Kimura’s Disease: A Rare Clinical Entity for A Head & Neck Surgeon

Background: Kimura’s disease, previously known as a variant of angiolymphoid hyperplasia with eiosinophilia (ALHE), is now considered a distinct clinical entity. In contrast to ALHE, it presents with exuberant systemic autoimmune response involving lymphoid system more readily and at times salivary glands. Disease typically presents with a head and neck region mass associated with peripheral eiosinophilia and raised IgE levels with occasional but concurrent renal or pulmonary involvement in advanced cases. Association of this disease to allergic rhinitis has not been reported in the previous medical literature.Case Presentation: Young Asian male was referred to us with suspicion of primary parotid tumor. He had typical symptom complex of allergic rhinitis with recurrent frontal and parotid region swelling associated with peripheral eiosinophilia (25%) and elevated IgE levels (1703 IU/mL). FNAC of the lesions was inconclusive and hence underwent US- guided core biopsy, which revealed a diagnosis of Kimura’s disease. Superficial parotidectomy and excision of frontal lesion were performed and histopathology of the lesion confirmed Kimura’s disease with involvement of parotid gland. Now the patient is on oral corticosteroids and mast cell stabilizers without recurrence for last 3 months since operative intervention.Conclusions: Kimura’s disease rarely involves parotid gland and its association with allergic rhinitis is being reported first time in medical literature to best of our knowledge. Kimura’s disease should include in the differential diagnosis of a parotid region mass

Papillary Thyroid Microcarcinoma Presenting as Horner’s Syndrome: A Novel Clinical Presentation

Background: There is considerable worldwide rising incidence of slow growing Papillary Thyroid Microcarcinoma (PTMC) due to increasing availability of modern imaging tools. Cervical lymph node metastasis still remains the most frequent site of its metastasis. Here we present a rare case of PMC resulting in Horner’s syndrome, which to our knowledge is the first case in the history of known medical literature.Case Report: A 32 years old male presented with right posterior triangle cervical lymphadenopathy, drooping of right eyelid and anhydrosis for last 3 years. Biopsy of the swelling revealed metastatic papillary thyroid carcinoma. US neck and computerized tomography showed a mass in the right suprclavicular region closely adherent to the common carotid and the stellate ganglion area without any significant pathology within thyroid and the lung. The patient underwent total thyroidectomy with type II block neck dissection. The specimen revealed microscopic foci of papillary thyroid carcinoma involving right lobe, largest focus measuring 0.2cm. Cervical lymph nodes of level II were negative for cancer metastasis however level III, IV and V were positive for metastasis. Patient underwent I131 radio-ablation postoperatively and is disease free since operation.Conclusion: Here we demonstrate a novel presentation of the PTMC inform of Horner’s syndrome and give brief review of literature regarding presentation of PTMC

Non-Alpine Epithelioid Angiosarcoma of Thyroid Gland: A Rare Clinical Scenario

Malignant sarcomatous tumors of thyroid gland of vascular endothelial origin are uncommon. Moreover, epithelioid variety of angiosarcoma of thyroid gland is even rarer and exhibit relatively aggressive oncological behavior especially in Non-Alpine world. Here we report such a case of the thyroid neoplasm which proved to be angiosarcoma of thyroid gland on final immunohistological analysis and was treated with total thyroidectomy followed by adriamycin based chemoradiation. This tumor accours very rarely in Non-alpine region and to the best of our knowledge only 19 cases of such a variety have been previously reported in the literature in form of case reports. We also give a brief review of the literature

Xanthogranulomatous Cholecystitis Mimicking as Gallbladder Carcinoma：A Caution for Hepatobiliary Surgeon

Background: Xanthogranulomatous Cholecystitis (XGC) is a destructive inflammatory process of the gall bladder which can rarely extend into neighboring structures mimicking advanced carcinoma of the gall bladder. To the best of our knowledge six such cases have been reported in medical literature in which Xanthogranulomatous cholecystitis had lead to involvement of surrounding structures. Preoperative diagnosis of such a lesion remains difficult and most of such cases are diagnosed postoperatively following resectional surgery. Case Presentation: A 40 years old lady was admitted with the clinical picture of cholecystitis and gastric outlet obstruction. Ultrasonography showed gall stones with pericholecystic collection communicating with GB lumen. CT scan showed a mass arising from gallbladder with pericholecystic fluid with gross distension of the stomach. LFTs, CEA and CA 19-9 levels were within normal limits. Endoscopy of the stomach showed an apparently non-epithelial rounded mass projecting into gastric lumen causing partial obstruction of the gastric outlet. On exploration, a firm mass involving gallbladder and stomach was identified for which en-bloc extended cholecystectomy and Billroth-II gastrectomy was performed. Histopathology of the specimen revealed XGC with secondary involvement of pylorus of the stomach.Conclusion: Given the rarer preoperative diagnosis of XGC, which morphologically and radiologically mimics carcinoma, such cases should be managed aggressively. A brief literature review has also been discussed

Servicescape under consideration of Hedonic and Utilitarian approach, a Conceptual debate related to customer satisfaction in context of female clothing brand in Pakistan

This research offers to explore the relationship between the customer satisfaction and servicescape under consideration of two motives as hedonic approach (related to fun & amusement) and utilitarian approach (related to satisfying the needs). This study depicts that which approach is influenced more by creating positive service environment and to revisit the consumers especially in case of females in Pakistan. To investigate how and which consumers are influenced from the different shopping experience exclusively in female clothing in Pakistan a qualitative approach has been used in this study. This conceptual study defends the soundness of relationship through intense literature review. According to this study, use of ambient factors, cleanliness, aesthetic factors, signs and symbols create a long lasting effect on customer satisfaction as they also wish to have some leisure and amusement by shopping particularly in case of females. In Pakistan, most of the females who are engaged in the shopping of different arrays are inclined towards hedonic servicescape more than utilitarian servicescape

Do positive and negative variations in stock indexes lead to depreciation in local currencies? A beyond symmetrical evidence from ASEAN-5 region

Preliminary studies overlooked the importance of the financial crisis in the asymmetric transmission of financial market shocks to FX market returns. Moreover, existing studies also concentrated on the response of aggregate equity market returns to the forex market returns rather than the vice versa asymmetric effect for the ASEAN-5 region. We utilised the panel based ARDL and NARDL framework using pooled mean group method for conducting this study. There are 415 observations spanning the pre-crisis period of January 2001 to December 2007. Furthermore, 595 and 1135 observations are taken into consideration when post-recessionary, and overall sampling periods of January 2010 to December 2019 and January 2001 to December 2019 are considered, correspondingly. Overall, the findings indicated that in the short run, only negative equity market returns caused depreciation in the local currencies of ASEAN-5 member countries during the pre-crisis period, whereas only positive shocks during the post-crisis regime appreciated the local currencies of ASEAN-5 member countries. Furthermore, only longer-term negative financial market shocks contribute to post-crisis local currency deflation in the ASEAN-5 member nations. This demonstrates that investors and exporters must consider the importance of the particulate crisis period when formulating forward currency arrangements

Servicescape under consideration of Hedonic and Utilitarian approach, a Conceptual debate related to customer satisfaction in context of female clothing brand in Pakistan

This research offers to explore the relationship between the customer satisfaction and servicescape under consideration of two motives as hedonic approach (related to fun & amusement) and utilitarian approach (related to satisfying the needs). This study depicts that which approach is influenced more by creating positive service environment and to revisit the consumers especially in case of females in Pakistan. To investigate how and which consumers are influenced from the different shopping experience exclusively in female clothing in Pakistan a qualitative approach has been used in this study. This conceptual study defends the soundness of relationship through intense literature review. According to this study, use of ambient factors, cleanliness, aesthetic factors, signs and symbols create a long lasting effect on customer satisfaction as they also wish to have some leisure and amusement by shopping particularly in case of females. In Pakistan, most of the females who are engaged in the shopping of different arrays are inclined towards hedonic servicescape more than utilitarian servicescape

Industry 4.0 project prioritization by using q-spherical fuzzy rough analytic hierarchy process

The Fourth Industrial Revolution, also known as Industry 4.0, is attracting a significant amount of attention because it has the potential to revolutionize a variety of industries by developing a production system that is fully automated and digitally integrated. The implementation of this transformation, however, calls for a significant investment of resources and may present difficulties in the process of adapting existing technology to new endeavors. Researchers have proposed integrating the Analytic Hierarchy Process (AHP) with extensions of fuzzy rough sets, such as the three-dimensional q-spherical fuzzy rough set (q-SFRS), which is effective in handling uncertainty and quantifying expert judgments, to prioritize projects related to Industry 4.0. This would allow the projects to be ranked in order of importance. In this article, a novel framework is presented that combines AHP with q-SFRS. To calculate aggregated values, the new framework uses a new formula called the q-spherical fuzzy rough arithmetic mean, when applied to a problem involving the selection of a project with five criteria for evaluation and four possible alternatives, the suggested framework produces results that are robust and competitive in comparison to those produced by other multi-criteria decision-making approaches

TOPSIS method based on q-rung orthopair picture fuzzy soft environment and its application in the context of green supply chain management

Green supplier selection has been an important technique for environmental sustainability and reducing the harm of ecosystems. In the current climate, green supply chain management (GSCM) is imperative for maintaining environmental compliance and commercial growth. To handle the change related to environmental concern and how the company manages and operates, they are integrated the GSCM into traditional supplier selection process. The main aims of this study were to outline both traditional and environmental criteria for selecting suppliers, providing a comprehensive framework to assist decision-maker in prioritizing green supplier effectively. In order to address issue to simulate decision-making problems and manage inaccurate data. A useful technique of fuzzy set was proposed to handle uncertainty in various real-life problems, but all types of data could not be handled such as incomplete and indeterminate. However, several extensions of fuzzy set were considered, such as intuitionistic fuzzy set, Pythagorean fuzzy set, q-rung orthopair fuzzy set, and q-rung orthopair fuzzy soft set considering membership and nonmember ship grade to handle the uncertainty problem. However, there was a lack of information about the neutral degree and parameterization axioms lifted by existing approaches, so to fill this gap and overcome the difficulties Ali et al. proposed a generalized structure by combining the structure of picture fuzzy set and q-rung orthopair fuzzy soft set, known as q-rung orthopair picture fuzzy soft sets, characterized by positive, neutral and negative membership degree with parameterization tools and aggregation operator to solve the multi criteria group decision-making problem. Additionally, the TOPSIS method is a widely utilized to assist individuals and organizations in selecting the most appropriate option from a range of choices, taking into account various criteria. Finally, we demonstrate an illustrative example related to GSCM to enhance competitiveness, based on criteria both in general and with a focus on environmental consideration, accompanied by an algorithm and flow chart

Haploidentical vs. sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia

The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLAmatched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P <_ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P <_ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (<_18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission