Sialolith and adenoid cystic carcinoma in the submandibular gland: a rare case

Salivary calculi occur most frequently in the submandibular gland of the human beings. It is because of the specific anatomy of both the glands and its duct. Presentation typically consists of a painful swelling of the gland at meal times, when the effect of obstruction is most acute. The clinical signs, in most of times, can lead us to the diagnosis easily. The coexistence of sialolith and malignant tumors are very rare. This case report is about a male patient of 45 year with a swelling in the submandibular region for the last eighteen months with an intermittent episode of moderate to severe pain which increased during a mealtime and diagnosed as sialolith on radiograph, but on biopsy proved to be adenoid cystic carcinoma along with sialolith. This case report describes the coexistence of sialolithiasis and adenoid cystic carcinoma in the submandibular gland with advantages and limitations of various imaging studies to be used by health care professionals prior to reaching definitive conclusio

Obesity management for cardiovascular disease prevention

Background: Obesity is a complex disease that leads to higher morbidity and mortality and its rate in the United States is rapidly rising. Targeting obesity management is one of the cornerstones of preventive medicine. Early intervention can significantly reduce the risk of developing cardiovascular disease. While it is well known that lifestyle interventions such as healthful nutrition and routine physical activity are the first and most important step in management, some do not achieve the desired results and require further therapies. Methods: A literature review was conducted, that included clinical documents, public scientific citations and peer review articles to evaluate anti-obesity medications, endoscopic procedures and bariatric surgeries in the management of obesity. We also included effects of these interventions on weight loss, cardiovascular disease risk reduction and side effects. Results: This clinical review summarizes recent evidence for the different approaches in obesity management including medications, common endoscopic procedures and bariatric surgeries. For more detailed review on the different management options discussed, we recommend reviewing Obesity Medicine Association Clinical Practice Statement [1]. Conclusion: Management of obesity reduces cardiovascular risk, improves metabolic parameters and other important health outcomes. Different management approaches are available, hence, a high level of awareness of the growing epidemic of obesity is needed to ensure timely referrals to obesity medicine specialists.</p

Therapy Related Chronic Myeloid Leukemia (trCML) or non-Therapy Related Second Malignancy Chronic Myeloid Leukemia (smCML) following Diffuse Large B-Cell Lymphoma(DLBCL): A Case Report and Review of Literature

  Introduction: Second malignancy could be either previous therapy related or non-therapy related like syndromic or shared etiologic exposure. It could be either a hematological/solid malignancy following tretment for previous solid tumour or prior hematological malignanacy.Review of literature regarding secondary Chronic Myeloid Leukemia (CML) following previous active treatment for primary cancer is listed out for further understanding.Presentation of Case: We describe a 71 year old elderly male who developed Chronic Myeloid Leukemia(CML) after a period of 6 years during follow up of Stage IV Diffuse Large B-Cell Lymphoma(DLBCL) for which he received 8 cycles of R-CHOP based Chemo-immunotherapy in 2008 .Whether it is therapy related Chronic Myeloid Leukemia (trCML) following prior cytotoxic treatment or simply a non-therapy related second malignancy hronic Myeloid Leukemia(smCML) is a matter of debate.However our patient responded dramatically like denova CML to imatinib therapy.Conclusion: Therapy related CML or non therapy related second malignancy CML following DLBCL treatment is rare but responds dramatically like denova CML to imatinib therapy.     

SARS-CoV-2: comparison of IgG levels at 9 months post second dose of vaccination in COVID-survivor and COVID-naïve healthcare workers

Background: Natural (asymptomatic/symptomatic COVID-19 infection) and artificial (vaccination) exposure to the pathogen represent two modes of acquiring active immunity. No definitive guidelines exist regarding whether COVID-survivors (with infection/re-infection/re-re-infection in the three COVID-19 waves) require a modified vaccination schedule. Most countries are offering a third vaccine dose and many are contemplating a fourth dose. Our aim was to gauge the IgG-antibody levels 9m post second vaccination in healthcare workers (HCW) and compare these with IgG-levels 1m post-vaccination in the same cohort for any decline, and to compare the post-vaccination IgG-levels in COVID-survivors and COVID-naïve HCW at 9m.Methods: This prospective observational single-centric cohort study included 63 HCW of either sex, aged 18-70y who completed 9m post-vaccination. The IgG-titre was tested at 9-10m post second vaccination in COVID-survivors and COVID-naïve HCW.Results: At 1m and 9m post-vaccination IgG-levels in COVID-survivors (23.097±4.58 and 15.103±4.367 respectively; p<0.0001) and COVID-naïve HCW (16.277±6.36 and 9.793±6.928 respectively; p=0.0013) had unequal variance (Welsch test; p=0.0022 at 9m). 9/31 COVID-naïve HCW but none of the 32 COVID-survivors tested COVID-positive in the second wave post second vaccination. 11/31 and 3/32 HCW belonging to the former and latter groups developed COVID-19 in the third wave consequently deferring their third/precautionary vaccination.Conclusions: Although HCW with IgG-levels in all brackets developed COVID-19, the severity of symptoms corresponded with the IgG-levels. COVID-19 is here to stay, but in peaceful co-existence in endemic proportions. Considering evidence that immunity acquired by vaccination/natural infection is ephemeral, re-invention of vaccines to match the ever-mutating virus is foreseen.

MRI Appearance of Florid Cystic Endosalpingiosis of the Uterus: a Case Report

Endosalpingiosis is a non-neoplastic proliferation of ectopic tubal epithelium. It may be found incidentally or the patients may present with chronic pelvic pain. It may resemble a gynecologic malignancy on imaging findings and clinicians and radiologists should be aware of this benign entity to render a correct diagnosis and to avoid over-treatment. We report here the MR imaging appearance of a case of florid cystic endosalpingiosis

Evaluation of Stress Pattern Caused by Mini-Implant in Mandibular Alveolar Bone with Different Angulations and Retraction Forces: A Three-Dimensional Finite Element Study

Objective:The objective of the study was to evaluate the stress pattern in cortical and cancellous bones, periodontal ligament, and in the implant itself when a mini-implant (MI) is inserted in the inter-radicular space between mandibular first molar and second premolar at various angulations and different retraction forces.Methods:Finite element study was conducted with MI insertion at 30°, 45°, 60°, 75°, and 90° angulations in the mandibular posterior region (between second premolar and first molar). At these angulations, horizontal forces of 150, 200, and 250 g were applied to the middle of the MI head. von Mises stress values were then evaluated using the ANSYS software.Results:Highest von Mises stress values were detected in the MI itself, followed by cortical bone, cancellous bone, and periodontal ligament. The von Mises stress values in cortical bone were highest at 30° angulation and lowest at 90° angulation. In the cancellous bone, the stress value was found to be maximum at 90°. The von Mises stress values in the MI were lowest at 90°. In all four structures, as the load increased from 150 to 250 g, the von Mises stress values increased.Conclusion:The von Mises stress values in the cortical bone, MI, and periodontal ligament were found to be lowest at 90°. Placement of the MI at 90° appears to be an ideal angulation when applied with a horizontal load. Force range used is within clinically recommended levels; however, the increase in load causes an increase in the stress values

Hypertension guidelines and coronary artery calcification among South Asians: Results from MASALA and MESA

Untreated hypertension may contribute to increased atherosclerotic cardiovascular disease (ASCVD) risk in South Asians (SA). We assessed HTN prevalence among untreated adults free of baseline ASCVD from the MASALA & MESA studies. The proportion of participants who received discordant recommendations regarding antihypertensive pharmacotherapy use by the 2017-ACC/AHA and JNC7 Guidelines across CAC score categories in each race/ethnic group was calculated. Compared with untreated MESA participants (n = 3896), untreated SA (n = 445) were younger (55±8 versus 59±10 years), had higher DBP (73±10 versus 70±10 mmHg), total cholesterol (199±34 versus 196±34 mg/dL), statin use (16% versus 9%) and CAC=0 prevalence (69% versus 58%), with fewer current smokers (3% versus 15%) and lower 10-year-ASCVD-risk (6.4% versus 9.9%) (all p\u3c0.001). A higher proportion of untreated MASALA and MESA participants were diagnosed with hypertension and recommended anti-hypertensive pharmacotherapy according to the ACC/AHA guideline compared to JNC7 (all p\u3c0.001). Overall, discordant BP treatment recommendations were observed in 9% SA, 11% Whites, 15% Blacks, 10% Hispanics, and 9% Chinese-American. In each race/ethnic group, the proportion of participants receiving discordant recommendation increased across CAC groups (all p\u3c0.05), however was highest among SA (40% of participants). Similar to other race/ethnicities, a higher proportion of SA are recommended anti-hypertensive pharmacotherapy by ACC/AHA as compared with JNC7 guidelines. The increase was higher among those with CAC\u3e100 and thus may be better at informing hypertension management in American South Asians

Identification and management of atherosclerotic cardiovascular disease risk in south Asian populations in the U.S.

South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population

Role of Serine/Threonine Kinase 11 (STK11) or liver kinase B1 (LKB1) Gene in Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome (PJS) is a well-described inherited syndrome, characterized by the development of gastrointestinal polyps and characteristic mucocutaneous freckling. PJS is an autosomal prevailing disease, due to genetic mutation on chromosome 19p, manifested by restricted mucocutaneous melanosis in association with gastrointestinal (GI) polyposis. The gene for PJS has recently been shown to be a serine/threonine kinase, known as LKB1 or STK11, which maps to chromosome subband 19p13.3. This gene has a putative coding region of 1302 bp, divided into nine exons, and acts as a tumor suppressor in the hamartomatous polyps of PJS patients and in the other neoplasms that develop in PJS patients. It is probable that these neoplasms develop from hamartomas, but it remains possible that the LKB1 or STK11 locus plays a role in a different genetic pathway of tumor growth in the cancers of PJS patients. This article focuses on the role of LKB1 or STK11 gene expression in PJS and related cancers