Comparison of Prognostic Performance of 8th and 7th Edition of AJCC Staging System for Patients With Gallbladder Cancer Undergoing Curative Intent Surgery.

BACKGROUND: We compared the predictive performance of the 7th and 8th editions of the AJCC staging systems in stratifying disease-related survival outcomes in patients with GBC undergoing curative intent surgery. METHODS: Patients that underwent curative intent surgery for GBC at our institution (2014 and 2021) were included in the study. Various clinico-pathological data were extracted to perform Kaplan-Meier survival analysis. RESULTS: A total of 240 patients were included in the study. Both, TNM-7, and TNM-8 staging systems can stratify patients into stages with statistically significant differences in disease-free and overall survival. Survival rates drop with stage progression. Using TNM-8, 8/240 (3.33%) patients were upstaged from Stage IIIB (TNM-7) to IVB (TNM-8) and 12/240 (5%) were down-staged from Stage IVB(TNM-7) to IIIB(TNM-8). Survival curves of the re-classified patients matched those of the corresponding TNM-8 stage. Additionally, there was statistically significant difference in their survival (p < 0.001) compared to their corresponding TNM-7 stage. There was no statistically significant difference in survival rates between stages IIA, IIB (TNM-8), and stage II (TNM-7). However, stage IIA had a slightly better survival than stage IIB. CONCLUSION: Though both TNM-7 and TNM-8 are useful for stratifying patients with GBC, TNM-8 has a better prognostic performance than TNM-7.

Temporal trends in indoor bioaerosols: implications for dental healthcare environments.

Antibiotic resistance, a significant public health hazard, is predicted to cause 10 million deaths worldwide by 2050. The study aimed to identify culturable bioaerosols in the indoor air of dental units in Lahore and assess their antibiotic resistance. Air samples were collected from 10 dental unit locations at different distances, with average concentrations of fungi and bacteria falling within intermediate ranges, per the Global Index of Microbial Contamination (GIMC/m3) index. The study found higher antibiotic-resistant strains in hospital dental units, particularly during winter. The most vigorous strain, S.aureus-NAJIH18, exhibited 70% resistance to ceftazidime. The research highlights the importance of quantifying microbial pollutants for evaluating their source and complexity. It suggests proactive mitigation techniques, such as focused cleaning and air filtration, to improve indoor air quality can mitigate the spread of antibiotic-resistant strains. These insights offer hope in combating the growing public health threat of antibiotic resistance.

Significance of Charlson co-morbidity index as predictive factor for post-op complications after radical nephrectomy.

The current study planned to explore the correlation between an elevated Charlson Comorbidity Index score and post-operative complications following radical nephrectomy in patients with renal cell carcinoma. A total of 70 patients aged 30-80 years undergoing radical nephrectomy were categorised into low Charlson Comorbidity Index score <4 group A and high score >4 group B. Post-operatively, complications were noted in 21(30%) patients, with higher grades more prevalent in the group B patients (relative risk: 1.96, p=0.004). The finding underscored the importance of considering comorbidities in assessing the risk of complications following radical nephrectomy.

Uniportal video-assisted thoracoscopic surgery in semi-prone position utilising direct endobronchial intubation for oesophagus leiomyoma excision.

Leiomyomas are the most common benign tumours of oesophageal smooth muscle origin. In this era of constantly evolving medical technology, video-assisted, robot-assisted and endoscopic approaches are the minimally invasive strategies for the excision of these lesions. Here, we report our modification of this surgery. The lesion was excised with uniportal video-assisted thoracoscopic surgery in a semi-prone position with single-lumen endobronchial intubation.

Radical surgery for de novo gallbladder carcinoma-Single-center analysis of prognostic factors and survival outcomes from an endemic region.

BACKGROUND AND OBJECTIVE: Gallbladder cancer (GBC) is an aggressive malignancy where curative resection is possible in few and survival is poor. There are limited data on outcomes in patients with de novo GBC from endemic regions undergoing surgery for curative intent. We report survival outcomes in this group of patients from a region with high incidence of disease. METHODS: We reviewed the records of all GBC patients (2014-2018) and included those who underwent radical cholecystectomy (RC) for de novo GBC. Univariable and multivariable analyses were performed to identify factors influencing recurrence and survival. RESULTS: A total of 649 patients with GBC were evaluated for surgery and curative intent surgery was attempted in 246 (38%) patients. Of these 246 patients, RC was performed in 115 patients, with histologically confirmed de novo GBC. Locally advanced disease (≥stage IIIB) was present in 52 (45.2%) patients. Median time to recurrence and overall survival (OS) were 31 and 36 months, respectively. Lymph node positivity (p = 0.005) and grade significantly influenced OS on multivariable analysis. CONCLUSION: Satisfactory survival outcomes are possible after RC for de novo GBC. Extended resections performed in high volume centers combined with appropriate adjuvant treatment can offer significant survival benefits, with acceptable morbidity and mortality rates.

Impact of COVID-19 pandemic on cancer surgery: Patient's perspective.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has impacted cancer care globally. The aim of this study is to analyze the impact of COVID-19 on cancer healthcare from the perspective of patients with cancer. METHODS: A cross-sectional survey was conducted between June 19, 2020, to August 7, 2020, using a questionnaire designed by patients awaiting cancer surgery. We examined the impact of COVID-19 on five domains (financial status, healthcare access, stress, anxiety, and depression) and their relationship with various patient-related variables. Factors likely to determine the influence of COVID-19 on patient care were analyzed. RESULTS: A significant adverse impact was noted in all five domains (p = < 0.05), with the maximal impact felt in the domain of financial status followed by healthcare access. Patients with income levels of INR < 35 K (adjusted odds ratio [AOR] = 1.61, p < 0.05), and 35K- 100 K (AOR = 1.96, p < 0.05), married patients (AOR = 3.30, p < 0.05), and rural patients (AOR = 2.82, p < 0.05) experienced the most adverse COVID-19-related impact. CONCLUSION: Delivering quality cancer care in low to middle-income countries is a challenge even in normal times. During this pandemic, deficiencies in this fragile healthcare delivery system were exacerbated. Identification of vulnerable groups of patients and strategic utilization of available resources becomes even more important during global catastrophes, such as the current COVID-19 pandemic. Further work is required in these avenues to not only address the current pandemic but also any potential future crises.

Continuing cancer surgery through the first six months of the COVID-19 pandemic at an academic university hospital in India: A lower-middle-income country experience.

BACKGROUND: The novel coronavirus pandemic (COVID-19) hinders the treatment of non-COVID illnesses like cancer, which may be pronounced in lower-middle-income countries. METHODS: This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID-19-related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. RESULTS: From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% - 14.12%). Postoperative complications were similar (p = .593, 95% CI: -2.61% - 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID-19-related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID-19-related mishaps were averted. CONCLUSIONS: We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID-19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.

Structure-Based Designing, Solvent Less Synthesis of 1,2,3,4-Tetrahydropyrimidine-5-carboxylate Derivatives: A Combined In Vitro and In Silico Screening Approach.

OBJECTIVE: In this study, small molecules possessing tetrahydropyrimidine derivatives have been synthesized having halogenated benzyl derivatives and carboxylate linkage. As previously reported, FDA approved halogenated pyrimidine derivatives prompted us to synthesize novel compounds in order to evaluate their biological potential. METHODOLOGY: Eight pyrimidine derivatives have been synthesized from ethyl acetoacetate, secondary amine, aromatic benzaldehyde by adding catalytic amount of CuCl2·2H2O via solvent less Grindstone multicomponent reagent method. Molecular structure reactivity and virtual screening were performed to check their biological efficacy as an anti-oxidant, anti-cancer and anti-diabetic agent. These studies were supported by in vitro analysis and QSAR studies. RESULTS: After combined experimental and virtual screening 5c, 5g and 5e could serve as lead compounds, having low IC50 and high binding affinity.

Microporous carbon material from fish waste for removal of methylene blue from wastewater.

Microporous fish waste-based activated carbon material (MFC) was prepared, with a large surface area of 2,193.52 m²/g, a pore size of 2.67 nm and micropore and total pore volumes of 0.9168 cm³/g and 0.9975 cm³/g, respectively. Adsorption efficiency of MFC was investigated by removal of methylene blue dye from wastewater. The Langmuir model and pseudo-second-order kinetics adequately described the adsorption process. MFC exhibited a high adsorption capacity of 476.19 mg/g at 30 °C, and reached equilibrium within 1 h. MFC could be an efficient and low-cost adsorbent for cationic dye removal during wastewater treatment.

p16 and p53 in HPV-positive versus HPV-negative oral squamous cell carcinoma: do pathways differ?

BACKGROUND: p16 overexpression and wild-type p53 expression are associated with human papilloma virus (HPV) in cervical and oropharyngeal cancer. Role of HPV-related carcinogenesis in the etiology of oral squamous cell carcinoma (OSCC) is still vague in Indian population. We aimed to explore the expression pattern of p16 and p53 in HPV-positive and HPV-negative OSCC to elicit differences, if any. Further their effect on survival of patients was studied. METHODS: Thirty-one consecutive HPV-positive as well as 31 age and sex-matched HPV-negative OSCC cases from a case series of 369 histologically diagnosed cases of OSCC were included in this study. HPV was detected by two methods, viz. real-time PCR and conventional PCR in biopsy samples. p16 and p53 protein expression was assessed by immunohistochemistry, and p16 mRNA expression was quantified with real-time PCR using SYBR Green assay. RESULTS: p16 was expressed in six (19.4%) HPV-positive and in four (12.9%) HPV-negative cases. Overall mutant-type p53 expression in 62 OSCC cases was 54.8%. Out of ten p16-positive cases, eight expressed mutant-type p53 and only two cases expressed wild-type p53. Risk factors including oral tobacco consumption and alcohol were present in all these ten p16-positive cases. Survival of patients was not affected by HPV, p16 and p53 status. CONCLUSION: Presence of mutant-type p53 and exposure to tobacco-related risk factors in both HPV-positive and negative cases suggest existence of p53-related carcinogenesis in HPV-positive cases in Indian population.

Diagnostic dilemma of granulomatous inflammation in cancer patients.

OBJECTIVE: To determine the frequency of granulomatous inflammation on histopathological findings amongst cancer patients and correlating them with tuberculosis. METHODS: The retrospective review was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised medical records of cancer patients with a histopathological finding of granulomatous inflammation between January 2010 and December 2015. Data was reviewed, including clinical history, availability of acid fast bacilli stain on tissue and mycobacterium tuberculosis culture results. Data related to treatment, duration and outcomes was also reviewed and was analysed using SPSS 19. RESULTS: Out of 28690 cancer patients during the study period, 17345(60.4%) had undergone biopsy for different reasons, and of those, 78 (0.45%) had granulomatous inflammation and formed the study sample. Among them, 40(51.3%) patients had caseous granulomatous inflammation while 38 (48.7%) had non-caseous granulomas. Acid fast bacillus tissue stain was performed on 77(98.7%) patients, of whom only 9 (11.5%) specimens showed acid fast bacilli. Mycobacterium tuberculosis culture was performed on 53(68%) specimens and among them 13(16.7%) grew mycobacterium tuberculosis. Anti-tuberculosis treatment was offered to 38 (48.7%) patients, including those with positive AFB stain and MTB culture results. Of them, 32(41%) patients completed the treatment while 4(5.1%) defaulted and 2(2.6%) died. Symptomatic and radiological improvement was observed in 16(20.5%) patients. CONCLUSIONS: Granulomatous inflammation was infrequently encountered in cancer patients. Mycobacterium tuberculosis cultures assisted in definitive decision-making but granulomatous inflammation could not be anticipated when the specimens were initially processed except when visible caseation was encountered. Processing specimens for mycobacterium tuberculosis cultures when caseation was encountered may be a reasonable strategy to adopt.

Systemic delivery of ß-blockers via transdermal route for hypertension.

Hypertension is the most common cardiovascular disease worldwide. Moreover, management of hypertension requires long-term treatment that may result in poor patient compliance with conventional dosage forms due to greater frequency of drug administration. Although there is availability of a plethora of therapeutically effective antihypertensive molecules, inadequate patient welfare is observed; this arguably presents an opportunity to deliver antihypertensive agents through a different route. Ever since the transdermal drug delivery came into existence, it has offered great advantages including non-invasiveness, prolonged therapeutic effect, reduced side effects, improved bioavailability, better patient compliance and easy termination of drug therapy. Attempts were made to develop the transdermal therapeutic system for various antihypertensive agents, including ß-blockers, an important antihypertensive class. ß-blockers are potent, highly effective in the management of hypertension and other heart ailments by blocking the effects of normal amounts of adrenaline in the heart and blood vessels. The shortcomings associated with ß-blockers such as more frequent dose administration, extensive first pass metabolism and variable bioavailability, make them an ideal candidate for transdermal therapeutic systems. The present article gives a brief view of different ß-blockers formulated as transdermal therapeutic system in detail to enhance the bioavailability as well as to improve patient compliance. Constant improvement in this field holds promise for the long-term success in technologically advanced transdermal dosage forms being commercialized sooner rather than later.

Profusion of microplastics in dental healthcare units; morphological, polymer, and seasonal trends with hazardous consequences for humans.

Given the convenience of using plastics, addressing the growing concerns about their hazardous health effects is imperative. Consequently, a comprehensive risk assessment is necessary to gauge the potential harm microplastics pose. With its urgent call to action, this study aimed to investigate the indoor source and abundance of microplastics in private dental units during routine professional activities. The current analyzed microplastic quantity variations based on morphological characteristics, seasonal fluctuations and polymer-types. The polymer hazard index (PHI) was calculated to evaluate the significant human health risks posed to dental professionals by inhalation of microplastics. Dust samples were collected using a clean brush and steel pan from various flat and horizontal surfaces within each dental unit. The study found that clinical dental units had fewer microplastics (587 ± 184.9 MPs/g/day) than teaching hospitals (1083.80 ± 133.7MPs/g/day), with comparatively more abundance in winter (31 %). ATR-FTIR analysis determined polyethylene terephthalate to be a more abundant polymer (39 %). This study also found an average inhalation microplastic intake risk of 20.23 MP/g/day and 5259.85 MP/g/year for clinical and 29.45 MP/g/day and 765.12 MP/g/year for teaching hospital dental units. Female dental professionals have 1.1 times more microplastic inhalation risks than male dental professionals. According to PHI findings, overall minor to medium polymer risk was determined. In conclusion, this evidence-based research underscores the urgent need for a shift towards more sustainable practices in the dental healthcare sector. Dental professionals should prioritize using non-plastic material protective equipment and a proper ventilation system to reduce exposure to these particles.