Pathologic and clinical tumor size discordance in early-stage cervical cancer: Does it matter?

OBJECTIVE: The objective of this study was to assess the rate of discordance between clinical and pathologic tumor size for women with stage IB1 cervical cancer (FIGO 2009 criteria), assess risk factors for discordance, and determine the impact of discordance on oncologic outcomes. METHODS: This was a secondary analysis of a prior multi-institutional retrospective review of patients diagnosed with stage IB1 (FIGO 2009 staging) cervical cancer undergoing radical hysterectomy between 2010 and 2017. Demographic, clinicopathologic, and oncologic data were collected. Pathologic upstaging was defined as having a preoperative diagnosis of stage IB1 cervical cancer with pathology demonstrating a tumor size >4 cm. Demographic and clinicopathologic data was compared using chi-square, fisher exact or 2-sided t-test. Survival was estimated using the Kaplan-Meier method. RESULTS: Of the 630 patients, 77 (12%) were upstaged. Patients who were upstaged had lower rates of preoperative conization (p < .001) or preoperative tumor sizes ≤2 cm (p < .001). Upstaged patients had increased odds of deep stromal invasion, lymphovascular space invasion, positive margins and positive lymph nodes. Almost 88% of upstaged patients received adjuvant therapy compared to 29% of patients with tumors ≤4 cm (odds 18.49, 95% CI 8.99-37.94). Finally, pathologic upstaging was associated with an increased hazard of recurrence (hazard ratio [HR] 1.95, 95% CI 1.03-3.67) and all-cause death (HR 2.31, 95% CI 1.04-5.11). CONCLUSIONS: Pathologic upstaging in stage IB1 cervical cancer is relatively common. Upstaging is associated with an 18-fold increased risk of receipt of adjuvant therapy. Patients undergoing preoperative conization and those with tumors <2 cm had lower risks of upstaging. Improvement in preoperative assessment of tumor size may better inform primary treatment decisions.

Bacterial isolation of milk samples submitted from clinical mastitis buffaloes during 2007 to 2016.

The present study determined trends in the isolation of bacterial pathogens in milk samples submitted from clinical mastitis buffaloes at the University mastitis laboratory during 2007 to 2016. Culture results (n = 3945) were classified into six categories (Staphylococcus spp., 28.7%; Streptococcus spp., 1%; Corynebacterium spp., 1.1%; gram-negative organisms, 3.2%; others including mixed growths, 3.3%; and no growth, 62.7%). Overall, culture results were significantly associated with year (χ2 = 112.28; df = 10; P < 0.001) and season (χ2 = 136.03; df = 20; P < 0.001). From 2007-2009 to 2013-2016, the isolation of Staphylococcus spp. increased from 28.2 to 48.4%, while isolation of Streptococcus spp. (50 to 20%) and Corynebacterium spp. (65.1 to 16.3%) decreased. The proportion of samples characterized as no growth increased from 26.4% (2007-2009) to 46.3% (2013-2016). Further, the proportion of clinical mastitis cases increased over the study years (goodness-of-fit χ2 = 59; df = 2; P < 0.001). With respect to season, the proportion of Staphylococcus spp. (30.6%; 346/1132), Corynebacterium spp. (48.8%; 21/43), and gram-negative bacteria (55.9%; 71/127) were more associated with the monsoon, and that of Streptococcus spp. (47.5%; 19/40) with the winter. Seasonal effects were also observed on the occurrence of clinical mastitis cases; comparatively, more clinical mastitis cases (35.6%; 523/1473) were observed during the monsoon season (goodness-of-fit χ2 = 276.7; df = 4; P < 0.001) as compared with other seasons. The present study concludes that Staphylococcus spp. are the major cause of intramammary infections in buffaloes with clinical mastitis, demanding more studies regarding its epidemiology and pathogenicity. Also, more efforts are needed in the prevention and control of clinical mastitis in buffaloes, especially, during the monsoon season.

Analytical assessment of clinical sensitivity and specificities of pharmaceutical rapid SARS-CoV-2 detection nasopharyngeal swab testing kits in Pakistan.

Despite of the global unity against COVID-19 pandemic, the threat of SARS-CoV-2 variants on the lives of human being is still not over. SARS-CoV-2 pandemic has urged the need of rapid viral detection at earliest. To cope with gradually expanding scenario of SARS-CoV-2, accurate diagnosis is extremely crucial factor which should be noticed by international health organizations. Limited research followed by sporadic marketing of SARS-CoV-2 rapid pharmaceutical detection kits raises critical questions against quality assurance and quality control measures. Herein we aimed to interrogate effectivity and specificity analysis of SARS-CoV-2 pharmaceutical rapid detection kits (nasopharyngeal swab based) using conventional gold standard triple target real-time polymerase chain reaction (USFDA approved). A cross-sectional study was conducted over 1500 suspected SARS-CoV-2 patients. 100 real time-PCR confirmed patients were evaluated for pharmaceutical RDT kits based upon nasopharyngeal swab based kits. The SARS-CoV-2 nasopharyngeal swab based rapid diagnostic kit (NSP RDTs) analysis showed 78% reactivity. Among real time PCR confirmed negative subjects, 49.3% represented false positivity. The positive predictive analysis revealed 67.82%, while negative predictive values were 64.40%. The NSP RDTs showed limited sensitivities and specificities as compared to gold standard real time PCR. Valid and authentic detection of SARS-CoV-2 is deemed necessary for accurate COVID-19 surveillance across the globe. Current study highlights the potential consequences of inadequate detection of SARS-CoV-2 and emerging novel mutants, compromising vaccine preventable diseases. Current study emphasizes need to wake higher authorities including strategic organizations for designing adequate measures to prevent future SARS-CoV-2 epidemics.

Interplay of interleukins (IL6, IL10) and 25 hydroxycholecalciferol in asthmatic subjects with chronic post-COVID condition (PCC).

The study aimed to compare and correlate serum levels of IL-6, 10, and 25-hydroxycholecalciferol in individuals with asthma with and without post-COVID condition (PCC). The study was designed to investigate the inflammatory response and serum 25-hydroxycholecalciferol status in asthmatics with and without PCC. A cross-sectional study of 252 subjects (128 asthmatics and 124 non-asthmatic subjects) was carried out. Interleukins and 25-hydroxycholecalciferol levels were estimated on ELISA. The principle findings were that IL-6 and 25-hydroxycholecalciferol levels were significantly increased (p<0.001), while IL-10 levels were non-significant in asthmatics with PCC compared to those without PCC. However, 25-hydroxycholecalciferol levels were significantly increased, but no significant change was observed in IL-6, and IL-10 levels in non-asthmatics with and without chronic PCC. A significant positive correlation (r = 0.258) was found between 25-hydroxycholecalciferol and IL-6 but a significant negative correlation (r = -0.227) with IL-10 in asthmatics with PCC. Similarly, a significant negative correlation (r = -0.285) was found between 25-hydroxycholecalciferol and IL-10 but was non-significant with IL-6 in asthmatics without PCC. The correlation of 25-hydroxycholecalciferol with IL-10 was significant (0.683), but IL-6 was non-significant in non-asthmatics with PCC. Multiple regression analysis showed that age, IL-6, gender, and PCC were significantly related in adjusted values to 25-hydroxycholecalciferol. This study sheds light on the complex liaison between 25-hydroxycholecalciferol levels and inflammatory responses in asthmatics, especially those with PCC. The findings suggest that although asthmatics with PCC maintain sufficient levels of 25-hydroxycholecalciferol, they show a substantial increase in the proinflammatory response. This suggests that PCC exacerbates the pro-inflammatory response in asthma. Moreover, the study reveals that asthmatics, whether with or without PCC, display a negative correlation between 25-hydroxycholecalciferol and the anti-inflammatory response. This emphasizes the main influence of asthma on the overall inflammatory response. These findings reveal a complex interplay between vitamin D levels and inflammatory mediators in asthmatic individuals with and without PCC.

A prospective randomised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products Sterimar™ and Sinus Rinse™ following functional endoscopic sinus surgery.

OBJECTIVES: To compare the efficacy and tolerability of two commonly used nasal douching products, low-volume high-pressure Sterimar™ and high-volume low-pressure Sinus Rinse™ following functional endoscopic sinus surgery. DESIGN: Prospective randomised single-blinded study. SETTING: Tertiary referral centre. PARTICIPANTS: Thirty-one patients, undergoing functional endoscopic sinus surgery for chronic rhinosinusitis with and without polyps, were recruited for the study. The patients acted as their own comparators self-administering each douche three times daily into one randomly allocated nostril for a period of 12 weeks following the surgery. MAIN OUTCOME MEASURES: The primary outcome measure was a blinded objective endoscopic assessment of each operated side using a modified Lund-Kennedy endoscopic assessment tool undertaken at 2, 4 and 12 weeks postoperatively. As secondary outcome measures, the patients were asked to express a preference between the two products based on perceived effectiveness and ease of use. RESULTS: Compared with the preoperative scores, there was a statistically significant improvement in the SNOT-22 score at all three postoperative time points (P < 0.001). Compared with week 2, there was a statistically significant reduction in the modified Lund-Kennedy endoscopic scores (P < 0.05) for both Sterimar™ and Sinus Rinse™ at weeks 4 and 12. When comparing Sterimar™ with SinuRinse™, there was a statistically significant lower modified Lund-Kennedy score at 2 and 4 weeks postoperatively for the side treated with Sinus Rinse™ (P ≤ 0.05), indicating a more favourable outcome. However, this difference was not apparent at 12 weeks postoperatively (P = 0.66). At all time points, patients perceived Sinus Rinse™ to be more effective than Sterimar™ (P < 0.0001), but there was no significant difference in the patients' preference for either product (P > 0.05). CONCLUSION: High-volume low-pressure saline irrigation is recommended as an efficacious, easy to use and well-tolerated adjunct to endoscopic sinonasal toilet in the early postoperative period following functional endoscopic sinus surgery.

Primary type 3 abomasal ulceration in cattle and buffalo: clinico-biochemical parameters, treatment, and prognostic indicators.

Background: The clinical findings, laboratory alterations, and prognosis of primary type 3 abomasal ulcer (AU3) are poorly reported in the literature. Aims: To describe clinical findings, hemato-biochemical changes, and peritoneal fluid changes in bovines suffering from primary AU3, and to monitor responses to medical treatment and outcomes. Methods: The study included 32 bovines (20 cattle and 12 buffaloes) diagnosed with primary AU3 along with a control group. Results: Common clinical findings were depressed demeanor, anorexia, dehydration, scanty feces, melena, mushy atonic rumen, tachycardia, and tachypnea. Colic was observed in 56.3% of animals. The mean hemoglobin, hematocrit, platelet count, and lymphocyte count were lower (P≤0.05), while WBC and neutrophil count were higher than the values of the control group (P≤0.05). The levels of BHBA, NEFA, glucose, total bilirubin, AST, CK, LDH, BUN, creatinine, and lactate were higher (P≤0.05), while cholesterol, total protein, albumin, sodium, potassium, chloride, and calcium were lower than the values of the control group (P≤0.05). The rumen chloride concentration was increased. The left shift was observed in a higher percentage of nonsurvivors than survivors (P≤0.05). The nonsurvivors had higher levels of bilirubin, CK, LDH, BUN, creatinine, and rumen chloride (P≤0.05), and lower levels of total protein, albumin, and globulin (P≤0.05). Conclusion: Type 3 abomasal ulcers occurred during the various stages of lactation as well as in pregnant animals. The response to medical treatment was fair, long time survival rate was good, and there was no recurrence. There was no effect on fetal survival or milk yield in the subsequent lactation.

Insulin-like growth factor-1 gene polymorphism in rheumatoid arthritis patients.

OBJECTIVES: Insulin-like growth factor-1 (IGF-1) regulates several biological functions, and low plasma levels of IGF-1 are known to contribute towards the pathogenesis of rheumatoid arthritis (RA). In view of the biological significance of IGF-1, we investigated the association of RA with the polymorphism of a 192-bp allele which is cytosine-adenosine repeat located 1 kb upstream from the IGF-1 gene transcription site and is known to regulate serum IGF-1 levels. METHODS: Blood samples were collected from 52 healthy controls (HC) and 68 RA patients to measure the levels of IGF-1 and to isolate genomic DNA. Polymorphism of the IGF-1 gene was examined using polymerase chain reaction (PCR). Disease severity, duration, and activity were recorded for all RA patients. RESULTS: We observed that 97% of all the subjects who participated in this study showed the presence of a 192-bp allele of the IGF-1 gene. All healthy controls exhibited the presence of 192-bp wild-type allele. All non-carriers of the 192-bp allele were Arabs and had RA. Gender correlated significantly with allele frequencies as 14% of the male and only 2% of the female RA patients were non-carriers of 192-bp allele. Plasma IGF-1 levels were significantly lower (p < 0.01) in RA patients compared to HC, and all RA patients who were non-carriers of the 192-bp allele had a significantly high disease activity score. No correlation was found between the duration of RA and the presence or absence of this allele. CONCLUSIONS: This study suggests a possible association of the IGF-1 gene polymorphism with developing RA, particularly in males as non-carriers of the 192-bp allele.

Ultrasonographic assessment of change in omasal position during the last month of gestation and first month of lactation in buffaloes.

INTRODUCTION: This study was aimed to determine the effect of advanced pregnancy on the topography and size of the omasum in 22 healthy Murrah buffaloes. The omasum was scanned 15-20 days before and after parturition, as per the standard procedure. The dorsal and ventral margins of the omasum were identified and marked at each intercostal space (ICS). The dorsal and ventral limits up to the dorsal midline were measured. The omasum was scanned in 6th to 11th ICS during advanced pregnancy and 7th to 11th ICS after the parturition. Irrespective of the pregnancy, the dorsal and ventral margins of the omasum were located farther dorsal and close to the spine in the 6th, 7th and 11th ICS. Except in one buffalo, the omasum was scanned in four consecutive ICS during the advanced pregnancy. After parturition the omasum was scanned in four and five consecutive ICS in 17 and five buffaloes, respectively. The mean dorsal and ventral limits of the omasum increased significantly (P .

INTRODUCTION: Cette étude visait à déterminer l'effet d'une gestation avancée sur la topographie et la taille de l'omasum chez 22 buffles de Murrah en bonne santé. L'omasum a été scanné 15 à 20 jours avant et après la parturition, selon la procédure standard. Les marges dorsale et ventrale de l'omasum ont été identifiées et marquées au niveau de chaque espace intercostal (EIC). Les limites dorsale et ventrale jusqu'à la ligne médiane dorsale ont été mesurées. L'omasum a été scanné du 6ème au 11ème EIC pendant la gestation avancée et du 7ème au 11ème EIC après la mise-bas. Indépendamment de la gestation, les marges dorsale et ventrale de l'omasum étaient situées plus loin dorsalement et plus près de la colonne vertébrale dans les 6ème, 7ème et 11ème EIC. Sauf chez un buffle, l'omasum a été scanné dans quatre EIC consécutifs au cours de la gestation avancée. Après la mise-bas, l'omasum a été scanné dans quatre et cinq EIC consécutifs chez 17 respectivement 5 buffles. Les limites dorsales et ventrales moyennes de l'omasum ont augmenté de manière significative (P.

Otosclerosis 2: the medical management of otosclerosis.

The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. There is some increase in the incidence of stapedial otospongiosis in a low-fluoride area compared with a high-fluoride area. Sodium fluoride treatment has a role to play in preventing the onset and progression of hearing loss in patients suffering from otosclerosis. Sodium fluoride therapy has been shown to have some beneficial effect on dizziness associated with otosclerosis. In view of the possibility of systemic side effects of sodium fluoride therapy, a regular follow up of patients is warranted. Biphosphonates can be used as an alternative treatment to sodium fluoride in cases where the patient is intolerant to sodium fluoride therapy. Hearing aid is also a treatment option, but it does not halt the disease process.

Otosclerosis 3: the surgical management of otosclerosis.

The surgical management for otosclerosis has evolved from stapes mobilisation to total extraction of the footplate, the so called 'stapedectomy', to a small hole in the stapes footplate, the 'stapedotomy'. The aim of stapes surgery is to restore the vibration of fluids within the cochlear canal. Revision stapedectomy should be approached with caution. Stapedectomy can lead to some minor and other more serious complications.

Coronavirus disease 2019: scientific overview of the global pandemic.

Coronavirus disease 2019 (COVID-19) is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Genome sequencing of the virus revealed that it is a new zoonotic virus that might have evolved by jumping from bats to humans with one or more intermediate hosts. The immediate availability of the sequence information in the public domain has accelerated the development of quantitative RT-PCR-based diagnostics. Numerous clinical trials have been prioritized globally for testing new vaccines and treatments against this disease. This review provides a broad insight into different aspects of COVID-19, an introduction to SARS-CoV-2 mitigation strategies and the present status of diagnostics and therapeutics.

Otosclerosis 1: the aetiopathogenesis of otosclerosis.

Otosclerosis is a bone dystrophy localised to the inner ear and the stapes footplate. Otosclerosis is a frequent cause of deafness in adults. The patient with otosclerosis typically presents with a history of slowly progressive conductive or mixed hearing loss that is usually bilateral and often asymmetric, usually between the ages of 15 and 45 years. The disease is characterised by alternating phases of bone resorption and formation. The majority of studies on families with otosclerosis suggest an autosomal dominant mode of inheritance with incomplete penetrance.

Pattern analysis of microtubule-polymerizing and -depolymerizing agent combinations as cancer chemotherapies.

Subcellular distribution of mass can be analyzed by a technique that involves culturing cells on interferometers and digitizing their interference contours. Contour sampling resulted in 102 variables per cell, which were predictors of oncogenic transformation. Cell phenotypes can be deconstructed by use of latent factors, which represent the covariance of the real variables. The reversal of the cancer-type phenotype by a combination of microtubule-stabilizing and -depolymerizing agents was described previously. The implications of these results have been explored by clinicians who treated patients with the combination of docetaxel and vinorelbine (Navelbine). The current study was performed to determine the effects of different combinations on phenotype and in phases of the cell cycle other than mitosis. Combinations of paclitaxel with either colchicine, podophyllotoxin, nocodazole, or vinblastine caused phenotype reversal. Paclitaxel analogue, 7-deoxytaxol, by itself caused reversal. Factors #4, (filopodia), #5 (displacement and/or deep invaginations in the periphery), #8, and #12 took on values typical of normal cells, whereas the values of #7 (p21-activated kinase), and #13 (rounding up) shifted toward the cancer-type. All combinations altered microtubule arrangement at the cell edge. Delivery schedules and drug ratios used in clinical studies were subjected to analysis. Clinical response rates were better when the combination was not interspersed with a single agent (P=0.004). The results support the idea that efficacy depends upon simultaneous exposure to both agents, and suggest a novel mechanism for combination therapies. These therapies appear to restore in transformed cells some of the features of a contact-inhibited cell, and to impede progress through the cell cycle even when provided at nanomolar concentrations.

Blood biochemical and ruminal liquor profile in buffaloes (Bubalus bubalis) showing omasal impaction.

The blood biochemical and ruminal fluid parameters of 5 buffaloes showing omasal impaction were studied, together with 10 healthy buffaloes as control. The diseased buffaloes had significantly higher serum aspartate aminotransferase, bilirubin, glucose, blood urea nitrogen, creatinine, total protein, globulin and fibrinogen levels and significantly lower plasma calcium, potassium and chloride concentrations than the controls. The ruminal liquor of the diseased buffaloes revealed characteristic physical, chemical and microbial changes and had significantly higher methylene blue reduction time and ammonia-nitrogen level.

Stridor and emphysema due to cystic echinococcosis in cattle and buffalo intermediate hosts in Punjab, India.

The clinical symptoms associated with hydatid disease in the bovine populations remain largely unknown and the disease is usually considered asymptomatic in these intermediate hosts. We report occurrence of symptoms such as sudden onset of continuous stridor, coughing and wheezing due to hydatid cysts present in the lungs of infected cattle and buffalo. Two cattle and one buffalo presented to the Teaching Veterinary Hospital, Guru Angad Dev Veterinary & Animal Sciences University with the complaint of continuous stridor, coughing and wheezing with normal feed and water intake were followed up. The comprehensive clinical examination followed by haematology, radiography of upper and lower respiratory tract, ultrasonography of lungs, liver and reticulum revealed presence of multiple hydatid cysts in the lung parenchyma. There was presence of subcutaneous emphysema in one of the infected animal. Radiography revealed cysts occupying up to 60% of alveolar space in the lungs. Endoscopy up to hilus was carried out to rule out the presence of any other mass/lesion in the respiratory tract. Per cutaneous aspiration (Ultrasound guided) of cystic fluid confirmed the diagnosis and fertile nature of hydatid cysts. The current study reports association of stridor and emphysema with hydatid disease in bovine hosts and it is important that veterinary practitioners in endemic areas consider hydatid disease for differential diagnosis when investigating the etiology of stridor and emphysema in bovine intermediate hosts.

Henoch-Schönlein's purpura in adults versus children/adolescents: A comparative study.

OBJECTIVE: To assess the possible differences in etiological and clinical factors between children/adolescents (< or = 20 years) and adults (> 20 years) with Henoch-Schonlein purpura (HSP). METHODS: A retrospective-cum-prospective study of consecutive patients with HSP who presented to our teaching hospital over 5 years. Patients were classified as having HSP according to the criteria proposed by Michel et al and the ACR criteria. RESULTS: 102 patients (43 of all patients being male and 59 female) were classified as having HSP; 20 of the patients were adults (mean age 32.1 +/- 11.7 years) and 82 were children/adolescents (mean age 6.2 +/- 2.6 years). We were unable to identify any precipitating event in 40% of the adults and 37% of the children/adolescents. The frequency of previous drug treatment and of previous upper respiratory tract infection was similar in both groups. At symptom onset, palpable purpura was the chief clinical manifestation in both groups. However, renal involvement, in all its aspects, was more frequent and severe in adults. Adults also had a higher frequency of diarrhoea (with or without occult blood) and leucocytosis, but a lower frequency of thrombocytosis. The frequency of joint manifestations, nausea, vomiting, malena/hematochezia and intussuseption was equal in both groups. Adults required more aggressive therapy, and had a longer hospital stay (10.2 vs. 4.3 days). The outcome was relatively worse in adults, with complete recovery in 18 adults (90%) compared to 81 children/adolescents (98.8%) after a mean +/- SD follow up of 2.8 +/- 1.7 and 2.4 +/- 1.3 years, respectively. CONCLUSION: In adulthood, HSP is a more severe clinical syndrome, with a higher frequency of diarrhoea and renal involvement. Adults also require aggressive treatment more frequently and have a longer hospital stay.