A rare case of primary parasitic leiomyoma mimicking as ovarian mass: a clinical dilemma

Uterine leiomyomas are the most common benign pelvic tumors in women of reproductive age group. Parasitic or wandering leiomyomas are known for their rarity, atypical clinical presentation & unusual location, posing challenge in making radiological and clinical diagnosis. More recently, rise in incidence of secondary parasitic leiomyomas has been reported as a complication of laparoscopic myomectomy and morcellations. We report an interesting case of primary parasitic leiomyoma which initially seemed to be a case of ovarian tumor. A 38 year old woman presented with chief complaints of pain in lower abdomen since 4 months with abdominal swelling since 2 months with CT abdomen suggestive of 8.7x5.2 cm exophytic right ovarian neoplasm with differential diagnosis of broad ligament fibroid in pouch of douglas. She had no previous history of abdominal or laparoscopic myomectomy and no family history of genital tract and breast malignancy. On clinical examination, no mass could be palpated per abdominally but a firm mass of 8 x6 cm size was felt through posterior fornix. Intraoperatively, a solid mass with lobulated surface was noted in pouch of Douglas attached through a thin vascular pedicle to sigmoid colon. Differential diagnosis considering location of tumor and pathological examination included possibility of gastrointestinal stromal tumor or extra-gastrointestinal stromal tumor or wandering leiomyoma. However, on histopathological slide examination (using immunohistochemistry), GIST was ruled out and diagnosis of parasitic fibroid was confirmed. Therefore, while dealing with pelvic tumors with atypical clinical presentation, possibility of these rare tumors have to be kept in mind for appropriate management

Comorbidity burden and adherence to preventive health behavior among cancer survivors

Advances in cancer treatments and early diagnosis have led to remarkable improvements in survival from major cancer types. Hence, the number of women living with a cancer diagnosis in the United States continues to increase. These women face many health challenges that negatively impact their quality of life, including an increased burden of comorbidity and ongoing symptoms from their cancer treatment. Adherence to health behavior guidelines may ameliorate some of the treatment-related side effects. This dissertation has three study aims: 1) to estimate the comorbidity burden and poor health status and associated productivity loss among breast cancer survivors (BCS) and women without cancer of middle age; 2) to examine the prevalence of functional impairment and adherence to physical activity recommendations among a population-based sample of gynecologic cancer survivors (GCS); and 3) to conduct a systematic review of the adherence to surveillance mammography among women diagnosed with primary breast cancer. For study aims 1 and 2, we used the Behavioral Risk Factor Surveillance System survey, a publicly available population-based dataset. In study aim 1, we used multivariable logistic regression to compare comorbidity burden and poor health status among middle-aged BCS and women without a history of cancer. For study aim 2, we used multinomial logistic regression to examine the association between meeting physical activity guidelines and having functional impairment among GCS. For study aim 3, we conducted a systematic review of the published literature from inception to June 2014 using Medline, PubMed, CINAHL and PsycINFO electronic databases to examine the rates of adherence to surveillance mammography among BCS. The results of study aim 1 indicate that the levels of comorbidity burden and poor health status were moderately higher among middle-aged BCS compared to women without a history of cancer. Productivity loss was not found to be different for BCS compared to women without a history of cancer. The results of study aim 2 indicate that more than half of the GCS did not meet physical activity guidelines and one thirds of this population faced significant burdens of functional impairment. The data indicate that functional impairment was associated with not meeting physical activity guidelines. The systematic review conducted for study aim 3 indicates that adherence to surveillance mammography is sub-optimum among BCS and decreases as time since diagnosis increases. ^ Overall, this study provides population estimates of the health burdens facing breast and GCS and enhances our understanding of the potential barriers to the adoption of preventive health behaviors among understudied subgroups of female cancer survivors. It informs public health practitioners of the need to implement targeted interventions and develop evidence-based intervention strategies for physical activity and surveillance mammography programs, so as to lower the health burden among this growing population of cancer survivors. Adherence to health behavior should be integral part of cancer care for survivors. Future studies should focus on identifying modifiable factors including individual, clinical, and psychosocial factors to develop personalized interventions.

Performance Evaluation of Skull Stripping Methods and Tools

Abstract-Skull Stripping aims to segment the brain tissue (cortex and cerebellum) from the skull and nonbrain tissues in brain MR images . In this paper, a comparison evaluation of two widely used methods BET(Brain Extraction Tool) and BSE(Brain Surface Extraction) in brain image segmentation is presented. Performance analysis of segmentation methods integrated with the latest versions of FSL and BrainSuite is considered. Results obtained in this paper can be utilized to assist the users for selecting the appropriate method for brain tissue segmentation

A rare case of primary parasitic leiomyoma mimicking as ovarian mass: a clinical dilemma

Uterine leiomyomas are the most common benign pelvic tumors in women of reproductive age group. Parasitic or wandering leiomyomas are known for their rarity, atypical clinical presentation & unusual location, posing challenge in making radiological and clinical diagnosis. More recently, rise in incidence of secondary parasitic leiomyomas has been reported as a complication of laparoscopic myomectomy and morcellations. We report an interesting case of primary parasitic leiomyoma which initially seemed to be a case of ovarian tumor. A 38 year old woman presented with chief complaints of pain in lower abdomen since 4 months with abdominal swelling since 2 months with CT abdomen suggestive of 8.7x5.2 cm exophytic right ovarian neoplasm with differential diagnosis of broad ligament fibroid in pouch of douglas. She had no previous history of abdominal or laparoscopic myomectomy and no family history of genital tract and breast malignancy. On clinical examination, no mass could be palpated per abdominally but a firm mass of 8 x6 cm size was felt through posterior fornix. Intraoperatively, a solid mass with lobulated surface was noted in pouch of Douglas attached through a thin vascular pedicle to sigmoid colon. Differential diagnosis considering location of tumor and pathological examination included possibility of gastrointestinal stromal tumor or extra-gastrointestinal stromal tumor or wandering leiomyoma. However, on histopathological slide examination (using immunohistochemistry), GIST was ruled out and diagnosis of parasitic fibroid was confirmed. Therefore, while dealing with pelvic tumors with atypical clinical presentation, possibility of these rare tumors have to be kept in mind for appropriate management

Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? : A mixed methods process evaluation

OBJECTIVE: To assess the feasibility, acceptability and relevance of the Parwarish, a positive parenting intervention (adapted from PLH-Teens) in three diverse settings in India. DESIGN: This mixed methods study used the Medical Research Council framework for process evaluations of complex interventions. SETTING: This study was set in disadvantaged communities in urban Agra, rural Uttar Pradesh and tribal Jharkhand in India. PARTICIPANTS: Data were collected from 86 facilitators, implementers, parents and teens who participated in the Parwarish intervention among 239 families. INTERVENTION: Couples from target communities facilitated groups of parents and teens over the 14-module structured, interactive Parwarish intervention which focused on building communication, reducing harsh parenting and building family budgeting skills. OUTCOME MEASURES: We assessed relevance, acceptability and feasibility of the intervention using mixed methods. Qualitative data collected included semistructured interviews and focus group discussions with implementers, facilitators, parents and young people who were transcribed, translated and thematically analysed to develop themes inherent in the data. Quantitative data which assessed attendance, fidelity to the intervention and facilitator training and coaching were analysed descriptively. RESULTS: Findings were grouped under the three domains of facilitation, community engagement and programme support with the following seven themes: (1) community-based facilitators increased contextual validity of the intervention; (2) gender relations were not only influenced by Parwarish implementation but were also influenced and transformed by Parwarish; (3) facilitator responsiveness to group concerns increased participation; (4) participation gathered momentum; (5) Parwarish's strong core and porous periphery allowed adaptations to local contexts; (6) technology that included Skype and WhatsApp enhanced implementation and (7) critical reflection with community trained coaches strengthened facilitation quality and programme fidelity. CONCLUSION: This study found Parwarish engaging, feasible and acceptable in three diverse, low-income communities, although constrained by patriarchal gender relations. It paves the way for larger-scale implementation in other South Asian settings

Regretting Ever Starting to Smoke: Results from a 2014 National Survey

Background: The majority of smokers regret ever starting to smoke, yet the vast majority continue to smoke despite the fact that smoking kills nearly 50% of lifetime users. This study examined the relationships between regret and smoker characteristics, quit history, risk perceptions, experiential thinking, and beliefs and intentions at time of smoking initiation. Methods: Data from the 2014 Tobacco Products and Risk Perceptions Survey, a nationally representative survey of United States adults, were analyzed to provide the latest prevalence estimates of regret and potential predictors. Relationships among predictor variables and regret were analyzed using correlations, t-tests, and multinomial logistic regression. Results: The majority of smokers (71.5%) regretted starting to smoke. Being older and non-Hispanic white were significant predictors of regret. Smokers having a high intention to quit, having made quit attempts in the past year, worrying about getting lung cancer, believing smoking every day can be risky for your health, perceiving a risk of being diagnosed with lung cancer during one’s lifetime, and considering themselves addicted to cigarettes were significant predictors of regret for smoking initiation. Conclusions: This study provides updated prevalence data on regret using a national sample, and confirms that regret is associated with perceived risk. The findings from this study can be used to inform smoking intervention programs and support the inclusion of smoker regret in cost–benefit analyses of the economic impact of tobacco regulations

Efficacy of transdermal buprenorphine patch on post-operative pain relief after elective spinal instrumentation surgery

Background and Aims: Transdermal buprenorphine patch (TDB) is increasingly used for chronic pain management because of non-invasive dosing, longer duration of action and minimal side effects. However its role in acute post-operative pain management for spinal instrumentation surgery is not well established. The aim of this study was to evaluate the analgesic efficacy of buprenorphine patch for postoperative pain relief in patients undergoing spinal instrumentation surgery. Methods: In this randomised, placebo-controlled, double-blinded, prospective study, 70 adult patients undergoing elective spinal instrumentation surgery were randomly allocated into two groups-TDB Group (buprenorphinepatch) and TDP Group (placebo patch). Time to first rescue analgesic requirement was the primary outcome. All patients also were monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status till 48 h after surgery. Statistical analysis was carried out using student independent t-test if normally distributed or with Mann–Whitney U-test if otherwise. Results: Time to first post-operative rescue analgesic (tramadol) requirement was much delayed in TDB Group than TDP Group (708.0 ± 6.98 min vs 54 ± 0.68 min, P < 0.001) and the total tramadol requirement was higher in TDB Group (490.60 ± 63.09 averagevs. 162.93 ± 63.91 mg, P < 0.001). Intra-and post-operative haemodynamic status was also stable in TDB Group without any adverse event. Conclusion: A TDB patch (10 μg/hour) applied 24 hours before surgery can be used as a postoperative analgesic for lumber fixation surgery without any drug-related adverse effect

Localized In Situ Nanoemulgel Drug Delivery System of Quercetin for Periodontitis: Development and Computational Simulations

This study was aimed at formulating a bioabsorbable, controlled-release, nanoemulgel of Quercetin, a potent antimicrobial and anti-inflammatory agent for the treatment of periodontitis that could improve its solubility and bioavailability. Screening of components was carried out based on the solubility studies. Nanoemulsion containing cinnamon oil as the oil phase, tween 80 and Carbitol&reg; as the surfactant-cosurfactant mixture (Smix) and water as the aqueous phase containing 125 &micro;g/200 &micro;L of Quercetin was prepared by using spontaneous emulsification method. Nanoemulgel was prepared using 23% w/v poloxamer 407 as gel base. Comprehensive evaluation of the formulated nanoemulgel was carried out, and the optimized formulation was studied for drug release using Franz vertical diffusion cells. The formulated nanoemulgelexhibited a remarkable release of 92.4% of Quercetin at the end of 6 h, as compared to that of pure Quercetin-loaded gel (&lt;3% release). The viscosity of the prepared nanoemulgel was found to be 30,647 &plusmn; 0.32 cPs at 37 &deg;C. Also, molecular dynamics (MD) simulation was utilized to understand the gelation process and role of each component in the formulation. The present study revealed that the developed nanoemulgel of Quercetin could be a potential delivery system for clinical testing in periodontitis