Case Study of Atypical Fibroxanthoma: Presentation and Management.

Atypical fibroxanthoma (AFX) is a rare spindle cell proliferation arising from significant sun exposure. AFX often appears as a red papule, typically found in the head and neck region of elderly patients. Since there is no specificity in immunohistology, various stains differentiate AFX from other skin cancers. The stains include cluster of differentiation 68 (CD68), cluster of differentiation 163 (CD163), vimentin, cytokeratin epithelial (CKAE), and melanin. While local recurrence is common, AFX rarely metastasizes. Thus, the treatment options are complete surgical excision or micrographically oriented histographic surgery.

Food-Energy-Water Nexus in compliance with Sustainable Development Goals for integrating and managing the core environmental verticals for sustainable energy and circular economy.

Food, energy, and water resources are intricately interconnected, and nexus provides a holistic approach for addressing these complex links to minimize inefficiencies and waste. Nexus approach and circular economy are considered as effective solutions for sustainability. Quantification of these relations is the first step towards incorporating nexus modeling which helps sustainable production and consumption. For achieving the Sustainable Development Goals, understanding and effectively managing the FEW nexus becomes imperative. With an integral performance perspective, there is a need to address the interdependencies and trade-offs among food, energy, and water systems and challenges of economic, social and environmental sustainability. The aim of this study is to provide a comprehensive analysis of the FEW nexus, identify key opportunities and challenges, and propose integrated strategies for managing these core environmental verticals sustainably. The study addresses the accomplishment of these goals through nexus approaches and outlines the need for technological advancements for shared benefits among resources, contributing to conceptual development of nexus and circular economy. The results highlight the critical importance of adopting a nexus approach to advance sustainable development goals, enhance resource efficiency, and promote synergistic solutions across food, energy, and water systems.

Utilization of agricultural residues for energy and resource recovery towards a sustainable environment.

Fungal pre-treatment using Pleurotus ostreatus (PO) was carried out on individual and combinations of agro-waste wheat straw (WS), rice straw (RS), and pearl millet straw (PMS) with the addition of biochar (5%,7.5% and 10%) to reduce the pre-treatment duration. Further remaining substrate known as spent mushroom substrate (SMS) was used in anaerobic digestor (AD) for estimation enhanced biomethane yield. Equal ratios of RS + WS, WS + PMS, PMS + RS, and RS + PMS + WS and biochar addition were taken for enhancing pre-treatment, PO growth and AD process. The extent of pre-treatment was recorded with the maximum lignin removal of 40.4% for RS + PMS + WS as compared to untreated counterparts and 0.5%, 2.2%, and 3.3% times more lignin removal from individual PMS, RS, and WS respectively. Addition of biochar to the substrates reduced the total pre-treatment duration by days as compared to the non-biochar substrates. Biological efficiency (BE) used for the analysis of mushroom growth varied from 51-92%. Further, the average bio-methane yield was 187 ml/gVS for SMS of PMS + WS + RS with 10% biochar indicating an increment of 83.33% from untreated SMS of PMS + WS + RS. This, higher biomethane yield was 9.35%, 22.22% and 57.14% times higher than individual SMS of PMS, RS, and WS respectively. The current study shows that biochar not only enhances the bio-methane yield but also reduces the biological pre-treatment duration and removes the dependency on one lignocellulosic biomass for energy (bio-methane) and food (mushroom) production.

Rare Variant of Meigs Syndrome Associated With Pericardial Effusion.

Meigs syndrome is an uncommon entity associated with benign ovarian tumor, pleural effusion, and ascites. Its association with pericardial effusion is extremely rare. We report a case of Meigs syndrome associated with recurrent pericardial effusion that resolved after surgical resection of the ovarian tumor. (Level of Difficulty: Beginner.).

Insights into sustainable resource and energy recovery from leachate towards emission mitigation for environmental management: A critical approach.

The exponential generation of municipal solid waste (MSW) and landfill disposal without any treatment has increased the continuous generation of landfill leachate. Improper MSW and leachate management are contributing to environmental degradation and water and soil pollution, which must be treated. Numerous works have been conducted on leachate treatments for energy and resource recovery. This review presents a comprehensive study of leachate management in which different treatment methods are discussed to analyze the suitability of processes that can be employed to treat leachate efficiently. Further, the characteristics of leachate are examined as properties of leachate may be varied depending upon the region. Still, several challenges related to leachate management and its treatments are discussed in this study. An integrated system could be a better option for treating leachate because it contains large amounts of organic and inorganic compounds. Proper leachate management would help to recover energy and value-added products (metals).

Contemporary updates on bioremediation applications of graphene and its composites.

Graphene, a 2D single-layered carbon sp2 hybrid substance set in a honeycomb network, is widespread in many carbon-based materials. Due to its extraordinary optical, electrical, thermal, mechanical, and magnetic competences as well as its significant specific surface area, it has attracted a lot of interest recently. Synthesizing graphene refers to any process for creating or extracting the material, depending on the desired purity, size, and efflorescence of the finished good. Numerous methods have been employed for graphene synthesis categorized as top-down procedures and bottom-up procedures. Graphene finds its implementations in various industries such as electronics, energy, chemical, transport, defence, and biomedical areas such as accurate biosensing. It has been widely used in water treatment as a binder for organic contaminants and heavy metals. Many researches have fixated on creating various modified graphene, graphene oxide composites, graphene nanoparticle composites and semiconductor hybrids of graphene for contaminant removal from water. In this review, we have tried to address various production methods for graphene and its composites along with their advantages and disadvantages. Furthermore, we have presented a summary on graphene's outstanding immobilization of a variety of contaminants like toxic heavy metals, organic dyes, inorganic pollutants and pharmaceutical wastes. Additionally, a development of graphene-based microbial fuel cell (MFC) has been evaluated in an effort to produce ecological wastewater treatment and bioelectricity.

Clinical characteristics, evaluation and outcomes of chylopericardium: a systematic review.

OBJECTIVE: Chylopericardium (CPE) is a rare condition associated with accumulation of triglyceride-rich chylous fluid in the pericardial cavity. Due to minimal information on CPE within the literature, we conducted a systematic review of all published CPE cases to understand its clinical characteristics, management and outcomes. METHODS: We performed a literature search and identified cases of patients with CPE from 1946 until May 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant articles for pooled analyses of clinical, diagnostic and outcome data. RESULTS: A total of 95 articles with 98 patients were identified. Patient demographics demonstrated male predominance (55%), with a mean age of 37±15 years. Time from symptom onset to diagnosis was 5 (Q1 4.5, Q3 14) days, with 74% of patients symptomatic on presentation. Idiopathic CPE (60%) was the most common aetiology. Cardiac tamponade secondary to CPE was seen in 38% of cases. Pericardial fluid analysis was required in 94% of cases. Lymphangiography identified the leakage site in 59% of patients. Medical therapy (total parenteral nutrition, medium-chain triglycerides or octreotide) was undertaken in 63% of cases. In our cohort, 32% progressed towards surgical intervention. During a median follow-up of 180 (Q1 180, Q3 377) days, CPE recurred in 16% of cases. Of the patients with recurrence, 10% were rehospitalised. CONCLUSION: CPE tends to develop in younger patients and may cause serious complications. Many patients fail medical therapy, thereby requiring surgical intervention. Although overall mortality is low, associated morbidities warrant close follow-up and possible reintervention and hospitalisations.

Role of Percutaneous Transhepatic Biliary Drainage as an Adjunct to Endoscopic Retrograde Cholangiopancreatography.

Background: There is limited literature on the role of percutaneous transhepatic biliary drainage (PTBD) as an adjunct to endoscopic retrograde cholangiopancreatography (ERCP). This study evaluates the role of PTBD in patients with failed ERCP or post-ERCP cholangitis. Methods: Retrospective evaluation of clinical and intervention records of patients with biliary obstruction referred for PTBD following failed ERCP or post-ERCP cholangitis was performed. The cause of biliary obstruction, baseline serum bilirubin, white blood cell (WBC) count, serum creatinine, and procalcitonin were recorded. Technical success and clinical success (resolution of cholangitis, reduction in bilirubin levels, WBC count, creatinine, and procalcitonin) were assessed. Results: Sixty-three patients (35 females, mean age 51.4 years) were included. Indications for ERCP included malignant causes in 47 (74.6%) cases and benign causes in 16 (25.4%) cases. Indications for PTBD were failed ERCP in 21 (33.3%) and post-ERCP cholangitis in 42 (66.7%). PTBD was technically successful in all patients. Clinical success rate was 68.2% in the overall group. Mild hemobilia was noted in five (7.9%) patients. There were no major complications or PTBD related mortality. Cholangitis and acute kidney injury resolved following PTBD in 63.1% and 80% of the patients, respectively. Total serum bilirubin reduced by 47.8% and 69.4% after one week and one month of the PTBD, respectively. The average fall in procalcitonin was 5.17 ng/mL after one week of the PTBD. Conclusion: PTBD is an important adjunctive drainage procedure in patients with ERCP failure or post-ERCP cholangitis.

Retroperitoneal versus transperitoneal percutaneous catheter drainage of necrotic pancreatic collections: a comparative analysis.

PURPOSE: To compare the success rate, clinical outcomes, and complications of retroperitoneal (RP) versus transperitoneal (TP) percutaneous catheter drainage (PCD) of the necrotic pancreatic fluid collections. MATERIALS AND METHODS: This retrospective study comprised consecutive patients with acute pancreatitis who underwent PCD of lesser sac collections amenable to drainage via both TP and RP routes. The patients were divided into two groups based on the route of drainage (group I, RP, and group II, TP). The technical success, clinical success, complications, and clinical outcomes were compared between the groups. Subgroup analysis was performed based on the timing of drainage (acute necrotic collections, ANC vs. walled-off necrosis, WON) and organ failure (OF). RESULTS: Seventy-nine patients [mean age, 38.7 ± 12.3 years, 54 males] were included in the study. Group I and II comprised 22 (27.8%) and 57 (72.2%) patients, respectively. The procedures were technically successful in all the patients. There was no significant difference in the complication rate between the two groups. The clinical success was higher in group II (75.4%) as compared to group I (54.5%). However, the difference was not statistically significant (p = 0.070). There was no significant difference in the hospital stay (p = 0.298), intensive care unit stay (p = 0.401), need for surgical necrosectomy (p = 0.243), and mortality (p = 0.112) between the two groups. The outcomes in patients with OF and ANC were not affected by the route of PCD. Clinical success rate was significantly higher in WON undergoing TP drainage (p = 0.009). CONCLUSION: Both RP and TP routes of PCD are safe and effective. Clinical success rate was significantly higher in WON undergoing TP drainage.

Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection : Meta-analysis of Randomized Controlled Trials.

GOALS: The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT). BACKGROUND: FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI. STUDY: We performed a comprehensive search to identify randomized controlled trials comparing FMT against MT in patients with CDI. Outcomes of interest were clinical cure as determined by the resolution of diarrhea and/or negative C. difficile testing. Primary CDI is defined as the first episode of CDI confirmed endoscopically or by laboratory analysis. Recurrent C. difficile infection (RCDI) is defined as laboratory or endoscopically confirmed episode of CDI after at least 1 course of approved antibiotic regimen. RESULTS: A total of 7 studies with 238 patients were included in meta-analysis. Compared with MT, FMT did not have a statistically significant difference for clinical cure of combined primary and RCDI after first session [risk ratio (RR): 1.52, 95% confidence interval (CI): 0.90, 2.58; P =0.12; I2 =77%] and multiple sessions of FMT (RR: 1.68; CI: 0.96, 2.94; P =0.07; I2 =82%). On subgroup analysis, FMT has statistically higher rate of response than MT (RR: 2.41; CI: 1.20, 4.83; I2 =78%) for RCDI. However, for primary CDI there is no statistically significant difference between FMT and MT (RR: 1.00; CI: 0.72, 1.39; I2 =0%). CONCLUSION: As per our analysis, FMT should not be utilized for every patient with CDI. It is more effective in RCDI, but the results were not significant in patients with primary CDI.

Heterogeneity of cellular inflammatory responses in ageing white matter and relationship to Alzheimer's and small vessel disease pathologies.

White matter lesions (WML) are common in the ageing brain, often arising in a field effect of diffuse white matter abnormality. Although WML are associated with cerebral small vessel disease (SVD) and Alzheimer's disease (AD), their cause and pathogenesis remain unclear. The current study tested the hypothesis that different patterns of neuroinflammation are associated with SVD compared to AD neuropathology by assessing the immunoreactive profile of the microglial (CD68, IBA1 and MHC-II) and astrocyte (GFAP) markers in ageing parietal white matter (PARWM) obtained from the Cognitive Function and Ageing Study (CFAS), an ageing population-representative neuropathology cohort. Glial responses varied extensively across the PARWM with microglial markers significantly higher in the subventricular region compared to either the middle-zone (CD68 p = 0.028, IBA1 p < 0.001, MHC-II p < 0.001) or subcortical region (CD68 p = 0.002, IBA1 p < 0.001, MHC-II p < 0.001). Clasmatodendritic (CD) GFAP+ astrocytes significantly increased from the subcortical to the subventricular region (p < 0.001), whilst GFAP+ stellate astrocytes significantly decreased (p < 0.001). Cellular reactions could be grouped into two distinct patterns: an immune response associated with MHC-II/IBA1 expression and CD astrocytes; and a more innate response characterised by CD68 expression associated with WML. White matter neuroinflammation showed weak relationships to the measures of SVD, but not to the measures of AD neuropathology. In conclusion, glial responses vary extensively across the PARWM with diverse patterns of white matter neuroinflammation. Although these findings support a role for vascular factors in the pathogenesis of age-related white matter neuroinflammation, additional factors other than SVD and AD pathology may drive this. Understanding the heterogeneity in white matter neuroinflammation will be important for the therapeutic targeting of age-associated white matter damage.