Papillary Carcinoma Thyroid Co-existing with Upper Aerodigestive Tract Squamous Cell Carcinoma: Case Series

The incidental discovery of papillary carcinoma of thyroid in a patient being investigated for squamous cell carcinoma of oral cavity is a rare clinical situation and appropriate management may vary from what was actually planned. We report a case series of 10 patients admitted with variable complaints of pain on swallowing, change in voice and breathing difficulty. Total Laryngectomy was done along with lymph node neck dissection. On histopathological examination, it showed poorly differentiated Squamous cell carcinoma. Tissue sent as paratracheal lymph node showed thyroid tissue with foci of Papillary carcinoma of thyroid which was a coincidental finding. A total of 10 cases with dual malignancy of Upper aerodigestive tract Squamous cell carcinoma coexisting with Papillary carcinoma thyroid as an incidental finding. Of which nine were male and one was female, had undergone Total Laryngectomy, Hemiglossectomy and Hemimandibulectomy was done along with lymph node neck dissection

Evaluation of Appropriateness of Platelet transfusions in a Tertiary Care Centre

Introduction:  Blood transfusion is an essential part of modern health care. Transfusion is considered appropriate when it is used to treat conditions leading to significant morbidity and mortality and which cannot be prevented or managed effectively by other means. The aim of this study was to evaluate appropriateness of platelet transfusions in a tertiary care centre as per National blood transfusion guidelines. Materials & Methods: This study was conducted in a tertiary care centre. A total of 4236 blood request forms were analyzed over a period of 12 months out of which 8.3% (n=352) were for Platelets (PLT). Number of units requested were noted and appropriateness of requested transfusions was assessed according to the National guidelines on transfusion. Results: A total of 4236 blood request forms were analyzed in this study out of which 8.3% (n=352) were for Platelets (PLT). There were 352 platelet requests out of which 59.6 % (n=210) requests were considered appropriate, 30.2% (n=106) were considered inappropriate and 10.2% (n=36) requests could not be assessed due to unavailability of platelet count. Out of 30.2% (n=106) inappropriate transfusions, in 14.8% (n=52) transfusions were appropriate but number of units transfused was inappropriate and in 15% transfusion itself was considered inappropriate. Conclusion: It was observed that 30.2% (n=106) were considered inappropriate and in 10.2% (n=36) requests could not be assessed due to unavailability of platelet count. Regular audits and CMEs should be conducted and development of standard hospital transfusion guidelines are the measures which can be incorporated in this hospital to rationalize the use of blood components

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

OCR Oriented Reading System for Blind People

The current engendering of the digital phones has prominent hardware endowment and a speedier operation that is robust and ample to evolve applications that facilitate the user to be a part of and act with the Universe at their own convenience. this method is an OCR scanning system that uses a camera application present in your smartphone consolidated with Optical Character Recognition (OCR). OCR may well be a mechanism that converts pictures of manuscripts or printed content into machine-encoded text. During this system, the application will scan and convert the content that is written in English (West Germanic language) accent into a speech format. By victimization of the Text to Speech Module speech output is generated. The seek of coming up with the type of voice/speech is to give out datum that is bestowed in the given image to the visually impaired people

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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