Dendrimers: novel carriers for drug delivery

Dendrimers are highly branched, organic compounds with well-defined, symmetrical structure. From chemical point of view they are three-dimensional polymers, characterized by a globular shape. At the end of the arms are terminals, functional groups, which can be easily modified in order to change their chemical and physical properties. Dendrimers have nanoscopic particle size range from 1 to 100 nm. They are ideal drug delivery systems due to their feasible topology, functionality and dimensions, their size is very close to various important biological polymers and assemblies such as DNA and proteins. The structure of dendrimer molecules begins with a central atom or group of atoms labeled as the “core.” From this central structure, branches of other atoms called ‘dendrons.’ The continuous branching results in layers of branch structure called “generations.”Synthesis of dendrimers done by four methods. These are ‘Divergent’ Dendrimer Growth , ‘Convergent’ Dendrimer Growth ,‘Double Exponential’ and ‘Mixed’ Growth ,‘Click’ Synthesis (Hypercores and branched monomers growth). Mechanisms of drug loading onto dendrimer carriers by physical encapsulation of drug molecules and chemical conjugation of drug molecules. The conjugates show increased solubility, decreased systemic toxicity and selective accumulation in solid tumors. Various applications as pharmaceutical and non pharmaceuticals. Dendrimers may have toxicity mainly attributed to the interaction of the cationic dendrimers surface with negative biological load membranes damaging cellular membranes causing hemolytic toxicity and cytotoxicity also limitation that does not apply where the drug is solubilised with dendrimer and then released in the gut for absorption. Some Marketed products of dendrimers are available named as Starburst, Priostar, Stratus CS, Vivagel, Alert ticket, SuperFect, Taxotere

Coexistence of breast hemangioma with fibroadenoma: a rare case report

Vascular tumors of the breast are uncommon and include angiosarcomas and hemangiomas. Angiosarcomas are more common and benign hemangiomas are rare. We report a case of 16 years old female patient with hemangioma of breast coexisting with very commonly occurring breast fibroadenoma. The rarity of literature on breast hemangioma especially coexistent with fibroadenoma, and its importance in differentiation from the more common malignant counterpart, the angiosarcomas deserves mention

Cavernous haemangioma of spleen: a rare case report

Tumours of the spleen are as such rare. Of these rare tumours, haemangioma is the most commonly encountered benign tumour with fewer than 100 cases reported. It is either an incidental finding or presents as splenic enlargement or with complications. Preoperative investigations are often inconclusive and may not distinguish between haemangioma and metastases. We report a case of 40 years female with cavernous haemangioma of spleen presenting as massive splenomegaly. Splenic haemangioma presenting as massive splenomegaly is extremely rare and deserves a mention

Wegener’s granulomatosis masquerading as Pansinusitis and Nasal Polyposis: a diagnostic Dilemma

Wegener’s Granulomatosis is characterized by granulomas of the upper and lower respiratory tracts, glomerulonephritis and systemic vasculitis of small and medium sized vessels. A “limited” form of the disease points to the presence of clinical findings restricted to the upper respiratory tract and/or lungs. Limited sino-nasal disease is rare and, coupled with the higher incidence of tuberculosis, bacterial and fungal sinusitis, a timely diagnosis often poses a challenge. We present a case of a female patient in the seventh decade with features of pansinusitis and nasal polyps, initially diagnosed as, granulomatous lesion of infective etiology, which later turned out to be Wegener’s granulomatosis

Microfilaria in malignant pleural effusion: an unusual incidental finding or causative association?

Lymphatic filariasis is common in tropical countries and is endemic in India. Filaria has a wide spectrum of presentation. Filarial lung involvement is usually in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia. Filariasis presenting with pleural effusion is an unusual presentation. Malignancy in association with filarial pleural effusion is extremely rare and its role in tumorigenesis is controversial. In this context, we hereby report a case of 60 year old male, chronic smoker, who presented with left sided chest pain, cough, breathlessness, generalized weakness and swelling over left infrascapular region. Pleural fluid cytology repeated thrice due to degenerative changes, finally revealed malignant cells along with microfilaria. FNAC from left infrascapular swelling showed cytological features suggestive of metastatic deposits of Adenocarcinoma

Complications as indicators of quality assurance after 401 consecutive colorectal cancer resections: the importance of surgeon volume in developing colorectal cancer units in India

<p>Abstract</p> <p>Background</p> <p>The low incidence of colorectal cancer in India, coupled with absence of specialized units, contribute to lack of relevant data arising from the subcontinent. We evaluated the data of the senior author to better define the requirements that would enable development of specialized units in a country where colorectal cancer burden is increasing.</p> <p>Methods</p> <p>We retrospectively analyzed data of 401 consecutive colorectal resections from a prospective database of the senior author. In addition to patient demographics and types of resections, perioperative data like intraoperative blood loss, duration of surgery, complications, re-operation rates and hospital stay were recorded and analyzed.</p> <p>Results</p> <p>The median age was 52 years (10-86 years). 279 were males and 122 were females. The average duration of surgery was 220.32 minutes (range 50 - 480 min). The overall complication rate was 12.2% (49/401) with a 1.2% (5/401) mortality rate. The patients having complications had an increase in their median hospital stay (from 10.5 days to 23.4 days) and the re-operation rate in them was 51%. The major complications were anastomotic leaks (2.5%) and stoma related complications (2.7%).</p> <p>Conclusions</p> <p>This largest ever series from India compares favorably with global standards. In a nation where colorectal cancer is on the rise, it is imperative that high volume centers develop specialized units to train future specialist colorectal surgeons. This would ensure improved quality assurance and delivery of health care even to outreach, low volume centers.</p

Delivery of hepato-pancreato-biliary surgery during the COVID-19 pandemic: an European-African Hepato-Pancreato-Biliary Association (E-AHPBA) cross-sectional survey

Background: The extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery. Methods: An online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects of service delivery. Results: Overall, 145 (25%) members responded. Most units, particularly in COVID-high countries (>100,000 cases) reported insufficient critical care capacity and reduced HPB operating sessions compared to COVID-low countries. Delayed access to cancer surgery necessitated alternatives including increased neoadjuvant chemotherapy for pancreatic cancer and colorectal liver metastases, and locoregional treatments for hepatocellular carcinoma. Other aspects of service delivery including COVID-19 screening and personal protective equipment varied between units and countries. Conclusion: This study demonstrates that the COVID-19 pandemic has had a profound adverse impact on the delivery of HPB cancer care across the continents of Europe and Africa. The findings illustrate the need for safe resumption of cancer surgery in a “new” normal world with screening of patients and staff for COVID-19

Evidence Map of Pancreatic Surgery–A living systematic review with meta-analyses by the International Study Group of Pancreatic Surgery (ISGPS)

Background: Pancreatic surgery is associated with considerable morbidity and, consequently, offers a large and complex field for research. To prioritize relevant future scientific projects, it is of utmost importance to identify existing evidence and uncover research gaps. Thus, the aim of this project was to create a systematic and living Evidence Map of Pancreatic Surgery. Methods: PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for all randomized controlled trials and systematic reviews on pancreatic surgery. Outcomes from every existing randomized controlled trial were extracted, and trial quality was assessed. Systematic reviews were used to identify an absence of randomized controlled trials. Randomized controlled trials and systematic reviews on identical subjects were grouped according to research topics. A web-based evidence map modeled after a mind map was created to visualize existing evidence. Meta-analyses of specific outcomes of pancreatic surgery were performed for all research topics with more than 3 randomized controlled trials. For partial pancreatoduodenectomy and distal pancreatectomy, pooled benchmarks for outcomes were calculated with a 99% confidence interval. The evidence map undergoes regular updates. Results: Out of 30, 860 articles reviewed, 328 randomized controlled trials on 35, 600 patients and 332 systematic reviews were included and grouped into 76 research topics. Most randomized controlled trials were from Europe (46%) and most systematic reviews were from Asia (51%). A living meta-analysis of 21 out of 76 research topics (28%) was performed and included in the web-based evidence map. Evidence gaps were identified in 11 out of 76 research topics (14%). The benchmark for mortality was 2% (99% confidence interval: 1%–2%) for partial pancreatoduodenectomy and <1% (99% confidence interval: 0%–1%) for distal pancreatectomy. The benchmark for overall complications was 53% (99%confidence interval: 46%–61%) for partial pancreatoduodenectomy and 59% (99% confidence interval: 44%–80%) for distal pancreatectomy. Conclusion: The International Study Group of Pancreatic Surgery Evidence Map of Pancreatic Surgery, which is freely accessible via www.evidencemap.surgery and as a mobile phone app, provides a regularly updated overview of the available literature displayed in an intuitive fashion. Clinical decision making and evidence-based patient information are supported by the primary data provided, as well as by living meta-analyses. Researchers can use the systematic literature search and processed data for their own projects, and funding bodies can base their research priorities on evidence gaps that the map uncovers. © 2021 The Author