Production and characterization of bioemulsifier by Parapedobacter indicus.

The current study evaluated Parapedobacter indicus MCC 2546 for its potential to produce a bioemulsifier (BE). Screening methods performed for BE production by P. indicus MCC 2546 showed good lipase activity, positive drop collapse test, and oil-spreading activity. Furthermore, it showed maximum emulsification activity (225 EU/ml) and emulsification index (E24 50%) at 37°C in Luria Bertani broth at 72 h with olive oil as a substrate. The optimal pH and NaCl concentration for maximum emulsification activity were 7 and 1%, respectively. P. indicus MCC 2546 lowered the surface tension of the culture medium from 59.65 to 50.42 ± 0.78 mN/m. BE produced was composed of 70% protein and 30% carbohydrate, which showed the protein-polysaccharide nature of the BE. Furthermore, Fourier transform infrared spectroscopy analysis confirmed the same. P. indicus MCC 2546 showed a catecholate type of siderophore production. This is the first report on BE and siderophore production by the genus Parapedobacter.

A UK based two-centre review of multifocality and its role in the treatment of papillary thyroid cancer.

INTRODUCTION: Multifocality is increasingly observed in papillary thyroid carcinoma (PTC) due to improvements in imaging and histopathological analysis. However, its significance in management, particularly as a sole risk-factor, remains controversial. This study aimed to investigate the prognostic value of multifocality in predicting recurrence following thyroid lobectomy in a contemporary group of PTC patients managed in the UK. METHODS: Patients with PTC in NHS Lothian (2009-19) and Guys and St Thomas NHS Foundation Trust (2012-19) were identified. Categorical variables were compared using Chi-squared or Fisher's exact test. Five-year recurrence free survival (RFS) were analysed using Kaplan-Meier method and compared using log-rank. RESULTS: Of 828 patients; 492 (59%) had unifocal and 336 (41%) multifocal disease on final pathology. A higher rate of pathological nodal disease (22%v36%,p < 0.001), total thyroidectomy (TT) (78%v92%,p < 0.001) and radioactive iodine (RAI) (57%v75%,p < 0.001) was demonstrated in patients with multifocality. With a median follow-up of 50 months, overall 5-year RFS was 96.5%; 96.5% for unifocal versus 96.6% for multifocal disease (p = 0.695). Recurrence was not shown to be associated with multifocality on either univariate or multivariate analysis. Amongst patients with T1/2N0M0 disease (n = 341), more patients were treated with TT and RAI with multifocal compared to unifocal disease (<0.001). Only two patients within this group recurred during follow up, both of whom had multifocal disease and were treated with TT and RAI (5yRFS100%v98.1%,p = 0.051). CONCLUSION: Multifocality is a common feature of PTC but does not appear to be an independent predictor of outcome. Therefore, treatment intensification on the basis of multifocality alone seems unwarranted.

Potential life-threatening complication of tonsillectomy: cervicofacial surgical emphysema.

A 30-year-old woman presented to the accident and emergency department 3 days post-tonsillectomy with bleeding from the tonsillar fossa and left-sided facial swelling. The patient denied any dysphagia or breathing difficulties but experienced pain on neck movement. On examination, although the bleeding had stopped on reaching the emergency department, a small clot was noted in her left tonsillar fossa. A left facial/submandibular swelling was seen, which had been present since her operation and was slowly enlarging. Flexible nasendoscopy showed a mild left sided oropharyngeal swelling but was otherwise normal. She was treated initially with antibiotics and hydrogen peroxide gargles. After 24 hours of observation and a slight worsening of the swelling she underwent a CT of the neck. This showed widespread indurated subcutaneous surgical emphysema, originating from the left tonsillar bed. Following a period of observation and improvement in her symptoms, she was discharged home with safety netting.

Laryngeal dysplasia and narrow band imaging: Secondary analysis of published data supports the role in patient follow-up.

BACKGROUND: Clinicians have recognised the role of narrow band imaging (NBI) in the management of head and neck cancer in several studies. However, a recent systematic review was unable to pool the data on diagnostic efficacy in this setting owing to the heterogeneity in the published data. METHODS: Secondary analysis of data, utilising Bayes' theorem, from meta-analyses and randomised trials. RESULTS: In patients with a histological diagnosis of mild dysplasia who show no abnormalities on NBI, the post-test probability of malignancy is estimated to be 2.3%, compared to 10.3% with conventional white light imaging (WLI). For severe dysplasia, similar post-test probabilities after NBI and WLI are estimated to be 8.0% and 29.7%, respectively. Post-test probabilities in this setting indicate the chance of missing malignancy following a negative NBI or WLI in patients who undergo no further intervention. This study also provides a nomogram designed for use in this setting. CONCLUSIONS: This study identifies the evidence base for use of NBI in the follow-up for laryngeal dysplasia.