Pediatric Malignant Pelvic Paraganglioma-A Diagnostic and Surgical Challenge.

Pheochromocytoma are chromaffin cell-derived tumors that have an exceptionally high genetic predisposition. The presentation of extra-adrenal and pelvic paraganglioma (PGL) in children is uncommon. Due to the relative rarity, PGL tumors' presentation and disease behavior may vary. Genetic testing, imaging, and biochemical investigation are employed to diagnose PGL. Surgical resection with preoperative angioembolization has been practiced in alleviating the burden of torrential intraoperative bleeding.

Spontaneous Near Fatal Hemorrhage into Neurofibromatosis Type 1 Lesion in the Scalp.

Neurofibromatosis type 1 (NF1) (von Recklinghausen's disease) is an autosomal dominant disorder characterized by café-au-lait spots, pigmented hamartomas of the iris, and multiple neurofibromas. Patients can present with hemorrhage secondary to trauma or rarely with spontaneous hemorrhage, both of which can be lethal and life-threatening. We report a 14-year-old girl with a rapidly expanding hematoma in a rare presentation of spontaneous bleed into the NF1 lesion in her scalp. Soon after presentation, she went into hemorrhagic shock. Emergency coiling of the left maxillary artery and branches successfully arrested the bleeding, while resuscitation reversed the hemorrhagic shock.

Evaluation of Diagnostic Value of SPECT/CT Imaging in Post-radioiodine Therapy in Thyroid Cancer.

Objectives: This study aimed to investigate the value of single photon emission computed tomography/computed tomography (SPECT/CT) imaging in well-differentiated thyroid cancer (DTC) after radioiodine (I-131) ablation/therapy for clinical staging and risk stratification. It also aimed to determine whether SPECT/CT would change the management plan or predict the clinical outcomes of DTC patients. Methods: A total of 78 DTC patients underwent first post radioiodine therapy "Whole body iodine-131 scintigraphy (WBS) along with SPECT/CT" at the Department of Radiology and Molecular imaging, Sultan Qaboos University Hospital, Muscat, Oman, between January 2014 and August 2017. Differences between WBS and SPECT/CT, change in clinical staging, risk stratification and management were recorded. The clinical outcome at 6-12 months was recorded. A generalised McNemar test was used to assess disagreement between WBS and SPECT/CT. Results: According to the American Thyroid Association (ATA) risk stratification, the sample showed low (35.8%), intermediate (53.8%) and high-risk groups (10.2%) on WBS, which changed to 44.8%, 38.4% and 16.6%, respectively, on SPECT/CT imaging. Overall change in risk stratification was noted in 16.7% and TNM stage in 11.5% of patients after SPECT/CT imaging. SPECT/CT changed the therapeutic plan and clinical outcome in 19.2% of patients. Conclusion: SPECT/CT allows better detection and characterisation of metastatic lymph nodes and distant metastasis in DTC patients compared to WBS imaging alone. It alters TNM staging, ATA risk classification and management in a significant number of patients. It is recommended that SPECT/CT should be done routinely along with WBS in well-differentiated thyroid carcinoma.

A novel, eco-friendly bio-nanocomposite (Alg-Cst/Kal) for the adsorptive removal of crystal violet dye from its aqueous solutions.

Herein, we report the synthesis of a novel bio-nanocomposite (Alg-Cst/Kal) for the effective removal of the dye "Crystal Violet" from its aqueous solutions. In order to observe the surface morphology and functional groups, the bio-nanocomposite was characterized using various techniques such as SEM, EDX, TEM, FTIR, XRD, and TGA. The effect of parameters like contact time, pH, concentration and temperature on the adsorption of the dye over adsorbent has been studied in detail. The dye - adsorbent system has been tested over various isotherm models and found to follow the Freundlich adsorption isotherm model at 303 K. The developed bio-nanocomposite material exhibits an excellent adsorption toward Crystal Violet with a maximum adsorption capacity of 169.49 mg.g-1. The experimental data has been further validated by applying various kinetic models and the pseudo-second order kinetic model was the best suited model. The calculated rate constant values ranged from 0.0046 to 0.0204 g.mg-1.min-1 for different dye concentrations. The positive values of change in enthalpy, ΔH° (9.765 kJ.mol-1) and change in entropy, ΔS° (0.0565 kJ.mol-1.K-1) obtained through thermodynamic studies demonstrate the endothermic nature and spontaneity of the adsorption process, respectively. The adsorption capacity of the adsorbent for the removal of the Crystal Violet dye was also compared with other adsorbents and found maximum. Novelty statement A novel bio-nanocomposite is synthesized by modifying the biopolymer alginate, cysteine and mixing the clay, kaolinite (Kal). The adsorption abilities of the material was tested the on the cationic hazardous dye, Crystal Violet. The material is novel and no attempt has so far been made to examine its batch adsorption abilities to remove hazardous dyes from the wastewater. The results are highly encouraging as out of all the adsorbents tested so far highest adsorption of the dye is observed in the present studies.

Radiological and Embryological Relevance of Persistent Sciatic Arteries: A Rare Presentation.

Persistent sciatic artery (PSA) is an extremely rare condition that is present in around 0.05% of the population and is commonly associated with many complications. The management is conservative or through surgical intervention and depends on the type of complication. The case presented is of a 40-year-old man who complained of persistent pain in the buttock region. On radiology, bilateral PSAs were observed exiting through the infra-pyriformis compartment of the greater sciatic foramen accompanying the sciatic nerve. The femoral artery and the external iliac artery are small in caliber. In this case report, we discuss the underlying embryology that might have led to the persistence of this vessel with illustrations and the abnormal radiological pattern of this anomaly. Increased awareness of PSA can improve patient care and prevent potentially hazardous complications during hip and renal transplant surgery.

Complications and Management of Totally Implantable Central Venous Access Ports in Cancer Patients at a University Hospital in Oman.

OBJECTIVES: Totally implantable central venous access ports (port-a-caths) are increasingly used for the safe administration of chemotherapy; however, their use is associated with complications. This study reviews patterns of complications, reasons for premature removal and the duration of the use of port-a-caths in patients receiving cancer treatment at Sultan Qaboos University Hospital (SQUH) and compares the infection rate with the literature and the researchers' experiences. METHODS: This retrospective follow-up study included patients who had received cancer treatment through a port-a-cath and were admitted to SQUH between January 2007 and April 2019. Demographic features, underlying diagnosis, clinical stage, treatment, duration of use and the cause of premature removal of the port-a-cath were recorded. RESULTS: A total of 516 port-a-caths were inserted in 482 cancer patients. The majority of devices were implanted by interventional radiologists (n = 459; 89.0%) and the right internal jugular vein was most frequently accessed (n = 396; 76.7%). The mean indwelling time of a port-a-cath was 288 days (range: 3-1,872 days) for patients with complications and 550 days (range: 7-3,123 days) for patients without complications. Port-a-cath-related infection was the main complication (n = 63; 12.2%). Patient age, gender, treatment intent, underlying diagnosis, clinical stage, chemotherapy regimen, number of treatment courses, operator implanting the port, the type of micro-organism isolated from the port-a-cath and body mass index were significant factors affecting catheter indwelling time (P <0.05). On multivariate analysis, however, none of the factors was found to be significant. CONCLUSION: Infection was the most common complication necessitating port-a-cath removal. The infection rate was much lower than the researchers' previous experience and compares favorably with several published reports.

Good Clinical Success Rates Are Seen 5 Years After Meniscal Repair in Patients Regularly Undertaking Extreme Flexion.

PURPOSE: To report the functional and radiologic outcomes of meniscal repair healing in a cohort of patients with a high demand for loaded extreme flexion angles after undergoing meniscal repair. METHODS: We performed a retrospective clinical and radiologic evaluation of patients who perform extreme knee flexion activities on a daily basis at a minimum follow-up of 2 years after meniscal repair. International Knee Documentation Committee, Lysholm, and Tegner scores were obtained, and clinical examinations and radiologic (magnetic resonance imaging and radiography) evaluations were performed. RESULTS: Of 47 eligible patients, 39 patients (40 knees) were available for review with an average follow-up time of 5 years (range, 2-9 years). The average age was 26.7 years (range, 19-39 years); 38 patients were men. The average time from injury to surgery was 20.9 months (range, 3 days to 120 months). Associated anterior cruciate ligament injury was present in 31 knees, but only 20 underwent simultaneous anterior cruciate ligament surgery. The mean International Knee Documentation Committee score was 88.9 (range, 53-99). The mean Lysholm score was 90.9 (range, 48-100). The mean Tegner activity level dropped from 6.18 before injury to 5.51 at the time of evaluation. According to the Barrett criteria for clinical outcomes, complete healing was observed in 29 of 40 knees (72.5%). There was a statistically significant correlation between the functional outcomes and the clinical outcomes (P = .008). On magnetic resonance imaging, 22 of 38 knees (57.9%) showed completely healed menisci. CONCLUSIONS: The results of this study suggest that loaded deep knee flexion may be safe after a period of restricted rehabilitation, and clinical and radiologic tissue healing is independent of the overall functional outcome. LEVEL OF EVIDENCE: Level IV, case series with subgroup analysis.

Removal of caffeine, nicotine and amoxicillin from (waste)waters by various adsorbents. A review.

The fast growth in the anthropogenic activities, that involve a wide use of pharmaceuticals, has led to the appearance of new toxic and hazardous chemical compounds, called "emerging pollutants", which could cause unpredictable consequences to the ecosystems. The current review is focused on emerging pollutants occurring in food or air and include caffeine and nicotine, as well as on pharmaceuticals, in particular amoxicillin, and the concerns caused by its wide usage for medical purposes. This review, for the first time, analyzes and discusses the potential risks and implications of caffeine, nicotine and amoxicillin as emerging environmental pollutants, a field that remains underrepresented to date. Both caffeine and nicotine belong to life style compounds, while pharmaceutical amoxicillin is one of the very popular ß-lactam antibiotics used to take care of human and animal infections. The review covers the toxic effect caused by caffeine, nicotine and amoxicillin on humans and animals and describes some of the main adsorbents utilized for their removal (e.g., grape stalk, tea waste, wheat grains, bentonite, activated carbon, acid and base modified grape slurry wastes, graphene oxides, modified graphene oxides, zeolites, etc.). The isotherm and kinetic models for the analysis of caffeine, nicotine and amoxicillin adsorption by different adsorbents are presented. The impact of pH, temperature, adsorbent dosage and thermodynamic studies were deeply analyzed. The review also discusses the mechanism of adsorption for the above-mentioned emerging pollutants, which includes π-π interaction, cation-π bonding, electron-donor and electron-acceptor forces, van der Waals forces, electrostatic interactions, etc. The present review has a potential value for chemists, ecologists, toxicologists, environmental engineers, and other professionals that are involved in environmental protection.

In Silico Target Identification and Validation for Antioxidant and Anti-inflammatory Activity of Selective Phytochemicals

Abstract Phytochemicals present in plant extract include a number of biological active compounds which have shown promising antioxidant and anti-inflammatory activities in many animal studies. Present knowledge about the biochemical interactions of these compounds present in phytochemical extracts and target enzymes or proteins responsible for antioxidant and anti-inflammatory activity is limited. Present work is an attempt to identify and validate possible biological targets as enzymes or proteins involved in these targeted studies using molecular docking as computational method. IMPPAT: Indian Medicinal Plants, Photochemistry and Therapeutics (a curated database) has been used to retrieve various phytochemicals derived from selected plants which includes Carica papaya, Citrus limon, Curcuma longa, Dalbergia sissoo and Punica granatum. These phytochemicals are further evaluated using molecular docking against three enzymes involved in antioxidant activity which includes Superoxide dismutase (SOD), Glutathione peroxidase (GPX) and Catalase (CAT). Cyclooxigenase-2 (COX-2) has been tested for anti-inflammatory activity of these phytochemicals. Gliadin (Triticum aestivum), Tea Extract (Punica granatum), Hesperidin (Citrus limon), Terrestribisamide (Triticum aestivum), Vitamin P (Carica papaya) and 1,2,6-Trigalloylglucose (Punica granatum) are few phytochemicals which has shown promising binding affinities towards target proteins or enzymes Superoxide dismutase (SOD), Glutathione peroxidase (GPX) and Catalase (CAT) and cyclooxigenase-2 (COX-2).

Primary Gastric Yolk Sac Tumour.

Primary gastric yolk tumours are extremely rare. We report a 52-year-old male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 after having undergone a gastrectomy abroad due to a suspected poorly-differentiated adenocarcinoma. The patient subsequently returned to Oman to receive chemotherapy. However, while undergoing chemotherapy, an abdominal computed tomography scan revealed a lobulated mesenteric mass. Microscopic examination of the resected lesion confirmed a diagnosis of a yolk sac tumour. The mass was diffusely positive for α-fetoprotein (AFP) and a gastric carcinoma stain was negative. Gastrectomy slides from the patient's previous surgery were examined retrospectively. The morphology was typical for a yolk sac tumour and was negative for epithelial markers. An AFP stain showed diffuse immunoreactivity. Thus, the patient was deemed to have had a primary gastric yolk sac tumour which had later metastasised to the mesocolon. Germ cell tumour protocols were initiated and the patient responded well to treatment.

Freundlich and Langmuir adsorption isotherms and kinetics for the removal of Tartrazine from aqueous solutions using hen feathers.

Tartrazine, a yellow menace, is widely being used in cosmetics, foodstuffs, medicines and textile. It is carcinogenic and also catalyzes allergic problems. In the present work the ability to remove Tartrazine from aqueous solutions has been studied using waste material-hen feathers, as adsorbent. Effects of pH, concentration of the dye, temperature and adsorbent dosage have been studied. Equilibrium isotherms for the adsorption of the dye were measured experimentally. Results were analyzed by the Freundlich and Langmuir equation at different temperatures and determined the characteristic parameters for each adsorption isotherm. The adsorption process has been found endothermic in nature and thermodynamic parameters, Gibb's free energy (DeltaG degrees), change in enthalpy (DeltaH degrees) and change in entropy (DeltaS degrees) have been calculated. The paper also includes results on the kinetic measurements of adsorption of the dye on hen feathers at different temperatures. By rate expression and treatment of data it has been established that the adsorption of Tartrazine over hen feathers follows a first-order kinetics and a film diffusion mechanism operates at all the temperatures.

Adsorption of a hazardous dye, erythrosine, over hen feathers.

Erythrosine is a popular dye that is widely used in cosmetics, foodstuffs, medicines, and textiles. It is highly toxic to mankind and can lead to many diseases including carcinogenicity. Removal of erythrosine has been carried out using waste material--hen feathers--as adsorbent. The effects of pH, concentration of the dye, temperature, and adsorbent dosage have been studied. Adsorption of erythrosine over hen feathers has been correlated with Freundlich and Langmuir isotherms and satisfies both models. The adsorption process has been found endothermic in nature and thermodynamic parameters, Gibb's free energy (DeltaG(0)), change in enthalpy (DeltaH(0)), and change in entropy (DeltaS(0)) have been calculated. The paper also includes results on the kinetic measurements of adsorption of the dye on hen feathers at different temperatures. The adsorption follows a first-order kinetics at all the temperatures and values of the rate constant (k(ad)) have been calculated as 0.0179, 0.0177, and 0.0172 s(-1) at 30, 40, and 50 degrees C, respectively. By rate expression and treatment of data it has been ascertained that the adsorption of erythrosine over hen feathers follows a particle diffusion mechanism.

Process development for the removal and recovery of hazardous dye erythrosine from wastewater by waste materials-Bottom Ash and De-Oiled Soya as adsorbents.

Erythrosine is a water-soluble xanthene class of dye. It is widely used as colorant in foods, textiles, drugs and cosmetics. It is highly toxic, causes various types of allergies, thyroid activities, carcinogenicity, DNA damage behaviour, neurotoxicity and xenoestrogen nature in the humans and animals. The photochemical and biochemical degradation of the erythrosine is not recommended due to formation of toxic by-products. The present paper is an attempt to remove erythrosine from wastewater using adsorption over Bottom Ash-a power plant waste and De-Oiled Soya-an agricultural waste. Under the batch studies, effect of concentration of dye, temperature, pH of the solution, dosage of adsorbents, sieve size of adsorbents, etc., have been studied for the uptake of the dye over both adsorbents. The adsorption process verifies Langmuir and Freundlich adsorption isotherms in both the cases and based on the data different thermodynamic parameters have been evaluated. Batch studies also include kinetic measurements, rate constant study, mass transfer behaviour and establishment of mechanistic pathway for both the cases. For the bulk removal of the dye column operations have been carried out and breakthrough capacities of the Bottom Ash and De-Oiled Soya columns have been calculated. Attempts have also been made for the recovery of the adsorbed dye from exhausted columns by eluting dilute NaOH and more than 90% of the dye was recovered.