Extra-skeletal Ewing’s Sarcoma of Caecum Causing Intussusception: First such Reported Case

Introduction: Ewing’s sarcoma is a tumor of primitive cells which primarily affects long bones. Extra-skeletal Ewing’s sarcoma has been rarely reported in small bowel. Its presentation can be varied but it is an extremely unlikely cause of an Ileo-Colic Intussusception as seen in present case.Case Presentation: A 32 years old male patient presented with symptoms suggestive of bowel obstruction. CT scan was suggestive of Ileo-colic intussusception. Patient underwent diagnostic laparoscopy and right hemicolectomy. Histopathology examination of specimen revealed Ewing sarcoma of colon.Conclusion: Extra-skeletal Ewing’s sarcoma is a rare entity. To the best of our knowledge this is the first reported case in English literature, of a Caecal Ewing’s sarcoma causing Intussusception. Further study of such cases may help in better understanding and establishing treatment protocol for this condition

CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma.

BACKGROUND: Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with CT characteristics of an adrenocortical adenoma (ACA). AIM: To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT. METHODS: For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield units (HU), absolute percentage washout (APW), and relative percentage washout (RPW) were collected in addition to clinical parameters. RESULTS: Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0.5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU > 10 and available washout data, 22 (28.9%) had a high APW and/or RPW, suggestive of ACA. CONCLUSION: Based on the lack of PCCs with an unenhanced attenuation of <10 HU and the low proportion (0.5%) of PCCs with an attenuation of 10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation of ≤10 HU. The assessment of contrast washout, however, is unreliable for ruling out PCC

Inventory and pricing decisions for imperfect quality items with inspection errors, sales returns, and partial backorders under inflation

In this paper, an optimal replenishment inventory policy for imperfect quality items is presented with a selling price-dependent demand under inflationary conditions using a discounted cash flow (DCF) approach. Due to the presence of defectives in the system, all items go through a 100% inspection process. However, the screening process is also considered to be imperfect and involves errors, namely Type-I and Type-II. In addition, shortages are allowed and are partially backlogged. An optimal solution for the proposed model is derived by maximizing the expected profit function by jointly optimizing three decision variables: selling price, order quantity, and backorder level. To validate the theoretical results, a numerical example along with comprehensive sensitivity analysis is offered. The model has pertinence in industries like textiles, electronics, furniture, footwear, automobiles, and plastics

Supply Chain with Customer-Based Two-Level Credit Policies under an Imperfect Quality Environment

The present model develops a three-echelon supply chain, in which the manufacturer offers full permissible delay to the whole seller, while the latter, in turn, adopts distinct trade credit policies for his subsequent downstream retailers. The type of credit policy being offered to the retailers is decided on the basis of their past profiles. Hence, the whole seller puts forth full and partial permissible delays to his old and new retailers respectively. This study considers bad debts from the portion of new retailers who fail to make up for the delayed part of the partial payment. The analysis shows that it is beneficial for the whole seller to make shorter contracts, particularly with new retailers, along with the fetching of a higher fraction of initial purchase cost from them. In addition to the above-described scenario, the lot received by the whole seller from the manufacturer is not perfect, and it contains some defects for which he employs an inspection process before selling the items to the retailers. In order to make the study more realistic, Type-I, as well as Type-II misclassification errors, and the case of out-of-stock are considered. The impact of Type-I error has been found to be crucial in the study. The present paper determines the optimal policy for the whole seller by maximizing the expected total profit per unit time. For the optimality of the solution, theoretical results are provided. Finally, a numerical example and a sensitivity analysis are done to validate the model

The mediating role of sleep quality on the relationship between internet gaming disorder and perceived stress and suicidal behaviour among Indian medical students

Background In the recent digital era, individuals with internet gaming disorder (IGD) have reported a much higher prevalence of poor sleep quality, perceived stress and suicidal behaviour. However, the underlying mechanisms for these psychological problems remain unknown.Aims The primary aims of this study were to explore the mediating role of sleep quality on the relationship between IGD and the health outcomes of perceived stress and suicidal behaviour and to assess the prevalence and risk factors for IGD among medical students.Methods A cross-sectional study enrolling 795 medical students from two medical colleges in a rural area of North India was conducted from April to May 2022. The study participants were chosen using a stratified random sampling approach. A self-administered questionnaire was used to collect data, including sociodemographic and personal information and gaming characteristics. The study also included the Gaming Disorder and Hazardous Gaming Scale, the Pittsburgh Sleep Quality Index, the Perceived Stress Scale-10 and the Suicide Behaviors Questionnaire–Revised to measure IGD, sleep quality, perceived stress and suicidal behaviour, respectively. Multiple logistic regression for the risk factors and Pearson’s correlation test for the relationship between variables were used. Hayes’ PROCESS macro for SPSS was employed to carry out mediation analysis.Results Among the 348 gamers with a mean age of 21.03 (SD 3.27) years, the prevalence of IGD was 15.23% (95% confidence interval: 11.6% to 19.4%). In the correlational analysis, small to large (r: 0.32–0.72) significant relationships between scores of IGD and other health outcomes were established. The indirect effect (B=0.300) via sleep quality accounted for 30.62% of the total effect (B=0.982) of IGD on perceived stress (partially mediated), while sleep quality (B=0.174) accounted for 27.93% of the total effect (B=0.623) of IGD on suicidal behaviour (partially mediated). The factors of being male, living in a single-parent family, using the internet for other than academic purposes (1–3 hours and more than 3 hours/day), playing games for more than 3 hours/day and playing games with violent content were associated with IGD symptoms.Conclusions Using a dimensional measure, the results specified the relationship between IGD and perceived stress and suicidal behaviour by demonstrating that sleep quality meditated them. This modifiable mediating factor can be addressed by psychotherapy to mitigate the risk of perceived stress and suicidal behaviour among the future medical workforce

Abnormal body composition in patients with adrenal adenomas

OBJECTIVE: Increased visceral fat and sarcopenia are cardiovascular risk factors that may explain increased cardiovascular morbidity and frailty in patients with adrenal adenomas. Our objective was to compare body composition measurement of patients with adrenal adenomas to referent subjects without adrenal disease Design: Cross-sectional study, 2014-2018 Methods: Participants were adults with nonfunctioning adrenal tumor (NFAT), mild autonomous cortisol secretion (MACS) and Cushing syndrome (CS), and age, sex and body mass index 1:1 matched referent subjects without adrenal disorders. Main outcome measures were body composition measurements calculated from abdominal computed tomography imaging. Intraabdominal adipose tissue and muscle mass measurements were performed at the 3rd lumbar spine level. RESULTS: Of 227 patients with adrenal adenomas, 20 were diagnosed with CS, 76 with MACS and 131 with NFAT. Median age was 56 years (range, 18-89), and 67% were women. When compared to referent subjects, patients with CS, MACS, and NFAT demonstrated a higher visceral fat (odds ratio (OR) of 2.2 [95% CI 0.9-6.5], 2.0 [1.3-3.2], and 1.8 [1.2-2.7] and a lower skeletal muscle area (OR of 0.01 [95% CI 0-0.09], 0.31 [0.18-0.49], and 0.3 [1.2-2.7]), respectively. For every 1 mcg/dL cortisol increase after overnight dexamethasone, visceral fat/muscle area ratio increased by 2.3 (P=0.02) and mean total skeletal muscle area decreased by 2.2cm2 (P=0.03). CONCLUSION: Patients with adrenal adenomas demonstrate a lower muscle mass and a higher proportion of visceral fat when compared to referent subjects, including patients with NFAT. Even a subtle abnormality in cortisol secretion may impact health of patients with adenomas

Response Letter to the Editor from Sweeney AT : &quot;cT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma&quot;

Contains fulltext : 225780.pdf (Publisher’s version ) (Closed access