A Hemangiopericytoma in the External Auditory Canal: A Rare Clinical Presentation and Management.

Hemangiopericytomas (HPCs) are rare vascular tumors originating from pericytes, with a predilection for the musculoskeletal system and occasional occurrence in the head and neck region. HPCs arising in the external auditory canal (EAC) are exceptionally rare, making their diagnosis and management a clinical challenge. A 71-year-old male presented with a six-month history of a painless, progressively enlarging mass in his right EAC, accompanied by tinnitus and hearing loss. Physical examination revealed a mobile, reddish mass in the concha of the left auricle, nearly occluding the EAC. Contrast-enhanced computed tomography of the temporal bone demonstrated a heterogeneously enhancing mass with erosion of adjacent structures. Histopathological examination and immunohistochemistry confirmed the diagnosis of an HPC. The tumor was surgically excised, and the patient underwent adjuvant radiotherapy. Over a two-year follow-up period, no recurrence was observed. This case highlights the rarity of HPCs in the EAC and underscores the importance of considering this diagnosis in patients presenting with atypical EAC masses. A multidisciplinary approach, including surgical excision and radiotherapy, is crucial for achieving favorable outcomes and reducing the risk of recurrence. Long-term follow-up is essential due to the potential for late recurrence.

Clinicopathological Profile in Patients with Tubercular Cervical Lymphadenitis and Its Treatment Outcome.

Tuberculosis is a common occurrence in developing countries. Drug resistance, co-morbidities, and limited availability of new rapid tests such as the GeneXpert/MTB Rif assay make diagnosis and treatment of extrapulmonary tuberculosis burdensome. A cross-sectional study was carried out at Employees' State Insurance Corporation Medical College and Hospital, Faridabad, Haryana of patients treated for tubercular cervical lymphadenopathy from December 2021 to March 2023 in the department of ENT. This study included 58 patients. The clinicopathological profile of patients and the outcome of treatment with antitubercular therapy were noted. The majority of patients had level V (39.6%) involvement. Incidental diagnosis of diabetes mellitus was seen in 2 cases (3.4%). Fever was the commonest constitutional symptom observed in 27.5% of cases. FNAC was suggestive of tubercular abscess in 48.2% and the GeneXpert MTB/RIF assay detected Mycobacterial tuberculosis in all the cases with rifampicin resistance in only one case. 56 cases (96.5%) had complete resolution after completion of antitubercular therapy including patients with rifampicin resistance and patients with diabetes mellitus. In the remaining two cases, treatment was prolonged for a few months before the resolution of the disease was observed. Timely diagnosis, patient compliance to antitubercular therapy, and adequate management of comorbidities lead to successful treatment outcomes in tubercular cervical lymphadenitis. Delayed response to treatment in a few cases needs further research into factors like immune status, nutrition, living conditions, and quality of drugs available to the public.

Docetaxel-tethered di-Carboxylic Acid Derivatised Fullerenes: A Promising Drug Delivery Approach for Breast Cancer.

Docetaxel (DTX) has become widely accepted as a first-line treatment for metastatic breast cancer; however, the frequent development of resistance provides challenges in treating the disease.C60 fullerene introduces a unique molecular form of carbon, exhibiting attractive chemical and physical properties. Our study aimed to develop dicarboxylic acid-derivatized C60 fullerenes as a novel DTX delivery carrier. This study investigated the potential of water-soluble fullerenes to deliver the anti-cancer drug DTX through a hydrophilic linker. The synthesis was carried out using the Prato reaction. The spectroscopic analysis confirmed the successful conjugation of DTX molecules over fullerenes. The particle size of nanoconjugate was reported to be 122.13 ± 1.63 nm with a conjugation efficiency of 76.7 ± 0.14%. The designed conjugate offers pH-dependent release with significantly less plasma pH, ensuring maximum release at the target site. In-vitro cell viability studies demonstrated the enhanced cytotoxic nature of the developed nanoconjugate compared to DTX. These synthesized nanoscaffolds were highly compatible with erythrocytes, indicating the safer intravenous route administration. Pharmacokinetic studies confirmed the higher bioavailability (~ 6 times) and decreased drug clearance from the system vis-à-vis plain drug. The histological studies reveal that nanoconjugate-treated tumour cells exhibit similar morphology to normal cells. Therefore, it was concluded that this developed formulation would be a valuable option for clinical use.

Somatosensory Mapping Using a Novel Sensory Discrimination Task: Technical Note.

BACKGROUND AND OBJECTIVES: Although diffuse gliomas in the primary somatosensory cortex (S1) are often considered resectable, gliomas in the primary motor cortex require motor mapping to preserve motor function. Recent evidence indicates that some somatosensory cortex neurons may trigger motor responses, necessitating refined somatosensory mapping techniques. METHODS: Using piezoelectric tactile stimulators on patients' faces and hands, we delivered 25 Hz vibrations and prompted patients to discriminate between dermatomes. Testing included areas contralateral to tumor-infiltrated and to non-tumor-infiltrated cortical regions. Sensory thresholds were determined by reducing stimulus intensity based on performance. Intraoperatively, electrocorticography electrode arrays were used to map sensory responses, and postoperative assessments evaluated sensory outcomes. RESULTS: The high-grade glioma case involved a 61-year-old man with right-sided weakness and numbness with a left parietal mass on MRI. Preoperative testing showed that the average vibratory detection threshold of the hand contralateral to the suspected tumor site was significantly higher than that of the hand contralateral to healthy cortex (P < .001). Intraoperative mapping confirmed the absence of functional involvement in cortical structures overlying the tumor. Postoperative imaging confirmed gross total resection, and sensory vibratory thresholds were normalized (P = .51). The low-grade glioma case included a 54-year-old man with a left parietal nonenhancing mass on MRI. No baseline sensory impairments were found on preoperative testing. Intraoperative mapping identified motor and sensory cortices, guiding tumor resection while preserving motor function. Postoperative MRI confirmed near-total resection, but new sensory impairments were noted in the hand and face contralateral to the resection site (P < .001). These deficits resolved by postoperative day 11, with no evidence of tumor progression on follow-up imaging. CONCLUSION: The sensory discrimination task provides a quantifiable method for assessing sensory changes and functional outcomes related to glioma. This technique enhances our understanding of how glioma infiltration remodels sensory systems and affects clinical outcomes in patients.

Comparative Study of Endoscopic Transcanal Tympanoplasty and Tympanoplasty by Conventional Postaural Approach in a Tertiary Care Hospital in Central India.

Background Chronic otitis media (COM) often necessitates tympanoplasty to repair the tympanic membrane. While conventional postaural tympanoplasty (PA) is well-established, endoscopic transcanal tympanoplasty (ET) is gaining traction for its minimally invasive benefits. This study aims to compare these two surgical techniques regarding their anatomical and functional outcomes and assess the role of platelet-rich plasma (PRP) in improving these outcomes. Material and methods This prospective comparative study was conducted at Acharya Vinoba Bhave Rural Hospital, involving 60 patients with COM. Participants were randomly assigned to receive either ET or PA, with each group further subdivided based on PRP use. Preoperative evaluations included auditory function tests and diagnostic endoscopy. Postoperative assessments were performed at seven days, one month, and three months to evaluate graft acceptance and hearing improvement using pure tone audiometry (PTA). Statistical analyses included the chi-square test, t-test, ANOVA, and paired t-test. Results The study included patients with a mean age of 38.1 years, predominantly female (71.67%). ET demonstrated superior anatomical outcomes compared to PA, with higher graft acceptance rates and better hearing improvements. The average hearing gain was 10.4 dB in the ET group versus 8.1 dB in the PA group. PRP uses enhanced graft acceptance and hearing restoration across both surgical approaches, contributing to better overall outcomes. Conclusion ET offers significant advantages over conventional postaural tympanoplasty in terms of anatomical and functional results. PRP further improves surgical outcomes, making ET a preferable option for tympanoplasty in COM patients. These findings support the broader adoption of ET and PRP to enhance patient outcomes in tympanoplasty procedures.

Treatment of Oral Lymphangiomas by Coblation.

INTRODUCTION: Lymphangioma is a malformation of superficial lymphatic vessels. Tongue lymphangiomas are relatively uncommon. Multiple treatment modalities have been reported, with variable treatment responses. Most of the traditional treatment modalities have a high recurrence rate. CASE REPORT: We describe the use of coblation in the management of lymphangioma circumscriptum of the dorsum of tongue in two patients. Radiofrequency ablation of oral lymphangiomas showed early postoperative oral intake and minimal postoperative pain. There was no recurrence of disease on 1 year follow up. CONCLUSION: Improved wound healing, early postoperative oral intake and minimal postoperative pain, make radiofrequency ablation a highly valuable treatment modality for oral lymphangiomas and may be recommended as the treatment of choice.

A Giant Vallecular Cyst in an Adult: A Case Report.

Vallecular cysts (VCs) are rare benign lesions arising from the obstruction of mucous gland ducts. VCs are uncommon anomalies found in both pediatric and adult populations. They are also known as mucous-retention cysts, preepiglottic cysts, ductal cysts, base-of-tongue cysts, and epiglottis cysts. VCs are often asymptomatic in adults and may present with nonspecific symptoms such as globus sensation, voice changes, dysphagia, hoarseness, or airway obstruction when symptomatic. This case report details a rare occurrence of a giant VC in an adult male, emphasizing the diagnostic approach and surgical management and highlighting the importance of managing the airway in such cases and the advantages of endoscopic procedures.

Pleural Metastatic Melanoma With Recurrent Malignant Pleural Effusions.

Pleural metastatic melanoma is rare, and associated malignant pleural effusions are even rarer. We present a case of pleural metastatic melanoma with recurrent malignant pleural effusions. The initial diagnosis showed no metastatic disease, and the patient underwent resection and received a year of immunotherapy for localized disease. However, two years later, the patient presented with pleural metastatic melanoma with unresolving malignant pleural effusions requiring an indwelling pleural catheter and eventually, thoracotomy with decortication. Clinicians should have a high index of suspicion for pleural metastatic melanoma in the setting of recurrent pleural effusions, even though it is a rare occurrence.

Otorhinolaryngologic Manifestations of Tuberculosis: A Comprehensive Review of Clinical and Diagnostic Challenges.

Tuberculosis (TB) is a significant global health issue, predominantly affecting the lungs but also capable of involving the otorhinolaryngologic (ear, nose, and throat) regions. This comprehensive review explores the epidemiology, pathophysiology, clinical presentation, diagnostic challenges, management strategies, and public health implications of otorhinolaryngologic TB. The disease's diverse clinical manifestations, such as chronic ear discharge, nasal obstruction, and hoarseness, often mimic other common conditions, complicating diagnosis and delaying treatment. Diagnostic confirmation requires a combination of clinical assessment, laboratory tests, and imaging techniques, each with inherent limitations. Effective management necessitates a multidisciplinary approach, integrating medical and surgical interventions tailored to individual patient needs. Potential complications, including airway obstruction and hearing loss, highlight the importance of timely and appropriate treatment. The review underscores the critical role of public health measures in TB control. It also identifies emerging trends in diagnosis and treatment, emphasizing the need for ongoing research to improve patient outcomes and contribute to the global effort to control and eventually eradicate TB. This review aims to give healthcare providers a deeper understanding of otorhinolaryngologic TB, enhancing diagnostic and therapeutic approaches and improving patient care.

Deep Learning Models for Health-Driven Forecasting of Indoor Temperatures in Heat Waves in Canada: An Exploratory Study Using Smart Thermostats.

In Canada, extreme heat occurrences present significant risks to public health, particularly for vulnerable groups like older individuals and those with pre-existing health conditions. Accurately predicting indoor temperatures during these events is crucial for informing public health strategies and mitigating the adverse impacts of extreme heat. While current systems rely on outdoor temperature data, incorporating real-time indoor temperature estimations can significantly enhance decision-making and strengthen overall health system responses. Sensor-based technologies, such as ecobee smart thermostats installed in homes, enable effortless collection of indoor temperature and humidity data. This study evaluates the efficacy of deep learning models in predicting indoor temperatures during heat waves using smart thermostat data, to enhance public health responses. Utilizing ecobee smart thermostats, we analyzed indoor temperature trends and developed forecasting models. Our findings indicate the potential of integrating IoT and deep learning into health warning systems, enabling proactive interventions, and improving sustainable health care practices in extreme heat scenarios. This approach highlights the role of digital health innovations in creating the resilient and sustainable healthcare systems against climate-related health adversities.

Leveraging Zero-Effort Technology for Quantification of Sleep Quality Metrics.

Sleep quality is a critical factor in human health and well-being, with implications for various physiological and psychological processes. Traditional methods of sleep data collection are often limited by the quality and reliability of the data due to issues such as recall bias and subjective interpretation. This research aims to propose a novel framework that objectively measures and evaluates sleep quality using smart thermostats equipped with motion sensors, providing noninvasive and effortless sleep monitoring. The study conducts a comprehensive analysis of sleep patterns, exploring the relationship between activity sensors and sleep quality. By analyzing behavioral characteristics, the study identifies periods or clusters of days that require attention in terms of health and stress levels. The approach ensures privacy, ease of access, and integrates environmental factors, enabling a comprehensive understanding of an individual's sleep health. The findings suggest that this zero-effort technology can significantly enhance sleep monitoring at both individual and population levels, with implications for health monitoring, stress management, and personalized healthcare interventions. Future work will focus on expanding the data set, incorporating more variables, and integrating contextual data to further improve sleep quality analysis and support real-time health interventions.

Stereocontrolled and time-honored access to piperidine- and pyrrolidine-fused 3-methylenetetrahydropyrans using lactam-tethered alkenols.

Polycyclic oxygen-heterocycles bearing the 3-methylenetetrahydropyran (i.e., 3-MeTHP) motif are resident in bioactive molecules such as hodgsonox and iridoid. Meanwhile, the δ- and γ-lactam topologies as well as their reduced variants (i.e., piperidines and pyrrolidines) are at the core of several pharmaceuticals and fragrances. A stereocontrolled, time-honored, and cost-effective strategy that merges a 3-MeTHP motif with the aforementioned azaheterocyclic scaffolds could exponentially expand the 3D-structural space for the discovery of new small molecules with medicinal value. In these studies, readily affordable lactam-tethered alkenols have been interrogated in two complementary cascade approaches, leading to the regioselective and stereocontrolled synthesis of lactam-fused 3-MeTHPs. The first approach hinges on regioselective 6-endo-trig bromoetherification of the alkenols and concomitant elimination to arrive at the desired 3-MeTHPs. The methylene portion of the 3-MeTHP is unveiled at a late stage, which is noteworthy since all existing approaches to 3-MeTHPs rely on early-stage introduction of the methylene group. The second strategy involves transition metal-catalyzed alkoxylation of the tethered alkenol followed by base-induced double bond isomerization. The lactam-fused 3-MeTHPs are obtained in high site- and diastereo-selectivities. Post-modification of the bicycles has led to the construction of 3-MeTHP-fused saturated piperidines and pyrrolidines as well as 3-MeTHPs bearing four contiguous stereocenters.

Fentanyl and xylazine crisis: Crafting coherent strategies for opioid overdose prevention.

The United States is in the throes of a severe opioid overdose epidemic, primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine, a veterinary sedative often mixed with fentanyl. The high potency and long duration of fentanyl is compounded by the added risks from xylazine, heightening the lethal danger faced by opioid users. Measures such as enhanced surveillance, public awareness campaigns, and the distribution of fentanyl-xylazine test kits, and naloxone have been undertaken to mitigate this crisis. Fentanyl-related overdose deaths persist despite these efforts, partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies. A multifaceted approach is imperative in effectively combating the opioid overdose epidemic. This approach should include expansion of treatment access, broadening the availability of medications for opioid use disorder, implementation of harm reduction strategies, and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.

Decitabine enclosed biotin-zein conjugated nanoparticles: synthesis, characterization, in vitro and in vivo evaluation.

Aim: This study focuses on biotinylated nanocarriers designed to encapsulate amphiphilic molecules with self-biodegradable properties for enhanced drug delivery.Methods: Biotin-zein conjugated nanoparticles were synthesized and tested in C6 cell lines to evaluate their viability and cellular uptake. Optimization was achieved using a a central composite design. The nanoparticles underwent thermogravimetric analysis, and their pharmacokinetics and biodistribution were also studied.Results: The optimized nanoparticles displayed 96.31% drug encapsulation efficiency, a particle size of 95.29 nm and a zeta potential of -17.7 mV. These nanoparticles showed increased cytotoxicity and improved cellular uptake compared with free drugs. Thermogravimetric analysis revealed that the drug-loaded nanocarriers provided better protection against drug degradation. Pharmacokinetic and biodistribution studies indicated that the formulation had an extended brain residence time, highlighting its effectiveness.Conclusion: The biotin-zein conjugated nanoparticles developed in this study offer a promising nano-vehicle for in vivo biodistribution and pharmacokinetic applications. Their high drug encapsulation efficiency, stability and extended brain residence time suggest they are effective for targeted drug delivery and therapeutic uses.

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The Association Between Task Complexity and Cortical Language Mapping Accuracy.

BACKGROUND AND OBJECTIVES: Direct cortical stimulation (DCS) mapping enables the identification of functional language regions within and around gliomas before tumor resection. Intraoperative mapping is required because glioma-infiltrated cortex engages in synchronous activity during task performance in a manner similar to normal-appearing cortex but has decreased ability to encode information for complex tasks. It is unknown whether task complexity influenced DCS mapping results. We aim to understand correlations between audiovisual picture naming (PN) task complexity and DCS error rate. We also asked what functional and oncological factors might be associated with higher rates of erroneous responses. METHODS: We retrospectively reviewed intraoperative PN and word reading (WR) task performance during awake DCS language mapping for resection of dominant hemisphere World Health Organization grade 2 to 4 gliomas. The complexity of word tested in PN/WR tasks, patient characteristics, and tumor characteristics were compared between correct and incorrect trials. RESULTS: Between 2017 and 2021, 74 patients met inclusion criteria. At median 18.6 months of follow-up, 73.0% were alive and 52.7% remained recurrence-free. A total of 2643 PN and 978 WR trials were analyzed. A greater number of syllables in PN was associated with a higher DCS error rate (P = .001). Multivariate logistic regression found that each additional syllable in PN tasks independently increased odds of error by 2.40 (P < .001). Older age was also an independent correlate of higher error rate (P < .043). World Health Organization grade did not correlate with error rate (P = .866). More severe language impairment before surgery correlated with worse performance on more complex intraoperative tasks (P < .001). A higher error rate on PN testing did not correlate with lower extent of glioma resection (P = .949). CONCLUSION: Word complexity, quantified by the number of syllables, is associated with higher error rates for intraoperative PN tasks but does not affect extent of resection.

Revisiting the 1,3-azadiene-succinic anhydride annulation reaction for the stereocontrolled synthesis of allylic 2-oxopyrrolidines bearing up to four contiguous stereocenters.

Polysubstituted 2-oxopyrrolidines bearing at least two contiguous stereocenters constitute the core of several pharmaceuticals, including clausenamide (antidementia). Here, we describe a flexible annulation strategy, which unites succinic anhydride and 1,3-azadienes to produce allylic 2-oxopyrrolidines bearing contiguous stereocenters. The approach is chemoselective, efficient, modular, scalable, and diastereoselective. The scalable nature of the reactions offers the opportunity for post-diversification, leading to incorporation of motifs with either known pharmaceutical value or that permit subsequent conversion to medicinally relevant entities.

Optimizing the Clinical Direction of Artificial Intelligence With Health Policy: A Narrative Review of the Literature.

Artificial intelligence (AI) has the ability to completely transform the healthcare industry by enhancing diagnosis, treatment, and resource allocation. To ensure patient safety and equitable access to healthcare, it also presents ethical and practical issues that need to be carefully addressed. Its integration into healthcare is a crucial topic. To realize its full potential, however, the ethical issues around data privacy, prejudice, and transparency, as well as the practical difficulties posed by workforce adaptability and statutory frameworks, must be addressed. While there is growing knowledge about the advantages of AI in healthcare, there is a significant lack of knowledge about the moral and practical issues that come with its application, particularly in the setting of emergency and critical care. The majority of current research tends to concentrate on the benefits of AI, but thorough studies that investigate the potential disadvantages and ethical issues are scarce. The purpose of our article is to identify and examine the ethical and practical difficulties that arise when implementing AI in emergency medicine and critical care, to provide solutions to these issues, and to give suggestions to healthcare professionals and policymakers. In order to responsibly and successfully integrate AI in these important healthcare domains, policymakers and healthcare professionals must collaborate to create strong regulatory frameworks, safeguard data privacy, remove prejudice, and give healthcare workers the necessary training.

The Association between Glymphatic System and Perivascular Macrophages in Brain Waste Clearance.

The glymphatic system suggests the convective bulk flow of cerebrospinal fluid (CSF) through perivascular spaces and the interstitial spaces of the brain parenchyma for the rapid removal of toxic waste solutes from the brain. However, the presence of convective bulk flow within the brain interstitial spaces is still under debate. We first addressed this argument to determine the involvement of the glymphatic system in brain waste clearance utilizing contrast-enhanced 3D T1-weighted imaging (T1WI), diffusion tensor imaging (DTI), and confocal microscopy imaging. Furthermore, perivascular macrophages (PVMs), which are immune cells located within perivascular spaces, have not been thoroughly explored for their association with the glymphatic system. Therefore, we investigated tracer uptake by PVMs in the perivascular spaces of both the arteries/arterioles and veins/venules and the potential association of PVMs in assisting the glymphatic system for interstitial waste clearance. Our findings demonstrated that both convective bulk flow and diffusion are responsible for the clearance of interstitial waste solutes from the brain parenchyma. Furthermore, our results suggested that PVMs may play an important function in glymphatic system-mediated interstitial waste clearance. The glymphatic system and PVMs could be targeted to enhance interstitial waste clearance in patients with waste-associated neurological conditions and aging.