Ductal carcinoma in situ and invasive carcinoma originating in a Fibroadenoma with concurrent benign phyllodes tumor: A case report.

INTRODUCTION AND IMPORTANCE: This case report presents a rare occurrence of multiple bilateral breast fibroadenomas, one evolving into ductal carcinoma in situ (DCIS) and invasive carcinoma, occurring simultaneously with a benign phyllodes tumor in the same breast. The importance of this case lies in emphasizing the crucial need for surveillance in patients with a long history of fibroadenomas and the necessity to investigate any rapid change in the size of fibroadenoma. CASE PRESENTATION: A 35-year-old multiparous female with a 17 year history of bilateral multiple breast lumps presented with recent onset of right breast pain and yellowish nipple discharge. Two lumps in her right breast had demonstrated an increase in size. Examination revealed a significant mass in the retroareolar region of the right breast and another at the 2 o'clock position. Histopathological examination of the biopsy specimens revealed fibroadenoma and benign phyllodes tumor. The patient underwent a bilateral breast lumpectomy. Further histopathological examination revealed ductal carcinoma in situ and invasive carcinoma within a complex fibroadenoma in the right breast and benign phyllodes tumor. Sentinel lymph node biopsy was negative. She had adjuvant radiations and trastuzumab. Regular follow-ups show no recurrence. CLINICAL DISCUSSION: Fibroadenomas are usually benign but rarely undergo malignant change. Quick response to size changes and early detection greatly enhance patient results. CONCLUSION: Ductal carcinoma in situ and invasive breast cancer, a rare malignancy found within a fibroadenoma, necessitates histopathological specimens and immunohistochemical results for accurate diagnosis. Survival rates are significantly enhanced through a multidisciplinary approach.

Cecal volvulus with acute appendicitis in a 33-year-old male managed by manual detorsion, cecopexy, and appendectomy: A case report.

INTRODUCTION: A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for just 1-1.5 % of all cases of bowel obstruction. CASE PRESENTATION: A 33-year-old intellectually disabled male presented to the emergency department with complaints of generalized abdominal pain, absolute constipation, and non-projectile vomiting. He had a grossly distended and rigid abdomen with generalized tenderness and guarding. The abdomen was hyper-resonant. Bowel sounds were hypoactive. Digital rectal examination revealed an empty and collapsed rectum with no stool staining of the finger. Laboratory reports showed leukocytosis and neutrophilia. Radiographic imaging was consistent with acute intestinal obstruction. Laparotomy was performed, and cecal volvulus with viable bowel and acute appendicitis was diagnosed intra-operatively. Manual detorsion, cecopexy, and appendectomy were performed. The patient had an uneventful postoperative course. The patient is still on follow-up since June 2023, and no complication has occurred. CLINICAL DISCUSSION: Cecal volvulus is an uncommon cause of intestinal obstruction with multiple etiologies. The annual incidence of cecal volvulus is estimated to be between 2.8 and 7.1 cases per million. Cecal volvulus may lead to life-threatening complications such as bowel ischemia and perforation. CONCLUSION: Diagnosis of cecal volvulus must be made promptly to prevent bowel gangrene and perforation. In this case, manual detorsion and cecopexy were performed as the bowel was viable per-operatively due to early surgical intervention.

Bioremediation of Neonicotinoid Pesticide, Imidacloprid, Mediated by Bacillus cereus.

Imidacloprid, a toxic pesticide of the chloronicotinyl category, is employed extensively in agricultural fields, and its exposure causes serious health issues. Biodegradation is considered to be a green and economical approach to remediate pesticides. Herein, imidacloprid degradation efficiency of Bacillus sp. is highlighted, among which Bacillus cereus exhibited the greatest degradation; optimization of experimental variables (pH, imidacloprid and agitation time) via Box-Behnken factorial design and analysis of variance (ANOVA) revealed 92% biodegradation at the initial substrate concentration of 0.03 mM, aerobically in 11 days under favorable pH 7. The subsequent metabolites, identified through liquid chromatography-mass spectrometry, were 5-hydroxy imidacloprid, imidacloprid-guanidine and 6-chloronicotinic acid.

Fetal Outcomes in Preterm Cesarean Sections.

Introduction Neonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean delivery and fetal outcomes. Methods A prospective study was conducted at the Combined Military Hospital in Peshawar, Pakistan, from October 1, 2020, to March 31, 2021. All women reporting to the hospital with a cephalic presentation and singleton pregnancies between the 27th and 34th weeks of gestation were included in the study. Pregnancies with an abnormal presentation, those diagnosed with a congenital abnormality, and those with indications for growth restriction or preterm delivery were excluded from the study. We also excluded infants delivered via vacuum or forceps. The outcomes of interest in this study included neonatal death prior to discharge, neonatal respiratory distress, sepsis, intraventricular hemorrhage (IVH), seizure, subdural hemorrhage (SDH), or appearance, pulse, grimace, activity, and respiration (APGAR) test score of less than 7 at five minutes. Maternal features including diabetes, hypertension and gestational age of delivery, parity, previous cesarean sections (CS), and last pregnancy outcomes were documented in a predefined pro forma. Results Our sample size consisted of 288 women, who were classified into two groups. Group A comprised 144 women who gave birth vaginally and group B consisted of 144 women who underwent CS. It was observed that women who underwent cesareans had a higher likelihood of a history of hypertension and related pathologies. It was also observed that these women had a greater likelihood of being of higher age compared to women who underwent vaginal deliveries. Neonates of women who had CS were at a greater risk of presenting with respiratory distress than those who had spontaneous vaginal deliveries. Conclusion Based on our findings, respiratory distress was significantly more common in babies of women who delivered via CS. However, there was no difference in neonatal outcomes in terms of IVH, seizures, SDH, and APGAR score of <7.

Metallic nanoparticles for catalytic reduction of toxic hexavalent chromium from aqueous medium: A state-of-the-art review.

The ever increasing concentration of toxic and carcinogenic hexavalent chromium (Cr (VI)) in various environmental mediums including water-bodies due to anthropogenic activities with rapid civilization and industrialization have become the major issue throughout the globe during last few decades. Therefore, developing new strategies for the treatment of Cr(VI) contaminated wastewaters are in great demand and have become a topical issue in academia and industry. To date, various techniques have been used for the remediation of Cr(VI) contaminated wastewaters including solvent extraction, adsorption, catalytic reduction, membrane filtration, biological treatment, coagulation, ion exchange and photo-catalytic reduction. Among these methods, the transformation of highly toxic Cr(VI) to benign Cr(III) catalyzed by metallic nanoparticles (M-NPs) with reductant has gained increasing attention in the past few years, and is considered to be an effective approach due to the superior catalytic performance of M-NPs. Thus, it is a timely topic to review this emerging technique for Cr(VI) reduction. Herein, recent development in synthesis of M-NPs based non-supported, supported, mono-, bi- and ternary M-NPs catalysts, their characterization and performance for the reduction of Cr(VI) to Cr(III) are reviewed. The role of supporting host to stabilize the M-NPs and leading to enhance the reduction of Cr(VI) are discussed. The Cr(VI) reduction mechanism, kinetics, and factors affecting the kinetics are overviewed to collect the wealthy kinetics data. Finally, the challenges and perspective in Cr(VI) reduction catalyzed by M-NPs are proposed. We believe that this review will assist the researchers who are working to develop novel M-NPs catalysts for the reduction of Cr(VI).

Risk Factors Associated With Birth Asphyxia in Term Newborns at a Tertiary Care Hospital of Multan, Pakistan.

Background Perinatal asphyxia is one of the main causes of death in term newborns. During the past two decades, no significant progress has been made in reducing neonatal deaths in developing countries. This study was aimed to determine various factors associated with birth asphyxia in term newborns at a tertiary care hospital of Multan, Pakistan. Methods This case-control study was conducted at the Neonatal pediatrics Department, The Children's Hospital, Multan in collaboration with the labor room of Nishtar Hospital Multan from April 2020 to September 2020. Newborns delivered in the labor room with a low Apgar score of five or less at the first minute were recruited as cases and newborns with an Apgar score of more than five in the first minute were recruited as controls. The demographic information of neonates and mothers was noted. A Performa was used to collect all information. All data were analyzed through SPSS 26.0 (IBM SPSS Inc., Chicago, IL, USA). Results A total of 426 newborns (213 cases and 213 controls) were enrolled. In cases, there were 132 males and 81 females whereas there were 115 males and 98 females in the control group (P=0.09). Majority 132 (62%) mothers of cases were primiparous compared with 110 (52%) mothers of control. The difference in parity of mothers of cases and control (P=0.03) was significant. Prolonged labour was noted in cases 123 (58%) vs. controls 55 (26%) (P=0.001) while fetal distress was found in 120 (56%) cases and 45 (21%) controls (P=0.001). Meconium was found in the amniotic fluid in 171 (80%) cases and 86 (40%) controls (P=0.001). All other risk factors turned out to be insignificant between cases and controls (P>0.05). Conclusion Meconium stained liquor is a major risk factor for birth asphyxia. Prolonged labor of more than 24-hour period, as well as fetal distress, is also a major risk factor of perinatal asphyxia. Involving obstetricians in the present research give more reliability and reproducibility of the data collected.

An Evaluation of the Practice for the Requisition of Blood Products and its Utilization in Neurosurgical Patients Undergoing Elective Surgery at a Tertiary Care Hospital.

BACKGROUND: Neurosurgical procedures are associated with profound blood loss that necessitates need for intraoperative and postoperative blood transfusion. Excessive ordering of blood based on physicians' habitual practice may lead to unintentional misuse of blood bank services. For the optimal use of blood resources, transfusion practices have to be appropriate. AIMS: The aim of this study is to study the cross match to transfusion ratio and to review the blood utilization practices (transfusion index and maximal surgical blood order schedule) in elective neurosurgical procedures. SETTINGS AND DESIGN: A prospective, observational study comprising 740 patients undergoing elective neurosurgical procedures. MATERIALS AND METHODS: Blood requisition forms and patient records were analyzed of patients undergoing elective neurosurgical procedures from December 2017 to December 2018. A review and note was made of the patient's age, sex, and diagnosis. The number of units prepared, cross matched, and transfused were noted. STATISTICAL ANALYSIS: Statistical analysis was performed with the IBM SPSS software version 21.0. Blood utilization indices were computed and expressed as percentage. RESULTS: A total of 740 patients underwent elective surgical procedures. Among these, 346 patients were requested to prepare 614 units of blood. Out of these 740 patients, there were 56 patients who were in the pediatric age group. A total of 178 units were transfused in 102 patients. One hundred and forty-two units were transfused in the intraoperative period, whereas as 36 units were transfused in the postoperative period. CONCLUSION: There is an efficient usage of blood for patients undergoing surgery for meningiomas, posterior fossa tumors, spinal dysraphism, and craniovertrebral junctional anomalies. However, the blood resources were poorly utilized in patients undergoing surgery for subarachnoid hemorrhage and pituitary tumors. A revision of blood transfusion policy within the hospital is needed.

Clinicopathological pattern of cranial unifocal Langerhans cell histiocytosis: A study at medical college hospital.

BACKGROUND: Eosinophilic granuloma (EG) of bone refers to a generally benign form of Langerhans cell histiocytosis localized to the bone. Patients may present with a solitary lesion (monostotic) or multiple sites of involvement (polyostotic). MATERIALS AND METHODS: This study was done to evaluate the clinicopathological pattern of 6 cases of EGs of the skull diagnosed at a tertiary care hospital. All patients of EG were included with the help of medical records over a 5-year period that is, November 2009 to November 2014. They all had been preoperatively evaluated by skull X-ray and computed tomography. To rule out a multifocal disease scintigraphy was performed in all cases preoperatively. Surgical excision was performed, and EG was diagnosed on histopathology and immunohistochemistry. RESULTS: There was a male predominance. Parietal bone was the most common affected bone. Total excision of the lesion was performed in all cases. No patient received postoperative radiotherapy. The follow-up period ranged from 6 months to 3 years. No tumor recurrence was noted. CONCLUSION: With an unknown etiology, nonspecific clinical and radiological findings with diagnosis possible only on histopathological examination, EG needs to be considered in the differential diagnosis as a skull mass, especially in children.

Coexistent Papillary Carcinoma of Thyroid and Hashimoto's Thyroiditis - Diagnosis on Fine Needle Aspiration Cytology.

Hashimoto's thyroiditis is associated with an increased risk of developing papillary carcinoma of thyroid. We hereby report a case of Hashimoto's thyroiditis with papillary carcinoma in a 45-year-old ear old female diagnosed on fine needle aspiration cytology (FNAC) which was later confirmed on histopathological examination .Such an occurrence, when both lesions are picked up on FNAC in a patient with no palpable thyroid nodule is rare. The case is presented here for its rarity.

Primary paratesticular carcinoid in a 70-year-old male.

Carcinoid tumors are neuroendocrine tumors and most frequently occur within tissues derived from the embryonic gut. These tumors can occur in any organ but are very rare in the paratesticular region. We hereby report a case of paratesticular carcinoid in a 70-year-old male who, to the best of our knowledge, is the oldest patient reported so far in the world literature.