Prognostic significance of soft tissue deposits in head and neck squamous cell carcinoma: a systematic review and meta-analysis.

Soft tissue deposits, also known as tumour deposits (TDs), have not been studied well in head and neck squamous cell carcinoma (HNSCC) and are not included in any of the staging systems or treatment guidelines. The aim of this systematic review was to determine the prevalence and prognostic implications of TDs in patients with HNSCC. This systematic review of the literature was conducted following the PRISMA guidelines. The PubMed, Embase, and Scopus electronic databases were searched for relevant studies, from inception to August 2022. Although 14 studies qualified for inclusion, only eight were finally included in the review due to the considerable overlap of patients in several studies. Data from 7127 patients were analysed. The pooled prevalence of TDs was 21% (95% confidence interval (CI) 9-33%). The presence of TDs was adversely associated with overall survival and disease-free survival, with hazard ratios of 2.08 (95% CI 1.60-2.70) and 2.56 (95% CI 1.97-3.32), respectively. TDs are detected in a significant number of patients with HNSCC and adversely affect survival. Longitudinal prospective studies are needed to evaluate the prognostic implications of TDs in HNSCC for their potential role in cancer staging and adjuvant treatment planning.

Co-occurrence of Aicardi-Goutières syndrome type 6 and dyschromatosis symmetrica hereditaria due to compound heterozygous pathogenic variants in ADAR1: a case series from India.

Aicardi-Goutières syndrome type 6 (AGS6) and dyschromatosis symmetrica hereditaria (DSH) are allelic disorders caused respectively by biallelic and heterozygous pathogenic variants in ADAR1. We report three unrelated children presenting with features of both AGS6 and DSH, two of whom had compound heterozygous pathogenic variants in ADAR1. We also describe the novel genetic variants in our cases and review the literature on association of ADAR1-related AGS6 and DSH with these phenotypes.

Obturator Nerve Block in Transurethral Resection of Bladder Tumor: A Comparative Study by two Techniques.

CONTEXT: Sparing of obturator nerve is a common problem encountered during transurethral resection of bladder tumor (TURBT) under spinal anesthesia. AIMS: To evaluate and compare obturator nerve block (ONB) by two different techniques during TURBT. SETTINGS AND DESIGN: This is prospective observational study. SUBJECTS AND METHODS: Forty adult male patients from the American Society of Anesthesiologists Class I-IV planned to undergo TURBT under spinal anesthesia were divided into two groups of twenty each. In one group, ONB was performed with nerve locator. In other group, transvesical nerve block was performed with a cystoscope. The primary endpoints of this study were the occurrence of adductor reflex, ability to resect the tumor, and number of surgical interruptions. A number of transfusions required and bladder perforation were the secondary endpoints. RESULTS: There was statistically significant difference between the groups for resection without adductor jerk, resection with a minimal jerk, and unresectable with high-intensity adductor jerk. Bleeding was observed in both groups and one bladder perforation was encountered. CONCLUSIONS: We conclude that ONB, when administered along with spinal anesthesia for TURBT, is extremely safe and effective method of anesthesia to overcome adductor contraction. ONB with nerve locator appears to be more effective method compared to the transvesical nerve block.

Lactobacillus fermentum NCIMB 5221 and NCIMB 2797 as cholesterol-lowering probiotic biotherapeutics: in vitro analysis.

Cardiovascular and coronary artery disease risk are correlated with cholesterol levels and are significant health concerns. Current cholesterol-lowering approaches includes lifestyle and diet modifications, as well as statins which presents numerous shortcomings. The probiotic bacteria, Lactobacillus fermentum NCIMB 5221 and NCIMB 2797, have demonstrated cholesterol-lowering potential in animal studies. However, there is a lack in understanding the mechanism(s) behind these observed effects. The goal of this work is to investigate, in vitro, the cholesterol-lowering mechanisms of these two strains. To determine the cholesterol-lowering mechanisms, probiotic cholesterol assimilation, colon epithelial adhesion and inhibition of cholesterol uptake by colon epithelial (Caco-2) cells were investigated. L. fermentum NCIMB 2797 (P=0.012) and NCIMB 5221 (P=0.003) assimilated cholesterol and their cell surface hydrophobicity was 70.30±8.85% and 55.60±2.59%, respectively. Both L. fermentum strains showed no significant impact (P>0.05) on Caco-2 cell viability. Of most interest, Caco-2 pre-exposure to L. fermentum NCIMB 5221 significantly decreased (P=0.015) cholesterol uptake, with 85.98±2.07% uptake compared to the untreated cells. Similarly, L. fermentum NCIMB 2797 probiotic cells significantly decreased (P=0.019) cholesterol uptake by Caco-2 cells, with 86.45±1.71% uptake observed compared to the control cells. The results demonstrate that L. fermentum NCIMB 5221 and L. fermentum NCIMB 2797 have the potential via various modes of action to lower cholesterol. Additional studies are required to understand the mechanism(s) of action behind probiotic cholesterol assimilation and behind the cholesterol uptake inhibition by colon epithelial cells.

Investigation of probiotic bacteria as dental caries and periodontal disease biotherapeutics.

Oral diseases, specifically dental caries and periodontal disease, are characterised by increases in pathogenic microorganisms, increased demineralisation and increased inflammation and levels of inflammatory markers. Despite the therapeutic strategies, oral diseases have elevated prevalence rates. Recent work has demonstrated that probiotic bio-therapeutics can decrease oral pathogen counts, including caries-causing Streptococcus mutans and oral inflammation. The aim of this work was to investigate putative probiotic bacteria, selected for S. mutans inhibition and for their oral health-promoting characteristics. The probiotic bacteria were screened for S. mutans inhibition, probiotic bacteriocin activity, salivary pH modulation, probiotic nutrient (sucrose) competition, probiotic co-aggregation with S. mutans, bacterial attachment to oral epithelial keratinocytes, bacterial nitric oxide production and bacterial antioxidant activity. The results indicate that Lactobacillus reuteri strains NCIMB 701359, NCIMB 701089, NCIMB 702655 and NCIMB 702656 inhibited S. mutans to non-detectable levels (<10 cfu/ml). L. reuteri strains also demonstrated the highest antioxidant capacity of the tested strains (7.73-13.99 µM Trolox equivalents), suggesting their use as both caries and periodontal disease therapeutics. Although Lactobacillus fermentum NCIMB 5221 inhibited S. mutans at lower levels, it significantly buffered the pH (4.18) of saliva containing S. mutans, co-aggregated with S. mutans (10.09%), demonstrated high levels of sucrose consumption (138.11 mM) and successfully attached to gingival epithelial cells (11%). This study identified four L. reuteri strains and one L. fermentum strain to be further investigated as oral disease biotherapeutics.

'Umbrella' graft tympanoplasty.

OBJECTIVES: Tympanoplasty continues to pose a challenge in developing countries, where treatment cost and lack of compliance with second stage surgery are often important factors in determining the surgical strategy. This study aimed to determine the effectiveness of the newly developed, 'umbrella' autograft. MATERIALS AND METHODS: In 22 patients suffering chronic suppurative otitis media, in whom the incus and stapes suprastructure were found to be absent during surgery, reconstruction was achieved using cartilage-malleus umbrella graft assembly. Six-month post-operative results were evaluated on the basis of average hearing gain, measured at 0.5, 1, 2 and 3 kHz. RESULTS: At six months post-operatively, 77.3 per cent of patients showed hearing improvement. Audiography at this time indicated significant improvement (p < 0.001), suggesting that this hearing gain may stand the test of time. CONCLUSION: Umbrella graft tympanoplasty appears to be a promising technique in terms of cost-effectiveness and the autologous nature of implant materials.

Multicenter evaluation of individual donor nucleic acid testing (NAT) for simultaneous detection of human immunodeficiency virus -1 & hepatitis B & C viruses in Indian blood donors.

BACKGROUND & OBJECTIVE: India has a high prevalence of HIV-1, hapatitis C and B virus (HCV and HBV) in the blood donors but has yet to implement nucleic acid testing (NAT) in blood screening. We undertook a multicentre evaluation of blood donor testing by NAT for simultaneous detection of HIV-1, HBV and HCV in a single tube and also to determine the feasibility of NAT implementation in India's low volume setting. METHODS: A total of 12,224 unlinked samples along with their serological results were obtained from representative eight blood banks in India and were individually manually tested by the Procleix Ultrio Assay (Chiron Corp. Emeryville, CA) for simultaneous detection of HIV-1, HCV, and HBV. RESULTS: Of the 12,224 samples tested, 209 (1.71%) were seroreactive. One hundred thirty three samples (1.09%) were reactive by Ultrio assay, 84 samples were seroreactive but NAT non reactive. There were eight NAT yield cases: 1 HIV, 1 HIV-HCV co-infection, and 6 HBV. INTERPRETATION & CONCLUSION: Our observed NAT yield for all three viruses was 1 in 1528 (0.065%). We estimate NAT could interdict 3272 infectious donations a year among our approximate 5 million annual donations.

Haemangioendothelioma of paranasal sinuses with intracranial extension.

Maxillary sinus is a rare site for the occurrence of haemangioendothelioma. The present case is being reported in a 45 year old Hindu Male. The main complaint ware bilateral nasal obstruction und a mass protruding from he right nostril along with episodes of headache, vomiting and nasal bleeding. The. C.T. scan showed evidence of erosion of bony walls of maxillary antrum with intracranial extension of the tumor. There was no evidence of regional lymph nodes or distance metastasis. Histology of the tissue revealed a highly cellular and vascular tumor the diagnosis of haemangioendothelioma of the maxillary sinus retiform variety was established.

Disseminating myxoid leiomyosarcoma of the uterus.

CASE REPORT: A 60-year-old female, para 1, menopausal for last 12 years was admitted with complaints of distention and pain abdomen for last 2 months. There was no history of postmenopausal bleeding. On abdominal examination there was a vague mass in lower abdomen reaching upto umbilicus. On vaginal examination, uterus was eight weeks size and a vague mass was felt around it through all fornices. On exploratory laparotomy uterus was studded with multiple friable hemorrhagic growths perforating from fundus and filling the peritoneal cavity. TREATMENT: Total abdominal hysterectomy with bilateral salpingo-oophorectomy with debulking of tumour and omentectomy was performed followed by postoperative adjuvant radiotherapy. CONCLUSION: Histopathology report confirmed it to be uterine myxoid leiomyosarcoma which is an extremely rare variant of uterine sarcoma with poor prognosis exhibiting malignant biologic behaviour.

Eustachian tube function after transmyringeal ventilation.

This study anus at determining the effect of transmyringeal ventilation on Eustachian tube functions. Seventy ears clinically diagnosed as having otitis media with effusion or grade I and II retraction of pars-tensa of tympanic membrane were treated with antiallergics, decongestants, mucolytics, and antibiotics as required for maximum upto three months. In forty-five ears that showed neither symptomatic nor audiometric improvement, transmyringeal ventilation was restored by myringotomy and ventilation tube insertion. There after, Eustachian tube functions were assessed by using pressure equilibration test. The post-operative audiograms showed mean hearing gain of 16. 6 dB (S D±7.9) in majority (96%) of the ears. At first week 93% ears could not either totally or partially equilibrate positive or negative pressure. The percentage in the poor function group remained 91% even at the end of 6 months showing no significant effect of ventilation tube insertion on active ET functions.

A case of huge enlargement of cystosarcoma phylloides of breast in pregnancy.

A case of unilateral phylloides tumor of breast with sudden enlargement during pregnancy has been presented with successful pregnancy outcome followed by complete surgical excision (simple mastectomy) in the puerperium.

Maternal and fetal outcome in valvular heart disease.

OBJECTIVES: To compare the pregnancy outcomes of women having valvular heart disease with the pregnancy outcomes of healthy women. METHODS: A retrospective comparison of the maternal and fetal pregnancy outcomes of 312 women with valvular heart disease and 321 healthy women cared for at a tertiary care hospital during the same period. Statistical analysis was done using the chi(2)-test, with significance fixed at 0.05. RESULTS: Women with valvular heart disease had a significantly higher incidence of surgical interventions during pregnancy than women in the control group [13.4% (balloon mitral valvotomy) vs. 0.6% (ovarian cystectomy)], congestive heart failure (5.1% vs. 0%, P<0.001), and mortality [0.64% (two women) vs. 0%]. Perinatal outcome was also more adverse in the valvular heart disease group than in the control group, with increased preterm delivery rate (48.3% vs. 20.5%), reduced birth weight (2434+/-599 g vs. 2653+/-542 g; P<0.001), and a higher incidence of APGAR scores less than 8 (8.3% vs. 4%; P<0.01). There was also a higher rate of instrumental delivery (9.9% vs. 3.4%). However, the rate of cesarean deliveries was similar in the two groups. CONCLUSIONS: Pregnancy in women with valvular heart disease is associated with significantly higher maternal morbidity and adverse fetal outcomes and requires a team approach for optimal management.

A preliminary survey of patients' views on awareness, information, choices and expectations in women undergoing hysterectomy.

A questionnaire-study was undertaken among 50 women to take note of their views on awareness, information, choices and expectations on various aspects of hysterectomy performed on them. Most women (92%) did not know the type of hysterectomy and none of them was offered the alternative treatment, various types of hysterectomy done, type of anaesthesia used and hormone replacement therapy. A total of 96% wanted the surgeon to spend time with them explaining to them about various aspects of surgery and 46% thought the staff was sympathetic to them. A total of 26 women (52%) preferred to solve their problems with self-help groups (association of women with similar problems) and 84% wanted a leaflet to be distributed to them about various aspects of hysterectomy. This study concluded that Indian women to be involved in the decision making about their healthcare.

Laparoscopic oxidized cellulose (Surgicel) application for small uterine perforations.

OBJECTIVES: To test the efficacy and safety of laparoscopic oxidized cellulose application at the uterine perforation site. METHODS: In a prospective study over a 3.5-year period a total of 30 women undergoing combined surgical termination of pregnancy and laparoscopic sterilization who had a small uterine perforation were recruited. Oxidized cellulose (Surgicel) was inserted and attached to the perforation site with a laparoscope. The end point was sealing of the perforation and complete hemostasis. Laparotomy was performed if hemostasis was not achieved. RESULTS: The mean age, parity and gestation were 31.4 years, 3.8 and 9.3 weeks. The perforations occurred in the fundal region (60%), anterior wall (16.7%), posterior wall (13.3%), upper lateral wall (3.3%) and lower lateral wall (6.7%). Mean size of perforations, respectively according to site were 4.3 mm, 3.2 mm, 3.4 mm, 3 mm and 3.5 mm in the five groups. Laparoscopic oxidized cellulose application was successful in all women with fundal, anterior, posterior and upper lateral uterine wall perforations. In two women with perforations on the lower lateral wall, due to excessive blood loss, oxidized cellulose fell off; laparotomy was performed and hemostasis was achieved with sutures. All 28 laparoscopically-treated women were discharged on the next day in good condition with no complications. CONCLUSIONS: Laparoscopic oxidized cellulose application appears to be a safe and effective treatment for small uterine perforations that are bleeding moderately.

A randomized controlled comparison of minialpartomy and lapartomy in ectopic pregnancy cases.

BACKGROUND: As ectopic pregnancy is associated with significant maternal mortality and morbidity it may be worthwhile to find alternative surgical method to traditional laparotomy. AIMS: To compare the efficacy, safety and cost effectiveness of minilaparotomy surgery for ectopic pregnancy cases with standard laparotomy method. SETTING AND DESIGN: A total of 60 patients of ectopic pregnancy were randomized for minilaparotomy and laparotomy (30 cases each) for three years from January. 1998 to March 2001 in a medical college hospital. MATERIAL AND METHODS: Patients history, clinical examination, intraoperative, preoperative and postoperative data were recorded and compared in minilaparotomy and laparotomy groups. STATISTICAL ANALYSIS USED: Chi-square and Fischer chi-square test is used using P value of less than 0.05 as level of significance. RESULTS: Mean operative time was significantly less in minilaparotomy (38 minutes) than in laparotomy group (54 minutes). Postoperative complications were fever in 4(13.33%) and 6(20%) cases, paralytic ileus in 3(10%) and 8(26.66%) cases, urinary tract infection in 2(6.66%) and 3(10%) cases and wound infection in 1(3.33%) and 5(16.66%) cases respectively in the two groups and were significantly less in the minilaparotomy cases. Mean day of mobility, starting normal diet and discharge from the hospital were 10 hours and 24 hours, 1.5 days and 3.1 days and 3.4 days and 6.9 days respectively in the two groups and were significantly less in the minilaparotomy group than the laparotomy group. CONCLUSIONS: Surgery by minilaparotomy technique in ectopic pregnancy cases appears to be a safe and feasible method and is superior to conventional laparotomy as there are minimum perioperative and postoperative complications and patients can be discharged early from the hospital without the need of expensive equipment.

Mitral valve surgery and maternal and fetal outcome in valvular heart disease.

OBJECTIVES: To compare maternal and fetal outcomes in patients with non-operated valvular heart disease and patients who had surgery before or during pregnancy. METHODS: The 308 women with valvular heart disease who delivered in this hospital in the last 8 years were divided into three groups. The 218 (70.7%) women in group 1 had no surgical intervention; the 42 (13.6%) women in group 2 underwent balloon mitral valvotomy during pregnancy; and the 48 (15.5%) women in group 3 had surgical intervention before pregnancy (35 had balloon mitral valvotomy, eight had mitral valve replacement, and five had mitral valve repair). Maternal and fetal outcomes were compared for these three groups. RESULTS: The antenatal events differed significantly: 175 (80.3%), 40 (94.2%), and 46 (95.8%) patients in groups 1, 2 and 3, respectively, had uneventful pregnancies. In group 1, 14 (6.4%) patients had congestive heart failure (P>0.05) and 24 (11%) patients had cardiac arrhythmias, which was statistically significant. The rate of preterm deliveries did not differ significantly among the three groups. The groups did not differ in mean birth weight, mode of delivery, low birth weight, Apgar scores less than 8, stillbirths, neonatal death, or congenital anomalies. CONCLUSIONS: Mitral valve surgery before or during pregnancy did not significantly improve maternal and fetal outcomes but decreased adverse events such as congestive heart failure and cardiac arrhythmias. It should be therefore performed only in selected cases.

Incidential Fitz-Hugh-Curtis syndrome at laparoscopy for benign gynecologic conditions.

OBJECTIVES: To assess the prevalence of incidental Fitz-Hugh-Curtis syndrome in women undergoing diagnostic laparoscopy for sterilization, infertility or chronic pelvic pain. METHODS: This was a prospective study over a 4-year period in which a total of 320 women undergoing diagnostic laparoscopy for sterilization [Group I, 200 women (62.5%)], infertility [Group II, 60 women (18.7%)], or chronic pelvic pain [Group III, 60 women (18.7%)] were enrolled. After examination of the pelvic area and abdominal cavity, the liver area was visualized in all cases for evidence of perihepatitis and adhesions between liver and anterior abdominal wall or diaphragm (Fitz-Hugh-Curtis syndrome). Statistical analysis was performed using the chi-square test, with a P-value set at 0.05 for significance. RESULTS: The mean age was similar in the three groups, while mean parity was obviously less in the infertility group. Fitz-Hugh-Curtis syndrome was observed in 16 women (8%) in Group I, 10 women (16.6%) in Group II, and 18 women (30%) in Group III. The prevalence was highest in Group III and the difference was statistically highly significant in Group III vs. Group I (P<0.001), and in Group III vs. Group II (P<0.01). It was higher in the infertility group than in the sterilization group (P<0.05 in Group II vs. Group I). CONCLUSIONS: There was a very high prevalence of incidental Fitz-Hugh-Curtis syndrome in the chronic pelvic pain and infertility groups, and even in the sterilization group.