Epiglottic capillary hemangioma in an adult female: A rare case report.

INTRODUCTION AND IMPORTANCE: Capillary hemangioma of larynx can occur in both pediatric and adult population. However, epiglottic capillary hemangioma in adults is a very rare presentation. Its pathophysiological basis involves self limiting and self expanding vascularization and it is a characteristically well delineated benign mass. CASE PRESENTATION: Here we present a case of a 40-year-old female who presented with complaint of per oral bleed in spitting which was about a teaspoon in quantity since 1 month. There was no associated hoarseness, dysphagia, respiratory distress, hemoptysis or neck swelling. There were no other systemic manifestations i.e. weight loss, fatigue or anemia. There was no familial history. CLINICAL DISCUSSION: On examination, Indirect Laryngoscopy (IDL) revealed a mass on the posterior surface of epiglottis. 70° view endoscope confirmed the findings of IDL. All other neighboring structures i.e. vocal cords, anterior and posterior commissures and pyriform fossa were normal and no mass or pathology was seen. Imaging studies contrast enhanced CT scan of neck soft tissue window showed isodense opacity in supraglottic region. Surgical excision and hemostasis were carried out using Colorado bipolar cauterization. The histopathological investigation of the mass revealed a benign lesion compatible with capillary hemangioma. CONCLUSION: As until now, no case of capillary hemangioma of epiglottis has been reported, head and neck surgeons are not well aware of this case. This case report will add valuable insight to the relative surgeons/clinicians.

Knowledge on cause, clinical manifestation and treatment for fibromyalgia among medical doctors: A worldwide survey.

OBJECTIVES: Hench introduced the fibromyalgia syndrome almost 50 years ago. In the meantime, the prevalence has increased, the clinical criteria have changed and the way we explain (chronic) pain has altered. DESIGN: In the current study, we conducted a worldwide survey in which we investigate whether medical doctors are familiar with the American College of Rheumatology (ACR) criteria for fibromyalgia and, if so, whether these medical doctors adhere to the clinical guidelines following evidence-based treatments. RESULTS: In total, 286 medical doctors from 43 countries spread over 6 continents filled out the survey. In most of the countries, the diagnosis fibromyalgia was used. Only 10% adhere to the ACR criteria, widespread pain (44%), unrefreshed sleep (24%), fatigue (20%) and cognitive problems (8%) were most used diagnostic criteria. Of the respondents, 94 (32%) mentioned that the cause is unknown or idiopathic, but also a wide variety of other causes was mentioned. More than 70 different treatment options were provided, of which 24% of the responses were classified as according to the clinical guidelines. From this study, we conclude that many medical doctors do not follow the ACR criteria; the majority has an inappropriate knowledge of causes for fibromyalgia and that a minority of treatment advice adhere to the guidelines.

Pediatric intranasal lobular capillary hemangioma: A case report.

INTRODUCTION AND IMPORTANCE: Lobular capillary hemangioma (LCH) is a benign vascular lesion typically affecting the head and neck region, especially the nasal cavity. However, its occurrence in the nasal cavity of the pediatric population is rare, making its diagnosis and management crucial in such cases. CASE PRESENTATION: A 7-year-old female presented with left-sided nasal obstruction and recurrent epistaxis for 4 months. Examination revealed a dark purplish-red nasal mass, which bled easily upon probing. CT scans showed a soft tissue lesion with post-contrast enhancement. Histopathological examination confirmed lobular capillary hemangioma. The patient successfully underwent surgical excision without pre-operative embolization. CLINICAL DISCUSSION: LCH affects both the skin and mucous membranes. Although its exact etiology remains debated, trauma is a leading risk factor for its development. Biopsy and radiological investigations confirm its diagnosis. Differentiating LCH from other vascular disorders with similar presentations is essential for a thorough understanding and better management. Endoscopic surgical excision combined with electrodesiccation is the treatment of choice. CONCLUSION: Intranasal LCH in children is infrequent. An accurate diagnosis is essential for a comprehensive understanding. Surgical excision with electrodesiccation is the preferred treatment, but the role of pre-operative embolization is still under discussion.

Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study.

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women's perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety.

COVID-19 Pandemic and Maternal Psychological Wellbeing During the Malaysian Movement Control Order: A Cross-Sectional Study.

Background: COVID-19 pandemic had resulted in nationwide lockdown as a disease control measure. Potential harm to self and baby due to COVID-19 infection as well as uncertainties about delivery are among contributors to maternal anxiety. We aimed to assess the prevalence of psychological distress among pregnant women during the Malaysian Movement Control Order (MCO). Methods: A cross-sectional study was conducted between May and June 2020 in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered electronic questionnaire was distributed which included the following; (1) Depression, Anxiety and Stress Scale-21 (DASS 21), (2) Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), (3) MCO effect questionnaire, and (4) newly designed COVID-19 pregnancy-related anxiety. Chi-square test and logistic regression were performed to determine significant associations whilst mean scores comparison were conducted through Mann-Whitney-U-test. Results: Four hundred and fifteen women were included in the final analysis. The prevalence of psychological distress among our cohort was 14.7%; with a two-fold increase of risk among the non-Malays (AOR 1.98, 95% CI 1.00-3.89) whilst a greater number of social support showed a protective effect (AOR 0.51, 95%CI 0.28-0.92). Malay ethnicity (p < 0.001) alongside greater household income (p = 0.014) were positive predictors of a higher sense of maternal wellbeing. Multiparous women and those of higher economic status experienced the more negative effect of the MCO. Around 88% of our women reported a higher level of COVID-19 pregnancy-related anxiety. Younger (p = 0.017) and first-time mothers (p = 0.039) were more likely to be anxious. Although adequate maternal knowledge on COVID-19 was associated with a greater sense of maternal wellbeing (p = 0.028), it was also linked to a higher level of COVID-19 related anxiety (AOR 3.54, 95% 1.29-9.70). Conclusion: There was a relatively low prevalence of psychological distress among expectant mothers in Malaysia during the first wave of the COVID-19 pandemic. Expectant mothers should receive accurate and reliable information on the effect of COVID-19 on pregnancy to relieve some maternal anxiety. Maternal health screening is important to identify individuals who would benefit from extra support and mental health intervention, especially in prolonged lockdown.

Correction: Frankincense essential oil suppresses melanoma cancer through down regulation of Bcl-2/Bax cascade signaling and ameliorates heptotoxicity via phase I and II drug metabolizing enzymes.

[This corrects the article DOI: 10.18632/oncotarget.26930.].

Frankincense essential oil suppresses melanoma cancer through down regulation of Bcl-2/Bax cascade signaling and ameliorates heptotoxicity via phase I and II drug metabolizing enzymes.

Melanoma is a deadly form of malignancy and according to the World Health Organization 132,000 new cases of melanoma are diagnosed worldwide each year. Surgical resection and chemo/drug treatments opted for early and late stage of melanoma respectively, however detrimental post surgical and chemotherapy consequences are inevitable. Noticeably melanoma drug treatments are associated with liver injuries such as hepatitis and cholestasis which are very common. Alleviation of these clinical manifestations with better treatment options would enhance prognosis status and patients survival. Natural products which induce cytotoxicity with minimum side effects are of interest to achieve high therapeutic efficiency. In this study we investigated anti-melanoma and hepatoprotective activities of frankincense essential oil (FEO) in both in vitro and in vivo models. Pretreatment with FEO induce a significant (p < 0.05) dose-dependent reduction in the cell viability of mouse (B16-F10) and human melanoma (FM94) but not in the normal human epithelial melanocytes (HNEM). Immunoblot analysis showed that FEO induces down regulation of Bcl-2 and up regulation of BAX in B16-F10 cells whereas in FM94 cells FEO induced dose-dependent cleavage of caspase 3, caspase 9 and PARP. Furthermore, FEO (10 µg/ml) treatment down regulated MCL1 in a time-dependent manner in FM94 cells. In vivo toxicity analysis reveals that weekly single dose of FEO (1200 mg/kg body weight) did not elicit detrimental effect on body weight during four weeks of experimental period. Histology of tissue sections also indicated that there were no observable histopathologic differences in the brain, heart, liver, and kidney compare to control groups. FEO (300 and 600 mg/kg body weight) treatments significantly reduced the tumor burden in C57BL/6 mice melanoma model. Acetaminophen (750 mg/kg body weight) was used to induce hepatic injury in Swiss albino mice. Pre treatment with FEO (250 and 500 mg/kg body weight) for seven days retained hematology (complete blood count), biochemical parameters (AST, ALT, ALK, total bilirubin, total protein, glucose, albumin/globulin ratio, cholesterol and triglyceride), and the level of phase I and II drug metabolizing enzymes (cytochrome P450, cytochromeb5, glutathione-S-transferase) which were obstructed by the administration of acetaminophen. Further liver histology showed that FEO treatments reversed the damages (central vein dilation, hemorrhage, and nuclei condensation) caused by acetaminophen. In conclusion, FEO elicited marked anti-melanoma in both in vitro and in vivo with a significant heptoprotection.

Measures used by medical students to reduce test anxiety.

OBJECTIVE: To determine test anxiety in medical students and to assess the measures used by them to reduce it. METHODS: The cross-sectional study was conducted in August 2009 at the Dow University of Health Sciences, Karachi, and involved 388 medical students who were voluntary participants. The 10-item Westside Test Anxiety Scale, was used to measure anxiety and the pre-designed questionnaire asked the students about the frequent measures used by them to overcome anxiety during exams and their past Grade Point Average. All data was coded and analysed using SPSS version 16 with a prior set alpha level of 0.05. RESULTS: Of the 450 students who were initially considered for the study, 388 fulfilled the inclusion criteria. Among them, 101 (25.3%) were male students with a mean anxiety level of 2.55 +/- 1.27, and 287 (71.8%) were females with a mean anxiety level of 3.07 +/- 1.43 (p<0.05). Prayers and self-motivation (28.3%), sleep and relaxation (11%), television and music (10%), calling friends (8.5%) and revision (6.7%) were the frequent measures used by the medical students to overcome exam anxiety. Students in their fourth and final years of studies showed a higher level of anxiety compared to those in the 2nd and 3rd years. CONCLUSION: The study indicated high levels of exam anxiety among the medical students, showing that there is a need for anxiety-reduction programmes in medical colleges.

Awareness of hypertension among the medical students and junior doctors--a multicenter study from Pakistan.

OBJECTIVES: To evaluate the awareness of hypertension among medical students and junior doctors in Karachi, Pakistan. METHODS: This cross-sectional study was conducted using a structured questionnaire consisting of eleven multiple choice questions, encompassing major aspects of hypertension such as the definition, diagnosis, treatment, complications and risk factors. This survey was conducted from June to August 2010 on final year medical students of Dow University of Health Sciences and interns and residents working at four tertiary care hospitals. RESULTS: Analysis of 475 participants showed that only 127 (26.74%) participants were acquainted with the basic definitions including the cut-off levels for blood pressure among the general population, in diabetics, in those with chronic kidney disease and pre-hypertension. We further inquired about the drugs to be used as first-line of treatment in uncomplicated hypertension, in those with diabetic nephropathy and drugs that worsen blood-pressure and renal dysfunction. Only 40 (8.42%) participants correctly responded to all the three questions. While 97 (20.42%) answered all the three questions incorrectly. No participant correctly answered all of the 11 questions. Only 1 participant could answer 10 questions, correctly, whereas, 14 participants answered 9 correctly and 18 did 8. Majority of the participants (442) correctly answered 7 or less questions. Mean number of correct answers given by the final year students was 5.2 +/- 1.6, by interns 4.4 +/- 1.6 and those given by residents was 5.04 +/- 2.0. Statistically significant difference was noted between the number of correct answers by medical students, interns and residents. CONCLUSION: This study highlights obvious deficiencies in the knowledge of both junior and future doctors of Pakistan regarding hypertension which should be dealt seriously.

Assessment of the seroprevalence of viral hepatitis B, viral hepatitis C and HIV in multitransfused thalassaemia major patients in Karachi, Pakistan.

This cross-sectional study reveals the seroprevalence of hepatitis B, hepatitis C and HIV in multi-transfused thalassemia major patients. Thirty-four out of 79 (43.0%) patients enrolled in the study serologically tested positive for hepatitis C (mean ± standard deviation age = 12 ± 4.1 years), four (5.1%) for hepatitis B and none for HIV. Some of the measures that should be adapted are: safe blood transfusions; awareness programmes through print and electronic media; and the early screening of such hazardous infections.