Obesity and high risk pathological features of papillary thyroid carcinoma: A retrospective analysis of a university hospital in Pakistan

BACKGROUND: Incidence of papillary thyroid carcinoma (PTC) and the frequency of obesity is increasing globally. In literature, relationship between excessive body weight and bad prognostic features of PTC is still debatable. In this study, we aimed to explore the association of obesity with high risk pathological features of PTC in a population treated by total thyroidectomy +/- neck dissection. MATERIALS AND METHODS: Retrospective analysis of patients at Aga Khan University Hospital from January 2013 to December 2014, who underwent total thyroidectomy +/- neck dissection due to PTC. Patients were grouped according to World Health Organization (WHO) classification of BMI. They were categorized into two groups, i.e. normal (BMI= 18.5 - 24.9 kg/m2) and obese (BMI = 30 kg/m2) as none of our patients lie in underweight and overweight category. Pathological features i.e. T-stage, multifocality, bilaterality, extrathyroidal extension, vascular invasion and N-stage were assessed. All tumors were staged according to TNM staging system proposed by 2010 American Joint Committee on Cancer (AJCC). Odds ratio (OR) with 95% confidence interval was used to examine the association between BMI ∧ pathological characteristics of PTC. RESULTS: A total of 53 patients were treated for PTC in two-years period. There were 38 female and 15 male patients. Twenty-eight patients had BMI in normal while twenty-five in obese category. Patients who were in obese category had a significantly greater risk of having a multifocal tumor (OR=5.55, p-value=0.02) and bilaterality (OR=6.54, p-value=0.01) compared to normal weight patients. No positive associations were identified between BMI and extrathyroidal extension, high T-stage, vascular invasion and N-stage. CONCLUSION: Obesity is not associated with high risk pathological features such as extrathyroidal extention, high T-stage, vascular invasion and N-stage in PTC. Although it has been correlated with multifocal and bilateral tumors in this retrospective study, the presence of these factors alone is not adequate to support the association conclusively

Identification of avian Mycoplasma species in commercial broilers and layers with respiratory symptoms in Balochistan

Among many avian mycoplasmas, only the Mycoplasmas gallisepticum (MG) and Mycoplasmas synoviae (MS) are responsible for causing respiratory disease in commercial poultry. This study reported for the very first time the serological occurrence of M. gallisepticum and M. synoviae in blood samples (n = 600) from sixty flocks (n = 42 broiler and n = 18 layer flocks) with respiratory symptoms in Quetta, Pishin and Kuchlak districts of Balochistan, Pakistan. Sera were tested for MG and MS antibody responses by serum plate agglutination (SPA) test and by enzyme-linked immunosorbant assay (ELISA) Synbiotics kit. It was found that M. gallisepticum antibodies in broiler flocks detected by SPA and by ELISA tests were 10.47 and 19.76%, whereas M. synoviae were 7.86 and 11.19%, respectively. In layer flocks the MG and MS antibodies detected by SPA and ELISA were 19.44, 31.66 and 8.8, 25%, respectively. The overall antibodies of MG and MS in both broiler and layer flocks tested by SPA and ELISA was found to be 13.16, 23.33 and 8.16, 15.33%, respectively. In broiler and layer flocks the presence of antibodies against both M. gallisepticum and M. synoviae were found in tested flocks with respiratory symptoms. Further studies on prevalence and diagnosis of both the M. gallisepticum and M. synoviae in causing respiratory disease in commercial broilers and layers in Balochistan are required.Key words: Mycoplasma, broilers, serum plate agglutination, enzyme-linked immunosorbent assay

5-Hydr­oxy-2-methyl-4H-pyran-4-one

The title compound, C6H6O3, is a member of the pyrone family. The mol­ecules are planar (r.m.s. deviation of the asymmetric unit is 0.0248 Å, whereas that of the dimer is 0.0360 Å) and they are dimerized due to inter­molecular O—H⋯O hydrogen bonds. The dimers are connected to each other through hydrogen bonds involving the CH3 group and the hydr­oxy O atom. There are π–π inter­actions between the centroids of the pyrone rings at a distance of 3.8552 (13) Å. A C—H⋯π inter­action also exists between the carbonyl group and the centroid CgA of the pyrone ring, with O⋯CgA = 3.65 (1) Å and C⋯CgA = 4.363 (2) Å

A map of human cancer signaling

We conducted a comprehensive analysis of a manually curated human signaling network containing 1634 nodes and 5089 signaling regulatory relations by integrating cancer-associated genetically and epigenetically altered genes. We find that cancer mutated genes are enriched in positive signaling regulatory loops, whereas the cancer-associated methylated genes are enriched in negative signaling regulatory loops. We further characterized an overall picture of the cancer-signaling architectural and functional organization. From the network, we extracted an oncogene-signaling map, which contains 326 nodes, 892 links and the interconnections of mutated and methylated genes. The map can be decomposed into 12 topological regions or oncogene-signaling blocks, including a few ‘oncogene-signaling-dependent blocks' in which frequently used oncogene-signaling events are enriched. One such block, in which the genes are highly mutated and methylated, appears in most tumors and thus plays a central role in cancer signaling. Functional collaborations between two oncogene-signaling-dependent blocks occur in most tumors, although breast and lung tumors exhibit more complex collaborative patterns between multiple blocks than other cancer types. Benchmarking two data sets derived from systematic screening of mutations in tumors further reinforced our findings that, although the mutations are tremendously diverse and complex at the gene level, clear patterns of oncogene-signaling collaborations emerge recurrently at the network level. Finally, the mutated genes in the network could be used to discover novel cancer-associated genes and biomarkers

Cepstral analysis of hypokinetic and ataxic voices : correlations with perceptual and other acoustic measures

To investigate the validity of cepstral analyses against other conventional acoustic measures of voice quality in determining the perceptual impression in different motor speech disorders—hypokinetic and ataxic dysarthria, and speech tasks—prolonged vowels and connected speech. Prolonged vowel productions and connected speech samples (reading passages and monologues) from 43 participants with Parkinson disease and 10 speakers with ataxia were analyzed perceptually by a trained listener using GRBAS. In addition, acoustic measures of cepstral peak prominence (CPP), smoothed CPP (CPPs), harmonics-to-noise ratio (HNR), shimmer %, shimmer dB, amplitude perturbation quotient (APQ), relative average perturbation (RAP), jitter, and pitch perturbation quotient (PPQ) were performed. Statistical analysis involved correlations between perceptual and acoustic measures, as well as determination of differences across speaker groups and elicitation tasks. CPP and CPPs results showed greater levels of correlation with overall dysphonia, breathiness, and asthenia ratings than the other acoustic measures, except in the case of roughness. Sustained vowel production produced a higher number of significant correlations across all parameters other than connected speech, but task choice did not affect CPP and CPPs results. There were no significant differences in any parameters across the two speaker groups. The results of this study are consistent with the results of other studies investigating the same measures in speakers with nonmotor-related voice pathologies. In addition, there was an indication that they performed better in relation to asthenia, which might be particularly relevant for the current speaker group. The results support the clinical and research use of CPP and CPPs as a quantitative measure of voice quality in populations with motor speech disorder

Vaccines against toxoplasma gondii : challenges and opportunities

Development of vaccines against Toxoplasma gondii infection in humans is of high priority, given the high burden of disease in some areas of the world like South America, and the lack of effective drugs with few adverse effects. Rodent models have been used in research on vaccines against T. gondii over the past decades. However, regardless of the vaccine construct, the vaccines have not been able to induce protective immunity when the organism is challenged with T. gondii, either directly or via a vector. Only a few live, attenuated T. gondii strains used for immunization have been able to confer protective immunity, which is measured by a lack of tissue cysts after challenge. Furthermore, challenge with low virulence strains, especially strains with genotype II, will probably be insufficient to provide protection against the more virulent T. gondii strains, such as those with genotypes I or II, or those genotypes from South America not belonging to genotype I, II or III. Future studies should use animal models besides rodents, and challenges should be performed with at least one genotype II T. gondii and one of the more virulent genotypes. Endpoints like maternal-foetal transmission and prevention of eye disease are important in addition to the traditional endpoint of survival or reduction in numbers of brain cysts after challenge

The learners' perspective on internal medicine ward rounds: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates.</p> <p>Methods</p> <p>A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory).</p> <p>Results</p> <p>Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean ± SD 2.48 ± 1.02 and 2.49 ± 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean ± SD 3.71 ± 0.72). For their desired ward rounds, management of patients received the highest score (Mean ± SD 4.64 ± 0.55), followed by bedside examinations (Mean ± SD 4.60 ± 0.61) and clinical skills teaching (Mean ± SD 4.50 ± 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds.</p> <p>Conclusions</p> <p>This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees.</p

Rituximab in B-Cell Hematologic Malignancies: A Review of 20 Years of Clinical Experience

Rituximab is a human/murine, chimeric anti-CD20 monoclonal antibody with established efficacy, and a favorable and well-defined safety profile in patients with various CD20-expressing lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin lymphoma. Since its first approval 20 years ago, intravenously administered rituximab has revolutionized the treatment of B-cell malignancies and has become a standard component of care for follicular lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia, and mantle cell lymphoma. For all of these diseases, clinical trials have demonstrated that rituximab not only prolongs the time to disease progression but also extends overall survival. Efficacy benefits have also been shown in patients with marginal zone lymphoma and in more aggressive diseases such as Burkitt lymphoma. Although the proven clinical efficacy and success of rituximab has led to the development of other anti-CD20 monoclonal antibodies in recent years (e.g., obinutuzumab, ofatumumab, veltuzumab, and ocrelizumab), rituximab is likely to maintain a position within the therapeutic armamentarium because it is well established with a long history of successful clinical use. Furthermore, a subcutaneous formulation of the drug has been approved both in the EU and in the USA for the treatment of B-cell malignancies. Using the wealth of data published on rituximab during the last two decades, we review the preclinical development of rituximab and the clinical experience gained in the treatment of hematologic B-cell malignancies, with a focus on the well-established intravenous route of administration. This article is a companion paper to A. Davies, et al., which is also published in this issue

Sensitivity of simulated summer monsoonal precipitation in Langtang Valley, Himalaya, to cloud microphysics schemes in WRF

A better understanding of regional‐scale precipitation patterns in the Himalayan region is required to increase our knowledge of the impacts of climate change on downstream water availability. This study examines the impact of four cloud microphysical schemes (Thompson, Morrison, Weather Research and Forecasting (WRF) single‐moment 5‐class, and WRF double‐moment 6‐class) on summer monsoon precipitation in the Langtang Valley in the central Nepalese Himalayas, as simulated by the WRF model at 1 km grid spacing for a 10 day period in July 2012. The model results are evaluated through a comparison with surface precipitation and radiation measurements made at two observation sites. Additional understanding is gained from a detailed examination of the microphysical characteristics simulated by each scheme, which are compared with measurements using a spaceborne radar/lidar cloud product. Also examined are the roles of large‐ and small‐scale forcings. In general, the schemes are able to capture the timing of surface precipitation better than the actual amounts in the Langtang Valley, which are predominately underestimated, with the Morrison scheme showing the best agreement with the measured values. The schemes all show a large positive bias in incoming radiation. Analysis of the radar/lidar cloud product and hydrometeors from each of the schemes suggests that “cold‐rain” processes are a key precipitation formation mechanism, which is also well represented by the Morrison scheme. As well as microphysical structure, both large‐scale and localized forcings are also important for determining surface precipitation