Shifting trends of lung tumours and its diagnosis by lung biopsy: a study of 78 cases

Background: The objective of the study was to study the spectrum of pathological lesions in patients with lung mass and to study correlation between clinical findings, histopathological pattern and immunohistochemical stains in various biopsy specimen for differentiation and typing of tumors.Methods: This retrospective study was done for the period of three years at Department of Pathology, New Civil Hospital, Surat, India, which is a tertiary health care Centre. Here we studied 78 cases of lung biopsy received in formalin, which were subjected to histopathological examination. Immunohistochemistry was performed as and when required.Results: Total 78 lung biopsy specimens were examined. Out of which, 59 cases (75.6%) were neoplastic, 12 cases(15.4%) were non-neoplastic and 7 cases (9%) were inconclusive. The commonest histological type of malignancy was adenocarcinoma which is associated with peripheral mass lesion, female gender and in non-smokers. Commonest non-neoplastic lesion was tuberculosis.  Malignancy was seen quite common in patients presented with lung masses in our institute.Conclusions: Lung tumours are quite common in patients presented with mass lesion. Similar to global trend, adenocarcinoma is the commonest histological type now and associated with change in incidence among women, in non-smokers, molecular alteration and prognosis which need further investigation. Immunohistochemistry is helpful in cases which are not accurately subtyped by histomorphology alone.

Clinical profile and management of ectopic pregnancy in patients with ectopic pregnancy at GMERS medical college and hospital Dharpur-Patan, North Gujarat region, India

Background: Ectopic pregnancy is assuming greater importance because of its increasing incidence and its impact on woman’s fertility. Objective: To study the clinical profile and management of ectopic pregnancies.  Methods: This prospective  study was conducted over one year from 1st January 2013 to 31st December 2013 for risk factors, mode of presentation, status at admission, diagnostic and treatment modalities and management of patients with ectopic pregnancy.Results: Over all mean rate of ectopic pregnancy has been found 11.41/1000 births. Out of total 52 cases 32 (64%) were referred while 20 (36%) were emergency cases. Out of 52 patients, 23 (44.23%) were from urban areas and 29 (55.77%) were from rural areas. Majority of the patients (51.97%) were in 26-30 years age groups. Gravida 3 had highest incidence (30.76%) of ectopic pregnancy. Maximum (50%) ectopic pregnancies were found in women with active married life of 5-10yrs. Out of total 52 cases, 44 (84.62%) were ruptured ectopic pregnancy cases. Ampulla was the most common site for tubal ectopic pregnancy (51.92%). Abdominal pain was the most common presenting symptoms (92.30%) followed by amenorrhoea in 84.61% cases. Majority of patients had history of infertility (42.30%) as a major risk factor. Laparoscopic management was done in 13 (25%) patients out of them lap. salpingectomy was done 9 (17.31% of total) and lap. Salpingostomy was done in 4 (7.69% of total) patients.Conclusion: Although ectopic pregnancy will never be completely prevented, but incidence can be reduced and much of the morbidity and mortalities can be minimised by prevention and efficacious diagnostic and interventional strategies aimed primarily at those women who are at high risk for the condition and taking precaution that woman who likely to become high risk are handled in such a way that the number of these high risk women are reduced.

Placental laterality and uterine artery resistance as predictor of preeclampsia: a prospective study at GMERS Medical College, Dharpur-Patan, North Gujarat, India

Background: Placental abnormality is one of the initial events seen in patients who are destined to develop preeclampsia. The objective was to study whether ultrasonically identified; placental laterality and uterine artery resistance can be used as a predictor for development of preeclampsia.Methods:This prospective observational study was conducted at GMERS Medical College, Dharpur-Patan tertiary care teaching institute in North Gujarat from January 2013 to December 2014. A total 400 non high risk primigravida with singleton pregnancy were included, all patients with diabetes, hypertension, renal disease, and history of smoking were excluded. In all these patients, location of placenta was determined by ultrasonography at 18 to 22 weeks of gestation. Patients who had lateral placenta were subjected for colour Doppler study for determining uterine artery resistance index. All 400 patients were followed till delivery for occurrence of preeclampsia as per ACOG guidelines. All data was analyzed and statistical significance was determined by x2 test and value of p<0.05 is considered significant.Results:Out of 400 cases, 80 (20%) cases had laterally located placenta on ultra sound examination done at 18-24 weeks of gestation. Out of the 80 women with laterally located placenta, 28 (35%) developed preeclampsia. This relationship was statistically significant. All 80 patients who had lateral placenta, 26 patients had raised uterine artery resistance and out of those 26 patients, 22 developed preeclampsia and 54 had no change in uterine artery resistance. Out of those 54 only 6 had preeclampsia (p<0. 001). The sensitivity of determining uterine artery resistance as a predictive test was 84.6%, the specificity 88.8 %, positive predictive value 78.5 % and negative predictive value 92.3%.Conclusion: A chance of preeclampsia is more in patients with lateral placenta but its sensitivity and specificity increases significantly when it is combined with uterine artery velocimetric waveform study, and we can predict preeclampsia in patient who is having lateral placenta and raised uterine artery resistance.

A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

BACKGROUND: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based. METHODS: We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations. RESULTS: We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination. CONCLUSIONS: Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management

A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

BACKGROUND: Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place. METHODS: Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting. RESULTS: We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms. CONCLUSIONS: These protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Dicarboxylic Acid

Dicarboxylic acids are organic compounds that contain two functional carboxylic acid (–COOH) groups. Industrially, they are important in producing polyester, polyols, polyamides, and nylon and as a precursor to active pharmaceutical ingredients and additives. Dicarboxylic acids are important water-soluble components of atmospheric aerosols. Succinic, adipic, and glutaric acid may be harmful if inhaled, swallowed, or absorbed through the skin. All these acids alone or in combination do not show any mutagenic effect. Some of the dicarboxylic acids (sebacic acid) have been advocated to have an anti-hyperglycemic effect, whereas analysis of serum-free fatty acids from patients with Reye\u27s syndrome (acute encephalopathy with visceral steatosis syndrome) had revealed the presence of dicarboxylic acids in over half of the patients\u27 total free fatty acids; both medium-chain (6–12 carbon lengths) and long-chain (14–18 carbon lengths) dicarboxylic acids were identified in such studies. Malathion, a well-known organophosphate pesticide, was previously marketed as malathion dicarboxylic acid, is fetotoxic and toxic to infants and children.https://nsuworks.nova.edu/hpd_facbooks/1002/thumbnail.jp