Incidence of synchronous contralateral tonsillar malignancy in a known case of unilateral tonsillar carcinoma.

OBJECTIVE: The literature is divided with regards to contralateral tonsillectomy in a known/suspected case of ipsilateral tonsillar malignancy. In this study, we evaluate the incidence of indolent synchronous contralateral tonsillar malignancy (SCTC) in patients with known ipsilateral tonsillar malignancy. METHODS: All patients diagnosed with ipsilateral tonsillar carcinoma (TC) at a tertiary teaching center between January 2016 and December 2019 were screened. None of the patients were suspected to have bilateral TC. All patients underwent appropriate imaging in the form of Magnetic resonance imaging and computed tomography of head and neck region and then underwent bilateral tonsillectomy. The prevalence of bilateral tonsillar malignancy and the factors predicting them were analyzed. RESULTS: In all 59 patients were included in the study. The mean and median age of the patient population was 60.8 and 59 years, respectively, with a male to female ratio of 3.2:1. The incidence of bilateral tonsillar malignancy in carcinoma of unknown primary (CUP) was 3/10 (33.3%). Among the remaining 49 patients, incidence of synchronous contralateral tonsillar carcinoma (SCTC) was 2/49 (4.08%). Overall, 5/59 (8.5%) patients had synchronous bilateral tonsillar malignancy. Furthermore, dysplasia was found in the contralateral tonsil in 4/10 (40%) CUP patients. Among the remaining 49 patients, dysplasia was seen in the contralateral tonsil in 20/49 (40.8%) patients. The absence of p16 expression predicted higher probability of SCTC. Factors like gender, T stage, nodal status or smoking did not predict SCTC. CONCLUSION: We recommend bilateral tonsillectomy in all patients with suspected or proven TC (unilateral or bilateral) and CUP as it helps identify indolent SCTC and it does not add any significant morbidity to the patients. LEVEL OF EVIDENCE: III.

Hammering home the sickle: an instructive case of endobronchial anaplastic large cell lymphoma.

It is extremely unusual for primary pulmonary lymphoma, an uncommon occurrence in any form, to be of T-cell origin and to manifest as an endobronchial lesion. Each of these characteristics is rare individually, so cases that combine them are exceptional. We report a patient in whom primary pulmonary anaplastic large cell lymphoma, a T-cell neoplasm, presented with obstruction of the left upper lobe bronchus, resulting in left upper lobe atelectasis and creating the radiographic luftsichel sign. We briefly discuss anaplastic large cell lymphoma as a whole, place our case in the context of previously published literature on endobronchial anaplastic large cell lymphoma, and review the genesis of the luftsichel sign.

A QoS Optimization Approach in Cognitive Body Area Networks for Healthcare Applications.

Wireless body area networks are increasingly featuring cognitive capabilities. This work deals with the emerging concept of cognitive body area networks. In particular, the paper addresses two important issues, namely spectrum sharing and interferences. We propose methods for channel and power allocation. The former builds upon a reinforcement learning mechanism, whereas the latter is based on convex optimization. Furthermore, we also propose a mathematical channel model for off-body communication links in line with the IEEE 802.15.6 standard. Simulation results for a nursing home scenario show that the proposed approach yields the best performance in terms of throughput and QoS for dynamic environments. For example, in a highly demanding scenario our approach can provide throughput up to 7 Mbps, while giving an average of 97.2% of time QoS satisfaction in terms of throughput. Simulation results also show that the power optimization algorithm enables reducing transmission power by approximately 4.5 dBm, thereby sensibly and significantly reducing interference.

Anaesthetic management of neonatal primary hyperparathyroidism.

Neonatal primary hyperparathyroidism (NPHP) is a rare disease that presents in the first 6 months of life. It is almost invariably fatal unless a prompt diagnosis is made and urgent surgical intervention is instituted. Patients with hyperparathyroidism require special preoperative considerations. They require proper work-up from cardiac, renal and neurological point of view, correction of intravenous volume and electrolytes irregularities. We are presenting a case of an infant who started to have cyanosis and lethargy at 21st day of life. Initial diagnosis of pneumonia was made but later on diagnosed as hyperparathyroidism. He was planned for parathyroidectomy under general anaesthesia. He was induced with sevoflurane followed by fentanyl and atracurium and intubated with size 3.5 mm endotracheal tube (ETT). Later, he was maintained with isoflurane and O2/NO2. He was successfully extubated at the end of operation and was shifted to intensive care unit (ICU) for close monitoring.

Double trouble: Biochemically confirmed bilateral chylothorax with positive pleural fluid cytology due to breast adenocarcinoma.

Although chylothorax is a well-described complication of malignancy, especially lymphoma, breast adenocarcinoma has not been a commonly implicated primary tumor. There has been only one published report of biochemically confirmed bilateral chylothorax in solid malignancy, and this was not associated with breast adenocarcinoma. Likewise, there has been only one published report of bilateral chylothorax in solid malignancy with positive pleural fluid cytology on both sides; again, the primary tumor was not breast adenocarcinoma. Herein we present a case that combines all three of these rarely reported features: a patient with metastatic breast adenocarcinoma who developed biochemically confirmed bilateral chylothorax with documented positive pleural fluid cytology on both sides. This report is accompanied by a literature review of published cases of bilateral chylothorax in solid malignancy.

Association between glycemic control and the outcome in hospitalized patients with COVID-19.

PURPOSE: Coronavirus disease 2019 (COVID-19) clinical outcome and disease severity affected by several factors; deterioration of glycemic control is one of them. Therefore, achieving optimum blood glucose parameters is hypothesized for better consequences of COVID-19. However, varying data supporting this hypothesis is available in literature. The intention of this study was to investigate the role of glycemic management on the prognosis of hospitalized COVID-19 patients with varying degrees of severity. METHODS: From April 2020 to January 2021, we carried this retrospective cohort in a clinical care facility in Pakistan. RESULTS: Mortality was lowest in patients with HbA1c of less than 7% (53 mmol/mol) (p < 0.001). Similarly, mortality was found lowest in patients with fasting blood glucose less than 126 mg/dl and random blood glucose less than 160 mg/dl (p < 0.001 in each). In contrast, need for admission in critical care was found highest in patients with HbA1c between 7 and 10% (53-86 mmol/mol) (p 0.002). However, participants with blood glucose levels during fasting greater than 200 mg/dl and random blood glucose levels greater than 250 mg/dl were found to have a greater need for invasive mechanical ventilation. Cox regression hazard showed no difference in risk of death and invasive mechanical ventilation based on previous glycemic control. CONCLUSION: Effective diabetic management is correlated with a considerably lower risk of mortality and invasive mechanical ventilation in COVID-19 cases.

A study of plithogenic graphs: applications in spreading coronavirus disease (COVID-19) globally.

During the last two decades, the world has experienced three major outbreaks of Coronaviruses, namely severe acute respiratory syndrome (SARS- CoV), middle east respiratory syndrome (MERS-CoV), and the current ongoing pandemic of severe acute respiratory syndrome 2 (SARS-CoV-2). The SARS-CoV-2 caused the disease known as Coronavirus Disease 2019 (COVID-19). Since its discovery for the first time in Wuhan, China, in December 2019, the disease has spread very fast, and cases have been reported in more than 200 countries/territories. In this study, the idea of Smarandache's pathogenic set is used to discuss the novel COVID-19 spread. We first introduced plithogenic graphs and their subclass, like plithogenic fuzzy graphs. We also established certain binary operations like union, join, Cartesian product, and composition of pathogenic fuzzy graphs, which are helpful when we discuss combining two different graphs. In the end, we investigate the spreading trend of COVID-19 by applying the pathogenic fuzzy graphs. We observe that COVID-19 is much dangerous than (MERS-CoV) and (SARS-CoV). Moreover, as the SARS-CoV and MERS-CoV outbreaks were controlled, there are greater chances to overcome the current pandemic of COVID-19 too. Our model suggests that all the countries should stop all types of traveling/movement across the borders and internally too to control the spread of COVID-19. The proposed model also predicts that in case precautionary measures have not been taken then there is a chance of severe outbreak in future.

Pattern of Vascular Anomalies Associated With Sinus Venosus Atrial Septal Defect.

Objective To evaluate children with sinus venosus atrial septal defect (SV-ASD) for associated vascular anomalies. Methodology A total of 72 children with sinus venosus atrial septal defect with partial anomalous pulmonary venous return who presented to pediatric cardiology unit, Lady Reading Hospital Peshawar, from January 2019 till June 2021 were included in this cross-sectional study. Diagnosis of sinus venosus atrial septal defect was confirmed through two-dimensional (2D) and Doppler echocardiography performed by a pediatric cardiologist. Cardiac CT angiography was performed and assessed by a pediatric cardiac interventionist and radiologist. Patients were managed according to standard protocols and guidelines. The data were entered and analyzed with Statistical Package for the Social Sciences (SPSS) version 20. Percentages were used to express frequencies. Results Mean age was 8.3 ± 2.7 years (interquartile range (IQR): two months to 18 years). There were 37 (51.4%) male and 35 (48.6%) female patients. Out of 72 patients, 64 (88.8%) patients had superior sinus venosus atrial septal defect, while inferior sinus venosus atrial septal defect was found in eight (11.1%) patients. In six (8.3%) patients, associated secundum atrial septal defect was identified. Bilateral superior vena cava was found in seven (9.7%) patients. Left aortic arch was seen in 70 (97.2%) patients, whereas two (2.7%) patients had right aortic arch. Conclusion Sinus venosus ASD is a rare type of atrial septal defect which is also associated with both pulmonary and systemic vascular anomalies. Diagnosing these vascular anomalies is of paramount importance before any corrective intervention can be done. Recognizing the pattern of these anomalies should be known to every interventional cardiologist, radiologist, and cardiac surgeon. Echocardiography alone is not a good tool to assess these extracardiac structures. Imaging modalities like CT angiography and MRI have refined our preoperative workup which is essential for the ultimate outcome of the corrective intervention.

Influence of Elbow Angle on Erosion-Corrosion of 1018 Steel for Gas-Liquid-Solid Three Phase Flow.

Erosive wear due to the fact of sand severely affects hydrocarbon production industries and, consequently, various sectors of the mineral processing industry. In this study, the effect of the elbow geometrical configuration on the erosive wear of carbon steel for silt-water-air flow conditions were investigated using material loss analysis, surface roughness analysis, and microscopic imaging technique. Experiments were performed under the plug flow conditions in a closed flow loop at standard atmospheric pressure. Water and air plug flow and the disperse phase was silt (silica sand) with a 2.5 wt % concentration, and a silt grain size of 70 µm was used for performing the tests. The experimental analysis showed that silt impact increases material disintegration up to 1.8 times with a change in the elbow configuration from 60° to 90° in plug flow conditions. The primary erosive wear mechanisms of the internal elbow surface were sliding, cutting, and pit propagation. The maximum silt particle impaction was located at the outer curvature in the 50° position in 60° elbows and the 80° position in 90° elbows in plug flow. The erosion rate decreased from 10.23 to 5.67 mm/year with a change in the elbow angle from 90° to 60°. Moreover, the microhardness on the Vickers scale increased from 168 to 199 in the 90° elbow and from 168 to 184 in the 60° elbow.

Production of liquid fuels from Kraft lignin over bimetallic Ni-Mo supported on ZIF-derived porous carbon catalyst.

Non-noble bimetallic NiMo supported on zeolitic imidazolate framework-derived porous carbon (NiMo@FDC) catalyst for lignin depolymerization has been successfully developed. The synergism between Ni and Mo species in NiMo@FDC catalyst could promote the catalytic cleavage of C-O linkages in Kraft lignin. At a low reaction temperature of 240 °C and under 4 MPa H2, the lignin liquefaction yield was 98.85 wt% and minimum coke yield was 1 wt%, particularly when using 10%NiMo@FDC catalyst. Additionally, at a high reaction temperature of 300 °C and under 2 MPa H2, there was an overall yield of 86 wt% of liquid product and 42 wt% of petroleum ether soluble product. The higher heating value (HHV) increased from 27.65 MJ kg-1 to 34.11 MJ kg-1. In the cycling experiment, the bifunctional catalyst also demonstrated reversability and stability. The synergy of Ni hydrogenation sites and Mo coupled adsorption sites identified a possible mechanism path, which could offer considerable potential for lignin depolymerization.

Hydroconversion of Kraft lignin for biofuels production using bifunctional rhenium-molybdenum supported zeolitic imidazolate framework nanocatalyst.

Non-noble bimetallic nanoparticles anchored on Zeolitic Imidazolate Frameworks, bifunctional ReMo@ZNB catalyst, has been demonstrated to promote Kraft lignin depolymerization. In this study, the catalytic activities under different heat treatment conditions are ranked as follows: ReMo@ZNB-700 (Air) > ReMo@ZNB-500 (Air) > ReMo@ZNB-700 (N2). Particularly, bimetallic ReMo nanocatalyst with Re/Mo atomic ratio of 1/3 shows superior performance. Excellent yields of Ethyl acetate soluble products (92.18%) and Petroleum ether extracted biofuels (78%) are obtained at 300℃ and 24 h, and the calorific value is 32.33 MJ/kg. The ReMo@ZNB catalyst exhibits superior recyclability and regeneration after cycle experiment. Structural characterization results reveal that the incorporation of ReMo can engender the transformation of lattice morphology, the strength of hydrogenation and acid adsorption. The possible mechanism is based on the synergism of adsorption coupling and hydrogenation over ReMo@ZNB catalyst. The synergic action initiates potential perspectives for improving lignin hydroconversion.

A novel two-dimensional echocardiographic finding in cardiac amyloidosis.

BACKGROUND: A number of echocardiographic findings characteristic of cardiac amyloidosis (CA) have been described, each with limitations. METHODS: A distinctive wall motion pattern of preserved myocardial thickening at left ventricular apex with hypokinesis in basal and midsegments was observed in two patients with biopsy proven CA. Following this observation, endomyocaradial biopsy files beginning in 2007 were reviewed. Seven consecutive patients with documented CA were identified. Two-dimensional (2D) echocardiograms for each were reviewed in consensus by two experienced echocardiographers. Clinical and electrocardiographic data were obtained from chart review. RESULTS: All patients were men with class II-IV heart failure. Six had light chain CA, 1 senile CA. Six patients had coronary angiography. One had a 60% left anterior descending coronary artery stenosis. Five had nonobstructive disease. Echocardiograms for all seven patients demonstrated the distinctive pattern of preserved myocardial thickening at apex with hypokinesis in basal and midsegments. Reduced ejection fraction was present in six and increased wall thickness and myocardial echogenicity in seven. Other echo signs of amyloid were variably present. Three had low voltage on electrocardiogram. CONCLUSION: A distinctive 2D echocardiographic pattern of preserved segmental wall motion at left ventricular apex with hypokinesis in basal to midsegments was consistently identified in seven consecutive patients with endomyocardial biopsy-proven CA.

Pseudo-Ductility, Morphology and Fractography Resulting from the Synergistic Effect of CaCO3 and Bentonite in HDPE Polymer Nano Composite.

Polymeric materials such as High density polyethylene(HDPE) are ductile in nature, having very low strength. In order to improve strength by non-treated rigid fillers, polymeric materials become extremely brittle. Therefore, this work focuses on achieving pseudo-ductility (high strength and ductility) by using a combination of rigid filler particles (CaCO3 and bentonite) instead of a single non-treated rigid filler particle. The results of all tensile-tested (D638 type i) samples signify that the microstructural features and surface properties of rigid nano fillers can render the required pseudo-ductility. The maximum value of tensile strength achieved is 120% of the virgin HDPE, and the value of elongation is retained by 100%. Furthermore, the morphological and fractographic analysis revealed that surfactants are not always going to obtain polymer-filler bonding, but the synergistic effect of filler particles can carry out sufficient bonding for stress transfer. Moreover, pseudo-ductility was achieved by a combination of rigid fillers (bentonite and CaCO3) when the content of bentonite dominated as compared to CaCO3. Thus, the achievement of pseudo-ductility by the synergistic effect of rigid particles is the significance of this study. Secondly, this combination of filler particles acted as an alternative for the application of surfactant and compatibilizer so that adverse effect on mechanical properties can be avoided.

Effect of Sand Fines Concentration on the Erosion-Corrosion Mechanism of Carbon Steel 90° Elbow Pipe in Slug Flow.

Erosion-corrosion of elbow configurations has recently been a momentous concern in hydrocarbon processing and transportation industries. The carbon steel 90° elbows are susceptible to the erosion-corrosion during the multiphase flow, peculiarly for erosive slug flows. This paper studies the erosion-corrosion performance of 90° elbows at slug flow conditions for impact with 2, 5, and 10 wt.% sand fines concentrations on AISI 1018 carbon steel exploiting quantitative and qualitative analyses. The worn surface analyses were effectuated by using laser confocal and scanning electron microscopy. The experiment was conducted under air and water slug flow containing sand fines of 50 µm average size circulated in the closed flow loop. The results manifest that with the increase of concentration level, the erosion-corrosion magnitude increases remarkably. Sand fines instigate the development of perforation sites in the form of circular, elongated, and coalescence pits at the elbow downstream and the corrosion attack is much more obvious with the increase of sand fines concentration. Another congruent finding is that cutting and pitting corrosion as the primitive causes of material degradation, the 10 wt.% sand fines concentration in carrier phase increases the erosion-corrosion rate of carbon steel up to 93% relative to the 2 wt.% sand fines concentration in slug flow.

Cancellation of surgery in patients attending the preoperative anaesthesia assessment clinic: a prospective audit.

OBJECTIVE: To find the causes of operating room cancellation in patients attending preoperative anaesthesia clinic and scheduled for surgery at our institution. METHODS: This audit included all those patients who presented to the pre anaesthesia clinic with their surgeries planned in the main operating rooms of our hospital. The duration of this audit was two months. Cancelled cases were identified from the operating room lists and the reasons for cancellations were categorized into above mentioned four factors. RESULTS: Fifty five (55) cancellations were identified; patient related factors (58%) were the most frequent cause followed by anaesthetic (22%), surgical (18.2%) and administrative (1.8%) factors. In patients related factors, most common causes appeared to be no-shows and patient's financial issues. CONCLUSION: Most of the patient related factors were found to be uncontrollable. Anaesthetic related cancellations might be reduced with better communication between anaesthetist themselves and the surgeons. Overbooking of cases and other administrative issuescan be reduced with better organizational strategies

High-dose chemotherapy with autologous stem cell rescue in stage IIIB inflammatory breast cancer.

BACKGROUND: Despite the advances in breast cancer care, inflammatory breast cancer (IBC) has a poor prognosis. The purpose of this study was to determine the efficacy of high-dose chemotherapy (HDCT) with thiotepa, mitoxantrone and carboplatin (TMJ regimen) in women with TNM stage IIIB IBC. PATIENTS AND METHODS: Between 1991 and 1998, twenty-eight patients with stage IIIB IBC underwent an autologous stem cell transplant after undergoing chemotherapy, surgery and/or radiation. Stem cells were collected from the bone marrow and periphery after mobilization with growth factors. Patients received thiotepa 250 mg/m2 once daily i.v. for 3 days, mitoxantrone 40 mg/m2 for 1 day and carboplatin 333 mg/m2 once daily i.v. for 3 days as the conditioning regimen for the HDCT. Radiation therapy and tamoxifen was offered to patients post HDCT if appropriate. Progression-free survival and overall survival was assessed over a 15-year period. RESULTS: At the time of last follow-up in May, 2007, sixteen patients had relapsed. The median overall survival was 49.5 months. The median progression free survival was 40 months. There were no transplant-related deaths. Mucositis and infections were the major side-effects. These results show that HDCT with the TMJ regimen is safe and effective in patients with stage IIIB IBC.