The efficacy of lymph node fine needle aspiration cytology

Fine needle aspiration cytology (FNAC) of lymph nodes is a safe, easy, cheap and quick diagnostic tool, which involves the examination of a random sample of cells from a lymph node. To assess the distribution of diagnostic categories and the efficacy of lymph node fine needle aspiration cytology at our institution. These were compared to the literature. Methodology: All of lymph node FNAC cases taken between the 1st January 2012 and the 31st December 2013 were retrieved from our Laboratory Information System. A total of 300 cases were retrieved and then placed into one of six categories; Category 1: Non-diagnostic, 2: Reactive, 3: Probably reactive but lymphoma cannot be excluded, 4: Non-Hodgkin lymphoma, 5: Hodgkin lymphoma, and 6: Metastasis. These were then correlated with the histology of the lymph node excision specimens. The proportion of diagnoses placed under categories 1, 2, 3, 4, 5 and 6 represent 14%, 53%, 4.3%, 5.7%, 1.7% and 21.3% of the total respectively. The overall efficacy of FNAC showed a sensitivity of 84.5%, specificity of 99.3%, a false negative rate of 10%, a false positive rate of 0.7%, accuracy of 93.1%, positive predictive value of 98.8% and negative predictive value of 89.9%. FNAC of lymph nodes is a very useful and effective tool in triaging patients with lymphadenopathy.peer-reviewe

An unusual case of intertrigo in an adult caused by purely cutaneous Langerhans cell histiocytosis

We report a case of persistent intertrigo in an adult, eventually diagnosed as cutaneous Langerhans cell histiocytosis (LCH). It is known that LCH has a predilection for intertriginous areas, however purely cutaneous disease as in our case, is uncommon and usually other systems are affected. Following the report, literature of similar cases is reviewed to determine possible outcomes and to decide on the best possible treatment options.peer-reviewe

Mercy Towards Decarceration: Examining the Legal Constraints on Early Release from Prison

There are close to seven million people under correctional supervision in the United States, both in prison and in the community. The U.S. criminal justice system is widely regarded as an inherently unmerciful institution by scholars and policymakers, but also by people who have spent time in prison and their family members; it is deeply punitive, racist, expansive and damaging in its reach. In this article, we probe the meanings of mercy for the institution of parole

Laryngeal lymphoma : the high and low grades of rare lymphoma involvement sites

The larynx is an extremely rare site of involvement by lymphomatous disease.We present two cases of isolated laryngeal high-grade and another low-grade lymphoma, together with a literature review of laryngeal lymphoma management.peer-reviewe

Primary bilateral non-Hodgkin’s lymphoma of the adrenal gland presenting as incidental adrenal masses

Although lymphoma may occasionally involve the adrenal glands as part of a generalized disease process, primary adrenal lymphoma (PAL) is a rare disease. We present a case of a 62-year-old woman with a history of mild/moderate hereditary spherocytosis with a well-compensated baseline haemoglobin, who presented with rapidly progressive symptomatic anaemia. During the diagnostic workup, imaging revealed bilateral large adrenal masses and she was later diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL), with the adrenal glands being the dominant site of the disease. The patient was started on systemic chemotherapy, but her disease progressed with neurological involvement which responded to second-line therapy. Her adrenal disease however was refractory to further therapy.peer-reviewe

Lactate preconditioning promotes a HIF-1α-mediated metabolic shift from OXPHOS to glycolysis in normal human diploid fibroblasts

Recent evidence has emerged that cancer cells can use various metabolites as fuel sources. Restricting cultured cancer cells to sole metabolite fuel sources can promote metabolic changes leading to enhanced glycolysis or mitochondrial OXPHOS. However, the efect of metabolite-restriction on non-transformed cells remains largely unexplored. Here we examined the efect of restricting media fuel sources, including glucose, pyruvate or lactate, on the metabolic state of cultured human dermal fbroblasts. Fibroblasts cultured in lactate-only medium exhibited reduced PDH phosphorylation, indicative of OXPHOS, and a concurrent elevation of ROS. Lactate exposure primed fbroblasts to switch to glycolysis by increasing transcript abundance of genes encoding glycolytic enzymes and, upon exposure to glucose, increasing glycolytic enzyme levels. Furthermore, lactate treatment stabilized HIF-1α, a master regulator of glycolysis, in a manner attenuated by antioxidant exposure. Our fndings indicate that lactate preconditioning primes fbroblasts to switch from OXPHOS to glycolysis metabolism, in part, through ROS-mediated HIF-1α stabilization. Interestingly, we found that lactate preconditioning results in increased transcript abundance of MYC and SNAI1, key facilitators of early somatic cell reprogramming. Defned metabolite treatment may represent a novel approach to increasing somatic cell reprogramming efciency by amplifying a critical metabolic switch that occurs during iPSC generation

Parathyroid carcinoma : clinical course, diagnosis and management

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism often resulting in severe hypercalcaemia. It tends to follow a rather aggressive course with a high propensity for locoregional spread and distant metastasis. En bloc resection is the mainstay of treatment, with surgery also playing a role in the palliation of hypercalcaemia for recurrent and metastatic disease. While adjuvant chemotherapy and radiotherapy have shown disappointing outcomes, bisphosphonates and calcimimetic agents are effective in the management of recalcitrant hypercalcaemia in parathyroid carcinoma. We report a case of parathyroid carcinoma in a lady who initially presented with a neck mass, severe hypercalcaemia, a bony swelling over the shin and elevated parathyroid hormone levels. The diagnosis was confirmed histologically following a thyroid lobectomy, isthmectomy and parathyroidectomy. In the three years which followed the patient received two courses of palliative radiotherapy, two thoracotomies for pulmonary metastatectomy, an extensive neck re-exploration and fashioning of a tracheostomy for aggressive local recurrence with invasion of the larynx.peer-reviewe

The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels : Two group comparison design

Introduction Australian and New Zealand accreditation standards for occupational therapy courses mandate consumer involvement in the design, delivery, and evaluation of courses. Consumer involvement in medical, dental, and nursing education has been evidenced as a factor for increasing student empathy. To date, there has been no known research on the impact of mental health consumer involvement on occupational therapy students' empathy. The aim of this study was to investigate if occupational therapy students who receive teaching from a mental health consumer demonstrate higher levels of empathy compared with students who receive teaching delivered by occupational therapy academics. Methods Pre–post, quasi experimental, two group comparison design was used to measure second-year student empathy pre and post a consumer-led teaching tutorial. Students (N = 217) were randomised into two groups across three university campuses: ‘teaching as usual group’ (control) or ‘consumer-led’ group (experimental group). The Jefferson Scale of Empathy was used to measure student empathy. Results N = 138 matched scales were returned. Little difference in empathy scales was detected between groups. The ‘consumer-led’ group increased for the empathy scale by 3.4(95% CI: 0.7,6.1, p = 0.014) but was not statistically significant compared to 1.3(95% CI: −1.0,3.5, p = 0.267) for the control group. Both groups scored highly on empathy. Conclusion This study found that occupational therapy students had pre-existing high levels of empathy. The challenge for future research is to identify appropriate ways to measure the impact of mental health consumer involvement on occupational therapy curriculum and students

Metastatic melanoma mortality in Malta

BACKGROUND: There are currently no studies looking specifically at the characteristics of the primary melanoma in patients who died of metastatic melanoma in Malta. This retrospective study looks at the demographics of these patients and the characteristics of their primary melanoma.METHOD: Mortality data secondary to metastatic melanoma between 2007 and 2016 was gathered from the Malta National Mortality Registry. All patients whose death certificates had metastatic melanoma as the cause of death were included. Further data on histology and imaging was gathered from the Malta National Cancer Registry and the hospital electronic database.RESULTS: There were 87 recorded deaths (45 male; 42 female) in Malta secondary to metastatic melanoma between 2007 and 2016, with an average age at diagnosis of the primary melanoma of 64.3 years (range 23-92 years), average age at death of 67.9 years (range 28-96 years) and an average duration of survival after diagnosis of primary melanoma of 34.7 months (range 1-180 months). The commonest histological subtype of the primary cutaneous melanoma was nodular. The commonest site for the primary cutaneous melanoma was the back. The mean Breslow thickness was 4.23mm (range 0.3-13mm). The commonest site of metastasis was to distant lymph nodes, followed by the skin, liver and lung.CONCLUSION: Mortality secondary to metastatic melanoma is prevalent in the over 60 age group, with the back being the commonest site of the primary melanoma. Identification of patients who are at higher risk of death from melanoma in Malta allows for their more effective targeting in local melanoma screening and education campaigns.peer-reviewe

Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid in Malta : a case report and clinical series

Bullous Pemphigoid (BP) is an autoimmune blistering disease associated with a number of predisposing factors including age, neurological disease, diabetes mellitus and drugs. Over the past few years Dipeptidyl peptidase-4 Inhibitors (DPP4-Is), referred to as gliptins have been increasingly associated with the development of this blistering disease. Locally, since the introduction of gliptins into the national formulary we have noted a surge in the number of cases of presumed gliptin-induced BP. We present a local case report followed by a short case series which highlights the typical characteristics of patients with gliptin-induced BP and shows the surge in the number of local cases. Patients with drug-induced BP as opposed to conventional BP, tend to respond quicker upon cessation of the culprit drug, therefore physicians should be aware of this association and have a low threshold for investigating diabetics who present with unexplained pruritus, erythema and bullae especially if these patients are on DPP4-Is.peer-reviewe