Cystic Pancreatic Neuroendocrine Tumor: A Diagnostic Dilemma.

Pancreatic neuroendocrine tumors are typically solid neoplasms but in rare instances may present as cystic lesions. Preoperative diagnosis of a cystic pancreatic lesion is challenging and requires a multidisciplinary and multimodal approach. We hereby describe an elderly female who came with complaints of abdominal lump. Radiologically, it appeared to be a pancreatic hydatid cyst located at the head of the pancreas, following which resection was done. Histopathological study of the lesion turned out to be a cystic pancreatic neuroendocrine tumor. Thus, we present this unique case due to its rarity and diagnostic challenge.

Intravascular papillary endothelial hyperplasia: Olanzapine-induced vascular proliferation?

Intravascular papillary endothelial hyperplasia (Masson's tumor) is a reactive vascular lesion of obscure etiopathogenesis, often seen in the head and neck. Its presentation as a scalp swelling, however, is extremely uncommon. We describe the first report in an adult, being treated for bipolar illness. A young male presented with a right frontotemporal scalp swelling since 3 weeks. He was also being treated for bipolar illness with olanzapine. Examination revealed a soft, non-pulsatile swelling. After inconclusive aspiration results, a complete excision was performed. Histopathology revealed proliferating endothelial cells arranged as papillary fronds confined to vessel lumina, devoid of atypia, accompanied by thrombosed vessels facilitating a diagnosis of Masson's tumor. The patient is free of recurrence five months after surgery. Further studies on a possible effect of olanzapine on vascular proliferation in experimental in vivo and in vitro models would definitely aid in elucidating clinical relevance, if any.

Chemical recycling of waste clothes: a smarter approach to sustainable development.

Amount of fabric waste has increased many folds in the past few years due to increasing population and rapidly changing fashiosn trends. Its larger portion being dumped in the landfills is creating a lot of problem in its management. This is causing problems to environmental components of earth, viz., air, water, and land. Chemically, cotton-based fabrics are made up of mainly cellulose with small components of other chemicals and contribute to a big segment of overall textiles. Along with donating the cloths for various purposes, scientific solutions are also feasible for valorizing waste fabrics to value-added products. This review article focuses on important strategies for addressing fabric waste for their possible conversion to significant products of varied applications. It emphasizes on chemical routes suitable for this purpose for producing cellulose, sugar, composites, etc. This will provide an insight to the readers for understanding the chemical significance of waste fabric and exploring the best possible ways for its efficient management, ensuring a step ahead towards sustainable development.

Refractory cancer pain in young child at end-of-life: Can we alleviate the suffering?

Pain is a common and highly distressing symptom in children with advanced malignancies and it is often multifactorial at the end-of-life. The prognosis of cancer pain is reported to be worse in those with mixed pain type, high pain severity, daily opioid use, and poor emotional well-being. We describe a case of 13-year-old boy, known case of metastatic Ewing sarcoma right iliac bone, who presented to our palliative care ward with intractable pain and was finally discharged home for terminal care with high doses of morphine, ketamine, and midazolam infusion through elastomeric pump attached to a peripherally inserted central catheter (PICC line). The suffering of imminently dying children should be reduced, and judicious dose escalation of opioids along with adjuvants is appropriate and often necessary.

Pyoderma gangrenosum: An uncommon cause of nonsexually acquired genital ulcer disease.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis affecting various sites, isolated genital PG being an uncommon presentation. We report a case of a 50-year-old diabetic male who presented with 2 penile ulcers. Extensive evaluation was done for sexually and nonsexually transmitted infections, malignancy, drug-induced vasculitis, and immunobullous etiology. A diagnosis of PG was made based on the clinical findings and histopathological exclusion of other causes. The patient showed a rapid response to prednisolone, dapsone, and colchicine. This report highlights the importance of keeping PG as a differential diagnosis in cases of genital ulcers which may mimic other sexually transmitted infections.

Nanoporous carbon materials as a sustainable alternative for the remediation of toxic impurities and environmental contaminants: A review.

Due to rapidly deteriorating water resources, the world is looking forward to a sustainable alternative for the remediation of noxious pollutants such as heavy metals and organic and gaseous contaminants. To address this global issue of environmental pollution, nanoporous carbon materials (NPCMs) can be used as a one-stop solution. They are widely applied as adsorbents for many toxic impurities and environmental contaminants. The present review provides a detailed overview of the role of different synthesis factors on the porous characteristics of carbon materials, activating agents, reagent-precursor ratio and their potential application in the remediation. Findings revealed that synthetic parameters result in the formation of microporous NPCMs (SBET: >4000 m3/g; VTotal (cm3/g) ≥ 2; VMicro (cm3/g) ≥ 1), micromesoporous (SBET: >2500 m3/g; VTotal (cm3/g) ≥ 1.5; VMicro (cm3/g) ≥ 0.7) and mesoporous (SBET: >2500 m3/g; VTotal (cm3/g) ≥ 1.5; VMicro (cm3/g) ≥ 0.5) NPCMs. Moreover, it was observed that a narrow pore size distribution (0.5-2.0 nm) yields excellent results in the remediation of noxious contaminants. Further, chemical activating agents such as NaOH, KOH, ZnCl2, and H3PO4 were compared. It was observed that activating agents KОН, H3PO4, and ZnCl2 were generally used and played a significant role in the possible large-scale production and commercialization of NPCMs. Thus, it can be interpreted that with a well-planned strategy for the synthesis, NPCMs with a "tuned" porosity for a specific application, in particular, microporosity for the accumulation and adsorption of energetically important gases (CO2, CH4, H2), micro-mesoporosity and mesoporosity for high adsorption capacity for towards metal ions and a large number of dyes, respectively.

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls.

Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance. Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section. Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at least one prior cesarean section were included in the study. Following imaging features were evaluated: (1) gray scale covering intraplacental lacunae, disruption of uterovesical interface, myometrial thinning, loss of retroplacental clear space, and focal exophytic masses; and (2) color Doppler covering intraplacental lacunar flow, hypervascularity of uterine serosa-bladder wall interface, and perpendicular bridging vessels between placenta and myometrium. Study Design Present study is a prospective one in a tertiary care hospital. Results Of the 19 PAS cases, 18 were correctly diagnosed on ultrasonography (USG) and confirmed either by histopathological analysis of hysterectomy specimen or per-operatively due to difficulty in placental removal. PAS was correctly ruled out in 27 of 31 patients. The diagnostic accuracy of USG was 90%. The sensitivity, specificity, positive, and negative predictive values were 94.7, 87.1, 81.8, and 96.4%, respectively. Conclusion Ultrasound is indispensable for the evaluation of pregnant patients. It is an important tool for diagnosing PAS, thereby making the operating team more cautious and better equipped for difficult surgery and critical postoperative care. It can be relied upon as the sole modality to accurately rule out PAS in negative patients, thereby obviating unnecessary psychological stress among patients due to possible hysterectomy.

The comparison of the efficacy of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomized controlled trial.

INTRODUCTION: The ultrasound (US)-guided erector spinae plane (ESP) block is a new regional anesthetic technique that offers significant advantages over paravertebral block as it is easy and safe to perform. We aim to compare the efficacy of US-guided paravertebral block with ESP block for postoperative analgesia in modified radical mastectomy (MRM). METHODS: Eighty female patients of age group 18-70 years, belonging to physical status American Society of Anesthesiologists (ASA) I and II, undergoing MRM were included in the study. In Group P, patients received paravertebral block and in Group E, patients received ESP block before induction of general anesthesia. Both the groups received 0.5% 20 mL ropivacaine. The time to first rescue analgesia and total doses of rescue analgesics were recorded in the postoperative period. Numeric Rating Scale (NRS) scores at 0 min, 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h were noted, and patient satisfaction was evaluated at 24 h. Unpaired t-test or the Mann-Whitney U test was used to compare quantitative variables while Chi-square test or Fisher's exact test was used to compare qualitative variables. RESULTS: The time for the first analgesic request was 232.5 min (140-1200) in ESP group as compared to paravertebral group in which the duration was 205 min (135-1190) (P value = 0.29). The total dose of rescue analgesics and NRS scores in postoperative period were comparable. However, the time to perform ESP block was significantly shorter than that of paravertebral block. CONCLUSION: ESP block can be used as a safe and easy to perform alternative analgesic technique over paravertebral block in breast cancer surgeries.

A critical review on the use of potentiometric based biosensors for biomarkers detection.

Potentiometric-based biosensors have the potential to advance the detection of several biological compounds and help in early diagnosis of various diseases. They belong to the portable analytical class of biosensors for monitoring biomarkers in the human body. They contain ion-sensitive membranes sensors can be used to determine potassium, sodium, and chloride ions activity while being used as a biomarker to gauge human health. The potentiometric based ion-sensitive membrane systems can be coupled with various techniques to create a sensitive tool for the fast and early detection of cancer biomarkers and other critical biological compounds. This paper discusses the application of potentiometric-based biosensors and classifies them into four major categories: photoelectrochemical potentiometric biomarkers, potentiometric biosensors amplified with molecular imprinted polymer systems, wearable potentiometric biomarkers and light-addressable potentiometric biosensors. This review demonstrated the development of several innovative biosensor-based techniques that could potentially provide reliable tools to test biomarkers. Some challenges however remain, but these can be removed by coupling techniques to maximize the testing sensitivity.

Supernumerary Remnant Vas Deferens Like Wolffian-Derivatives in a Young Child With Abdominal Cocoon Syndrome-A Clinicopathological Novelty.

The abdominal cocoon syndrome is a rare cause of recurring intestinal obstruction in children. It refers to encasement of the small bowel by a fibrocollagenous membrane forming a cocoon. We report a nine year old male presenting with abdominal pain, distension, bilious vomiting and inability to pass stool and flatus for two days. In view of a persistently increasing bilious nasogastric output, an urgent exploratory laparotomy was performed. The small bowel loops were matted together forming a cocoon densely adherent to the parietal peritoneum with supra-colic fibrous bands. The bands histologically displayed multiple ductal remnants with epithelium resembling that of ductus deferens. These structures showed immunopositivity for pan-cytokeratin and basal CD10.Workup for tuberculosis and other etiological causes was unremarkable. This is the first documented case of abdominal cocoon in a pediatric subject associated with supernumerary wolffian remnants.

Malignant Brenner tumour of the ovary manifesting as distal intestinal obstruction and perforation.

A rare case of malignant Brenner tumour of ovary manifesting with intestinal perforation due to colonic infiltration is elaborated in the present report. Brenner's tumour accounts for 1%-2% of all ovarian neoplasms and malignant Brenner tumour is even rarer and only about 5% of Brenner tumours are malignant. A 62-year-old woman came to surgical emergency with 1-month history of abdominal pain, vomiting and constipation with a palpable mass in right iliac fossa. Abdominal radiograph was suggestive of colonic obstruction. Contrast-enhanced CT of the abdomen revealed cystic right ovarian mass of 10.2×8.8 cm2 with pneumoperitoneum. Exploratory laparotomy was done, which revealed mass arising from right ovary involving terminal ileum, cecum and ascending colon. Possibility of ovarian malignancy was kept. Patient underwent debulking surgery along with ileostomy and descending colon mucous fistula was created. Histology was compatible with malignant Brenner tumour of the ovary.

Design and development of volume phase holographic grating based digital holographic interferometer for label-free quantitative cell imaging.

In this paper, a volume phase holographic optical element based digital holographic interferometer is designed and used for quantitative phase imaging of biological cells [white blood cells, red blood cells, platelets, and Staphylococcus aureus (S. aureus) bacteria cells]. The experimental results reveal that sharp images of the S. aureus bacteria cells of the order of ${\sim}{1}\;{\unicode{x00B5}{\rm m}}$∼1µm can be clearly seen. The volume phase holographic grating will remove the stray light from the system reaching toward the grating and will minimize the coherent noise (speckle noise). This will improve the sharpness in the image reconstructed from the recorded digital hologram.

Sequestration of toxic congo red dye from aqueous solution using ecofriendly guar gum/ activated carbon nanocomposite.

In the present study, a potential Guar gum/activated carbon nanocomposite as an adsorbent was synthesized and utilized for the sequestration of toxic congo red dye from synthetic wastewater. The nanocomposite was characterized using different techniques such as SEM, EDX, TEM, FTIR and XRD. Various physico-chemical parameters such as influence of contact time, pH, adsorbent dose, temperature and initial dye concentration were investigated to optimize conditions for maximum adsorption of congo red. Equilibrium data fitted well with Langmuir isotherm model having maximum adsorption capacity of 831.82 mgg-1 at 313 K. The kinetic studies demonstrated that the adsorption followed a pseudo-second order kinetic model. The thermodynamic study showed that the adsorption of congo red onto nanocomposite was spontaneous, exothermic with decreased in randomness at solid/liquid interface. The regeneration study indicated that the nanocomposite could be reused successfully upto five consecutive cycles. Therefore, the present material can be effectively and efficiently urilized for the removal of congo red dye from aqueous solution as well as industrial wastewater.

Evolving Concepts in Ultrasonography of Pediatric Intussusceptions: Unequivocal Differentiation of Ileocolic, Obstructive and Transient Small-Bowel Intussusceptions.

The main aim of the study was to elaborate on the various ultrasonographic parameters that can be used for definite differentiation of ileocolic, obstructive small-bowel and transient small-bowel intussusceptions (SBI). In this study, 90 children (63 boys and 27 girls) with suspected intussusception were evaluated. Of these, 54 cases were diagnosed as obstructive intussusceptions (33 ileocolic and 21 ileoileal), 15 cases were classified as transient SBIs and 21 cases were negative for intussusception. The mean fat core diameter was 1.45 ± 0.32 cm for ileocolic versus 0.37 ± 0.06 cm for obstructive SBI versus 0.29 ± 0.08 cm for transient SBI (p < 0.001). The mean lesion diameter was 3.23 ± 0.08 cm for ileocolic intussusceptions and 2.12 ± 0.038 cm for SBI (p < 0.001), and the ratio of inner fat core to outer wall thickness was greater than 1 for ileocolic intussusceptions and less than 1 for SBI. A statistically significant difference was found between segmental invagination of transient versus obstructive SBIs with mean values of 1.93 ± 0.39 cm and 3.17 ± 0.25 cm, respectively, and an "optimal" threshold at 2.5 cm.

To assess the Prevalence and Predictors of Cancer-related Fatigue and its Impact on Quality of Life in Advanced Cancer Patients Receiving Palliative Care in a Tertiary Care Hospital: A Cross-sectional Descriptive Study.

INTRODUCTION: Cancer-related fatigue (CRF) is one of the adverse outcomes of cancer and its treatment. Despite its high prevalence; the data are scarce from the Indian population on the prevalence of CRF and its predictors in advanced cancer patients. Hence, we aim to find the prevalence of the fatigue, its impact of fatigue on quality of life (QOL), and possible predictors. METHODS: This study was conducted after approval of the ethical committee in adult patients of advanced cancer receiving palliative care. The data collected included demographic details, nutritional status, any comorbidities involving cardiorespiratory, renal, pulmonary, and neurological system, type and stage of cancer, site of metastasis, any previous or ongoing chemotherapy or radiotherapy, history of drug intake, hemoglobin, and albumin. The study parameters included assessment of fatigue, QOL, and symptom assessment as per the validated tools. The primary objective of the study was to find the prevalence of fatigue in advanced cancer patients receiving palliative care. The secondary objectives were to find predictive factors of fatigue, its impact on QOL of patients, and the relation between the fatigue and QOL receiving palliative care. The correlation between fatigue score and QOL was analyzed using Pearson's correlation coefficient. Multiple linear regression analysis was performed for identifying the predictors of CRF. RESULTS: The fatigue was observed in all 110 patients in this study. Of these, severe fatigue was seen in 97 patients (Functional Assessment of Chronic Illness Therapy [FACIT]-F < 30). The median (interquartile range [IQR]) FACIT-F score was 14 (8-23). The median (IQR) of the overall QOL was 16.66 (16.6-50). The correlation between the fatigue (FACIT-F) and QOL was + 0.64 (P < 0.001). The predictors of fatigue included pain, physical functioning, Eastern Cooperative Oncology Group, tiredness, and the level of albumin. CONCLUSION: We conclude that the prevalence of fatigue in Indian patients with advanced cancer receiving palliative care was high and it has a negative impact on QOL. Pain, physical functioning, performance status, and albumin were found to be independent predictors of CRF.

Adsorption and photocatalysis assisted optimization for drug removal by chitosan-glyoxal/Polyvinylpyrrolidone/MoS2 nanocomposites.

Chitosan-glyoxal/Polyvinylpyrrolidone/MoS2 (CSG/PVP/MoS2) nanocomposites were synthesized via hydrothermal-ultrasonic method. The CSG/PVP/MoS2 nano catalyst was characterized by XRD, UV-visible spectroscopy, FTIR, SEM and X-ray photoelectron spectroscopy, and diclofenac was used for the adsorption and photo-degradation test. SEM revealed the CSG/PVP/MoS2 nanocomposite has coarse and semi-flake structure and UV-vis absorbance spectra indicated its strong UV light response. Additionally, the CSG/PVP/MoS2 presents enhanced adsorption-photocatalytic activities in comparison to CSG/PVP, and the degradation was reaching 94.5%. Kinetic study results demonstrated that the diclofenac photo-degradation could be explained by pseudo-first-order model. The material may have great potential in wastewater treatment applications. The synthesized nanomaterials were tested for their antibacterial properties against microorganisms Staphylococcus epidermidis and Pseudomonas aeruginosa. The antimicrobial property CSG/PVP/MoS2 nanocomposite was observed with a maximum of zone inhibition.