plane (TAP) block has favorable results and fewer associated adverse effects. Current evidence also reports that intravenous lidocaine infusion is effective in reducing acute postoperative pain and decreases overall opioid requirement. This study aimed to compare intravenous lidocaine infusion and bilateral subcostal TAP block for postoperative analgesia following laparoscopic cholecystectomy. Methods: Thirty patients were randomly classified into the control, lidocaine, and TAP block groups. Intravenous lidocaine infusion was used in the lidocaine arm intraoperatively, while bilateral subcostal TAP block was placed in the TAP block arm as an intervention. The primary outcome was 24 h average pain score. Secondary outcomes included rescue analgesic consumption, postoperative nausea and vomiting, and patient satisfaction. Results: Comparative analysis between groups showed that the 24 h mean pain score on the visual analog scale score was significantly decreased in the lidocaine group than the control group (mean difference with 95% confidence interval [CI], 2.47 (1.94, 3.00); P < 0.001). Furthermore, the mean pain score was significantly decreased in the lidocaine group than in the TAP block group (mean difference with 95% CI, 1.14 (0.56, 1.72); P < 0.001). Conclusions Intravenous lidocaine infusion is a superior modality for postoperative pain management in laparoscopic cholecystectomy than TAP block or routine management. Lidocaine also helped decrease rescue analgesic consumption and achieved better patient satisfaction.

Background: The World Health Organization has projected that by 2050, the global number of new cancer cases will reach 35 million [1]. In 2024, Mongolia ranks first in cancer mortality worldwide. As of 2024, Mongolia ranks 3rd globally for esophageal cancer with a rate of 19.8% per 100,000 people, and 1st for stomach cancer with a rate of 28.6% per 100,000 people [2]. In recent years, the number of new cases of esophageal and stomach cancers recorded in the population of Mongolia has been steadily increasing compared to other countries. According to statistical data in Mongolia, 8169 new cancer cases were registered in 2024, of which 4755 people died from cancer-related causes [3]. In 2024, 64.4% of cancer patients in Mongolia were diagnosed at a late stage, while only 35.6% were diagnosed at an early stage [4]. Compared to the previous year, early-stage cancer diagnosis increased by 65%, indicating an improvement in cancer detection. This progress is closely related to advancements in diagnostic methods. The development of medical technology, particularly the integration of advanced imaging features such as LCI (Linked Color Imaging) and BLI (Blue Light Imaging) into flexible endoscopy, has brought significant breakthroughs in endoscopic examinations [5]. Since 2023, the General Hospital of Khan-Uul District has been using the FUJINON 6000 model flexible endoscope from Japan, equipped with advanced imaging functions such as LCI (Linked Color Imaging) and BLI (Blue Light Imaging). The evaluation of the effectiveness of these technologies in accurately diagnosing early-stage cancers served as the basis for this study. Objective: The objective is to evaluate the accuracy of early-stage cancer detection using special light modes — LCI (Linked Color Imaging) and BLI (Blue Light Imaging) — among patients who underwent esophageal and gastric endoscopic examinations at the General Hospital of Khan-Uul District." Material and Method: In 2023 and 2024, a total of 4,842 patients underwent flexible endoscopic examinations of the esophagus and stomach at the General Hospital of Khan-Uul District. Among them, 82 patients with mucosal abnormalities or microvascular pattern changes in the esophagus, stomach, or small intestine were selected for retrospective analysis. Biopsies were obtained using advanced imaging technologies, specifically LCI (Linked Color Imaging) and BLI (Blue Light Imaging), to assess the diagnostic value of these modalities in detecting early neoplastic changes. Result: In 2023 and 2024, a total of 4,842 patients underwent flexible endoscopic examination of the esophagus and stomach at the General Hospital of Khan-Uul District. Among them, 82 patients with mucosal abnormalities were selected for further evaluation using LCI (Linked Color Imaging) and BLI (Blue Light Imaging), and biopsy samples were obtained. The findings were as follows:
• 18 cases of esophageal cancer were identified, of which 15 cases (83.3%) were early stage and 3 cases (16.6%) were advanced-stage.
• 26 cases of gastric cancer were detected, with 13 cases (50%) in the early stage and 13 cases (50%) in the advanced stage.
• 1 case of early-stage small intestinal cancer was also newly diagnosed.
All 28 early-stage cancer cases underwent endoscopic mucosal resection (EMR). The advantages of this procedure include minimal patient discomfort, no visible external wounds, low risk of bleeding or complications, and most importantly, organ preservation, which is a major clinical benefit. Conclusion LCI (Linked Color Imaging) and BLI (Blue Light Imaging) demonstrate greater accuracy in detecting mucosal abnormalities compared to conventional WLI (White Light Imaging) in the early diagnosis of esophageal and gastric cancers. Early detection of malignancies significantly improves patients’ quality of life and increases the 5-year survival rate to over 90%.

PURPOSE: Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedic surgeons considering the high rate of non-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate vs. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications. METHODS: A search of the literature was made with the keyword "clavicle" in PubMed/Ovid Medline/Embase and University of Edinburgh online library "discover Ed". A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors. RESULTS: A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studies. The most commonly reported incidence of complication was acromial osteolysis. The quality of studies was assessed using modified Coleman score. Other than 2 studies that were considered for the study that met the "fair" standard all of them were considered "poor" based on the modified Coleman score. CONCLUSION Both hook plate and locking plate provide acceptable operative treatment options for the lateral end of clavicle fracture. However, a consideration of surgeons' experience, the likelihood of a second operation, and the size of the lateral fragment should be considered when choosing between the 2 types of implants.
Humans ; Clavicle/surgery* ; Bone Plates ; Fractures, Bone/surgery* ; Fracture Fixation, Internal/instrumentation*

Multiple morphological abnormalities of the flagella (MMAF) represent a severe form of sperm defects leading to asthenozoospermia and male infertility. In this study, we identified a novel homozygous splicing mutation (c.871-4 ACA>A) in the adenylate kinase 7 (AK7) gene by whole-exome sequencing in infertile individuals. Spermatozoa from affected individuals exhibited typical MMAF characteristics, including coiled, bent, short, absent, and irregular flagella. Transmission electron microscopy analysis showed disorganized axonemal structure and abnormal mitochondrial sheets in sperm flagella. Immunofluorescence staining confirmed the absence of AK7 protein from the patients' spermatozoa, validating the pathogenic nature of the mutation. This study provides direct evidence linking the AK7 gene to MMAF-associated asthenozoospermia in humans, expanding the mutational spectrum of AK7 and enhancing our understanding of the genetic basis of male infertility.
Humans ; Male ; Sperm Tail/ultrastructure* ; Homozygote ; Consanguinity ; Asthenozoospermia/pathology* ; Infertility, Male/genetics* ; Mutation ; Pakistan ; Adenylate Kinase/genetics* ; Adult ; Pedigree ; RNA Splicing ; Exome Sequencing ; Spermatozoa