Clinical management and outcome of head and neck paragangliomas (HNPGLs): A single centre retrospective study.

CONTEXT: Head and neck paragangliomas (HNPGLs) are rare, usually benign, slow-growing tumours arising from neural crest-derived tissue. Definitive management pathways for HNPGLs have yet to be clearly defined. OBJECTIVE: To review our experience of the clinical features and management of these tumours and to analyse outcomes of different treatment modalities. METHODS: Demographic and clinical data were obtained from The Northern Ireland Electronic Care Record (NIECR) as well from a prospectively maintained HNPGL database between January 2011 through December 2023. RESULTS: There were 87 patients; 50 females: 37 males with a mean age of 52.3 ± 14.2 years old (range 17-91 years old). 58.6% (n = 51) of patients had carotid body tumours, 25.2% (n = 22) glomus vagal tumours, 6.8% (n = 6) tumours in the middle ear, 2.2% (n = 2) in the parapharyngeal space and 1.1% (n = 1) in the sphenoid sinus. 5.7% (n = 5) of patients had multifocal disease. The mean tumour size at presentation was 3.2 ± 1.4 cm (range 0.5-6.9 cm). Pathogenic SDHD mutations were identified in 41.3% (n = 36), SDHB in 12.6% (n = 11), SDHC in 2.2% (n = 2) and SDHA in 1.1% (n = 1) of the patients. Overall treatment modalities included surgery alone in 51.7% (n = 45) of patients, radiotherapy in 14.9% (n = 13), observation in 28.7% (n = 25), and somatostatin analogue therapy with octreotide in 4.5% (n = 4) of patients. Factors associated with a significantly higher risk of recurrence included age over 60 years (p = .04), tumour size exceeding 2 cm (p = .03), positive SDHx variants (p = .01), and vagal and jugular tumours (p = .04). CONCLUSION: The majority of our patients underwent initial surgical intervention and achieved disease stability. Our results suggest that carefully selected asymptomatic or medically unfit patients can be safely observed provided lifelong surveillance is maintained. We advocate for the establishment of a UK and Ireland national HNPGL registry, to delineate optimal management strategies for these rare tumours and improve long term outcomes.

Aflatoxins in the rice production chain: A review on prevalence, detection, and decontamination strategies.

Rice (Oryza sativa L.) is one of the most consumed cereals that along with several important nutritional constituents typically provide more than 21% of the caloric requirements of human beings. Aflatoxins (AFs) are toxic secondary metabolites of several Aspergillus species that are prevalent in cereals, including rice. This review provides a comprehensive overview on production factors, prevalence, regulations, detection methods, and decontamination strategies for AFs in the rice production chain. The prevalence of AFs in rice is more prominent in African and Asian than in European countries. Developed nations have more stringent regulations for AFs in rice than in the developing world. The contamination level of AFs in the rice varied at different stages of rice production chain and is affected by production practices, environmental conditions comprising temperature, humidity, moisture, and water activity as well as milling operations such as de-husking, parboiling, and polishing. A range of methods including chromatographic techniques, immunochemical methods, and spectrophotometric methods have been developed, and used for monitoring AFs in rice. Chromatographic methods are the most used methods of AFs detection followed by immunochemical techniques. AFs decontamination strategies adopted worldwide involve various physical, chemical, and biological strategies, and even using plant materials. In conclusion, adopting good agricultural practices, implementing efficient AFs detection methods, and developing innovative aflatoxin decontamination strategies are imperative to ensure the safety and quality of rice for consumers.

Responses to graded replacement of urea by maize steep liquor in diets for intensively fed lambs for meat production.

Urea is a common ingredient of the diets of intensively fed lambs, but is increasingly required for industrial processes. Maize steep liquor (MSL) is a by-product of maize grain degradation to produce starch that may be a suitable replacement. Fifty growing lambs were fed on equinitrogenous diets in which between 0% and 80% of the urea was replaced by MSL; their growth and metabolism were recorded over 70 days. Increasing replacement of urea by MSL increased feed intake and nutrient digestibilities, leading to increased growth rates, more efficient feed conversion, and increased nitrogen retention. Concentrations of triiodothyroxin, thyroxin, glucose, and methionine were increased by replacement of urea by liquor, and plasma urea was reduced. This study suggests that MSL is a suitable replacement for up to 80% of urea in the diet of rapidly growing lambs.

Multiple intracranial capillary hemangiomas and transient cerebrovascular insufficiency.

Hemangiomas constitute a heterogeneous group of benign vascular proliferations of skin and mucous membranes and very rarely known to develop in the brain or spinal cord. We report here a case of multiple intracranial capillary hemangiomas presenting with transient neurological deficit. The patient underwent stealth MRI brain utilizing 15 ml of Magnevist for stereotactic localization and biopsy was done to establish the diagnosis. It is pivotal to differentiate benign hemangiomas from primary cerebral vascular tumors including hemangioblastoma, hemangioendothelioma and hemangiopericytoma, as later are known for more aggressive biologic behavior.

Feeding value of urea molasses-treated wheat straw ensiled with fresh cattle manure for growing crossbred cattle calves.

The study was carried out to evaluate the influence of urea plus molasses-treated wheat straw (WS) ensiled with cattle manure (CM) on nutrients intake, their digestibilities, and growth performance of crossbred (Sahiwal × Holstein Friesian) cattle calves. The CM was mixed with ground WS in a ratio of 30:70 on dry matter (DM) basis. The WS-CM mixture treated with urea (4% DM) and molasses (4% DM) was allowed to ferment for 40 days in a cemented pit. Four iso-nitrogenous and iso-energetic fermented wheat straw (FWS)-based experimental diets were formulated. The FWS0, FWS20, FWS30, and FWS40 diets contained 0%, 20%, 30%, and 40% FWS, respectively. Twenty calves (9-10 months of age) were randomly allocated to four dietary treatments in a randomized complete block design, five in each group. Increasing trends for DM, organic matter, crude protein, and neutral detergent fiber intakes by calves were observed with increasing dietary FWS level. Weight gain was significantly different among calves fed different levels of FWS. The highest weight gain (491.8 g/day) was observed in calves fed FWS40 diet, while calves fed FWS0 and FWS20 diets gained 350.0 and 449.6 g/day, respectively. The results from this study imply that the FWS can be added up to 30% in the diet of growing crossbred calves without any detrimental effect on their performance.

Referrals to a tertiary hospital: A window into clinical management issues in functional gastrointestinal disorders.

BACKGROUND AND AIM: To investigate the quality of and reasons for referrals of patients with likely functional gastrointestinal disorders (FGID) and explore patients' experience of clinical management. METHODS: A cross sectional, mixed-methods study was undertaken. Referrals (July 2013-2015) to one gastroenterology outpatient department triaged as "likely FGID", the referred patients and their referring primary healthcare providers were examined. RESULTS: A total of 69% of patients reported not yet receiving an initial diagnosis, 52% reported persistent/distressing symptoms or reduced quality of life, 24% feared missed or worsening pathology, and 35% were seeking repeat specialist consultation. Most patients were dissatisfied (40%) or only partially satisfied (36%) with current management. Dissatisfaction was significantly related to the lack of provision of a diagnosis and effective treatment options (P < 0.001). Referral quality was poor and with the reason for referral clearly communicated in only 25%. Common referral reasons included repeat presentations (n = 32), diagnostic uncertainty (n = 19), to ensure nothing is missed (n = 19), patient request (n = 17), no response to treatment (n = 16), and to allay patient fears (n = 14). A total of 28/60 primary healthcare providers were confident that their patient had a FGID, yet sought confirmation (n = 16), second opinion (n = 8), or advice (n = 4). CONCLUSION: Current management of FGID in usual care is suboptimal, as evidenced by the tertiary referral load, patient dissatisfaction, and the lack of provision of diagnoses and effective treatment options. Some clinicians lack confidence in effectively identifying and managing these conditions. Resources and supports to equip and assist clinicians to identify and manage FGID successfully may enhance patient care.

First Reported Case of 'Epidermal Nevus Syndrome' with a Triad of Central Nervous System Deformities.

Epidermal nevus syndrome (ENS) is a term used to describe the occurrence of an epidermal nevus in association with other extra-cutaneous developmental anomalies, most commonly involving the nervous and musculoskeletal systems. The nevus is classified on the basis of the main component which may be keratinocytic, sebaceous, follicular, apocrine, or eccrine. Most patients who present with ENS is at the time of birth, though some become apparent later in life. This case describes a young female who presented with seizures and cognitive impairment along with a linear epidermal nevus on the midline of her face. The presence of the nevus prompted brain imaging which showed cortical dysplasia, multiple hamartomas in the temporal lobe, thalamus, and periventricular regions along with cerebellar atrophy and Dandy-Walker variant. To our knowledge, this is the first case in which three different types of brain lesions were found in the same patient.

Serum Apo A-1 and Its Role as a Biomarker of Coronary Artery Disease.

OBJECTIVES: To evaluate the role of apolipoprotein(Apo A-1) as a biomarker of coronary artery disease (CAD) and its comparison with the traditional marker high-density lipoprotein (HDL). METHODOLOGY: One hundred patients proven to have coronary artery disease by angiography were recruited and their serum biomarkers were compared with 100 normal individuals adjusted for age and sex. RESULT: The mean +/-standard deviation (SD) value of plasma Apo A-1 levels in the normal individuals were observed to be 207.42 +/- 41.35 (mg/dL) against 90.69 +/- 20.77 (mg/dL) in the cardiac patients. On the other hand the serum HDL levels were 52.93 +/-33.58 (mg/dL) in the normal individuals and 37.86 +/- 23.19 (mg/dL) in the cardiac patients. Both of these differences were statistically significant (p < 0.001). For Apo A-1, a large proportion of patients (85%) were found to be in the abnormal range when compared to the control group in which only 7% had an abnormal value. For HDL, a majority (70%) of the cardiac patients had abnormal values while 40% of the normal individuals also had abnormal values. The sensitivity of Apo A-1 for detecting CAD was 85%, while for HDL, it was only 69%. Similarly, the specificity of Apo A-1 for detecting CAD was 93%, while for HDL, it was 60%. When plotted on a receiver operating characteristic (ROC) curve, Apo A-1 had a much larger area under the curve when compared to HDL. CONCLUSION: This study suggests that Apo A-1 may, in fact, be more sensitive than HDL as a predictor of CAD. However, to completely elucidate its role as a biomarker, to set target serum levels and to increase its clinical use, further studies are required.

Influence of varying levels of dietary cation anion difference on ruminal characteristics, nitrogen metabolism and in situ digestion kinetics in buffalo bulls.

This study was conducted to examine the influence of varying dietary cation anion difference (DCAD) on nutrient intake, digestibility, ruminal characteristics, blood acid base status and in situ digestion kinetics in Nili Ravi buffalo bulls. Four iso-nitrogenous and iso-caloric diets having -110, +110, +220 and +330 mEq/kg dry matter (DM) DCAD were formulated which were represented by A (anionic), LC (low cationic), MC (medium cationic) and HC (high cationic), respectively. These diets were used in four ruminally cannulated Nili Ravi buffalo bulls in a 4 × 4 Latin Square Design. Improved nutrient intake was recorded at high DCAD levels while digestibility remained unaffected. Ruminal ammonia nitrogen, rumen pH, acetate and acetate : propionate ratio were higher in buffalo bulls fed MC and HC diets than those fed A and LC diets. Blood pH and HCO3⁻ also tended to increase as DCAD level was increased in the diet. Serum Ca and Cl concentrations were higher in bulls fed A and LC diets whereas serum Mg, P and S remained unaffected. Urine pH increased with increasing DCAD level. Nitrogen intake and blood urea nitrogen concentrations were also higher in bulls fed MC and HC diets. There was a consistent increase in ruminal DM and neutral detergent fiber degradability, rate of disappearance and extent of digestion at high DCAD levels in the diet. However, lag time decreased at high DCAD level. This study indicated that buffalo bulls fed MC and HC diets improved feed intake, ruminal characteristics and digestion kinetics.