MANEC TUMOR OF RECTUM. A RARE CASE SERIES OF 3 PATIENTS AND A LITERATURE REVIEW.

The term Mixed Adeno-Neuro-Endocrine Carcinoma (MANEC) was introduced in 2010 by the WHO Classification of Tumors of the Digestive System. It refers to a neoplasm with dual epithelial and neuroendocrine differentiation, each component representing at least 30% of the tumor. It is an uncommon tumor accounting for < 3% of all colon and rectum malignancies. We report three cases of this extremely rare MANEC of the rectum. All three cases presented with hematochezia, variable constipation, and abdominal pain. They were diagnosed and staged appropriately with colonoscopy, biopsy with immunohistochemistry, and imaging. They underwent an anterior resection with circular stapled anastomoses. Because of the low incidence of this histotype, we reviewed the clinical presentation, diagnostic characteristics, and treatment of MANEC of the colon and rectum.

New insights into defects and magnetic interactions inducing lattice disordering in Co2Fe0.5Cr0.5Al.

Atomic scale understanding of defect induced magnetic interactions resulting in lattice disordering has been deduced in a detailed manner for the first time in Co2Fe0.5Cr0.5Al based on Mössbauer spectroscopic studies and compared with the results obtained in Co2Fe0.8Cr0.2Al and Co2FeAl. An interesting linear correlation between valence electron concentration and the mean hyperfine fields at Fe sites in Co2FeAl based compounds has been deduced which is observed to exhibit different slopes with the substitution of Cr. This study elucidates an important role of the manifestation of the magnetic interactions especially between Fe, Co and Cr atoms leading to significant changes in the concentration and specific types of defects selectively produced in Co2Fe0.5Cr0.5Al as compared with that of Co2Fe0.8Cr0.2Al subjected to similar non-equilibrium treatments in this study. Further, for the first time this study elucidates the striking correlation of the effective value of the hyperfine field with the degree of ordering/disordering of the lattice with the Fe atoms associated with ordered sites experiencing a much higher value of the hyperfine field as compared to that of the disordered sites. This study also proposes optimal annealing treatment for the recovery of defects in Co2Fe0.5Cr0.5Al, which would be of significant importance in these spintronic materials.

Hepatoprotective Constituents of Macrocybe gigantea (Agaricomycetes) from India.

Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent, chronic liver diseases worldwide and currently has no specific therapy. Our previous study indicated the anti-NAFLD effect of Macrocybe gigantea (Massee) Pegler & Lodge in high-fat diet-fed animals. This study aimed to isolate and identify the active hepatoprotective constituents from M. gigantea using fatty acid induced steatotic HepG2 cells as in vitro model. The effect of the test materials on the viability of HepG2 cells was analyzed using MTT assay. The HepG2 cells were treated with a mixture of palmitate-oleate to induce steatosis; after 24 h of treatment with the test materials, the intracellular lipid content was estimated using Oil Red O staining. The levels of transaminases were also estimated in the spent media. Bioassay-guided isolation of hepatoprotective constituents from M. gigantea yielded two compounds viz., ergosterol and linoleic acid; their structures were confirmed using spectroscopic data. Among these two compounds, ergosterol significantly lowered the levels of intracellular triglyceride content of fatty acid induced HepG2 cells; it also lowered the leakage of transaminases. The reductions caused by linoleic acid were not statistically significant at the tested concentrations. Detailed investigations on efficacy and safety of these compounds and M. gigantea might yield some useful leads for the management of NAFLD.

Atomic scale insights on the growth of BiFeO3 nanoparticles.

This study provides new insights on the formation of the nanocrystallites of phase pure BiFeO3 prepared using sol-gel method with tartaric acid as the fuel as comprehended based on the local structure and magnetic hyperfine fields at Fe sites using Mossbauer spectroscopy. Important steps involved in the growth of the nanocrystallites of BiFeO3 in the sol-gel reaction are elucidated in a detailed manner in this study for the first time. Three important stages with the second stage marked by the formation of as high as 75% of nanocrystallites of BiFeO3 occurring over a narrow calcination temperature interval 700-723 K have been deduced in this study. Variation of hyperfine parameters with calcination temperature of the dried precursor gel leading to an increase in the mean size of crystallites of BiFeO3 has been deduced. The nanoparticles of BiFeO3 are deduced to exhibit weak ferromagnetic property in addition to being strongly ferroelectric based on the magnetization and P-E loop studies. Consequently an appreciable magneto electric coupling effect in terms of significant changes in P-E loop variation with the application of external magnetic field is elucidated in this study, which is comprehended based on the defects associated with BiFeO3 nanoparticles.

An atomic scale study of defects in Co2FeAl.

Changes in the local structure and magnetic properties at Fe sites due to defects were addressed in a detailed manner in Co2FeAl by 57Fe Mössbauer spectroscopy. Based on the systematic correlation of these results a comprehensive understanding of the defects and hence of the different types of disordering that occur in Co2FeAl subjected to different non-equilibrium treatments have been obtained in this study. As high as 35% of the Fe atoms were deduced to be associated with the A2 type of disordering in Co2FeAl, which provides a basic understanding of the observed much lower value of spin polarization as observed in this system against the high value predicted theoretically. Also this study revealed a striking linear correlation between the valence electron concentration and the effective magnetic hyperfine fields as deduced at different sites of occupation of 57Fe atoms.

Studies of local structure at Zr sites in pressure amorphized zirconium tungstate.

Amorphous to crystalline transition in pressure quenched Zr(0.5)Hf(0.5)W(2)O(8) has been studied with respect to local structures of ZrO(6) using the perturbed angular correlation technique. In an untreated crystalline sample close to 0.7 fraction of the probe atoms occupy Zr sites of regular ZrO(6) while the remaining three fractions are understood to be associated with contracted and distorted octahedra. The existence of six distinct ZrO(6) could be deduced based on perturbed angular correlation studies in the pressure amorphized sample. In the amorphous sample these ZrO(6) are associated with appreciable octahedral distortions. Isochronal annealing measurements show that these octahedra remain structurally quite stable up to 800 K. Values of quadrupole frequencies tend to become close to those experienced by probe atoms in a crystalline sample for annealing at 870 K, implying that around this temperature there is an onset of amorphous to crystalline transition. Complete restoration of quadrupole parameters to those of the untreated crystalline sample is seen subsequent to annealing at 975 K.

Rehabilitation of the tympanomastoid cavity in Canal Wall Down procedures.

During 1980 to 2004, 1602 Canal Wall Down (CWD) procedures was performed of which 978 had primary surgery and 624 were revision cases. We have highlighted various methods for total clearance of disease process from the tympanomastoid area, making of a smooth cavity, augmentation of middle ear space for better functional results, inlay temporalis fascia grafting, ossiculoplasty with live tissue grafts, natural obliteration of the cavity and meatoplasty.Healing of cavity and tympanic membrane (TM) graft was achieved in 1548 (94.2%) of cases. Revision surgery was performed in 32 cases for recurrence or residual cholesteatoma, mostly in the attic and middle ear. Persisting discharge was present in 12 cases. Serviceable hearing (airbone (A-B) gap closure up to 20 dB) was achieved in 1017 (63.5%) cases. Hearing was worse than pre-operative level in 154 (9.6%) cases. There was no improvement in hearing in 397 (24.8%) cases. Serviceable hearing was obtained after second stage ossiculoplasty in 34 (2%) cases.

Competing magnetic phases in La(0.7)Sr(0.3)MnO(3) as deduced from Mn site hyperfine parameters.

Time differential perturbed angular correlation measurements using the (181)Ta probe in La(0.7)Sr(0.3)Mn(0.995)Hf(0.005)O(3) reveal the presence of two distinct hyperfine components, identified with probe atoms occupying Mn sites which are rich and deficient in hole concentration. The Mn(4+) rich zones exhibit ferromagnetic ordering at all temperatures below 360 K, the bulk Curie temperature. In the case of Mn(4+) deficient zones, the paramagnetic order is seen to evolve into a canted antiferromagnetic ordering below 360 K, that becomes ferromagnetic below 250 K. Concomitantly, there is a change in the fractions below 250 K. The implications of these results are discussed in terms of electronic phase separation.

Adult intranasal meningoencephalocele presenting as a nasal polyp.

We present an isolated purely intranasal meningoencephalocele, presenting as a nasal polyp in an adult, which is uncommon. Based on a review of the literature, we emphasize that nasal obstruction may be the only presenting symptom of an intranasal meningoencephalocele.

Dilemmas in drug development for tropical diseases. Experiences with praziquantel.

This article analyzes policies that affected the availability of praziquantel, the drug of choice for schistosomiasis. The study examines how interactions among four actors (pharmaceutical producers, international agencies, non-governmental agencies, and national governments) affected praziquantel availability in poor countries. It also examines trends in praziquantel prices over time in different markets. This analysis demonstrates that the discovery of an effective new drug does not necessarily result in access to the drug for disease sufferers--especially if those sufferers are poor people in poor countries. The article proposes measures to improve international systems for making new drugs available in poor countries.

Health expenditures in Latin America and the Caribbean.

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average per capita health expenditure of US$ 162. On average, the countries spent 6.2% of their GDP on health, with the expenditures divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health, along with public health expenditure as a proportion of total health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.

Health expenditures in Latin America and the Caribbean

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average, per capita health expenditure of US$ 162. On average, the countries spent 6.2 percent of their GDP on health, with the expenditure divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.(AU)

National health expenditures: a global analysis.

As part of the background research to the World development report 1993: investing in health, an effort was made to estimate public, private and total expenditures on health for all countries of the world. Estimates could be found for public spending for most countries, but for private expenditure in many fewer countries. Regressions were used to predict the missing values of regional and global estimates. These econometric exercises were also used to relate expenditure to measures of health status. In 1990 the world spent an estimated US$ 1.7 trillion (1.7 x 10(12) on health, or $1.9 trillion (1.9 x 10(12)) in dollars adjusted for higher purchasing power in poorer countries. This amount was about 60% public and 40% private in origin. However, as incomes rise, public health expenditure tends to displace private spending and to account for the increasing share of incomes devoted to health.

PIP: Public, private, and total expenditures on health for all countries of the world were estimated as part of the World Development Report 1993: Investing in Health. Regressions were used to predict the missing values of regional and global estimates and to relate expenditure to measures of health status. Data were obtained on government, parastatal, and private health expenditure directly from governments, supplemented with reports and data from The World Health Organization, the World Bank, the International Labor Organization, regional development banks, and the United Nations Statistics Division, as well as material from nearly 1000 different reports, articles, and budgets. Information on government health expenditures was available for 138 countries. These expenditures were for the years from 1977 to 1990, with 119 countries having data for the period 1986-90. Information for the 24 OECD (Organization for Economic Cooperation and Development) countries for 1990 was obtained from the national health accounts. Data on government health expenditures from 43 other countries came from national budgets. Information for another 45 countries was taken from an International Monetary Fund (IMF) yearbook. Data for 21 countries not covered by these sources were obtained through the World Bank health and public sector studies. Finally, data for five countries came from ad hoc studies. The Established Market Economies (EME) accounted for over 87% of the total; inclusion of the Formerly Socialist Economies (FSE) of Europe raised the share to 90% or US$ 1532 billion. Spending on health in the US alone was 41% of global health expenditures, while spending in developing regions was only 10% or US$ 167 billion. In 1990 the world spent an estimated US$ 1.7 trillion on health, which constituted 8% of the global GDP. This amount was about 60% public and 40% private in origin. When expenditures are corrected for purchasing power parity, global spending amounted to a little under $ 1.9 trillion. This made developing country expenditure 380 versus 167 billion dollars, but there was little change in estimated spending by the EME and FSE countries.